The Relationship Between Safety Climate and Performance in Intensive Care Units: The Mediating Role of Managerial Safety Practices and Priority of Safety

Patient safety is defined as the absence of preventable harm to a patient during the delivery of healthcare. Evidence from several reports and research studies reflect the high incidence and subsequent high cost of patient harm in general and within intensive care units. Against this background, this study tests a theoretical framework addressing relationships among patient safety climate dimensions and their impact on safety performance. The dimensions refer to safety in terms of procedure suitability and information flow, managerial safety practices, and priority of safety. A retrospective cross-sectional analytical research study was conducted. The target population was recruited from the three intensive care units in the main tertiary level hospital in Malta. A sample of 215 healthcare professionals, who fit the eligibility criteria, participated in this research study, achieving a response rate of 82.7%. The “Survey on Patient Safety Climate” was utilized. Findings support the following hypotheses: the higher the extent to which safety procedures are perceived as suitable to the intensive care units' daily work demands and processes, the lower the intensive care units' clinical incidents (r = −0.269, p ≤ 0.01) and the higher the extent to which safety information flow is perceived as clear and unambiguous to the intensive care units' daily work demands and processes, the lower the intensive care units' clinical incidents (r = −0.295, p ≤ 0.01). Findings also support the following hypotheses: managerial safety practices mediate the relationship between safety procedure suitability/safety information flow and clinical incidents (p = 0.009, p = 0.014, respectively) and priority of safety mediates the relationship between safety procedure suitability/safety information flow/managerial safety practices and clinical incidents (p = 0.002, p = 0.002, p = 0.042, respectively). Health service managers must ensure employees perceive safety procedures as suitable and safety information as clear and unambiguous, emphasize the manager's role as a safety referent and safety change agent and create an organization that prioritizes safety over work pace, workload and pressure for production. Essentially, health service managers need to create safety leaders to drive the organization to patient safety.