What has been the impact of Covid-19 on Safety Culture? A case study from a large metropolitan teaching hospital

Introduction

Covid-19 has placed an unprecedented demand on healthcare systems worldwide. A positive safety culture is associated with improved patient safety and in turn patient outcomes. To date, no study has evaluated the impact of Covid-19 on safety culture.

Methods

The Safety Attitudes Questionnaire (SAQ) was used to investigate safety culture at a large UK teaching hospital during Covid-19. Findings were compared with baseline data from 2017. Incident reporting from the year preceding the pandemic was also examined.

Results

Significant increased were seen in SAQ scores of doctors and ‘other clinical staff’, there was no change in the nursing group. During Covid-19, on univariate regression analysis, female gender, age 40-49 years, non-white ethnicity, and nursing job role were all associated with lower SAQ scores. Training and support for redeployment were associated with higher SAQ scores. On multivariate analysis, non-disclosed gender (−0.13), non-disclosed ethnicity (−0.11), nursing role (−0.15), and support (0.29) persisted to significance. A significant decrease (p<0.003) was seen in error reporting after the onset of the Covid-19 pandemic.

Discussion

This is the first study to report SAQ during Covid-19 and compare with baseline. Differences in SAQ scores were observed during Covid-19 between professional groups and compared to baseline. Reductions in incident reporting were also seen. These changes may reflect perception of risk, changes in volume or nature of work. High-quality support for redeployed staff may be associated with improved safety perception during future pandemics.

WHAT IS ALREADY KNOWN ON THE SUBJECT

• Safety culture is associated with patient safety and outcomes

• This is the first study to investigate safety culture during the Covid-19 pandemic

• This study uses the Safety Attitudes Questionnaire (SAQ) and Datix incident reporting data to investigate determinants of safety climate during the Covid-19 pandemic.

• Safety climate is context specific, this study is strengthened by the availability of benchmarking data from before the onset of the Covid-19 pandemic.

• Significant differences in SAQ scores between professional groups were observed during Covid-19.

• Gender, ethnicity and job role were significant determinants of safety attitudes.

• Support during redeployment was associated with improved safety attitudes.

• The number of incidents that were reported reduced significantly during Covid-19, although the number of events leading to harm remained constant.