Table 1

Results of safety culture domains for Safety, Communication, Operational Reliability, and Engagement survey at Pediatric Nephrology Unit/Roosevelt Hospital in Guatemala

DomainWhat does it measure?Pediatric Nephrology Unit scoresCongruence across rolesPotential Interventions
Learning environmentWhether staff feel that they are learning and that their input is considered; openness that exist in the work setting
Strong learning environments foster open discussion about errors
Overall scores were favourable
  • Most staff claim they are learning and input is valued

  • Environment is conducive to discussion but necessarily about errors

Incongruent among roles
  • Administrative staff showing less favourable views than other staff

  • Use staff input

  • Encourage error reporting with just culture

  • Review errors from an improvement perspective, not punitive

Local leadershipStaff views on leadership support, feedback and guidance
Integral to promoting ‘psychological safety’, showing respect for staff
Mixed responses
  • Need for regular feedback

  • Lack of positive feedback

Incongruent among roles
  • Physicians having more favourable views towards feedback and expectations than others

  • Patient safety walkrounds

  • Increase local management access

  • Enhance feedback loops

Burnout climateHow staff feel about burnout and conflict across unit
Staff in settings with burnout are unable to welcome changes
Overall scores were unfavourable
  • Most staff perceive others around them as burned out, leading to conflict and poor performance

Incongruent among roles
  • Administrative and clinical support staff having unfavourable views

  • Team activities to enhance resilience (ie, ‘three good things’)

  • Designated staff break area

  • Optimise efficiency of workflows

Personal burnoutHow staff feel about their own burnout and resilience
Burnout associated with higher rate of medical errors
Overall scores unfavourable
  • Most staff have high level of burnout and challenges with job demands, fatigue

  • In combination with other domains, suggests burnout may be mitigated by better leadership support

Incongruent among roles
  • Nursing expressed lower levels of personal burnout, although their views towards burnout climate was favourable

  • Debriefings

  • Assuring staff breaks

TeamworkStaff views of team performance and ability to voice concerns and communicate
Predicts operational outcomes, including staff turnover, quality, costs, etc.
Overall favourable findings, including staff willingness to speak up and to ask questions
  • Conflict resolution scored favourably

  • Unfavourable scores related to dealing with difficult colleagues and interdepartmental communication

  • Given associated burnout, teamwork is challenged by fatigue and stress

Moderately incongruent among roles
  • Physicians having more favourable views towards interdepartmental communication

  • Some roles showed concerns related to breakdowns in communication

  • Comprehensive team briefings

  • Structured communication tools

  • Identify and eliminate sources of conflict

Safety climateStaff view of capacity to provide high-quality care; degree of transparency to discuss errors
Predicts clinical outcomes
Most scores were favourable
  • Discussion of errors rated unfavourably

  • Responses are very favourable about quality of care

Incongruent among roles
  • Nursing, administrative and clinical support staff having unfavourable views towards feedback

  • Nursing staff perceive difficulty in discussing errors

  • Integrate non-punitive error discussion into daily briefings

  • Standardise incident reporting methods

  • ‘Learning from Defects’ tool

Work–life balanceQuantifies activities which measure work–life balance
Associated with long-term resilience
Overall scores were unfavourable
  • In concert with other domains, suggests staff are not strong in emotional and wellness domains and may not have resources for self-care

Congruent among roles
  • Support self-awareness efforts

  • Organisational efforts to address burnout may offset unfavourable results

  • For each domain, definition of what the domain measures, survey results for Pediatric Nephrology Unit, congruence across professional roles in the unit and sample of tools to improve performance in that domain. Readers are referred to text for a full description of all information and appropriate references.