Dimensions Of Safety Culture Research Articles

Staying ahead of the curve: Navigating changes and maintaining gains in patient safety culture - a mixed-methods study

ObjectivesThis study examines how the results of the Hospital Survey on Patient Safety Culture changed between 2012 and 2019 and identifies organisational factors affecting these changes.DesignThe study combined the use...

Patient safety culture and associated factors among health care professionals at public hospitals in Dessie town, north east Ethiopia, 2019.

IntroductionPatient safety culture is defined as the attitudes, perceptions, and values that staffs share within an organization related to patient safety. The safety of health care is now a major global concern. It is likely that millions of people suffer disabling injuries or death directly related to medical care. Particularly in developing and transitional countries, patient harm is a global public health problem. The objective of the study is to assess patient safety culture and associated factors among health care professionals working in public hospitals in Dessie town, North East Ethiopia, 2019.MethodsFacility based quantitative study was employed from March 15 –April 30, 2019 in public hospitals in Dessie town. Four hundred and twenty two health care professionals were recruited to complete a structured pretested self-administered questionnaire. The data was cleaned, coded and entered in to Epi Info-7 and exported to SPSS version 20. Data was further analyzed using bivariate and multivariate logistic regression analyses. Variables with P value of less than 0.05 in multivariate analysis were declared as statistically significant at 95% CI.ResultsOf the 422 recruited a total of 411 participants completed the survey with a response rate of 97.4%. Close to half (184(44.8%)) of the participants indicated good patient safety culture. Good patient safety culture was positively associated with working in primary hospital (AOR = 2.56, 95% CI = 1.56, 4.21). On the other hand, good patient safety culture was negatively associated with health professional’s age between 25–34 year (AOR = 0.25, 95% CI = 0.08–0.74) and working in Pediatrics ward (AOR = 0.39, 95% CI = 0.17–0.9) and in emergency ward (AOR = O.25, 95%CI = 0.09–0.67).ConclusionThe overall level of patient safety culture was under 50%. Good patient safety culture had positive association with working in primary hospital and negative association with professionals’ age between 25–29 year, 30–34 year and working in pediatrics and emergency ward. Implementing actions that support all dimensions of safety culture should be promoted at all levels of hospitals.

A human factors intervention in a hospital - evaluating the outcome of a TeamSTEPPS program in a surgical ward

BackgroundPatient safety in hospitals is being jeopardized, since too many patients experience adverse events. Most of these adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months. Systems Engineering Initiative for Patient Safety 2.0 was used as a conceptual framework for the study.MethodsThis study had a pre-post design with measurements at baseline and after 6 and 12 months of intervention. The intervention was conducted in a urology and gastrointestinal surgery ward in Norway, and the study site was selected based on convenience and the leaders’ willingness to participate in the project. Survey data from healthcare professionals were used to evaluate the intervention. The organizational outcomes were measured by the unit-based sections of the Hospital Survey of Patient Safety Culture Questionnaire, and professional outcomes were measured by the TeamSTEPPS Teamwork Perceptions Questionnaire and the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire. A paired t-test, a Wilcoxon signed-rank test, a generalized linear mixed model and linear regression analysis were used to analyze the data.ResultsAfter 6 months, improvements were found in organizational outcomes in two patient safety dimensions. After 12 months, improvements were found in both organizational and professional outcomes, and these improvements occurred in three patient safety culture dimensions and in three teamwork dimensions. Furthermore, the results showed that one of the significant improved teamwork dimensions “Mutual Support” was associated with the Patient Safety Grade, after 12 months of intervention.ConclusionThese results demonstrate that the team training program had effect after 12 months of intervention. Future studies with larger sample sizes and stronger study designs are necessary to examine the causal effect of a team training intervention in this context.Trial registration numberISRCTN13997367 (retrospectively registered).

The Impact of a National Accreditation Program on Patient Safety Culture in a Tertiary Hospital: Pre- and Post-Evaluation Study.

