Medicolegal Issues

Understanding Physicians’ Attitudes toward Safety Culture


Results from a survey to assess physicians’ and medical trainees’ perceptions and attitudes about the culture of patient safety at the University of California at San Francisco (UCSF) Medical Center were reported at HM11 in Dallas by Patrick Kneeland, MD, who has since moved to Providence Regional Medical Center’s Everett Clinic in Seattle, where he co-chairs the Medical Quality Review Committee.

“We were interested in perceptions about what most determines a safety culture within a hospital,” and about differences and similarities between faculty, fellows, and residents, Dr. Kneeland explains. A positive safety culture is essential to enhancing patient safety, and it requires support and commitment at multiple levels.

Dr. Kneeland and colleagues used an established, validated instrument, the federal Agency for Healthcare Research and Quality’s “Hospital Survey on Patient Safety Culture,” which is used by hospitals to assess their staffs’ attitudes toward safety. But the UCSF team

modified the instrument to include additional survey dimensions, such as trainee supervision, event disclosure to patients, and physician-to-physician handoffs.1 Of 290 physicians surveyed in UCSF’s Department of Medicine, 53% completed the survey.

“What was surprising from our survey was the overall high degree of agreement, but with some interesting differences,” Dr. Kneeland explains. In terms of the overall rating of safety culture, on a 1-to-5 scale with five being the highest, fellows rated the safety culture the highest, followed by faculty, and then residents. “Even though, across the board, 70 percent or more said adverse events should be disclosed to patients, only half of the trainees felt encouraged to do so, and half felt there is some danger in doing so,” he says.

Findings led to a major educational initiative around error disclosure, and to having the chief residents openly discuss overnight adverse patient events at morning rounds. The goal is to make event reporting part of customary practice. UCSF plans to repeat the survey in five years, using the initial results as a benchmark, Dr. Kneeland adds.

For more information or to request a copy of the modified survey, email Dr. Kneeland at

Larry Beresford is a freelance writer in Oakland, Calif.


  1. Hospital Survey on Patient Safety Culture. AHRQ website. Available at: Accessed Feb. 24, 2012.

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