Improve Patient Safety Culture Research Articles

Promising Practices for Improving Hospital Patient Safety Culture

Patient safety culture has a positive influence on the effectiveness of patient safety and quality improvement interventions. A study was conducted to gain knowledge about promising best practices used by hospitals to improve patient safety culture hospitalwide. Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™ (SOPS) Hospital Survey longitudinal results from 536 hospitals that submitted data to the Hospital SOPS database from 2007 to 2014 were analyzed. Composite-level and aggregate improvement was measured, resulting in the identification of "top-improving," large hospitals (400 + beds). Semistructured interviews were conducted with one to three interviewees (for example, Vice President of Clinical Quality, Patient Safety Officer, Chief Medical Officer) from six top-improving hospitals. The transcripts of the interviews were analyzed to identify common themes and best practices among the hospitals. The mean change in the all-composite percent positive culture score was a 1.7 percentage point increase. The six hospitals interviewed had an average increase of 8.6 percentage points (range, 6.5-10.6) in their culture score. The three most common practices for improving culture as described by the hospital quality leaders from the six hospitals were (1) goal setting and strong action planning for quality improvement, (2) implementation of well-known patient safety initiatives and programs, and (3) rigorous survey administration methods. Among six large hospitals that improved their hospitalwide culture score, the common best practices were the implementation of routine culture measurement with a wide dissemination of results, strong action planning for improvement that includes leadership support and involvement from all staff levels, and multifaceted patient safety programs and education.

Survey and analysis of patient safety culture in a county hospital

Objective This study aimed to survey patient safety culture in a county hospital and to provide evidence for strategies to improve patient safety culture. Methods Nine hundred and thirty-two medical staff in a county hospital were surveyed with use of the Hospital Survey on Patient Safety Culture. Information was analyzed by one-way ANOVA and multiple linear regression analysis. Results Nine hundred and thirty-two questionnaires were distributed, of which 661 of those returned were valid. The subscale-level results showed that the positive response rate for “teamwork across units” was higher than 75.0%, indicating it was an area of strength. Five areas – “nonpunitive response to error,” “staffing,” “communication openness,” “overall perceptions of patient safety,” and “frequency of event reporting” – had potential for improvement, with a positive responsive rate lower than 50%. Twenty-nine percent of respondents gave their work area a patient safety grade of “excellent” or “very good.” Further, 60.1% of respondents had reported no event in the previous 12 months. Multiple linear regression analysis indicated that position and number of years working in this hospital were the factors influencing patient safety culture. Conclusion Patient safety culture in the county hospital has potential for improvement, especially in the areas of “nonpunitive response to error,” “staffing,” “overall perceptions of patient safety,” “communication openness,” and “frequency of event reporting.” Statement of Significance It has been recognized for almost 20 years that safety culture is important in ensuring high-quality and safe care. This article describes the results of a patient safety culture survey undertaken in one Chinese county hospital, which distributed the Hospital Survey on Patient Safety Culture to 932 health care staff. It reaffirms that there is still a long way to go until hospitals have successfully established positive safety cultures. In terms of relevance, we believe the findings will be most useful to the hospital where the study was undertaken. Many of the recommendations in the discussion should be useful for the hospital.

Safety culture among pediatric surgeons: A national survey of attitudes and perceptions of patient safety

PurposeImproving the culture of safety within health care is an essential component of preventing errors and improving overall health care quality. The purpose of this study was to characterize the attitudes and perceptions of patient safety among pediatric surgeons. MethodsWe conducted a cross-sectional online survey of American Pediatric Surgery Association members. Survey items assessed surgeons' knowledge, attitudes, and perceptions of patient safety. We performed descriptive statistics and evaluated associations between respondent characteristics and survey responses. ResultsResponse rate was 38% (353/928). Surgeons in academic practice (96% vs 83% private, P=0.01) and in leadership positions (98% vs 92%, P=0.03) were more likely to feel actively engaged in patient safety initiatives. Surgeons in private practice were less likely to feel safe having their own children undergo surgery at their institution (80% vs 96% academic, P<0.005). ConclusionPediatric surgeons have disparate attitudes and perceptions of patient safety within their hospitals. Significant variation exists based on surgeon characteristics. These findings underscore the need to identify barriers to surgeon engagement and develop educational initiatives to empower surgeons as leaders in improving patient safety culture. Level of evidenceV.