The objective of this study was to assess the effectiveness of the Saudi national accreditation program on patient safety culture in a secondary-tertiary public hospital in Saudi Arabia. Three hundred health professionals were randomly selected to participate in a survey. The survey was used in three phases: baseline, before accreditation, and after accreditation. Primary and secondary outcome measures were teamwork within hospital units, feedback and communication about errors, hospital handoffs and transitions, overall perceptions of safety, frequency of event reporting, and perception of patient safety grade. The survey response rate was 100%. A statistically significant impact of accreditation was found for teamwork within hospital units, feedback and communication about errors, and hospital handoffs and transitions (p = 0.002, 0.009, and 0.010, respectively). Ordinal logistic regression confirmed that the accreditation program had a significant effect on overall perceptions of safety (odds ratio [OR] [1.42-13.56], p = 0.010), frequency of event reporting (OR [0.91-7.96], p = 0.073), and staff awareness of grading safety culture (OR [0.02-0.70]) and reporting behavior (OR 0.10 [0.03-0.37]). The Saudi national accreditation program had a significant positive impact on some patient safety culture dimensions and outcomes. These findings provide local empirical evidence on the benefits of implementing national accreditation programs. Further research on a larger scale is highly recommended.

The effect of situation, background, assessment, recommendation-based safety program on patient safety culture in intensive care unit nurses.

BACKGROUND:Patient safety culture is an integral part of patient care standards and a prerequisite for safe care. SBAR is an acronym for Situation, Background, Assessment, Recommendation; this communication model has gained popularity in health-care settings, especially among professions such as nursing. However, there is little evidence that nursing professional education can enhance patient safety culture. The aim of this study was to investigate the effect of a SBAR-based training program on patient safety culture in intensive care unit (ICU) nurses.MATERIALS AND METHODS:The quasi-experimental study was carried out in 2018–2019 at areas covered by Shahrekord University of Medical Sciences, Iran. This study was performed on 60 nurses working in ICU. The participants were randomly assigned to two experimental and control groups of 30 each. For the experimental group, five workshop sessions of SBAR-based program were held. For the control group, the patient delivery process was performed according to the ward routine. Data were collected using patient safety culture questionnaires before and 1 month after the intervention, and were analyzed using descriptive and analytical tests such as paired t-test, independent t-test, and Chi-square test by SPSS 22.RESULTS:The mean score of safety culture was 31 ± 23.5 and 55.2 ± 28.6 in frequency of reporting events, 32.8 ± 17.8 and 54.3 ± 19 in overall perception of patient safety, 23 ± 20.1 and 52.9 ± 26 in communication channel openness, and 35.2 ± 19.8 and 52.4 ± 18.8 in information exchange and conveyance before and after training intervention, respectively, so that they improved from poor level to neutral-moderate level. There was no strength in any dimensions of safety culture; however, the implementation of the SBAR-based program was significantly associated with patient safety culture (P < 0.001).CONCLUSIONS:Improving patient safety culture requires attention to patient safety models such as SBAR approach that provides an appropriate and reliable structure for quality improvement. SBAR-based program training is effective in promoting patient safety culture; therefore, it is recommended that managers use this technique to promote patient safety culture.

Major educational factors associated with nursing adverse events by nursing students undergoing clinical practice: A descriptive study

BackgroundAs the main group of healthcare providers in hospitals, nurses have more frequent contacts than any other clinician and thus are in a better position to improve patient safety. With the purpose of cultivating competent nurses, nursing educators have the responsibility to promote patient safety. A better understanding of educational factors affecting nursing adverse events by nursing students undergoing clinical practice can help nursing educators find appropriate ways to fulfil their duty. ObjectiveTo examine the status quo of nursing adverse events and to discuss the major educational factors concerned in different regions of China. DesignA descriptive study design was undertaken in 2018. Participants and settingA convenience sample of 1173 nursing students undergoing clinical practice was recruited from 22 hospitals in different regions of China. MethodsThe Chinese version of the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS) was administered to and demographic and professional data were collected from clinical nursing students after obtaining informed consent. ResultsThe incidence of nursing adverse events in clinical student nurses was 17.8%. Approximately 87.01% of nursing adverse events were near miss. The positive response rate of safety attitudes and professionalism by clinical nursing students ranged from 57.5% to 96.9%. Logistic analysis indicated that gender, educational level, hospital regions, safety culture and professional behavior experience dimensions were the major factors influencing nursing adverse events. ConclusionAttention should be paid to the situation in which clinical nursing students are prone to nursing adverse events. Cooperation between nursing colleges and hospitals should be strengthened to promote patient safety in clinical nursing students. We suggest that nursing educators implement patient safety education in both theoretical and practical teaching and use multiple forms, especially simulation-based training, to strengthen safe nursing behavior to reduce the incidence of nursing adverse events.

