All ETDs from UAB

Advisory Committee Chair

Robert Hernandez

Advisory Committee Members

Stephen J O'Connor

Nir Menachemi

Bisakha Sen

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


SAFETY CULTURE AND PATIENT HARM EVENTS: A CONTINGENCY THEORY PERSPECTIVE IN THE CONTEXT OF COMPLEX ADAPTIVE SYSTEMS ALFONSO GATMAITAN ADMINISTRATION-HEALTH SERVICES ABSTRACT This study examines the correlation between a Culture of Patient Safety as measured by hospital staff surveys and actual patient harm attributed to hospital performance. It is generally accepted by health care management leaders that the presence of a strong culture of patient safety has become a critical component in reducing patient harm. However, little empirical evidence within multiple hospitals over time exists to support this belief. Healthcare managers can utilize this evidence in formulating patient safety improvement strategies within their organizations. A theoretical framework consisting of Contingency Theory within the context of complex adaptive systems was utilized to develop and address the hypothesis. Data regarding Culture of Patient survey results, abstracted and externally reported patient harm events and internally reported patient harm events was collected from a study group of seven hospitals within a single health system clustered in one state over a four year period. A linear regression model with repeated measures was modified due to either low counts or lack of normal distribution. Bed size and difference in case mix was treated as a covariate and recorded as case mix adjusted patient days used to account for the differences in bed size and case mix complexity among the hospitals. A Culture of Patient Safety was found to be correlated to broad measurements of patient harm but with respect to the low number of occurrences of certain hospital acquired conditions a Culture of Patient Safety was not found to have a significant correlation. However, the results can be viewed as suggesting that a Culture of Patient Safety is as essential as a structural element to achieving zero harm as more commonly accepted structural elements such as training and equipment. The results also suggest other differences between the hospitals beyond case mix and bed size have a significant effect. Such differences may lie in the actions and behaviors within the complex adaptive systems that make up each hospital microsystem and in the “fit” between patient safety with system strategy, resource allocation and management actions and behaviors.



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