Impact of medical safety huddles on patient safety: a stepped-wedge cluster randomised study.

Given the increasing focus on patient safety in healthcare systems worldwide, understanding the impact of Continuous Quality Improvement Programs (QIPs) is crucial. QIPs, including Morbidity and Mortality Conferences (MMCs) and Experience Feedback Committees (EFCs), have been identified as effective strategies for enhancing patient safety culture. These programs engage healthcare professionals in the identification and analysis of adverse events to foster a culture of safety (ie the product of individual and group value, attitudes, and perceptions about quality and safety). This study aimed to determine whether patient safety culture differed regarding care provider participation in MMCs and EFCs activities. A cross-sectional web-only survey was conducted in 2022 using the Hospital Survey on Patient Safety Culture (HSOPS) among 4780 employees at an 1836-bed, university-affiliated hospital in France. We quantified the mean differences in the 12 HSOPS dimension scores according to MMCs and EFCs participation, using Cohen d effect size. We performed a multivariate analysis of variance to examine differences in dimension scores after adjusting for background characteristics. Of 4780 eligible employees, 1457 (30.5%) participated in the study. Among the respondents, 571 (39.2%) participated in MMCs or EFCs activities. Participants engaged in MMCs or EFCs reported significantly higher scores in six out of twelve HSOPS dimensions, particularly in "Nonpunitive response to error", "Feedback and communication about error", and "Organizational learning" (Overall effect size = 0.14, 95% confidence interval = 0.11 to 0.17, P<0.001). Notably, involvement in both MMCs and EFCs was associated with higher improvements in patient safety culture compared to non-participation or singular involvement in either program. However, certain dimensions such as "Staffing", "Hospital management support", and "Hospital handoffs and transition" showed no significant association with MMCs or EFCs participation, highlighting broader systemic challenges. The study confirms the positive association between participation in MMCs or EFCs and an enhanced culture of patient safety, emphasizing the importance of such programs in fostering an environment conducive to learning, communication, and nonpunitive responses to errors. While MMCs or EFCs are effective in promoting certain aspects of patient safety culture, addressing broader systemic challenges remains crucial for comprehensive improvements in patient safety.

To assess healthcare professionals' perceptions of patient safety culture and to examine variations across clinical units in Eastern Ethiopian public hospitals. A cross-sectional study was conducted using the Hospital Survey on Patient Safety Culture (HSoPSC 2.0) tool. Analysis of variance and ordinal logistic regression analyses were performed. Results were presented as mean differences and an adjusted odds ratio (AOR) with a 95% confidence interval (CI), and statistical significance was set at a p-value < 0.05. Content analysis was performed for data provided through the open-ended response option. A total of 582 questionnaires were returned, yielding a response rate of 85%. Overall positive patient safety culture score was 47% (95% CI: 41-53%). Intensive care units (ICUs) scored significantly lower on patient safety culture dimensions compared to other clinical units. Factors contributing to the patient safety ratings included Midwives (AOR = 0.20, 95% CI: 0.06-0.71, p = 0.013), Organisational learning and continuous improvement (AOR = 1.35, 95% CI: 1.04-1.76, p = 0.025), Supervisor, manager, or clinical leader support for patient safety (AOR = 1.41, 95% CI: 1.06-1.89, p = 0.02), and Hospital management support for patient safety (AOR = 1.28, 95% CI: 1.00-1.63, p = 0.049). The challenges in ensuring patient safety included the absence of patient safety incident reporting systems, severe resource constraints, limited awareness regarding patient safety, ineffective communication, poor management support, and a blame-oriented organisational culture. Significant improvement in patient safety culture in Ethiopian public hospitals, especially in the ICU, is critically needed to mitigate healthcare risks and ensure patient safety. Addressing these issues requires targeted patient safety training, strong leadership support, and adequate resource allocation. Further exploration of ICU-specific patient safety insights and validation of the HSoPSC 2.0 tool within the Ethiopian healthcare context should be undertaken to ensure cultural and contextual relevance.

IntroductionA positive patient safety culture is considered a main condition for patient safety. Several initiatives have been taken with the intention to improve this culture in healthcare. Because these were...

Improvements in Patient Safety Structures and Culture following Implementation of a National Public Program: An Observational Study in Three Brazilian Hospitals

Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based training program that embeds patient safety within quality improvement methods. Kirkpatrick's "levels of evaluation" model was adopted to evaluate the program in health organizations across one city in the north of England. Questionnaires were used to assess reaction of participants to the program (Level 1). Improvements in patient safety knowledge and patient safety culture (Level 2) were assessed using a 12-item multiple-choice questionnaire and a culture questionnaire. Interviews and project-specific quantitative measurements were used to assess changes in professional practice and patient outcomes (Levels 3 and 4). All aspects of the program were positively received by participants. Few participants completed the MCQ at both time points, but those who did showed improvement in knowledge. There were some small but significant improvements in patient safety culture. Interviews revealed a number of additional benefits beyond the specific problems addressed. Most importantly, 8 of the 11 teams showed improvements in patient safety practices and/or outcomes. This program is an example of interprofessional education in practice and demonstrates that team-based learning using quality improvement methods is feasible and can be effective in improving patient safety, but requires time and space for participants. Alignment with continuing education arrangements could support mainstream adoption of this approach within organizations.

