• Blanca Gallego, Mary T Westbrook, Adam G Dunn, and Jeffrey Braithwaite.
• Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, NSW 2052, Australia.
• Int J Qual Health Care. 2012 Aug 1; 24 (4): 311-20.

ObjectiveTo use multilevel modelling to compare the patient safety cultures of types of services across a health system and to determine whether differences found can be accounted for by staffs' professions, organizational roles, ages and type of patient care provided.DesignApplication of a hierarchical two-level regression model.SettingAll services in the South Australian public health system.ParticipantsApproximately half of the health staff (n = 14 054) in the 46 organizations, classified into 18 types of service, which made up the South Australian public health system.InterventionsStaff completed the Safety Attitudes Questionnaire.Main Outcome MeasuresAttitudes regarding Teamwork Climate, Safety Climate, Job Satisfaction, Stress Recognition, Perception of Management and Working Conditions in participants' workplaces.ResultsAll SAQ indices showed statistically significant although modest variations according to service type. However, most of these differences were not accounted for by the differences in the demographic composition of services' staff. Most favourable safety attitudes were found in the breast screening, primary/community health services, community nursing and metropolitan non-teaching hospitals. Poorer cultures were reported in the psychiatric hospital, mental health, metropolitan ambulance services and top-level teaching hospitals. Demographic differences in safety attitudes were observed; particularly, clinical, senior managerial, aged care and older staff held more favourable attitudes.ConclusionsDifferences in staff attitudes have been demonstrated at a macro-level across the type of health services but for the most part, differences could not be explained by staffing composition.

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