Using Dominance Analysis to Identify the Most Important Dimensions of Safety Culture for Predicting Patient Safety

Lee, Seung Eun; Dahinten, V. Susan

Studies have demonstrated associations between safety culture and patient safety based on the perceptions of healthcare professionals, but limited attention has been given to the perceptions of nurses. Moreover, most studies have used regression modeling, an approach that limits researchers’ ability to identify the most important predictors of patient safety due to intercorrelations among predictors in the model. Therefore, the purpose of this study was to examine the effects of seven dimensions of safety culture on nurse-rated patient safety and identify the relative importance of these dimensions for predicting patient safety. This correlational study used data from the Agency for Healthcare Research and Quality’s 2018 Hospital Survey on Patient Safety Culture. Data from 13,031 nurses working in surgical areas of 443 hospitals in the United States were examined using logistic regression and dominance analysis. Staffing adequacy was the strongest predictor of patient safety, followed by hospital management support for patient safety and organizational learning/continuous improvement. However, dominance analysis showed that hospital management support for patient safety was the most important predictor rather than staffing adequacy. Nurse managers and hospital administrators should role model a culture of safety and demonstrate their valuing of patient safety by providing sufficient resources, listening to and valuing staff suggestions regarding patient safety, and providing feedback about organizational changes to improve patient safety.