Improving patient safety culture in Saudi Arabia (2012\u20132015): trending, improvement and benchmarking

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.

Bricks-and-mortar and patient safety culture

PurposeBuilding a new hospital requires a major investment in capital infrastructure. The purpose of this paper is to investigate the impact of bricks-and-mortar on patient safety culture before and two years after the move of a large tertiary hospital to a greenfield site. The difference in patient safety perceptions between clinical and non-clinical staff is also explored.Design/methodology/approachThis research uses data collected from the same workforce across two time periods (2013 and 2015) in a large Australian healthcare service. Validated surveys of patient safety culture (n=306 and 246) were analysed using descriptive and inferential statistics.FindingsUsing two-way analysis of variance, the authors found that perceived patient safety culture remains unchanged for staff despite a major relocation and upgrade of services and different perceptions of patient safety culture between staff groups remains the same throughout change.Practical implicationsA dramatic change in physical context, such as moving an entire hospital, made no measurable impact on perceived patient safety culture by major groups of staff. Improving patient safety culture requires more than investment in buildings and infrastructure. Understanding differences in professional perspectives of patient safety culture may inform organisational management approaches, and enhance the targeting of specific strategies.Originality/valueThe authors believe this to be the first empirically based paper that investigates the impact of a large investment into hospital capital and a subsequent relocation of services on clinical and non-clinical staff perceptions of patient safety culture.

Cultura de la seguridad del paciente en directivos y gestores de un servicio de salud

ObjectiveTo assess patient safety culture in directors/managers. MethodsCross-sectional descriptive study carried out from February to June 2011 among the executive/managing staff of the Aragón Health Service through semi-structured interviews. ResultsA total of 12 interviews were carried out. All the respondents admitted that there were many patient safety problems and agreed that patient safety was a priority from a theoretical rather than practical perspective. The excessive changes in executive positions was considered to be an important barrier which made it difficult to establish long-term strategies and achieve medium-term continuity. ConclusionsThis study recorded perceptions on patient safety culture in directors, an essential factor to improve patient safety culture in this group and in the organisations they run.

Exploring relationships between hospital patient safety culture and Consumer Reports safety scores

BackgroundA number of private and public companies calculate and publish proprietary hospital patient safety scores based on publicly available quality measures initially reported by the U.S. federal government. This study examines whether patient safety culture perceptions of U.S. hospital staff in a large national survey are related to publicly reported patient safety ratings of hospitals.MethodsThe Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (Hospital SOPS) assesses provider and staff perceptions of hospital patient safety culture. Consumer Reports (CR), a U.S. based non-profit organization, calculates and shares with its subscribers a Hospital Safety Score calculated annually from patient experience survey data and outcomes data gathered from federal databases. Linking data collected during similar time periods, we analyzed relationships between staff perceptions of patient safety culture composites and the CR Hospital Safety Score and its five components using multiple multivariate linear regressions.ResultsWe analyzed data from 164 hospitals, with patient safety culture survey responses from 140,316 providers and staff, with an average of 856 completed surveys per hospital and an average response rate per hospital of 56%. Higher overall Hospital SOPS composite average scores were significantly associated with higher overall CR Hospital Safety Scores (β = 0.24, p < 0.05). For 10 of the 12 Hospital SOPS composites, higher patient safety culture scores were associated with higher CR patient experience scores on communication about medications and discharge.ConclusionThis study found a relationship between hospital staff perceptions of patient safety culture and the Consumer Reports Hospital Safety Score, which is a composite of patient experience and outcomes data from federal databases. As hospital managers allocate resources to improve patient safety culture within their organizations, their efforts may also indirectly improve consumer-focused, publicly reported hospital rating scores like the Consumer Reports Hospital Safety Score.