Exploring patient safety culture in emergency departments: A Tunisian perspective

BackgroundEmergency departments (EDs) are considered a high-risk environment because of the high frequency of adverse events that occur within. Measuring patient safety culture is an important step that assists healthcare facilities in planning actions to improve the quality of care provided to patients. This study aims to assess patient safety culture within EDs and to determine its associated factors. MethodsA cross-sectional study conducted among professionals from all the EDs of public and private healthcare institutions in Tunisia. It spread from June to September 2017. We used the validated French version of the Hospital Survey on Patient Safety Culture questionnaire. ResultsIn total, 11 EDs were included in the study, with 442 participants and a participation rate of 80.35%. All the ten dimensions of patient safety culture were in need of improvement. ‘Teamwork within units’ scored the highest with 46%, however, the lowest score was attributed to 'the frequency of adverse events reporting' (19.6%). Several factors have been found significantly related to safety culture. Private EDs have shown significantly higher scores regarding nine patient safety culture dimensions. ConclusionThis study showed a concerning perception held by participants about the lack of a patient safety culture in their EDs. Also, it provided baseline results giving a clearer vision of the aspects of safety that need improvement.

Association between Safety Culture and Risk of Burnout: A Survey of Non-Medical Rescue Workers

Stressors such as safety culture in organizations that increase the risk of burnout have been studied in nursing and inpatient care settings. However, investigations in the setting of preclinical emergency medical services (EMS) are still limited. The study aims at (1) investigating burnout in health care workers in preclinical EMS and their perceived safety culture, and (2) analyzing the association between the two. Using the Maslach Burnout Inventory (MBI) and the Emergency Medical Services - Safety Attitudes Questionnaire (EMS-SAQ), an online survey was conducted with non-medical health care workers in preclinical EMS. Descriptive analyses were performed using frequencies, mean values, percentages and the Pearson correlation coefficient. A logistic regression model was used to determine the relationship between safety culture and the risk of burnout. A total of 1,101 questionnaires was considered for analysis. Most of the participants were male (86.2%) and younger than 40 years (73.2%). A high risk of burnout for participants was found for the dimensions of emotional exhaustion and depersonalization (EE 26.3% and DP 40.2%). In the context of measuring safety culture, especially management, working conditions, and safety climate were negatively perceived by the participants. Furthermore, high stress recognition (EE: OR=3.317, p<0.01; DP: OR=1.910, p<0.01), negative job satisfaction (EE: OR=0.297, p<0.01; DP: OR=0.576, p<0.01) and negatively perceived working conditions (EE: OR 0.598, p<0.05; DP: 0.937, p<0.05) were significantly associated with a high risk of burnout. This is the first large scale study investigating burnout among non-medical health care workers in preclinical EMS and their perceived safety culture in Germany as well as the association between the two. The results show the necessity to focus on perceived dimensions of safety culture in organizations, to develop measures reducing stress and improve job satisfaction and working conditions. In the context of increasing skills shortage, this is especially relevant with regard to the challenges of patient safety and quality of outcomes in care.

Seguridad del paciente y cultura de seguridad en gestores de instituciones sanitarias de una red de salud

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Hasta Güvenliği Kültürünün Tıbbi Hata Tutumları Üzerine Etkisi: Hemşirelerde Bir Uygulama

This study aims to examine the effects of patient safety culture perceptions on their attitudes of medical errors among nurses. The universe of the study is nurses working in a public hospital in Antalya (n = 350). The convenience sampling method was used in the study and the questionnaire was collected from 205 nurses. The data were obtained between October 2-November 3, 2018. The study results demonstrates that the dimensions of patient safety culture explained 28.2% of the total variance in the perception of medical error, 26.4% of the total variance in medical error approach, and 21.8% of the total variance in causes of medical errors. Patient safety culture also explains 32% of the total variance in all subdimensions of medical error. The results of this study highlight the importance of enhancing patient safety culture to protect patients from medical errors in health institutions. This study also revealed important factors that need to be considered for successful implementation of patient safety culture. It is recommended to have a common understanding and increase awareness in reducing medical errors and improving patient safety culture.

