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Original Articles: Pediatric Cardiac

Errors and the Burden of Errors: Attitudes, Perceptions, and the Culture of Safety in Pediatric Cardiac Surgical Teams

^a Department of Ophthalmology, School of Medicine, University of Szeged, Szeged, Hungary
^b Department of Anesthesiology, College of Medicine and Public Health, University of South Florida, Tampa, Florida; The Center for Patient Safety, University of Utrecht School of Medicine, Utrecht, the Netherlands
^c University of Chicago, Chicago, American Board of Medical Specialties, Evanston, Illinois
^d Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida
^e Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
^f Institute for Healthcare Studies, Northwestern School University, Chicago, Illunois
^g Feinberg School of Medicine, Northwestern School University, Chicago, Illinois
^h Cardiac Surgery, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts

Accepted for publication November 9, 2007.

^_* Address correspondence to Dr Bacha, Department of Cardiac Surgery, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (Email: emile.bacha{at}cardio.chboston.org).

Background: The fear of committing clinical errors in perioperative care has a negative impact on the psychological well-being of surgical team members and ultimately on patient care. We assessed the perceptions and attitudes of surgical teams relative to committing errors, the impact of errors, and the culture of safety.

Methods: Pediatric cardiac surgery team members at three academic hospitals were surveyed. The survey included scaled, open-ended questions and a clinical vignette. Respondents were asked about the safety climate, team climate, stress recognition, and the impact of error as they relate to making and the anticipation of making clinical errors.

Results: The response rate was 69%. Safety attitudes were influenced by the work environment climate. Many respondents felt unable to express disagreement and had difficulty raising safety concerns. Staffing levels, equipment availability, production pressures, and hectic schedules were concerns. Respondents admitted that errors occurred repeatedly, and that guidelines and policies were often disregarded.

Conclusions: A psychometrically sound teamwork culture tool was used and demonstrated that surgical teams are influenced by the recognition of medical errors and that these errors carry significant personal burden. The findings suggest that the safety attitudes among team members may impact their performance and need to be carefully taken into consideration. Providers’ reluctance to share safety events with others, as well as the perceived powerlessness to prevent events, must be addressed as part of an overall strategy to improve patient care outcomes. The study points to the need to address teamwork culture in efforts to improve patient care.