The study evidenced a negative safety climate in the ICU. When unfavorable, the climate can influence the healthcare providers’ adherence to the best practices and compromise quality of care and patient safety [5]. The safety climate has also been identified as unfavorable in other studies that used the same instrument, from the perspective of the multidisciplinary team in the ICU [9, 17].
The dietitian, psychologist, and physiotherapist had a perception of a worse Teamwork Climate when compared to the physicians. This result can be related to the physician-centered work model, linked to a historical cultural process, as well as to the power relations within the health team, this being traditional and legitimized over time [18].
Multidisciplinary and shared clinical decision-making will emerge from the organizational leadership’s investment in cultural change, with strategies developed in the ICU. Some management tools and models can facilitate this process, such as the implementation of multidisciplinary clinical protocols, therapeutic plans, clinical care goals, and multidisciplinary rounds [19].
Another finding of the study highlighted the more positive perception of the Safety Climate that the nurses had compared to the physicians. However, it appears that this data may vary. A number of studies in Australian ICUs using the SAQ revealed that the intensive care physicians perceived a better patient safety climate than the nurses [20].
In this study, the nurses’ perception of a better climate could be a result of their involvement in planning patient safety actions in the organizations. Nursing has been a pioneer in the educational path toward patient safety, with efforts having been focused on demonstrating the importance of multidisciplinary involvement [21]. The nurses have invested in strategies to develop and articulate cooperation between health institutions and education with regard to patient safety.
Professionals with employment contracts regulated by the CLL, who had been working in the institution for less time, had a better perception of the Teamwork Climate domain when compared to those providers with employment contracts regulated by the federal authority. This influence may be explained by the internal organizational contexts experienced for many years by the nursing care providers that had worked in the institution for longer. In this context, traditional physician-led care reduces the space for the participation of the multidisciplinary team [22]. The science of patient safety emphasizes that a well-developed and cohesive multidisciplinary team provides better care outcomes, such as length of stay in the units, and that it also increases patient satisfaction [23]. It is believed that the admission of healthcare providers from different specialties can contribute to the positive modification of this scenario and to the improvement of the Teamwork Climate. Other interventions, such as improving the processes of communication, cooperation, coordination, respect, and the work climate, are also necessary for inter-professional work to take place effectively, with a participatory, collaborative, and coordinated approach to decision-making among the team [24].
On the other hand, the professionals with master’s or doctoral degrees had a more negative perception of the climate related to Working Conditions when compared to those with graduate degrees or specializations. This result may be associated with the fact that these providers, represented here by physicians, nurses and a dietitian, are closer to positions of diagnostic decision-making, interventions and care, and may have impairments in their work due to the lack of organization of the management processes, delays by the sectors in fulfilling requirements, and unavailability of reports and exams, among other aspects. In this context, the lack of standardization and preparation for the handoff – which consists of transmitting relevant information for the continuity of the patient’s treatment, containing current health status, recent changes, ongoing treatment, and the transfer of responsibility for the patient to another provider or team – can lead to delayed, wrong or missed procedures [25]. One way to support clinical decision-making, based on improving communication among teams, is to structure communication strategies using tools such as the SBAR-Situation-Background-Assessment-Recommendation [26].
The results of this study also revealed that, more time since course completion equated to less Job Satisfaction. Institutions that present a sub-optimal level of professional satisfaction often have increases in staff turnover and the occurrence of adverse events, including falls, infections, and medication errors [27]. One study showed that older healthcare providers, mainly women, were more likely to be dissatisfied with their work. Lower Job Satisfaction can also be associated with other contexts, including extra hospital factors. Many providers have another employment contract and, when referring to working women, this is often associated with domestic chores, which can cause tiredness and exhaustion [28].
The providers with workloads greater than 30 hours (36h and 40h) perceived less stress than those that worked 30 hours per week. The hypothesis for this finding is associated with the fact that most providers that work 30 hours (73.5%) have an employment contract regulated by the federal authority. These professionals can work extra shifts in the units, with a mean of 3.5 extra shifts per month found in the present study. The increase in the working hours and voluntary overtime has been related to the increased likelihood of adverse events [29]. Work overload can lead to an increase in the length of patient stay and to a greater risk of death [30].
The Safety Climate influenced the Perceptions of the Management domain, contributing to 26.34% of its variability, which makes it possible to infer that the involvement of the management is of paramount importance for the construction and dissemination of the safety culture. Organizational leaders are decisive in developing a positive climate for the professional practice [8, 31]. A management model that fulfills the needs of all involved, providers and patients, can collaborate to strengthen the patient safety climate, in addition to providing coordinated, effective, and safe work for all [32]. The planning, implementation, and evaluation of the improvement actions in order to strengthen the safety climate must be associated with feedback, also considering organizational attitudes, infrastructure, and social and contextual awareness, for the interventions to be successful [32].
The limitations of the study include its performance in only two ICUs in the same hospital, the exclusion of non-care professionals, the analysis at a single point in time and the relatively small sample size.