Professional attitudes toward incident reporting: can we measure and compare improvements in patient safety culture?

To establish categories of professionals' attitudes toward incident reporting by analyzing the trends in incident reporting while accounting for general risk indicators. The incident reporting system was evaluated over 6 years. Reporting rates, stratified by year and profession, were estimated using the non-mandatory reported events/full-time equivalent (NM-IR/FTE) rate. Other indicators were collected using the hospital's official database. Staff attitudes toward self-reporting were analyzed. Univariate and multivariable analyses were performed. A 1000-bed Italian academic hospital. Staff of the hospital (over 3200 professionals). None. NM-IT/FTE rates, self-reported rates, patient complaints/praises, work accidents among professionals and 30-day readmissions. The overall reporting rate was 0.44 (95% confidence interval [CI]: 0.42-0.46) among doctors and 0.40 (95% CI: 0.39-0.41) among nurses. Between 2010 and 2015, only the doctors' reporting rate increased significantly (P = 0.04), from 0.29 (95% CI: 0.25-0.34) to 0.67 (95% CI: 0.60-0.73). Patient complaints decreased from 384 to 224 (P < 0.001) and work accidents decreased from 296 to 235 (P = 0.01), while other indicators remained constant. Multivariable logistic regression showed that self-reporting was more likely among nurses than doctors (odds ratio: 1.51; 95% CI: 1.31-1.73) and for severe events than near misses (odds ratio: 1.78; 95% CI: 1.11-2.87). Because the doctors' reporting rates increased during the study period, doctors may be more likely to report adverse events than nurses, although nurses reported more events. Incident reporting trends and other routinely collected risk indicators may be useful to improve our understanding and measurement of patient safety issues.

Status of patient safety culture in Arab countries: a systematic review

ObjectivesTo explore the status of patient safety culture in Arab countries based on the findings of the Hospital Survey on Patient Safety Culture (HSPSC).DesignSystematic review.MethodsWe performed electronic searches of the...

Application of Human Factors and Ergonomics in Improving Patient Safety Culture

Patient safety is a serious global public health issue. Estimates show that in developed countries as many as one in 10 patients is harmed while receiving hospital care. Increasingly complex healthcare, involvement of multiple disciplines and varied sources of information all contribute to the increasing likelihood and impact of medical errors. Different approaches and methods have been utilized and applied to optimize patient safety issues worldwide. Human factors and ergonomics provides a ‘tried and true’ framework for building and strengthening that elusive safety culture by correcting the mismatch between individuals, the equipments, systems, and process in which they work in, we can improve patient safety.

Identification of communication skills that improve patient safety culture: analysis of a communication skills training program for university hospital staff

Identification of communication skills that improve patient safety culture: analysis of a communication skills training program for university hospital staff

Improving Patient Safety Culture in Primary Care: A Systematic Review

Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which effect interventions have on the safety culture. To review literature on the use of interventions that effect patient safety culture in primary care. Searches were performed in PubMed, EMBASE, CINAHL, and PsychINFO on March 4, 2013. Terms defining safety culture were combined with terms identifying intervention and terms indicating primary care. Inclusion followed if the intervention effected patient safety culture, and effect measures were reported. The search yielded 214 articles from which two were eligible for inclusion. Both studies were heterogeneous in their interventions and outcome; we present a qualitative summary. One study described the implementation of an electronic medical record system in general practices as part of patient safety improvements. The other study facilitated 2 workshops for general practices, one on risk management and another on significant event audit. Results showed signs of improvement, but the level of evidence was low because of the design and methodological problems. These studies in general practice provide a first understanding of improvement strategies and their effect in primary care. As the level of evidence was low, no clear preference can be determined. Further research is needed to help practices make an informed choice for an intervention.

