Exploring the Association Between Organizational Culture and Large-Scale Adverse Events: Evidence from the Veterans Health Administration

摘要

Background: Large-scale adverse events (LSAEs) involve unsafe clinical practices stemming from system issues that mayaffect multiple patients. Although literature suggests a supportive organizational culture may protect against system-relatedadverse events, no study has explored such a relationship within the context of LSAEs. This study aimed to identify whetherstaff perceptionsoforganizationalculturewereassociatedwithLSAEincidence.Methods: The team conducted an exploratory analysis using the 2008–2010 data from the US Department of VeteransAffairs (VA) All Employee Survey (AES). LSAE incidence was the outcome variable in two facilities where similar infectioncontrol practice issues occurred, leading to LSAEs. For comparison, four facilities where LSAEs had not occurred wereselected, matched on VA–assigned facility complexity and geography. The AES explanatory factors included workgroup-level (civility, employee engagement, leadership, psychological safety, resources, rewards) and hospital-level Likert-type scalesfor four cultural factors (group, rational, entrepreneurial, bureaucratic). Bivariate analyses and logistic regressions were performed,with individual staff as the unit of analysis from the anonymous AES data.Results: Responses from 209 AES participants across the six facilities in the sample indicated that the four comparisonfacilities had significantly higher mean scores compared to the two LSAE facilities for 9 of 10 explanatory factors. Theadjusted analyses identified that employee engagement significantly predicted LSAE incidence (odds ratio = 0.58, 95%confidence interval = 0.37–0.90).Conclusion: Staffat the two exposure facilities in this study described their organizational culture to be less supportive.Lower scores in employee engagement may be a contributing factor for LSAEs.