Promote Patient Safety Culture Research Articles

Patient safety reporting and learning system of Catalonia (SNiSP Cat): a health policy initiative to enhance culture, leadership and professional engagement

Patient safety reporting and learning systems (PSRLS) are tools to promote patient safety culture in healthcare organisations (HCO). Many PRSLS are locally developed. WHO Global Action Plan on Patient Safety...

THE ROLE OF PATIENT SAFETY EDUCATION AND TRAINING IN IMPROVING PATIENT SAFETY

Background Patient safety education and trainings are an important element to promote patient safety culture. The demands on this training for the safety of healthcare staffs and patients are crucial due to the occurrence of preventable medical errors. These review aims to study the types of patient safety education and training that are delivered for the different target audiences as well as identifying the results of the training. Methods This study presents narrative review on literature on patient safety education and training. Peer-reviewed journals and previously published papers were searched using keywords including "patient safety training," "improvement," "outcome," "health care," and "health services". Inclusion criteria for the article include the article written in English and published between 2013 and 2018. We used several journal databases including the Journal of Patient Safety, BMJ, PubMed, BMJ Quality & Safety and Google Scholar. Results Reviews were done based on previously published papers. The findings revealed that the patient safety education and training are mostly conducted to nursing and medical students as well as trainee and residents. Besides, it was also conducted for anesthesiologists and patients. Typically, mannequin-based demonstrations and trainings are provided for medical students and educators through the workshop for physicians and nurses. In addition, most of the important role in ensuring patient safety is mainly done by nurses followed by the anesthesiologist. Conclusion In regards to patient safety, each department has a specific role in ensuring patient safety culture in a clinical unit. Patient safety education and training must be provided for all levels because they may greatly influence the outcome especially on the attitudes and behavioural changes.

The Critical Role of Leadership in Patient Safety Culture: A Mediation Analysis of Management Influence on Safety Factors.

This research aims to investigate the role of management leadership in promoting a culture of patient safety within healthcare organizations. Through a comprehensive mediation analysis of the Chinese version of the safety attitudes questionnaire (CSAQ) and patient safety culture, the study examines the interplay between these critical factors and their combined influence on healthcare outcomes. In a medical center located in Taiwan, a cross-sectional survey was carried out utilizing the CSAQ. Among the 1500 distributed surveys, 1037 were returned and deemed valid, resulting in a return rate of 69.13%. To investigate the main measures, Structural Equation Modeling with mediation analysis was employed to scrutinize the direct and indirect effects of factors including teamwork climate, job satisfaction, stress recognition, perceptions of management, working conditions, and emotional exhaustion on safety climate. The findings reveal that effective management leadership plays a pivotal role in shaping safety attitudes and fostering a robust patient safety culture. The study identifies three critical facets of patient safety that are entirely mediated by management perceptions: teamwork climate, working conditions, and stress recognition. The results highlight the importance of enhancing these dimensions to advance the patient safety culture within healthcare organizations. Moreover, stress recognition is identified as a critical factor influencing the organizational culture of patient safety. This research offers valuable insights for healthcare organizations seeking to prioritize patient safety and improve overall quality of care. By enhancing our understanding of the critical factors that shape safety attitudes and patient safety culture, this study provides a roadmap for effective management leadership and a culture of patient safety within healthcare organizations. The study underscores the significance of management leadership in promoting patient safety culture and highlights the importance of enhancing teamwork climate, working conditions, and stress recognition to advance patient safety culture.

A systematic integrative review of specialized nurses' role to establish a culture of patient safety: A modelling perspective.

