FINDING. While some hospitals have, on average, more positive patient safety cultures than others, there is substantial variation in patient safety culture within any given hospital. As the graph to the left indicates, in any given hospital some clinical areas can be quite positive in safety climate, while other clinical areas can be in serious need of improvement. Imagine, for example, what it would be like to work for a day in the clinical area of the first hospital (the left-most bar) where fewer than 2 out of 10 caregivers indicated that safety culture was positive. Your day in this clinical area would likely be dramatically different from a day of work in the clinical area of the same hospital where 9 out of 10 caregivers indicated that safety culture was positive. Indeed, even in the most positive, on average, hospital of the bunch (the right-most bar), there was at least one clinical area in which fewer than 3 out of 5 caregivers (less than 60%) reported that safety climate was positive. The data speak clearly and match the anecdotal experiences of caregivers -- some clinical areas in a hospital are exemplars of patient safety, while others are in need of major improvement.

IMPLICATION. Survey assessments of patient safety culture that ask people to report generally on their hospital likely obscure those specific clinical areas -- perhaps the ICU on the Fifth Floor -- that are safety leaders and, more importantly, those specific clinical areas -- perhaps the Pharmacy in the basement -- that are safety laggards.

ACTION. When conducting a survey-based assessment of patient safety culture, an approach that drives respondents to report on culture at the local, clinical area level will yield the most actionable results. For hospital leaders who want to deploy what are often scarce resources for enhancing patient safety in a data-driven, efficient way, a clinical area-focused approach provides the necessary datapoints to identify high-risk areas and target them for improvement.