A Pilot Study on Safety Climate in Chinese Hospital

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The present paper has 2 primary objectives as a pilot study on health-care safety climate in China: to develop its prototypical model well fit to the country’s current hospital situations and validated external reliability and to elicit essential characteristics of safety climate for hypothetical general features in Chinese health care.


A safety climate survey was carried out in 2008 at a university hospital in Shanghai, using an Operating Room Management Attitudes Questionnaire. We collected 1056 valid responses from doctors and nurses with 81% of overall response rate.


A 9-dimension model of safety climate was developed by applying principal component analysis to the entire sample with 44% of cumulative variance accounted for. Compared with the Japanese sample, safety climate in the Chinese hospital was characterized as strong awareness of own competence, positive attitudes to organization, but large power distance and unrealistic staff recognition of human error. Criterion validity of the construct was in part assured by significant correlations of 4 dimensions with self-reported staff behavior of accident reporting.


Safety climate has been not yet mature in the hospital surveyed that might be partly tied with blame culture. Considering health-care policies, procedures, and management styles shared with many other health-care organizations as well as Chinese culture, we would hypothesize that the immature nature is common in Chinese health care as overall characteristics of safety climate. From these results, we would suggest that a nonpunitive health-care culture should be fostered to improve patient safety in China.

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