Improving service operations: linking safety culture to hospital performance

Gregory N. Stock, Kathleen L. McFadden

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Purpose: The purpose of this paper is to examine the relationship between patient safety culture and hospital performance using objective performance measures and secondary data on patient safety culture. Design/methodology/approach: Patient safety culture is measured using data from the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture. Hospital performance is measured using objective patient safety and operational performance metrics collected by the Centers for Medicare and Medicaid Services (CMS). Control variables were obtained from the CMS Provider of Service database. The merged data included 154 US hospitals, with an average of 848 respondents per hospital providing culture data. Hierarchical linear regression analysis is used to test the proposed relationships. Findings: The findings indicate that patient safety culture is positively associated with patient safety, process quality and patient satisfaction. Practical implications: Hospital managers should focus on building a stronger patient safety culture due to its positive relationship with hospital performance. Originality/value: This is the first study to test these relationships using several objective performance measures and a comprehensive patient safety culture data set that includes a substantial number of respondents per hospital. The study contributes to the literature by explicitly mapping high-reliability organization (HRO) theory to patient safety culture, thereby illustrating how HRO theory can be applied to safety culture in the hospital operations context.

Original languageEnglish (US)
Pages (from-to)57-84
Number of pages28
JournalJournal of Service Management
Issue number1
StatePublished - 2017
Externally publishedYes


  • Operational performance
  • Patient safety performance
  • Safety climate
  • Safety culture
  • Service operations

ASJC Scopus subject areas

  • Business, Management and Accounting (miscellaneous)
  • Tourism, Leisure and Hospitality Management
  • Strategy and Management


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