Patient safety is a patient's right. Patient safety is a priority for health services worldwide. Leadership, teamwork and patient safety culture are factors that have a major contribution to causing patient safety problems. This study aims to determine the effect of leadership style, teamwork and patient safety culture on the achievement of patient safety targets at the Majalengka Regional General Hospital. This research method is a descriptive and verification method. The nature of the data used in this study is quantitative and the sources of research data are primary and secondary data. The research sample was 78 respondents of the Majalengka Regional General Hospital. Data collection techniques were interviews using questionnaires. Data analysis used descriptive analysis and multiple regression analysis. The results showed that leadership style was in the good category, while teamwork, patient safety culture and achievement of patient safety targets were in the fairly good category. Leadership style, teamwork and patient safety culture simultaneously have a significant positive effect on the achievement of patient safety targets at the Majalengka Regional General Hospital. Majalengka Regional General Hospital should strengthen the role of leadership style by improving patient safety culture because this can improve patient safety performance in employees and increase teamwork solidity through improving patient safety culture because this can also improve patient safety performance; The Regional Government should propose the creation of programs or policies in building an organizational culture to improve patient safety performance and in the recruitment process prioritize the right leadership style, namely supporting increasing rewards in the form of increased incentives based on performance.

The relationship between patient safety culture and adverse events: A questionnaire survey

Background The intensive care units are a high-risk environments for the occurrence of adverse events with serious consequences. The development of patient safety culture is a strategic focus to prevent these adverse events and improve patient safety and healthcare quality. This study aimed to assess patient safety culture in Tunisian intensive care units and to determine its associated factors. Methods It is a multicenter, descriptive cross-sectional study, among healthcare professionals of the intensive care units in the Tunisian center. The data collection was spread over a period of 2 months (October-November 2017). The measuring instrument used is the validated French version of the Hospital Survey On Patient Safety Culture questionnaire. Data entry and analysis was carried out by the Statistical Package for Social Sciences (SPSS 20.0) and Epi Info 6.04. Chi-square test was used to explore factors associated with patient safety culture. Results A total of 404 professionals participated in the study with a participation rate of 81.94%, spread over 10 hospitals and 18 units. All dimensions were to be improved. The overall perception of safety was 32.35%. The most developed dimension was teamwork within units with a score of 47.87% and the least developed dimension was the non-punitive response to error (18.6%). The patient safety culture was significantly more developed in private hospitals in seven of the 10 dimensions. Participants working in small units had a significantly higher patient safety culture. It has been shown that when workload is reduced the patient safety culture was significantly increased. Conclusions This study has shown that the patient safety culture still needs to be improved and allowed a clearer view of the safety aspects requiring special attention. Thus, improving patient safety culture. by implementing the quality management and error reporting systems could contribute to enhance the quality of healthcare provided to patients. Key messages The culture of culpability is the main weakness in the study. Encouraging event reporting and learning from errors s should be priorities in hospitals to enhance patient safety and healthcare quality.

To investigate patient safety culture and its relationship with obstacles to adverse event reporting in Chinese nursing homes. Reporting obstacles are related to high incidences and unreported rates of adverse events. Patient safety culture is also associated with adverse events. However, the relationship between reporting obstacles and patient safety culture in nursing homes is unclear. A cross-sectional survey was conducted with a random sampling method among 549 staff members in six nursing homes using instruments of the Nursing Home Survey on Patient Safety Culture and the Adverse Event Reporting Obstacle Scale. The Pearson correlation coefficient, independent t tests, ANOVA tests and multivariate regression analysis were used. Patient safety culture in nursing homes was associated with facility ownership (p<.001), facility scale (p<.001), reporting management (p<.001), whether it was an integrated care institution (p=.006), frequency of concern about patient safety (p=.001), occurrence of adverse events in departments (p=.001) and a punitive atmosphere (p=.044). Adverse event reporting obstacles were negatively correlated with patient safety culture (p<.05). An improvement in patient safety culture was associated with a reduction in reporting obstacles in nursing homes. A barrier-free adverse event reporting system should be built to reduce reporting obstacles and create a non-punitive patient safety culture in nursing homes.

