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Neonatal intensive care unit safety culture varies widely
  1. Jochen Profit1,2,3,
  2. Jason Etchegaray4,
  3. Laura A Petersen2,3,
  4. J Bryan Sexton5,
  5. Sylvia J Hysong2,3,
  6. Minghua Mei2,3,
  7. Eric J Thomas4
  1. 1Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
  2. 2Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
  3. 3Houston Veterans Affairs (VA) Health Services Research and Development Center of Excellence, Health Policy and Quality Program, Michael E DeBakey VA Medical Center, Houston, Texas, USA
  4. 4University of Texas – Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, Texas, USA
  5. 5Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, North Carolina, USA
  1. Correspondence to Jochen Profit, Houston Center for Quality of Care and Utilization Studies, VA HSR&D (152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; profit{at}


Background Variation in healthcare delivery and outcomes in neonatal intensive care units (NICUs) may be partly explained by differences in safety culture.

Objective To describe NICU care giver assessments of safety culture, explore variability within and between NICUs on safety culture domains, and test for association with care giver characteristics.

Methods NICU care givers in 12 hospitals were surveyed using the Safety Attitudes Questionnaire (SAQ), which has six scales: teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and working conditions. Scale means, SDs and percent positives (percent agreement) were calculated for each NICU.

Results There was substantial variation in safety culture domains among NICUs. Composite mean score across the six domains ranged from 56.3 to 77.8 on a 100-point scale and NICUs in the top four NICUs were significantly different from the bottom four (p<0.001). Across the six domains, respondent assessments varied widely, but were least positive on perceptions of management (3%–80% positive; mean 33.3%) and stress recognition (18%–61% positive; mean 41.3%). Comparisons of SAQ scale scores between NICUs and a previously published adult ICU cohort generally revealed higher scores for NICUs. Composite scores for physicians were 8.2 (p=0.04) and 9.5 (p=0.02) points higher than for nurses and ancillary personnel.

Conclusion There is significant variation and scope for improvement in safety culture among these NICUs. The NICU variation was similar to variation in adult ICUs, but NICU scores were generally higher. Future studies should validate whether safety culture measured with the SAQ correlates with clinical and operational outcomes in NICUs.

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  • Funding JP's contribution is supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (#1 K23 HD056298-01, PI: Profit). LAP was a recipient of the American Heart Association Established Investigator Award (#0540043N) at the time this work was conducted. LAP, SJH and MM also receive support from a Veterans Administration Center Grant (VA HSR&D CoE HFP90-20). SJH's contribution is supported in part by the Department of Veterans Affairs Health Services Research and Development Program (#CD 2-07-0818). EJT's effort is supported in part by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (#1 K24 HD053771-01, PI: Thomas and #1 PO1 HS1154401, PI: Thomas). JBS received support from an Agency for Healthcare Research and Quality (AHRQ) (grant # 1UC1HS014246). JE's effort is supported by a K02 award from AHRQ (#1 K02 HS017145-02) and the University of Texas at Houston – Memorial Hermann Center for Quality and Safety.

  • Competing interests None.

  • Ethics approval The original study was approved by the Johns Hopkins University Institutional Review Board, and the analysis of a de-identified data set was approved by the Institutional Review Board at Baylor College of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.