Sallie J. Weaver, PhD; Lisa H. Lubomksi, PhD; Renee F. Wilson, MS; Elizabeth R. Pfoh, MPH; Kathryn A. Martinez, PhD, MPH; Sydney M. Dy, MD, MSc
Note: The AHRQ reviewed contract deliverables to ensure adherence to contract requirements and quality, and a copyright release was obtained from the AHRQ before submission of the manuscript.
Disclaimer: All statements expressed in this work are those of the authors and should not in any way be construed as official opinions or positions of the Johns Hopkins University, the AHRQ, or the U.S. Department of Health and Human Services.
Financial Support: From the AHRQ, U.S. Department of Health and Human Services (contract HHSA-290-2007-10062I).
Potential Conflicts of Interest: Dr. Weaver: Grant (money to institution): AHRQ, U.S. Department of Health and Human Services; Travel/accommodations/meeting expenses unrelated to activities listed (money to author): Improvement Science Research Network. Dr. Lubomski: Grant (money to institution): AHRQ. Ms. Wilson: Grant (money to institution): AHRQ. Ms. Pfoh: Grant (money to institution): AHRQ. Dr. Martinez: None disclosed. Dr. Dy: Grant (money to institution): AHRQ. Disclosures can be also viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2567.
Requests for Single Reprints: Sallie J. Weaver, PhD, Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine and Armstrong Institute for Patient Safety and Quality, 750 East Pratt Street, 15th Floor, Room 1544, Baltimore, MD 21202; e-mail, email@example.com.
Current Author Addresses: Drs. Weaver and Lubomski: Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine and Armstrong Institute for Patient Safety and Quality, 750 East Pratt Street, 15th Floor, Baltimore, MD 21202.
Ms. Wilson: Johns Hopkins University, 1830 East Monument Street, Room 8061, Baltimore, MD 21287.
Ms. Pfoh: Johns Hopkins University, 624 North Broadway, Baltimore, MD 21205.
Dr. Martinez: University of Michigan, Department of General Medicine, 2800 Plymouth Road, Building 16, 4th Floor, Ann Arbor, MI 48109-2800.
Dr. Dy: Johns Hopkins University, Health Services Research and Development Center, 624 Broadway, Room 609, Baltimore, MD 21205-1901.
Author Contributions: Conception and design: S.J. Weaver, L.H. Lubomksi, K.A. Martinez, S.M. Dy.
Analysis and interpretation of the data: S.J. Weaver, E.R. Pfoh, K.A. Martinez, S.M. Dy.
Drafting of the article: S.J. Weaver, E.R. Pfoh, S.M. Dy.
Critical revision of the article for important intellectual content: S.J. Weaver, L.H. Lubomksi, S.M. Dy.
Final approval of the article: S.J. Weaver, R.F. Wilson, K.A. Martinez, S.M. Dy.
Obtaining of funding: S.M. Dy.
Administrative, technical, or logistic support: L.H. Lubomksi, R.F. Wilson, K.A. Martinez.
Collection and assembly of data: S.J. Weaver, L.H. Lubomksi, R.F. Wilson, K.A. Martinez, S.M. Dy.
Weaver SJ, Lubomksi LH, Wilson RF, Pfoh ER, Martinez KA, Dy SM. Promoting a Culture of Safety as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. 2013;158:369-374. doi: 10.7326/0003-4819-158-5-201303051-00002
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Published: Ann Intern Med. 2013;158(5_Part_2):369-374.
Developing a culture of safety is a core element of many efforts to improve patient safety and care quality. This systematic review identifies and assesses interventions used to promote safety culture or climate in acute care settings. The authors searched MEDLINE, CINAHL, PsycINFO, Cochrane, and EMBASE to identify relevant English-language studies published from January 2000 to October 2012. They selected studies that targeted health care workers practicing in inpatient settings and included data about change in patient safety culture or climate after a targeted intervention. Two raters independently screened 3679 abstracts (which yielded 33 eligible studies in 35 articles), extracted study data, and rated study quality and strength of evidence. Eight studies included executive walk rounds or interdisciplinary rounds; 8 evaluated multicomponent, unit-based interventions; and 20 included team training or communication initiatives. Twenty-nine studies reported some improvement in safety culture or patient outcomes, but measured outcomes were highly heterogeneous. Strength of evidence was low, and most studies were pre–post evaluations of low to moderate quality. Within these limits, evidence suggests that interventions can improve perceptions of safety culture and potentially reduce patient harm.
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