To understand specialized nurses' role in the culture of patient safety and their ability to promote and enforce it within healthcare. A systematic integrative review using the approach of Whittemore and Knafl. Systematic literature search for qualitative, quantitative and mixed-methods studies, followed by data evaluation, quality assessment, analysis and research synthesis with a narrative perspective. Findings were contextualized within a 'framework for understanding the development of patient safety culture'. Searches were conducted in PubMed [including MEDLINE], Scopus, CINAHL, Web of Science and EMBASE from Jan 2013 until Sep 2023. Sixteen studies published in English from six different countries were selected and used for research synthesis. Diverse enabling factors and enacting behaviours influencing specialized nurses' roles to promote patient safety culture were identified, mainly focusing on nurses' workload, professional experiences and organizational commitment. Patient safety outcomes focused on medication management, infection prevention, surveillance process in critical care, oversight on quality and safety of nurses' practice, patient care management, continuity of care, adherence to the treatment plan and implementation of a specialized therapeutic procedure. Specialized nurses can make a significant contribution to promote patient safety culture and support organizational initiatives to prevent adverse events. Stronger participation and leadership of specialized nurses in initiatives to improve patient safety culture requires appropriate investments and support by policy makers and managers in terms of resources and training. There is a gap in existing literature on the contribution that specialized nurses can make in promoting patient safety culture. Review results highlight the importance of interprofessional collaboration and teamwork by involving specialized nurses. They inform healthcare policy makers about recognizing their roles and competencies in patient safety culture. Preferred reporting items for systematic reviews and meta-analysis. No patient or public contribution.

Development of an electronic medical records project for Al-Razi hospital in Palestine.

Electronic medical records (EMR) are considered an important aspect to improve medical services provided to patients. The purpose of this study was to assess the development of an Electronic Medical Records Project for Al-Razi hospital in Palestine. The study was mixed method, qualitative and quantitative. The use of a questionnaire for the staff in the Al-Razi hospital and seven administrators' participants were meat as focus group. Approximately 136 participants in the study. The study findings reported that employees perceived the use of EMRs to have several benefits. The most common benefits include promoting patient safety culture and drug error reduction. In addition, the study findings reported that employees perceived the use of EMRs to have several challenges. The most common challenges include lack of knowledge and skill, insufficient time to use EMR, and limited of computers. Health informatics brings various benefits to the healthcare system. Some participants believed that the EMR system would improve patient care and it will improve patient satisfaction.

Leadership to promote patient safety culture in public hospitals managed by social health organizations

PurposeThis paper aims to identify the kind of internal climate leaders should offer health-care professionals to promote a patient safety culture in public hospitals managed by social health organizations in Brazil.Design/methodology/approachTwo surveys were applied to health-care professionals working at three Brazilian public hospitals. The internal climate survey reached 1,013 respondents, and the patient safety culture survey reached 1,302 participants. Both factor and regression analyses were used to analyze the study model and determine how internal climate influences patient safety culture.FindingsResults indicate that to promote a patient safety culture among health-care professionals, leaders should generate an internal climate based on trust to foster pride in working in the hospital. Possibly, the trust dimension is the most important one and must be developed to achieve job satisfaction and provide better services to patients.Research limitations/implicationsAll the hospitals studied were managed by the same Organização Social de Saúde. Due to the limited responses concerning the respondents’ profiles, demographic variables were not analyzed.Practical implicationsThis research reveals that the trust and pride dimensions can most strongly influence a positive patient safety culture, helping hospital leaders face this huge managerial challenge of consistently delivering high standards of patient safety.Originality/valueThis research studies the promotion of a patient safety culture in public hospitals managed by social health organizations, characterized by greater flexibility and autonomy in health-care management and by a greater need for accountability.

Patient Safety Policies and Practices among Selected Middle East Countries: Are We Walking on the Right Path?

