| This research is a three-part study of the culture of patient safety, evidence-based practice, and patient safety outcomes within the U.S. health care environment. Chapter 2 is a comprehensive review of the safety culture literature using qualitative meta-analysis methods from which a conceptual culture of safety framework and model, including subcultures and properties, was generated. The seven subcultures identified were: leadership, teamwork, evidence-based practice, communication, learning culture, just culture, and patient-centered culture. Chapter 3 further explores evidence-based practice and practice guidelines as components of safety culture. Physician and practice characteristics were examined to identify the effect practice guidelines have on physician practice. The data source was from the third round of the Community Tracking Study, Physician Survey, 2000-2001. An ordinal logistic regression model was estimated to capture the full range of responses. Recent medical school graduates (p<.01), women (p<.01), minorities (p<.001), ob-gyn specialists (p<.01), physicians who use computers for information in their practices ( p<.001), and physicians in non-solo practice types (p <.01) were significantly more likely to state practice guidelines had an effect on their practice. Chapter 4 evaluates the effect of teamwork and safety culture on the patient outcome of falls and falls with injury in 17 hospitals within a large healthcare system. A descriptive, correlational study was conducted with the unit of analysis the individual hospital. Multiple regression models were estimated to determine the role of teamwork and safety culture on falls and falls with injury, and year, facility, and licensed beds fixed-effects were used to control for temporality and unmeasured differences between hospitals. Teamwork climate in hospitals was a strong predictor for decreased falls (p<.001) and falls with injury ( p<.05). Care providers knowing the proper channels to direct questions regarding patient safety indicated significant negative associations for falls (p<.01) and falls with injury (p<.001). |
