Culture of Patient Safety in Black Serving and Non-Black Serving Hospitals - PROJECT SUMMARY/ABSTRACT
Patient safety events are an important leading cause of morbidity and mortality globally; harm from patient
safety events can be an important driver of health disparities. Black patients are at increased risk of patient
safety events compared to White patients. Black patients also receive care at lower quality hospitals than
White patients. In part this is due to the fact that in the US, hospital care is highly segregated with 25% of
hospitals caring for 90% of elderly Black patients. Hospitals that care for a high proportion of Black patients are
known as Black serving hospitals. Black serving hospitals perform worse on several Agency for Healthcare
Research Quality (AHRQ) patient safety indicators including those at the individual-provider level, surgical
related events, and hospital resource-dependent events. While higher patient safety events in Black serving
hospitals is likely due to several factors, one area of research that has not been conducted is examining the
differences in the culture of safety in Black serving versus non-Black serving hospitals. Evidence indicates that
health systems with a robust patient safety culture have fewer adverse safety events. Disparities in patient
safety culture may contribute to such inequities in patient safety in Black and non-Black serving hospitals.
Given these gaps, we propose in response to AHRQ’s Special Emphasis Notice for Health Services
Research to Advance Health Equity a mixed-methods study guided by Donabedian’s Quality Framework and
the National Institute on Minority Health and Health Disparities Research Framework with the aims to: 1)
Identify and compare patterns in patient safety culture for Black and non-Black serving hospitals; 2) Examine
associations of patient safety culture with financial resources and with patient safety outcomes in Black and
non-Black serving hospitals; and 3) Describe perceived facilitators and barriers that contribute to organizational
support and promotion of patient safety and identify best patient safety practices for diverse settings. In Aim 1,
we will use de-identified data from AHRQ’s Hospital Survey on Patient Safety Culture (HSOPS) to compare
patient safety culture in Black and non-Black serving hospitals. In Aim 2, we will link Medicare, American
Hospital Association, and other publicly available hospital characteristics datasets to identified HSOPS data to
examine the association of patient safety culture with patient safety events (PSEs) and identify other factors
associated with disparities in HSOPS and PSEs. In Aim 3, we will conduct group interviews with hospital
leaders (financial executive, clinician, patient safety officer) in Black and non-Black serving hospitals to identify
facilitators and barriers to effective patient safety culture practices and strategies to improve patient safety. Our
work will identify root causes of disparities in patient safety, explore differences in barriers to health equity, and
highlight best patient safety practices to improve hospital care quality and reduce health inequities as well as
engage with key stakeholders to accelerate dissemination of these best practices in Black serving and non-
Black serving hospitals with the ultimate aim of reducing morbidity and mortality of hospitalized Black patients.