Background: The Ministry of Health (MOH) is the foremost authority for public health services in the Middle East through a network of primary, secondary and tertiary healthcare centres. In 2017, the healthcare policy was updated for patient safety by the MOH. Human errors have always been a prime topic of debate in complex systems, especially healthcare, due to the adverse consequences leading to cultural blame; this adversely affects the patient safety policy and quality care and also leads to financial strain. As a result, patients continue to suffer harm and substandard care, and This can be avoidable through proper healthcare information and awareness among the organizations. Methodology: This review article has been written after evaluating 15 articles published in peer-reviewed journals globally. PubMed, Scopus, Springer, Research Gate, and Embase are some of the databases utilized for the literature research. The article also includes various studies that focus on patient safety culture. Results: A thorough review has been conducted, including measures taken by countries in the Middle East to enhance patient safety policy. Studies conducted across these countries provide an evidence-based understanding of the patient safety culture. Conclusion: There is a compelling need to promote patient safety culture to improve healthcare quality in the Middle East; this includes policies and measures adopted by various healthcare organizations, healthcare professionals, and those involved in medical education.

Key drivers of promoting patient safety culture from the perspective of medical staff at a tertiary hospital in China

PurposeUnderstanding the antecedents of patient safety culture among medical staff is essential if hospital managers are to promote explicit patient safety policies and strategies. The factors that influence patient safety culture have received little attention. The authors aim to investigate the antecedents of patient safety culture (safety climate) in relation to medical staff to develop a comprehensive approach to improve patient safety and the quality of medical care in China.Design/methodology/approachThe Chinese version of the Safety Attitudes Questionnaire (CSAQ) was used to examine the attitudes toward patient safety among physicians and nurses. This medical staff was asked to submit the intra-organizational online survey via email. A total of 1780 questionnaires were issued. The final useable questionnaires were 256, yielding a response rate of 14.38%. One-way analysis of variance (ANOVA) was employed to test if different sex, supervisor/manager, age, working experience, and education result in different perceptions. Confirmatory factor analysis (CFA) was used to verify the structure of the data. Then linear regression with forward selection was performed to obtain the essential dimension(s) that affect the safety culture (safety climate).FindingsThe CFA results showed that 26 CSAQ items measured 6 safety-related dimensions. The linear regression results indicated that working conditions, teamwork climate, and job satisfaction had significant positive effects on safety culture (safety climate).Practical implicationsHospital managers should put increased effort into essential elements of patient-oriented safety culture, such as working conditions, teamwork climate, and job satisfaction to develop appropriate avenues to improve the quality of delivered medical services as well as the safety of patients.Originality/valueThis study focused on the contribution that the antecedents of patient safety culture (safety climate) make with reference to the perspective of medical staff in a tertiary hospital in China.

Perceptions of patient safety culture among emergency room nurses in Jordanian accredited hospitals.

The aim of this study is to assess the perceptions of patient safety culture among emergency room nurses in Jordan. Patient safety culture is considered an international priority for health care institutions. There is a lack of studies on patient safety culture among emergency room nurses in international and Arab countries including Jordan. A cross-sectional design was used to perform among emergency room nurses (N= 424) who are working in two health sectors (government and private) in Jordan. Results showed that the total perception mean of patient safety culture was 70.6% (M= 3.87, SD=0.64), which indicates that the perceptions of patient safety culture among emergency room nurses need potential for improvement. Three areas in patient safety culture were reported as strong, including teamwork within units (77.4%; M= 3.87, SD=0.64), feedback and communication about the error (76.6%; M= 3.83, SD=0.65) and organisational learning-continuous improvement (75.4%; M= 3.77, SD=0.63). The lowest scores were for areas of frequency of events reported (63.6%; M= 3.18, SD=0.99) and handoffs and transitions (64.4%; M= 3.22, SD=0.78). Patient safety culture was correlated with income, educational level and principal of patient safety. Regular assessment for emergency rooms is required to provide essential information to hospital managers on the areas that need improvement to promote patient safety culture.

The blame game- experiences of female residents in obstetrics & gynecology regarding lapses in patient safety.