BackgroundMeasuring patient safety culture can provide insight into areas for improvement and help monitor changes over time. This study details the findings of a re-assessment of patient safety culture in a multi-site Medical City in Riyadh, Kingdom of Saudi Arabia (KSA). Results were compared to an earlier assessment conducted in 2012 and benchmarked with regional and international studies. Such assessments can provide hospital leadership with insight on how their hospital is performing on patient safety culture composites as a result of quality improvement plans. This paper also explored the association between patient safety culture predictors and patient safety grade, perception of patient safety, frequency of events reported and number of events reported.MethodsWe utilized a customized version of the patient safety culture survey developed by the Agency for Healthcare Research and Quality. The Medical City is a tertiary care teaching facility composed of two sites (total capacity of 904 beds). Data was analyzed using SPSS 24 at a significance level of 0.05. A t-Test was used to compare results from the 2012 survey to that conducted in 2015. Two adopted Generalized Estimating Equations in addition to two linear models were used to assess the association between composites and patient safety culture outcomes. Results were also benchmarked against similar initiatives in Lebanon, Palestine and USA.ResultsAreas of strength in 2015 included Teamwork within units, and Organizational Learning—Continuous Improvement; areas requiring improvement included Non-Punitive Response to Error, and Staffing. Comparing results to the 2012 survey revealed improvement on some areas but non-punitive response to error and Staffing remained the lowest scoring composites in 2015. Regression highlighted significant association between managerial support, organizational learning and feedback and improved survey outcomes. Comparison to international benchmarks revealed that the hospital is performing at or better than benchmark on several composites.ConclusionThe Medical City has made significant progress on several of the patient safety culture composites despite still having areas requiring additional improvement. Patient safety culture outcomes are evidently linked to better performance on specific composites. While results are comparable with regional and international benchmarks, findings confirm that regular assessment can allow hospitals to better understand and visualize changes in their performance and identify additional areas for improvement.

Patient safety culture is one of the most intriguing and researched new phenomena to emerge in the health literature in the last two decades. One in ten patients will experience an adverse event during their hospital stay (Australian Commission on Safety and Quality in Health Care, 2014). Improving patient safety culture is seen as one way of enhancing patient safety outcomes in health services. Despite the enormous interest in this area, there remains much that is unknown. The literature is voluminous and diverse, and the term “culture” is often used to explain lapses in health care outcomes. Numerous enquiries into health system failings have unequivocally attributed causation to issues of patient safety culture. While recommendations have been made to improve safety culture there is little evidence on how this can be achieved. This thesis investigates patient safety culture by looking at the antecedents that contribute to this phenomena and consequent outcomes. Key points of differentiation from existing work in this area are that the method employs an interprofessional approach and a post positivist philosophy. This research occurs over a period that includes the relocation of a major tertiary hospital. A longitudinal case study contains data collected from a staff survey in 2013, with a follow up in 2015. The context of studying patient safety culture longitudinally and encapsulating a major hospital move is unique to this PhD. Additionally, a patient perspective is provided using qualitative and quantitative methodology. Triangulation of findings from a comprehensive review of the literature, and three data collections makes some new discoveries not previously reported. These findings are presented in one literature review, three empirical papers and one mixed method report. A summary of each chapter is provided below. Chapter 1, the Introduction, includes high level information regarding the Australian health care system, describes the research setting and lays out the research aims and an overview of the chapters. In Chapter 2, the philosophy and methodology used is described. Theoretical models are presented and a philosophical research paradigm discussed. The overall methods are outlined and a summary of each paper is provided. Chapter 3, paper 1 is a comprehensive review of the literature including a bibliometric analysis and a synthesis of findings. This chapter demonstrates what is known and what isn’t known on patient safety culture, and refines the research questions to be considered in this thesis. Chapter 4 includes paper 2, an empirical paper that explores workforce relationships finding a significant interaction between employee engagement, interprofessional collaboration and patient safety culture. Chapter 5 includes two papers (papers 3 and 4) providing different perspectives of changing the work environment and using different paradigms. Paper 3 is an empirical paper from the staff perspective and paper 4 is a report of the patient’s experience derived from a patient survey and interviews. The impact of moving hospitals on patient safety culture is explored. Differences in the patient safety perceptions of clinical and non-clinical staff are compared and considered. Chapter 6, paper 5 explores the theme of developing workforce capacity and tests the moderating effect of reflexivity on patient safety culture and quality patient care. The goal here is to gain a better understanding of patient safety culture and inform the development of strategies aimed at improving quality of patient care. Finally, Chapter 7 brings all the findings together with a discussion and conclusions. Particular emphasis is given to the implications for practice and the unique contribution that this thesis makes to understanding the research endeavour.