Exploring Strength Areas of Patient Safety Culture Improvement in KAMC, Makkah, Saudi Arabia

Background: Patient safety culture is an extremely important aspect and a crucial issue in health services. Assessing patient safety culture is a fundamental in obtaining first-hand information on healthcare settings that will help to identify positive areas and shortcomings in patient safety practices that require future improvement. Objective: This study aims to investigate the strengths area of patient safety culture improvement. Also, this study evaluates employees’ perceptions concerning patient safety culture. Subjects and Methods: A mixed methodology and cross-sectional design was used to achieve the aim of the study. Hospital Survey on Patient Safety Culture questionnaire was used to collect data from 350 front line health care providers at specialized hospital, Makkah, Saudi Arabia. Results: The highest rated Patient safety culture dimensions from health care staff perspective was teamwork within units and across the unit, supervisor/ manager expectations and actions promoting patient safety and over all perception of patient safety. The lowest rated dimension was non punitive response to errors, Communication openness, and frequency of events reported. The most of the participants given excellent or very good score in overall patient safety grade, and the majority of the respondents never reported any events during last 12 months. The study statistically proved the relationship between patient safety culture and area of work and number of events reported. In this study result showed that there is significantly difference exist between 12 dimensions of composite items with patient’s safety culture. Conclusion and Recommendations: This study found the strengths and areas of improvements of patient safety culture in the hospital. The good leadership support, effective communication, sufficient staffing, team work, open communication about errors and adequate working hours can improve patient safety culture. This study recommends the health care leaders to create an institutional strategic plan to improve patient safety programs in hospital settings.

Portuguese Abstracts for Volume 32, Issue 9, 2020

Abstract Objective: To assess the impact of implementation of the TeamSTEPPS teamwork improvement concept on patient safety culture. Design: Pre–post culture assessment using the Hospital Survey on Patient Safety Culture, at baseline and 1 year after implementation of TeamSTEPPS. Setting: Two maternity wards within the same 480-bed multisite teaching hospital. Intervention: Implementation of the TeamSTEPPS teamwork improvement concept. Main Outcome Measures: Analysis of variation of the percentage of positive responses (score) in both wards (intervention and control) was conducted. Results: There was a significant increase in scores in three dimensions of patient safety culture in the intervention ward: Supervisor/Manager Expectations and Actions Promoting Safety increased from 48.7% in 2015 to 70.8% in 2016 (P &amp;lt; 0.005); Teamwork Within Units increased from 35.5% in 2015 to 54.5% in 2016 (P &amp;lt; 0.005); Nonpunitive Response to Errors increased from 16.7% in 2015 to 32.3% in 2016 (P &amp;lt; 0.005). Other dimensions showed no significant changes. In the control ward, there was a significant decrease in scores in one dimension. A secondary analysis of differences in differences still shows significant improvement in one dimension (Supervisor/Manager Expectations and Actions Promoting Safety P &amp;lt; 0.005). Conclusion: After implementing the TeamSTEPPS teamwork concept, patient safety culture significantly improved for 3 of 12 dimensions in the intervention group. When controlling for differences in baseline scores between implementation and control wards, a significant improvement remains in one dimension. This suggests that TeamSTEPPS could be considered when seeking to enhance patient safety culture, especially in high-risk environments such as maternity wards.

The safety attitudes questionnaire for out-of-hours service in primary healthcare-Psychometric properties of the Croatian version.

The aim of the study was to assess the reliability and construct validity of the Croatian translation of the Safety Attitudes Questionnaire—Ambulatory version (SAQ-AV) in the out-of-hours (OOH) primary care setting. A cross-sectional observational study using anonymous web-survey was carried out targeting a convenience sample of 358 health professionals working in the Croatian OOH primary care service. The final sample consisted of 185 questionnaires (response rate 51.7%). Psychometric properties were assessed using exploratory hierarchical factor analysis with Schmid-Leiman rotation to bifactor solution, McDonald’s ω, and Cronbach’s α. Five group factors were identified: Organization climate, Teamwork climate, Stress recognition, Ambulatory process of care, and Perceptions of workload. Items loading on the Stress recognition and Perceptions of workload factor had low loadings on the general factor. Cronbach’s α ranged between 0.79 and 0.93. All items had corrected item-total correlation above 0.5. McDonalds’ ω total for group factors ranged between 0.76 and 0.91. Values of ω general for factors Organization climate, Teamwork climate, and Ambulatory process of care ranged between 0.41 and 0.56. McDonalds’ ω general for Stress recognition and Perceptions of workload were 0.13 and 0.16, respectively. Even though SAQ-AV may not be a reliable tool for international comparisons, subsets of items may be reliable tools in several national settings, including Croatia. Results confirmed that Stress recognition is not a dimension of patient safety culture, while Ambulatory process of care might be. Future studies should investigate the relationship of patient safety culture to treatment outcome.