Objectives:Primary objective was to explore experiences of female residents of Obstetrics and Gynecology (OB/GYN) regarding lapses in patient safety (PS) while secondary objective was to explore factors hampering or favouring improvement of PS in OB/GYN.Methods:In this qualitative narrative study carried out in OB/GYN department of Combined Military Hospital (CMH) Lahore for six months from 1st April to 30th September 2021, six fourth-year residents were asked to write narratives of their personal experiences of medical error (witnessed or committed) in detail and reflect on those experiences, which were then transcribed. Code labels and themes were assigned manually. Interpretation of these themes was done after thematic content analysis.Results:Six, fourth-year female residents with a mean age of 28.6±1.8 participated in the study. Two main themes with sub-themes were identified: 1) Challenges in patient safety (Personal challenges, Workplace challenges, Barriers to PS), 2) Lessons learnt from experiences (Self-improvement and; Promotion of patient safety culture). Heavy workload with long working hours, lack of communication and teamwork, lack of experience and inadequate supervision were major factors involved in PS lapses experienced by residents.Conclusion:Incidents of Patient Safety (PS) lapses had a strong impact on the emotional and professional life of residents. Formal PS training with improvement of working conditions may help promote PS culture.

Differences between professionals' views on patient safety culture in long-term and acute care? A cross-sectional study.

This paper aims to assess how patient safety culture and incident reporting differs across different professional groups and between long-term and acute care. The Hospital Survey On Patient Safety Culture (HSPOSC) questionnaire was used to assess patient safety culture. Data from the organizations' incident reporting system was also used to determine the number of reported patient safety incidents. Patient safety culture is part of the organizational culture and is associated for example to rate of pressure ulcers, hospital-acquired infections and falls. Managers in health-care organizations have the important and challenging responsibility of promoting patient safety culture. Managers generally think that patient safety culture is better than it is. Based on statistical analysis, acute care professionals' views were significantly positive in 8 out of 12 composites. Managers assessed patient safety culture at a higher level than other professional groups. There were statistically significant differences (p = 0.021) in frequency of events reported between professional groups and between long-term and acute care (p = 0.050). Staff felt they did not get enough feedback about reported incidents. The study reveals differences in safety culture between acute care and long-term care settings, and between professionals and managers. The staff felt that they did not get enough feedback about reported incidents. In the future, education should take these factors into consideration.

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.

Perception of patient safety culture amongst healthcare personnel in a tertiary care hospital

Background: Patient safety in healthcare includes the safety of both patients (clients) and healthcare providers. It emphasizes reporting, analysis and prevention of medical errors that often lead to adverse health events and thus it becomes one of the most important aspects needed in a hospital setting. Purpose: The study aimed to assess the perception of patient safety culture amongst healthcare personnel in a tertiary care hospital. Methodology: A descriptive research design was selected as an appropriate method; 380 participants were selected through convenience sampling technique, including physicians, nursing officers and other technical staff. The setting for the study was all departments of a tertiary care hospital, All India Institute of Medical Sciences, Bhubaneswar. The Hospital Survey on Patient Safety Culture, a self-administered questionnaire, was used to assess the perception of patient safety culture. Results: The data were entered into SPSS version 20. The overall response rate in the present study was 84%. The average composite response rate was 57.37%. The dimension of 'teamwork within the unit', 'organisational learning' and 'feedback and communication error' showed the maximum positive responses 81.25%, 79.91% and 70.61%, respectively. Conclusion: Professional practice is a priority to promote patient safety culture amongst healthcare personnel. To have homogeneous patient safety culture amongst all healthcare professional, it is essential to increase awareness about patient safety amongst healthcare personnel and motivate them to participate in the service.

The Association between the Participation of Quality Control Circle and Patient Safety Culture.

