Abstract
Safety experts highlight the importance of senior managers creating a culture of safety in their organizations. However, little guidance exists about how senior managers can achieve the recommendation to improve safety culture. We propose that exposing senior managers to the frontline work context can increase safety culture through two mechanisms. First, senior manager observation of the day-to-day operations will enhance the accuracy of their perceptions of their own engagement with safety as well as the types of risks faced by frontline employees. More accurate managerial understanding of frontline safety will help align managers' and workers' perceptions, providing workers with confidence that safety is an important issue for senior managers, which could result in workers taking the
issue more seriously themselves. Second, more accurate managerial understanding of frontline safety may lead to more effective managerial action to improve safety, thus increasing the adequacy of organizational resources devoted to addressing safety hazards on the frontlines. We tested hypotheses in a longitudinal study of an intervention implemented in 20 randomly selected US hospitals. We examined pre-post changes in alignment of manager and worker perceptions in 110 work areas exposed to the intervention compared to 925 untreated controls. Results provide partial support for an intervention effect. We found a 7.8 percentage point (66% relative) reduction in pretest and posttest differences between how senior managers and frontline workers viewed adequacy of organizational resources in
intervention work areas in intervention hospitals relative to the same work areas in non-intervention hospitals (p<.05). Similar comparisons of differences in perceptions of managerial engagement with safety were not significant, but were in the expected direction. A reduction in perceptual differences about senior managers' commitment to patient safety signals a more shared understanding of the resources needed to ensure patient safety. Our research suggests that integrated interventions that expose senior managers to frontline work and workers' safety concerns may increase managers' awareness of safety risks and their commitment to resolving them.