Abstract
BackgroundFostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region.MethodsRandomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported.We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants’ demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome.ResultsTrial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (− 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39–3.35), and by 13.75 (2.41–354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable.ConclusionA educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged.Trial registrationIt was retrospectively registered with (ISRCTN41911128, 31/12/2010).
Highlights
Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care
Organizational culture is a complex phenomenon that can be understood from different epistemological viewpoints, using different methods and assessment instruments [5] and there is a complex two-way relationship between safety culture and patient and staff outcomes [6]
Twenty-four tutor-resident units in each group are required to detect an improvement in patient safety culture as measured by Patient Safety Grade of 30%, with 80% power and confidence level of 95%
Summary
Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. Organizational culture is a complex phenomenon that can be understood from different epistemological viewpoints, using different methods and assessment instruments [5] and there is a complex two-way relationship between safety culture and patient and staff outcomes [6] In this context, it is essential to implement interventions to expand the safety culture [7] and to carry out studies to evaluate these interventions. In primary health care, fostering the safety culture is essential to guarantee patient safety in the future [8, 9] and is considered critical in continuing education and effective teamwork. Healthcare professionals, both tutors and residents, should be encouraged to identify safety issues and propose solutions to ensure patients’ safety. Not all intervention always gets the expected effect [13, 14]
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