Promoting patient safety culture (PSC) is a critical issue for healthcare providers. Quality control circles program (QCCP) can be used as an effective tool to foster long-lasting improvements on the quality of medical institution. The effect of QCCP on PSC is still unknown. This was a retrospective study conducted with matching data. A safety attitudes questionnaire (SAQ) was used for the evaluation of PSC. The association between all scores of six subscales of SAQ and the participation QCCP were analyzed with both the Mann–Whitney and Kruskal–Wallis tests. A total of 2718 valid questionnaires were collected. Most participants of QCCP were females (78.9%), nurses (52.6%), non-supervisors (92.2%), aged <40 years old (64.8%), degree of specialist or university graduates (78%), and with work experience of <10 years (61.6%). Of all participants, the highest scores were in the dimension of safety climate (74.11 ± 17.91) and the lowest scores in the dimension of working conditions (68.90 ± 18.84). The participation of QCCP was associated with higher scores in four dimensions, namely: teamwork climate (p = 0.006), safety climate (p = 0.037), perception of management (p = 0.009), and working conditions (p = 0.015). The participation or not of QCCP had similar results in the dimension of job satisfaction and stress recognition. QCCP was associated with SAQ in subjects with the following characteristics: female, nurse, non-supervisor, aged >50 years old, higher education degrees and with longer working experiences in the hospital. In this first study on the association between each dimension of SAQ and the implementation of QCCP, we found that QCCP interventions were associated with better PSC. QCCP had no benefits in the dimensions of job satisfaction and stress recognition.

Relationship between Patient Safety Culture and Adverse Events in Hospital: A case study

Introduction: Patient safety culture is an important factor in reducing hospital's adverse event and improving patient safety. The aim of this study was to evaluate the relationship between patient safety culture and adverse events in hospitals of Hamadan city. Methods: The present study was a descriptive-analytical study which was performed in hospitals of Hamadan in 2018. The study population consisted of nurses working in hospitals. The patient safety culture questionnaire and adverse event checklist were used for data collection. Questionnaires were completed by 650 nurses. Multiple logistic regression was used to examine the relationship between the variables. Results: The highest mean score of patient safety culture was related to the dimension of organizational learning, and the lowest score was for exchange and transfer of information. 35.4 percent of nurses said they had seen at least one patient fall in the past year (the least adverse event). Moreover, 51.9 percent of nurses stated that at least one pressure ulcer, or a complaint by a patient or his/her family had happened at their workplace in the past year (the most adverse event). Finally, the mean score of the patient safety culture had a significant relationship with the incidence of adverse events. Conclusion: This study confirms the patient safety culture as a predictor of adverse events. Hence, health officials and hospital administrators should provide prerequisites for promoting patient safety culture and reducing adverse events through different strategies, such as encouraging adverse events reporting as well as holding nurse training courses. © 2020. All Rights Reserved.

Anonymous reporting of medical errors from The Egyptian Neonatal Safety Training Network

ENSTN is the first database to collect incidents and medical errors in NICU in Egypt. To ensure confidential and anonymous reporting system, identify the nature of medical errors and grade of harm as well as the risk factors. To promote patient safety culture and aid to decrease mortality and morbidity due to medical errors in NICU. Data reported by one University hospital and 12 non-University hospitals were collected through internet-based system on our webpage. Incident reporting icon in English and Arabic languages with standard structured data entry format was developed during the ENSTN project life time (www.egyneosafety.net).The system provides confidential and anonymous reporting. The number and types of reported events and factors that contributed to the events were verified and validated. In total, 2724 incidents were verified. The majority of incidents were from the English versions 2699 while Arabic version 25 incidents. English first version 866 incidents, second 155 and third final versions 1678 incidents. The most frequent events categories were equipment/devices in 29.94%, and treatment/medication errors in 29.68%. Incident classification showed that 43.20% of incidents were adverse events, 5.928% were sentinel, 50.166% near miss and 0.222% intentionally unsafe act, while 0.481% of incidents were not determined by reporters. The most frequent contributory factors were related to medication errors (28.34%), education/training (28.26%), and communication problems (27.82%). Serious patient harm was reported in 2.945%, death in 4.528% and minor harm in 25.259% of reported incidents. The ENSTN incidents reporting system successfully demonstrated the most common types and causes of medical errors in NICUs and underlying contributing factors. These findings suggest need multidisciplinary collaborative training. The ENSTN educational forum may play a role in reducing medical errors.

