Medical care, Safety measures, patient satisfaction, Patient safety


Patient safety climate is defined as a holistic snapshot of enacted work environment practices and procedures related to patient safety, derived from shared perceptions of social and environmental work characteristics. While patient safety climate has been touted as a critical factor underlying safe patient care, our understanding of input factors influencing shared climate perceptions and, in turn, the effects of climate as a collective, group-level construct on important outcomes remains underdeveloped, both theoretically and empirically. Therefore, the current study examines (1) the antecedents that impact individual patient safety climate perceptions and (2) the relationships between hospital unit patient safety climate and two important unit level outcomes: patient willingness to recommend a facility to others and patient safety. This study also examines climate strength--the degree to which climate perceptions are shared--as a moderator of these relationships. While climate is conceptualized as a holistic description of the working environment, existing evidence has focused on relationships between the independent dimensions of patient safety climate and patient safety. No study to date has examined the configurations (i.e. patterns or profiles) among the multiple dimensions of patient safety climate or how these configurations are related to important employee and patient outcomes. This gap is redressed in the current study by examining patient safety climate in terms of three profile characteristics: (1) climate elevation (i.e., mean positive or negative valence across all dimensions), (2) climate variability (i.e., variance among dimensions), and (3) climate shape (i.e., the pattern of peaks and valleys among climate dimensions). Evidence from studies of general organizational climate suggests that the shape of the pattern among climate dimensions, the overall mean score across dimensions, and the degree to which dimension scores vary are predictive of employee attitudes, customer satisfaction, and organizational financial performance (Dickson et al., 2006; Joyce & Slocum, 1984; Jackofsky & Slocum, 1988; Gonzalez-Roma, Peiro, & Zornoza, 1999; Litwin & Stringer, 1968; Schulte et al., 2009). The current study, then, tests a theoretical model of patient safety climate examining the configural nature of the construct. An archival dataset collected from seven hospitals located in a metropolitan area of the southeastern United States was utilized to test study hypotheses. Data was collected from 3,149 individuals nested within 84 hospital units using the Hospital Survey on Patient Safety Culture (Sorra & Nieva, 2004). Unit level patient safety and patient willingness to recommend was collected by the hospital risk management and nursing administration departments. Hierarchical linear modeling (HLM7; Raudenbush, Bryk, Cheong, Congdon, & du Toit, 2011) was utilized to test hypotheses regarding antecedents of individual level perceptions of patient safety climate to account for the fact that individuals were nested within hospital units. Traditional multiple regression analyses were utilized to test unit level hypotheses examining the relationships between unit level patient safety climate and patient outcomes. Results indicated that unit membership was significantly related to individual climate perceptions--specifically, individual-level climate profile elevation. In turn, individual climate profile elevation and profile variability were related to employee willingness to recommend their organization to family and friends in need of care. At the unit level of analysis, climate profile variability was significantly related to patient willingness to recommend the organization to others, and climate shape was found to be related to patient safety. Furthermore, these results were not dependent on climate strength. The current study meaningfully contributes to the conceptual understanding of the patient safety climate construct by examining the degree to which configural aspects of the construct are predictive of important outcomes across multiple levels of analysis. In this way, it extends beyond existing studies of climate configurations to examine relationships at multiple levels of analysis and to also examine the moderating effects of climate strength. Practically, results provide insight into how the construct of patient safety climate can be used diagnostically and prescriptively to improve patient care and the working environment for providers. In addition to contributing to the theoretical understanding of the patient safety climate construct, this study also augments the evidence-base available to administrators, front-line providers, and regulators regarding how patient safety climate can be used to guide and align quality improvement efforts for greatest impact.


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Graduation Date





Salas, Eduardo


Doctor of Philosophy (Ph.D.)


College of Sciences



Degree Program

Industrial and Organizational Psychology








Release Date

August 2011

Length of Campus-only Access


Access Status

Doctoral Dissertation (Open Access)