ANALYSIS OF MANAGEMENT EFFORTS IN SHAPING SAFETY CULTURE IN X HOSPITAL SEMARANG

Patient safety is the essence of health service quality. Hospitals are a combination of several elements that together produce a high-risk situation. Safety culture should be the core in hospital organization. From the data obtained there are still incidents of safety of patients in hospital X Semarang and there has been no trend decrease in the incidence of meaningful incidents over time. This research aims to determine the cultural overview of safety and how the management efforts influence in shaping the safety culture of hospital X Semarang. This type of research is quantitative analytic with survey method that analyzes management efforts in shaping safety culture in hospital X Semarang. Research conducted in January-March 2020. Data collection techniques using a questionnaire adapted from the American College of Healthcare Executives in 2017 and a description of safety culture were acquired by collecting data from a Patient safety culture questionnaire adopted from the Hospital Survey on Patient Safety Culture questionnaire published by The Agency for Healthcare Research and Quality (AHRQ) in 2004. Number of respondents as many as 220 people selected in proportionate stratified random sampling. The results showed that the safety culture at hospital X showed a positive response in the organizational learning dimension and continuous improvement (90.15%), the dimension of cooperation in units (81.82%) and dimension of management support to patient safety efforts (80.45%). The other dimension of safety culture has a negative response (< 75%). Management efforts that include the determination of vision, trust values, respect and inclusion, selection, development and management engagement, leadership development that prioritizes safety, just culture, expectations of organizational behaviour as well as assumptions, values and artifacts related to safety culture have an influence in the establishment of safety culture in hospital X Semarang. Keyword: Safety Culture, management efforts

Critical success factors for implementation of an incident learning system in radiation oncology department.

The aim of this study was to analyze critical success factors (CSFs) for implementation of an incident learning system (ILS) in a radiation oncology department (ROD) and evaluate the perception of the staff members along this process. Implementing an ILS is a way to leverage learning from incidents and is a tool for improving patient safety, consisting of a cycle of reporting and analyzing events as well as taking preventive actions. ILS implementation is challenging, requiring specific resources and cultural changes. An ILS was designed and implemented based on the CSF identified in the literature review. Before starting the ILS implementation, a structured survey was applied to assess dimensions of patient safety culture. After the period of implementation (7 months), the survey was applied again and compared with the initial assessment, and interviews were performed with staff members to evaluate the overall satisfaction with ILS and CSFs. Statistically significant improvements were observed in 5 dimensions (12 totals) of the safety culture survey, considering time points before and after the ILS implementation. According to interviewees, "Facilitating committee", "Efficient data collection", "Focus on improvement", "Just culture" and "Feedback to users" were the most relevant CSFs. The ILS designed and implemented at ROD was perceived as an important tool to support quality and safety initiatives, promoting the improvement in safety culture. The ILS implementation critical success factors were identified and have shown good agreement between the results of the literature and the users' practical perception.

Dimensions analysis of the Hospital Survey on Patient Safety Culture questionnaire in Iran: Psychometric properties.

The present study aimed to investigate the possible alternative factorial structure of the patient safety culture model in Iran. This study was performed based on data collected by Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire from 420 staff in four hospitals. Internal consistency reliability and construct validity were evaluated by Cronbach's alpha and correlation analysis. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to investigate the possible alternative factorial structure, examine and confirm the obtained structure, alternatively. Kaiser-Meyer-Olkin measure and Bartlett test were calculated to determine the factor ability of sample and fit of the factor analysis, alternatively. SPSS and AMOS version 25 were used. EFA identified 12 dimensions which one dimension has been also created from a new question. Distribution of items in all dimensions differed from the original HSOPSC questionnaire except two dimensions. The obtained structure was a proportional model. The calculation of Cronbach's alpha (∝ = .8) showed that, the internal consistency reliability was appropriate for all items in the questionnaire. Also, construct validity was acceptable for all factors. The structure of the dimensions obtained in this study was not consistent with the structure of the original HSOPSC model. Provide a model for assessing patient safety culture with relative stability with respect to the native culture of the region. Good content and construct validity. Differences in the distribution of items in dimensions. Formation of new dimensions. Performing a psychometric analysis of the instrument using EFA, CFA and SEM to examine the disagreement on the validity, reliability and dimensions of patient safety culture in previous studies in Iran. Numerous discrepancies in item wording comply with the approach advocated by the translation guideline for AHRQ survey on patient safety.

