All ETDs from UAB

Advisory Committee Chair

Stephen J O'Connor

Advisory Committee Members

William F Jessee

Amy Y Landry

Jeff M Szychowski

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


This study examines the use of Red Rules in patient safety culture. The presence of a strong culture of patient safety has become a critical component in reducing medical errors. Some hospitals are implementing Red Rules as a patient safety strategy with disciplinary consequences if not followed. The use of Red Rules and patient safety culture seem to be inconsistent. The theoretical framework for control-based and commitment-based management was utilized to develop and address four hypotheses. The hypotheses address the impact of Red Rules on 1) staff perceptions of safety, 2) frequency of events reported, 3) number of events reported, and 4) staff perceptions of non-punitive response to errors. A survey was conducted among hospitals that have taken the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture within the past five years. T-test, chi-square, and linear regression analyses were used to test the differences between hospitals using Red Rules and hospitals that do not use Red Rules. Key hospital characteristics (bed size, teaching status, ownership and control, geographic region) were treated as covariates and tested for significant differences. The results showed no statistically significant differences between hospitals that use Red Rules and those that do not. Likewise, none of the key hospital characteristics revealed significant differences. This is the first quantitative study on the effect of Red Rules in patient safety culture. Healthcare managers can utilize this evidence in formulating patient safety improvement strategies within their organizations.

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