The Impact of Variance in Perception of the Organization on Capacity to Improve in Hospital Work Groups

The Agency for Healthcare Research (AHRQ) and Quality Hospital Survey on Patient Safety Culture (HSPSC) is a widely used instrument for assessing hospital support for safety and improvement. The assessment emphasizes hospital departments and professional roles as the basis for analysis on the assumption that safety culture is rooted in departments and professions. Agreement in perception of the organization between major organizational roles (as opposed to professions or departments) has been shown in other settings to be an indicator of organizational success, and may be a more fundamental determinant of organizational culture than the department or profession. We applied this approach of grouping to hospital safety climate by segmenting responses on the AHRQ HSPSC into four major organizational roles: executive, manager, staff, and physician. Using data from five U.S. hospitals, we analyzed the degree of agreement in perceptions of these four groups and the relationship to perceived quality and safety. We then compared this approach to a department- and profession-based grouping in improving perceived safety culture. Lower variation across these four groups was related to higher ratings of safety culture. Further, the contribution of this grouping was greater and more consistent across scale scores compared to department- or profession-based grouping. The utility of this approach to analysis of surveys for developing strategies for improvement is presented with a case example. Potential further research and development based on this preliminary study are proposed.