Assessing patient safety culture in New Zealand primary care: a pilot study using a modified Manchester Patient Safety Framework in Dunedin general practices

Abstract

Patient safety is a major concern, both in hospitals and in primary care settings. The current focus internationally is on the prospect of improving patient safety through cultural transformation. There are no tools designed to assess and strengthen safety culture in New Zealand (NZ) general practices, but a United Kingdom (UK) group have developed a tool--the Manchester Patient Safety Framework (MaPSaF)--to assess safety culture in UK Primary Care Trusts. We aimed to modify the MaPSaF and test its acceptability and utility in the NZ primary care setting. We modified the MaPSaF to suit the NZ context and then used it in 12 Dunedin general practices at baseline and at three months. Participants were all practice personnel present in the practice on the day. Participants rated their practice individually on each of the nine MaPSaF dimensions of safety culture, then discussed the dimensions and their scores and chose a practice-wide consensus score for each dimension in turn. These discussions were recorded, transcribed and analysed to determine acceptability and utility of the modified framework in NZ practices. The framework process took about one hour. Most participants found the process acceptable and useful. The framework directed team discussion about patient safety issues and facilitated communication and prompted some practices to make changes. Some participants from smaller practices deemed the systems advocated in the framework superfluous. The framework can be adapted and used in NZ practices to stimulate learning about safety culture and to facilitate team communication.