Healthcare professionals' views on feedback of a patient safety culture assessment.

BackgroundBy assessing patient safety culture, healthcare providers can identify areas for improvement in patient safety culture. To achieve this, these assessment outcomes have to be relevant and presented clearly. The aim of our study was to explore healthcare professionals’ views on the feedback of a patient safety culture assessment.MethodsTwenty four hospitals participated in a patient safety culture assessment in 2012. Hospital departments received feedback in a report and on a website. In a survey, we evaluated healthcare professionals’ views on this feedback and the effect of additional information about patient safety culture improvement strategies on the appraisal of the feedback. 20 hospitals participated in part I (evaluation of the report), 13 hospitals participated in part II (evaluation of the website).ResultsHealthcare professionals (e.g. members of staff and department heads/managers) rated the feedback in the report and on the website positively (average mean on different aspects = 7.2 on a scale from 1 to 10). Interpreting results was sometimes difficult, and information was sometimes lacking, like specific recommendations and improvement strategies. The provision of additional general information on patient safety culture improvement strategies resulted only in a higher appraisal of the attractiveness (lay-out) of the report and the understandability of the feedback report. The majority (84 %) of the healthcare professionals agreed or partly agreed that the feedback on patient safety culture stimulated actions to improve patient safety culture. However, a quarter also stated that although the feedback report provided insight into the patient safety culture, they did not know how to improve patient safety culture in their hospital.ConclusionsHealthcare professionals seem to be positive about the feedback on patient safety culture and its effect on stimulating patient safety culture improvement. To optimally tune feedback on patient safety culture towards healthcare professionals, the following might help: 1) pay attention to the understandability of outcomes for its intended users; and 2) create feedback that is tailored towards specific hospital departments.

Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study

ObjectivesCurrent literature emphasises that clinical leaders are in a position to enable a culture of safety, and that the safety culture is a performance mediator with the potential to influence...

Attitude toward the Patient Safety Culture in healthcare systems

Introduction: Patient Safety Culture (PSC) involves a harmonious pattern of individual and organization behaviors based on common beliefs and values. This study aimed to evaluate the attitude of healthcare providers toward PSC in the hospitals and clinics of Zabol city, Iran. Materials and Methods: This descriptive cross-sectional study was conducted in 2015. Sample population consisted of the physicians, nurses, and paraclinical staff (radiologists and laboratory experts) engaged in different healthcare centers of Zabol city, Iran. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Data analysis was performed in SPSS V.22 at the significance level of 0.05. Results: In total, 231 healthcare practitioners were enrolled in this study. Participants were divided into three groups of physicians, nurses, and paraclinical staff (n=77, 33.33%). Mean of age and clinical experience was 29.94 and 6.23 years, respectively. Among the main aspects of PSC, “general understanding of patient safety” had the highest mean score (13.53), and the lowest mean score was achieved in “non-punitive response to error” (8.89). In the aspect of “manager expectations and actions promoting safety”, a significant difference was observed in the mean scores of the study groups (P=0.030). Moreover, our results showed a significant difference between the mean scores of physicians and nurses in the aspect of “openness and honesty in communication” (P=0.023). Conclusion: According to the results of this study, improvement of PSC is necessary for the efficient management of hospitals and clinics. This is attainable through collaborative and instructive workshops, developing educational programs, and designing incident reporting systems.

SP-0601: Does lean management improve patient safety culture?

SP-0601: Does lean management improve patient safety culture?

