Table 1

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

Domain	What does it measure?	Pediatric Nephrology Unit scores	Congruence across roles	Potential Interventions
Learning environment	Whether 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 leadership	Staff 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 climate	How 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 burnout	How 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
Teamwork	Staff 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 climate	Staff 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 balance	Quantifies 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.