What Has Been the Impact of Covid-19 on Safety Culture? A Case Study from a Large Metropolitan Healthcare Trust

  1. Max Denning
  2. Ee Teng Goh
  3. Alasdair Scott
  4. Guy Martin
  5. Sheraz Markar
  6. Kelsey Flott
  7. Sam Mason
  8. Jan Przybylowicz
  9. Melanie Almonte
  10. Jonathan Clarke
  11. Jasmine Winter Beatty
  12. Swathikan Chidambaram
  13. Seema Yalamanchili
  14. Benjamin Yong-Qiang Tan
  15. Abhiram Kanneganti
  16. Viknesh Sounderajah
  17. Mary Wells
  18. Sanjay Purkayastha
  19. James Kinross

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Abstract

Covid-19 has placed an unprecedented demand on healthcare systems worldwide. A positive safety culture is associated with improved patient safety and, in turn, with patient outcomes. To date, no study has evaluated the impact of Covid-19 on safety culture. The Safety Attitudes Questionnaire (SAQ) was used to investigate safety culture at a large UK healthcare trust during Covid-19. Findings were compared with baseline data from 2017. Incident reporting from the year preceding the pandemic was also examined. SAQ scores of doctors and “other clinical staff”, were relatively higher than 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 a level of significance. A significant decrease (p < 0.003) was seen in error reporting after the onset of the Covid-19 pandemic. This is the first study to investigate SAQ during Covid-19. Differences in SAQ scores were observed during Covid-19 between professional groups when 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.

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  1. Version published to 10.3390/ijerph17197034
  2. Version published to 10.1101/2020.06.15.20129080v3 on medRxiv
  3. Version published to 10.1101/2020.06.15.20129080v2 on medRxiv
  4. ScreenIT

    SciScore for 10.1101/2020.06.15.20129080: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Violin plots comparing SAQ scores among professions were created using RStudio v1.2 (Version 1.2.5042. 2020 RStudio, Inc).
    RStudio
    suggested: (RStudio, RRID:SCR_000432)
    TX: StataCorp LP).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Due to changes in the clinical context, a direct comparison of the two samples may be subject to limitations. However, comparisons between groups at each time point will still provide valuable insights. During Covid-19, nurses demonstrated significantly lower SAQ scores compared with doctors and other clinical staff. This contrasts with the baseline cohort where nurses had the highest safety attitude scores. In the Covid-19 cohort, whilst controlling for other covariates, non-disclosure of gender, non-disclosure of ethnicity and the nursing job role were predictive of poor SAQ score. In contrast, provision of support was predictive of high SAQ score. The results may reflect the unequal accessibility and effectiveness of current efforts to support stuff. There have been both national and local initiatives to support staff during the Covid-19 pandemic such as access to free food, staff counselling services, and transport allowances. Nationally, the ‘clap for carers’ campaign, commercial discounts, and social media initiatives may have also contributed. Other possible explanations include a sense of solidarity in which multiple staff came together to overcome the challenge of a novel disease. The lower scores for working conditions and job satisfaction in the nursing staff group compared to other roles may suggest that not all staff had equal access to support initiatives or that such initiatives were not equally effective for all staff. The finding that staff who did not disclo...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  5. Version published to 10.1101/2020.06.15.20129080v1 on medRxiv