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Impact of organizational culture on preventability assessment of selected adverse events in the ICU: evaluation of morbidity and mortality conferences

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Abstract

Purpose

To determine whether organizational culture is associated with preventability assessment of reported adverse events (AE) in intensive care units (ICU).

Design

Blind review of time randomly distributed case notes written in the form of structured abstracts by the nurses who participated in recently implemented morbidity and mortality conferences from December 2006 to June 2010 in a 18-bed ICU in France. Ninety-five abstracts summarizing the discussions of 95 AE involving 95 patients were reviewed by two external blinded pairs (each comprised of one senior intensivist and one psychologist).

Methods

A score for each organizational culture style was determined, with the highest scorer being considered the dominant style present in the abstract.

Results

Reliability of the classification and quantification of culture traits between pairs was very good or good for 13 dimensions and moderate for two others. The two pairs deemed 32/95 and 43/95 of AE preventable (κ = 0.59). Concordance was very good (κ = 0.85) between the external pairs for evaluation of the dominant culture style. The Cochran–Armitage trend test indicated an increasing trend for change of the dominant organizational culture style over time: the team-satisfaction-oriented culture took a leading role (p = 0.02), while the people-security-oriented culture decreased dramatically (p < 0.001). The task-security-oriented culture was significantly associated with a preventable judgment, while the people-security-oriented culture was significantly associated with an unpreventable judgment (p < 0.001).

Conclusions

This study demonstrated a strong relationship between preventability assessment of AE reported by caregivers and their organizational culture in the ICU.

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Acknowledgments

We thank Florence Guillaizeau and Emilie Lenain (Unité d’Epidémiologie et de Recherche Clinique, Hôpital Européen Georges Pompidou) for their help in the statistical analyses. We also thank Nicholas Heming (Service de Réanimation Médicale, Hôpital Européen Georges Pompidou) for assistance during revision of the manuscript. This work was supported fully by departmental sources.

Conflicts of interest

The authors have not disclosed any potential conflicts of interest.

Author information

Authors and Affiliations

  1. Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 20-40 rue Leblanc, 75908, Paris Cedex, France

    Iris Pelieu, Guillaume Héraud, Claire Lefur, Adeline Massin, Marlène Hennequin, Jean-Yves Fagon & Christophe Faisy

  2. Centre d’Investigations Epidémiologiques 4, INSERM, Hôpital Européen Georges Pompidou, Paris, France

    Pierre Durieux

  3. Santé Publique et Informatique Médicale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, INSERM U729, Paris, France

    Juliette Djadi-Prat

  4. Service Universitaire de l’Adulte et du Sujet Agé, Hôpitaux Universitaires Paris-Ouest, Issy-les-Moulineaux, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France

    Silla M. Consoli, Cécile You-Harada & Virginie Paget

  5. Service de Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France

    Alain Cariou

  6. Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France

    Bertrand Guidet

Authors
  1. Iris Pelieu
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  2. Juliette Djadi-Prat
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  3. Silla M. Consoli
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  4. Alain Cariou
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  5. Bertrand Guidet
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  6. Cécile You-Harada
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  7. Virginie Paget
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  8. Guillaume Héraud
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  9. Claire Lefur
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  10. Adeline Massin
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  11. Marlène Hennequin
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  12. Pierre Durieux
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  13. Jean-Yves Fagon
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  14. Christophe Faisy
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Corresponding author

Correspondence to Christophe Faisy.

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Pelieu, I., Djadi-Prat, J., Consoli, S.M. et al. Impact of organizational culture on preventability assessment of selected adverse events in the ICU: evaluation of morbidity and mortality conferences. Intensive Care Med 39, 1214–1220 (2013). https://doi.org/10.1007/s00134-013-2923-y

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  • DOI: https://doi.org/10.1007/s00134-013-2923-y

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