Confirmatory Factor Analysis of Patient Safety Culture in an Iranian Hospital: A Case Study of Fatemeh Zahra Hospital in Najafabad, Iran

Introduction: Transformation of patient safety culture towards developing an open culture can be the greatest challenge for achieving a safe healthcare system. This study aimed to carry out a structural analysis of the Persian translation version of a questionnaire assessing patient safety culture. Materials and Methods: The study was conducted to evaluate the Persian translation of patient safety culture questionnaire, developed by the National Patient Safety Agency. The questionnaire includes seven sections and 43 items investigating 12 dimensions of patient safety culture. The reliability of this questionnaire was confirmed with Cronbach's alpha (α>0.8). The questionnaire was distributed among employees of the Fatemeh Zahra Hospital in Najafabad, Iran, 2015. The collected data were analyzed using SPSS 18 and Amos 18. Results: Sufficiency of the sample size, as determined by Kaiser-Meyer-Olkin measure, was 0.809, which was significantly associated with zero; therefore, performing factor analysis was acceptable and justifiable. The value of Bartlett's test was 696, P-value was less than 0.001, and degree of freedom was equal to 91. In the final model, the relative Chi-square was equal to 1.75 and P-value was less than 0.001. Also, parsimony normed fit index, parsimony-adjusted comparative fit index, and root mean square error of approximation were equal to 0.571, 0.621, and 0.065, respectively. Conclusion: Based on the results of fitting indices for the model and the questionnaire used in the present study for assessing patient safety culture, it can be stated that the Persian translation of this instrument is valid and hospitals can use it to monitor patient safety culture improvement.

Contributions of healthcare staff to promote patient safety in intensive care

Objective: Presenting the recommendations of health professionals from an Intensive Care Unit for the improvement of patient safety culture. Methods: Descriptive-exploratory study, with a quantitative approach, resulting from the application of the Survey about Patient Safety in Hospitals, 59 professional staff participated between November 2013 and January 2014. Results: Were obtained 124 recommendations, which were categorized according to aspects of the instrument. Highlighting recommendations related to the support of the hospital management to patient safety, in particular, the supply of material resources; and also to organizational learning and continuous improvement, with suggestions for training and implementation of protocols aimed at standardizing the assistance. Conclusion: The study permitted to list significant recommendations for improvements in patient safety, and made it possible to identify the dimensions of safety culture that have more vulnerabilities.

Translation, Cultural Adaption and Validation of Hospital Survey on Patient Safety Culture in Kosovo

Background: An essential condition to improve patient safety is considered to ensure a supportive patient safety culture. Measuring the culture of patient safety in all health care institutions may be a first step to target improvements. Creating a culture of safety requires eliminating the culture of blame. In order to formulate actions for improvement, it is important for hospitals to assess their baseline scores for the existing safety culture and to determine the areas of priority. Aim: The aim of this study was first to measure the use, translation in Albanian and adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) assessment as a tool for improving patient safety in Kosovo Hospitals. The second aim was to measure the level of patient safety culture in Kosovo, in seven hospitals and one University Clinical Center (hospitals with over 50 beds, including psychiatric hospitals). Method: The questionnaire (HSOPSC) was translated into Albanian for use in the Kosovo. It was used forward-backward translation: the questions were translated into Albanian by one translator and then translated back into English by an independent translator who was blinded to the original questionnaire. Results: In the eight-factor model, the internal consistency of the factors and the construct validity of the HSOPSC questionnaire were mostly satisfactory. The construct validity was sufficient for all subscales, except for the 4 other subscale regarding intention to report incidents which correlated poorly with other subscales. In total, HSOPSC has 12 dimensions. Cronbach’s α showed that in Kosovarian society, we could use only 8 dimensions model. Conclusion: The hypothesis that HSOPSC would be a suitable instrument to provide important indicators for the improvement of patient safety culture was tested and it was confirmed, that HSOPSC could be used as 8 dimension model. HSOPSC is suitable to improve patient safety culture and provide each hospital with a basic profile on patient safety culture and recommendations for an oriented intervention plan.

Comparing NICU teamwork and safety climate across two commonly used survey instruments

Background and objectivesMeasurement and our understanding of safety culture are still evolving. The objectives of this study were to assess variation in safety and teamwork climate and in the neonatal...