Assessing patient safety culture and its associated factors in 12 emergencies across Tunisia

Abstract Background Although the emergency departments (EDs) are the front line of the public health system, they are considered high-risk environments because of the shocking frequency of adverse events, within. Developing safety culture among EDs professionals, as a strategic focus, remains a priority. The purpose of this study is to measure safety culture in EDs and to determine its associated factors. Methods This is a cross-sectional and multicenter study, conducted among professionals from all the EDs of public and private healthcare institutions in central Tunisia. It was conducted from June to September 2017. The instrument tool used was the self-administered Hospital Survey On Patient Safety Culture questionnaire translated and validated by the CCECQA. Data entry and analysis were performed using SPSS 20.0 and Epi info 6. Also, ethical considerations were taken into account. Results In total, the study included 442 participants from 12 ED, with a participation rate of 80.35%. All the ten dimensions of safety culture were all to be improved. As for 'teamwork within units', it scored the highest with 46%, however, the lowest scores were attributed to 'the frequency of reported adverse events' (19.6%) followed by 'the non-punitive response to error' (19.8%). Private EDs have shown significantly higher scores regarding nine safety culture dimensions. Also, the size of the hospital was significantly associated with all dimensions of the safety culture. Conclusions This study has shown that the level of safety culture needs to be improved in public and private EDs and also underlines the importance of developing the safety culture and the implementation of safety and quality management systems. Key messages Patient safety culture is to be improved in Tunisian emergencies, although it is significantly more developed in private settings. A punitive culture still reigns in Tunisian healthcare context.

Product safety culture: a preliminary study in the UK manufacturing industry

Do accidents where users are injured or killed by unsafe products reveal underlying weaknesses in the safety culture of the responsible organisations? While manufacturing firms have long been concerned with organizational culture factors that relate to product quality, there has been much less attention to the relationship with consumer safety. Product safety culture can be defined as the attitudes, norms, beliefs and behaviours of staff in manufacturing organisations that affect the integrity of a product in relation to the well-being of its users. There has been limited research into this type of safety culture, with the exception of several studies from the food industry. This exploratory study in one large company adopted a qualitative approach to identify the dimensions of product safety culture in the manufacture of engineered products. Study 1 consisted of phone interviews (8 managers, 2 workforce). Study 2 was on two UK manufacturing sites where interviews and focus groups were conducted (46 participants in total: 7 managers, 39 workforce). The transcriptions were coded using inductive thematic analysis to identify the main components of product safety culture. The findings indicated six principal dimensions: management commitment to product safety, communication, safety systems, trust, understanding of safety systems and product safety ethic. The first five dimensions are well-established components of culture relating to worker and process safety. The last dimension appears to be a distinctive component (compared to other types of safety culture) relating to an employee’s moral and ethical stance toward product safety, where user well-being is considered during product manufacture. This ethical component is a more novel feature which suggests that fostering concern for unknown product users may be an additional facet of product safety culture worth investigating in the effort to reduce the risks to consumers.

Evaluation of patient safety culture using a random forest algorithm

Safety culture is a multidimensional concept that may be associated with medical errors and patient safety events in healthcare delivery systems. However, limited evidence is available regarding which safety culture dimensions drive overall patient safety. Moreover, the use of advanced statistical analysis has been limited in past studies of safety culture data. To address these issues, we use hospital-level aggregate survey data from U.S. hospitals to analyze the relationship between the defined safety culture dimensions and the patient safety grade. We use a tree-based machine learning algorithm, random forests, to estimate accurate and stable associations. The results of our analysis show that safety perception, management support, and supervisor/manager expectations are the leading drivers of patient safety grade. More specifically, safety problems in the work unit and work climate provided by hospital management are specific drivers of patient safety outcomes. The random forest model sheds new light on the most important cultural features relevant to patient safety.

What is the role of transformational leadership, work environment and patient safety culture for person-centred care? A cross-sectional study in Norwegian nursing homes and home care services.

AimTo examine how transformational leadership, job demands, job resources and patient safety culture contribute in explaining person‐centred care in nursing homes and home care services.DesignCross‐sectional study.MethodsHealthcare professionals in four Norwegian nursing homes (N = 165) and four home care services (N = 139) participated in 2018. Multiple regression analyses were used to examine to what degree transformational leadership, job demands, job resources and patient safety culture dimensions predicted person‐centred care.ResultsTransformational leadership, job demands and job resources explained 41% of the variance in person‐centred care, with work pace as the strongest predictor (β = 0.39 p < .001). The patient safety culture dimensions explained 57.5% of the variance in person‐centred care, with staffing being the strongest predictor (β = 0.31 p < .001). There were small differences between nursing homes and home care. In total, transformational leadership, pace of work, staffing and factors related to communication were the strongest predictors for person‐centred care.