Abstract This thesis measures safety climate in a sample of Scottish acute hospitals. It demonstrates how staff perceptions related to safety issues are linked to their safety behaviours and also to the consequences, both for the workers and the patients. Following a review of the industrial and healthcare safety climate literatures, a theoretical model was proposed to investigate the underlying mechanisms between safety climate and safety outcomes. Based on this review, the Hospital Survey on Patient Safety Culture (HSOPSC) was selected as part of a questionnaire to measure safety climate, safety behaviours and safety outcomes. A total of 1969 clinical staff from seven Scottish acute NHS hospitals were surveyed. The psychometric analysis, using EFA and CFA, showed that the original 12 factor structure of the HSOPSC scale was replicated. A focus group study (n = 25) was conducted in two of the hospitals to extend the survey findings. The qualitative data supported the theoretical model proposed based on the literature review by demonstrating the role of managerial practices on safety-related issues. The group discussions further contributed to a wider conceptualization of safety culture by illustrating the multi-level perspective of staff on safety-related issues, including both the external influences and the individual factors. Using structural equation modelling on the same quantitative data set, managerial aspects of safety climate were examined in relation to safety outcomes (safety behaviours, worker and patient outcomes). Results demonstrated the effects of managerial commitment to safety at hospital and unit level on safety outcomes. It also showed the intervening role of safety compliance and safety participation between supervisory practices and self-reported injuries, both for workers and patients. Overall, this thesis provided a psychometrically robust safety climate measurement tool tested in Scottish acute hospitals, and showed the influence of safety-related managerial activities at different levels of the organization on safety outcomes for workers and patients separately.

Thesis (Ph. D.)--University of Virginia, 2007. / Includes bibliographical references. Also available online through Digital Dissertations.

Thesis (Ph. D.)--Virginia Commonwealth University, 2007. / Prepared for: Dept. of Health Administration. Bibliography: leaves 175-186.

Thesis equivalent (M.H.A.)--University of Michigan, 1974. / "H.A. 752-3."

Thesis equivalent (M.H.A.)--University of Michigan, 1974. / "H.A. 752-3."