Impact of Individual and Team Features of Patient Safety Climate: A Survey in Family Practices

Barbara Hoffmann; Carolin Miessner; Zeycan Albay; Jakob Schröber; Katrin Weppler; Ferdinand M. Gerlach; Corina Güthlin

doi:10.1370/afm.1500

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Figure 1
Flow chart displaying numbers of addressed and participating practices and health care professionals.

HCA=health care assistant.

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Table 1

Frankfurt Patient Safety Climate Questionnaire for General Practices (FraSiK)¹¹

Factor	Content	No. of Items	Example of Item
1. Teamwork climate	Collaboration, trust, respect, support, openness, handling of conflicts, team decision making	12	It’s easy for anyone in this practice to ask questions if they don’t understand something.
2. Error management	Handling of errors, reporting and analysis	6	Errors that occur in this practice are discussed by the whole team.
3. Perception of causes of errors	Causes of adverse events, recognition of stress as negatively impacting individual performance	6	When errors occur in this practice, it is because information has not been properly relayed.
4. Safety of clinical processes	Observing of rules, information handling	3	All information that is important for the healthcare of patients is available to me.
5. Job satisfaction	Job and workplace satisfaction	3	This practice is a good place to work.
6. Safety of practice structure	Maintenance of equipment, expiry dates of drugs, overall priority of safety	3	Medical equipment in this office is perfectly suited to the care of our patients.
7. Receptiveness to health care assistants and patients	Incorporation of suggestions from HCAs and patients	3	Patients’ suggestions are given some thought in this practice.
8. Staff perception of management (items addressed only to employees)	Feedback, fairness and openness of discussions	5	I receive constructive feedback on the quality of my work.
9. Quality and safety of medical care (items addressed only to doctors)	Clinical guidelines, safe medication handling	3	Patients are asked about their current medication when they come to see the doctor.

HCA=health care assistant.
Note: Responses to items were generally given in a 5-point Likert scale format, ranging from strongly disagree to strongly agree or from never to always (with 1 representing the lower and 5 the upper end of the scales). The 25 items that were not part of the 9 scales had either 5-point Likert or nominal scales, or free-text options.

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Table 2

Characteristics of Participating Health Care Assistants and Doctors

Participant Characteristic	Health Care Assistants	Doctors
Number of participants^a	1,480	599
Response rate, %	54.51	63.12
Female, %	98.3	42.7
Age, No. (%), y
≤30	452 (30.5)	2 (0.3)
31–40	295 (19.9)	55 (9.2)
41–50	448 (30.3)	177 (29.5)
51–60	243 (16.4)	246 (41.1)
>60	39 (2.6)	114 (19.0)
Professional experience, No. (%)
<1 year	46 (3.1)	9 (1.5)
1–5 years	202 (13.6)	27 (4.5)
5–10 years	209 (14.1)	57 (9.5)
10–20 years	411 (27.8)	133 (22.2)
≥20 years	584 (39.5)	360 (60.1)
Weekly working time, mean hr	27.0	47.4

↵a There were 32 participants with missing data.

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Table 3

Characteristics of Participating Practices

Characteristic	Whole Sample (n=1,800)	Participating Practices (n=618)
Practice status, %
Single-handed	80	65.9
Group	20	33.2
Location, %
Rural town	15.9	18.8
Small town	28.6	30.7
Medium-sized town	26.8	25.6
City	28.6	24.9
Team size, %
≤4	Unknown	38.8
5–8	Unknown	43.7
>8	Unknown	9.5

Note: Numbers do not add up to 100% because of missing data.

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Table 4

Scores for Patient Safety Climate Factors

Factor	Valid Cases	Mean Score (SD)^a	Range	Percentage Problematic Response^b	Missing Values, %
Safety of practice structure	1,995	4.71 (0.43)	2–5	0.6	5.5
Job satisfaction	2,047	4.66 (0.58)	1–5	1.5	3.03
Safety of clinical processes	2,067	4.39 (0.52)	1.67–5	1.1	2.08
Teamwork climate	2,051	4.33 (0.59)	1.17–5	3.4	2.84
Quality and safety of medical care	596	4.19 (0.56)	2.33–5	1.3	0.14
Receptiveness to healthcare assistants and patients	2,013	4.11 (0.62)	1.33–5	4.1	4.64
Staff perception of management	1,487	4.11 (0.79)	1.2–5	9.0	1.66
Error management	2,090	3.98 (0.69)	1–5	8.1	0.99
Perception of causes or errors	2,029	2.81 (0.73)	1–5	53.9	3.88

↵a A mean score of 4.00 or higher for each domain represents a positive safety climate.
↵b Percentage of problematic responses calculated by adding the number of the responses on the lower side of the scale for each individual and factor (values 1 or 2 indicating negative perceptions of safety climate) and dividing it by the total number of items for each factor.

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The Article in Brief

Impact of Individual and Team Features on Patient Safety Climate: A Survey in Family Practices

Barbara Hoffmann , and colleagues

Background This analysis of more than 2,100 questionnaires evaluates the impact of different individual and practice features on perceptions of the safety climate--shared employee perceptions of the priority of safety at an organization--in German primary care practices.

What This Study Found Though the family practice safety culture is positive overall, health care professionals' use of incident reporting and a systems approach to errors is fairly rare. The safety climate as perceived by doctors and health care assistants is not significantly influenced by individual and practice team characteristics. Participation of the whole practice team in the survey has a positive influence on safety climate, and doctors have more positive perceptions of 4 of the 7 climate factors evaluated than health care assistants.

Implications

The authors call for German primary care doctors and health care assistants to learn more about the causes of errors and adopt a systems approach to patient safety incidents in order to learn from past errors.