Combinational Effects of Clinical Area and Healthcare Workers’ Job Type on the Safety Culture in Hospitals

As patient safety is taking center stage in medical care, many resources have been invested to improve safety. Patient safety culture has been one of the most important constituents of safety and, therefore, has been measured with various instruments. One fundamental challenge is that a healthcare worker's safety attitude can be shaped by multiple factors such as job type and clinical area. Due to the complex organizational and cultural structure in a hospital, such multi-dimensional dynamics are not thoroughly understood. This study used the crossed random effects model to assess combinational effects of clinical area and job type and calculate the safety attitudes score of each combination with the empirical Bayes (EB) method. We used the Korean version of the Safety Attitudes Questionnaire (SAQ-K), which consists of six domains: teamwork climate (TC), safety culture (SC), job satisfaction (JS), stress recognition (SR), perception of management (PM) and working conditions (WC). Each clinical area and job type independently affects SAQ-K scores of all six domains. For TC, SC, SR, and PM, there were combinational effects of clinical area and job type on SAQ-K scores (e.g., a certain job type in a certain clinical area showed higher or lower SAQ-K scores than another clinical area, or the other way around). We also applied the EB method to achieve more accurate combination-level estimates when the variance in SAQ-K score of the combination was large, which is a common situation in hospitals with multiple clinical areas and job types.