Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2113, Australia.
St George Hospital, Kogarah, NSW, Australia.
BMC Health Serv Res. 2022 Apr 21;22(1):530. doi: 10.1186/s12913-022-07930-6.
Signs of disorder in neighbourhoods (e.g., litter, graffiti) are thought to influence the behaviour of residents, potentially leading to violations of rules and petty criminal behaviour. Recently, these premises have been applied to the hospital context, with physical and social disorder found to have a negative association with patient safety. Building on these results, the present study investigates whether physical and social disorder differ between hospitals, and their relationship to safety culture.
We conducted a cross sectional survey with Likert-style and open response questions administered in four Australian hospitals. All staff were invited to participate in the pilot study from May to September 2018. An analysis of variance (ANOVA) was used to examine differences in disorder by hospital, and hierarchical linear regression assessed the relationship of physical and social disorder to key aspects of safety culture (safety climate, teamwork climate). Open responses were analysed using thematic analysis to elaborate on manifestations of hospital disorder.
There were 415 survey respondents. Significant differences were found in perceptions of physical disorder across the four hospitals. There were no significant differences between hospitals in levels of social disorder. Social disorder had a significant negative relationship with safety and teamwork climate, and physical disorder significantly predicted a poorer teamwork climate. We identified five themes relevant to physical disorder and four for social disorder from participants' open responses; the preponderance of these themes across hospitals supported quantitative results.
Findings indicate that physical and social disorder are important to consider in attempting to holistically understand a hospital's safety culture. Interventions that target aspects of physical and social disorder in a hospital may hold value in improving safety culture and patient safety.
社区中出现的无序迹象（如垃圾、涂鸦）被认为会影响居民的行为，可能导致违反规则和轻微犯罪行为。最近，这些前提已被应用于医院环境，发现物理和社会无序与患者安全呈负相关。在此基础上，本研究调查了医院之间是否存在物理和社会无序的差异，以及它们与安全文化的关系。
我们在澳大利亚的四家医院进行了一项横断面调查，采用李克特式和开放式回答问题。所有员工都被邀请从 2018 年 5 月至 9 月参加试点研究。方差分析（ANOVA）用于检查医院之间无序的差异，分层线性回归评估物理和社会无序与安全文化的关键方面（安全氛围、团队合作氛围）的关系。使用主题分析对开放式回答进行分析，以详细说明医院无序的表现。
共有 415 名调查对象。在对四家医院的物理无序感知方面存在显著差异。在社会无序方面，医院之间没有显著差异。社会无序与安全和团队合作氛围呈显著负相关，物理无序显著预测团队合作氛围较差。我们从参与者的开放式回答中确定了与物理无序相关的五个主题和与社会无序相关的四个主题；这些主题在医院中的大量存在支持了定量结果。
研究结果表明，在试图全面了解医院的安全文化时，物理和社会无序是需要考虑的重要因素。针对医院物理和社会无序方面的干预措施可能在改善安全文化和患者安全方面具有价值。
