This dissertation examined the effect of safety climate on caregiver and patient safety outcomes in a national sample of hospitals. Hypotheses testing climate level and climate strength were not supported for caregiver injuries and postoperative patient outcomes. The main contribution of this dissertation was to test whether the system of care--as evidenced by the patterns of safety climate in multiple units--was related to patient harm.

The pattern of safety climate across units within hospitals predicted compliance with procedures for treating heart failure and pneumonia patients over and above the effect of safety climate elevation and variability. In addition, variability in safety climate between units in hospitals was related to lower compliance with procedures for treating heart attack patients. The sample consisted of caregiver survey data collected from 59 hospitals that belonged to a non-profit hospital system in the United States.