Measuring Psychological Safety, High-Reliability (HRO) Perception and Safety Reporting Intentions Among Pediatric Nurses
Purpose: The purpose of this study was to explore the relationships between psychological safety, perception of working in a high reliability organization (HRO) and safety event reporting intentions among pediatric nurses working in acute care. Background: The quality and safety of patient care is dependent upon nurses to report safety events and near-misses in order to address systems’ issues and identify improvement opportunities. To encourage feedback and promote reporting, many health care organizations have adopted the high reliability framework and strategies to promote team psychological safety. A dearth of literature exists on how the pediatric nurse perceives their workplace. This study addressed this gap by measuring the pediatric nurse’s level of psychological safety, perception of whether or not they work in an HRO and their safety event reporting intentions. Methods: Using nonprobability convenience sampling, data were collected from pediatric nurses (N=244) during a one-time, anonymous, 10-minute web-based survey. The survey was distributed to members of the Society of Pediatric Nurses (SPN) and by members of the National Pediatric Nurse Scientist Collaborative (NPNSC) to their respective constituent groups. The online survey comprised of four sections: a demographic form, the Safety Organizing Scale (SOS), the Team Psychological Safety Scale, and the Intention to Report Safety Events Scale. A two-part statistical model was fit using logistic regression and linear regression. Results: Psychological safety was found to have a positive and statistically significant relationship with Intention to Report Safety Events Scores (p<0.01; β=0.274). The findings also revealed that when all other variables were excluded from the statistical model, a positive and statistically significant relationship between HRO perception and safety event reporting intentions (p=0.034) existed. The logistic regression model revealed that the odds of a pediatric nurse achieving the highest safety reporting intention score of 7 increased by a factor of 0.3 with each additional year of practice. Conclusions: The findings demonstrated that a nurse’s perception of whether they work in a high reliability setting and how psychologically safe they feel profoundly effects their attitude towards safety event reporting. This work advances the state of the science by demonstrating how workplace culture, and specifically psychological safety and the HRO framework, influences reporting intentions. The information gained from this study will be useful to organizational leaders and professional groups who seek to improve patient safety reporting systems, communication strategies and existing workplace cultures.