Background and Purpose: The global emphasis on fostering a patient safety culture is a priority for many countries, including those in the Middle East. Hospitals worldwide are dedicated to enhancing the quality of patient care and safety, with an increasing recognition by hospital management of the role played by a robust patient safety culture. This study compares intensive care nurses' perceptions of patient safety culture and adverse events. Method: A comparative study was conducted in the intensive care units (ICUs) of four private and teaching hospitals utilizing The Hospital Survey on Patient Safety Culture (HSOPSC)-two in Riyadh and two in Cairo. Nonprobability sampling was employed across all registered nurses working in ICUs. Results: The study revealed that the highest percentage of errors occurred in patients' acquired infections (61.5%), while the lowest percentage was associated with patients' falls (7.8%). The strengths of the composites were continuous organizational learning improvement (85.9%) and management support for patient safety (81.4%). Areas for improvement were identified in composites such as handoffs and transitions (40.3%) and teamwork across units (49.5%). Notably, nurses in Cairo hospitals reported a higher frequency of adverse events compared to their counterparts in Riyadh hospitals. Implications for practice: The views of nurses working in both cities emphasized the importance of organizational learning to achieve ongoing improvement, teamwork within specific units, and managerial backing for ensuring patient safety. Moreover, the research emphasized the necessity for additional improvements in collaboration between different units, as well as in the processes of handoffs and transitions.

BackgroundAssessments of the culture surrounding patient safety can inform healthcare settings on how their structures and processes impact patient outcomes. This study investigated patient safety culture in Primary Health Care Centres in Kuwait, and benchmarked the findings against regional and international results. This study also examined the association between predictors and outcomes of patient safety culture in these settings.MethodsThis cross-sectional quantitative study used the Medical Office Survey on Patient Safety Culture. The study was targeted at staff of all the Primary Health Care Centres in Kuwait with at least one year of experience. Data were analysed using SPSS 23 at a significance level of ≤ .05. Univariate (means, standard deviations, frequencies, percentages) and bivariate (chi-squared tests, student t-tests, ANOVA F-tests, Kruskal–Wallis tests, Spearman’s correlation) analyses provided an overview of participant socio-demographics and the association between patient safety culture composites and outcomes. We undertook a multivariate regression analysis to predict the determinants of patient safety culture. Results were benchmarked against similar local (Kuwait, 2014), regional (Yemen, 2015) and international (US, 2018) studies.ResultsThe responses of 6602 employees from 94 centres were included in the study, with an overall response rate of 78.7%. The survey revealed Teamwork (87.8% positive ratings) and Organisational Learning (78.8%) as perceived areas of strength. Communication about Error (57.7%), Overall Perceptions of Patient Safety and Quality (57.4%), Communication Openness (54.4%), Owner/Managing Partner/Leadership Support for Patient Safety (53.8%) and Work Pressure and Pace (28.4%) were identified as areas requiring improvement. Benchmarking analysis revealed that Kuwait centres are performing at benchmark levels or better on four and six composites when compared to international and regional findings, respectively. Regression modelling highlighted significant predictions regarding patient safety outcomes and composites.ConclusionsThis is the first major study addressing the culture of patient safety in public Primary Health Care Centres regionally. Improving patient safety culture is critical for these centres to improve the quality and safety of the healthcare services they provide. The findings of this study can guide country-level strategies to develop the systems that govern patient safety practices.

Protocol for a stepped wedge cluster randomized quality improvement project to evaluate the impact of medical safety huddles on patient safety

The present study aims to describe the change in the perception of patient safety culture among physicians in the Department of Anesthesiology and Intensive Care Medicine at a regional hospital in Denmark after applying a structured patient safety culture program. A prospective cross-sectional experimental study was conducted. To improve patient safety culture, a four-step model was introduced. This included regular patient safety leadership rounds, simulation-based training, enhanced daily patient safety awareness, and strengthened clinical risk management. Perception of patient safety culture among physicians was monitored using the Safety Attitudes Questionnaire. Measurements were obtained before and during the implementation of the four-step model annually in a 5-year period. Data from 114 questionnaires from physicians were included. The results showed a significant improvement in perception of patient safety culture regarding safety climate and teamwork climate among physicians in general. Furthermore, we found an increase regarding stress recognition among junior doctors compared to specialist physicians. Finally, our results showed an initial drop in all three dimensions after the Covid-19-pandemic. Applying a structured, proactive four-step model consisting of patient safety leadership rounds, simulation-based training, patient safety awareness, and clinical management for improvement of patient safety culture can increase teamwork and safety climate among physicians, leading to a healthier and safer patient safety culture. The results show that both specialist physicians and junior doctors benefit from the interventions. More studies are recommended to further specify underlying causes for improvement of patient safety culture. This report presents perceptions about patient safety culture in an anesthesiology and intensive care department, and how this can be altered by a structured approach for improvement over a 4 year period. A combination of clinical rounds with focus on patient safety, simulation-training, daily patient safety awareness dialogue, and strengthened clinical risk management improved perceptions in junior and senior doctors, as well as relieved perceived stress. The impact on actual patient safety, or preventable adverse events, remains to be documented as the next step.