Perspectives of healthcare professionals in Qatar on causes of medication errors: A mixed methods study of safety culture

BackgroundThere is a lack of robust, rigorous mixed methods studies of patient safety culture generally and notably those which incorporate behavioural theories of change. The study aimed to quantify and explain key aspects of patient safety culture which were of most concern to healthcare professionals in Qatar.MethodsA sequential explanatory mixed methods design of a cross-sectional survey followed by focus groups in Hamad Medical Corporation, Qatar. All doctors, nurses and pharmacists were invited to complete the Hospital Survey on Patient Safety Culture (HSOPS). Respondents expressing interest in focus group participation were sampled purposively, and discussions based on survey findings using the Theoretical Domains Framework (TDF) to explain behavioural determinants.ResultsOne thousand, six hundred and four questionnaires were received (67.9% nurses, 13.3% doctors, 12.9% pharmacists). HSOPS composites with the lowest levels of positive responses were non-punitive response to errors (24.0% positive) and staffing (36.2%). Specific TDF determinants potentially associated with these composites were social/professional role and identity, emotions, and environmental context and resources. Thematic analysis identified issues of doctors relying on pharmacists to correct their errors and being reluctant to alter the prescribing of fellow doctors. There was a lack of recognition of nurses’ roles and frequent policy non-adherence. Stress, workload and lack of staff at key times were perceived to be major contributors to errors.ConclusionsThis study has quantified areas of concern relating to patient safety culture in Qatar and suggested important behavioural determinants. Rather than focusing on changing behaviour at the individual practitioner level, action may be required at the organisational strategic level to review policies, structures (including resource allocation and distribution) and processes which aim to promote patient safety culture.

Variation in compliance with safe surgery checklist in hospitals with different levels of patient safety culture

ABSTRACT Background Positive patient safety climate can improve the adherence of care services to safety standards and consequently promote safe surgery as fundamental healthcare services. This study aimed to investigate the variation in compliance with safe surgery checklist in hospitals with different levels of safety culture. Methods This was a descriptive cross-sectional study conducted in six training hospitals affiliated by Qom University of Medical Sciences, Iran in 2016. Patient safety culture was assessed among 206 operating room staff who were selected to participate in the study through consensus method. In addition all safe surgery checklists in study time period (April to June 2016) were collected and analyzed by SPSS version 20 and use of descriptive and analytical statistical tests. Results Findings revealed that patient safety culture among employees was assessed in a moderate level (117.05 ± 4.7). Among different dimensions of patient safety climate, the highest score belonged to teamwork (36.9 ± 1.2), perception of safety among personnel (32.1 ± 0.7), and managerial support (31.7 ± 0.4). Furthermore results confirmed that hospitals with different levels of patient safety culture had various compliance rates with safe surgery checklist. Conclusion Promoting patient safety culture in hospitals can increase the congruence rate of safe surgery standards in operating rooms. Therefore focusing on significant cultural dimensions such as effective communication and teamwork, supportive work environment and continuous organizational learning are suggested to improve patient safety culture among personnel.

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...

Applying an ecological restoration approach to study patient safety culture in an intensive care unit.

To gain an understanding of medication safety culture and other quality issues in a Brazilian intensive care unit using a restorative approach. Patient safety should be considered one of the pillars of quality in health care. Thus, patient safety culture is increasingly being explored as a guide for quality improvement efforts. A qualitative approach. Participatory photographic research methods from the field of ecological restoration were adapted in this study. This study used focus groups, then subsequent nurse-led photo-narrated walkabouts, and photo elicitation with 23 nurses and one physician in interactive phases of data collection and analysis over an eight-month timeframe. The core themes identified were: the 'medication system shapes patient safety' and the 'feeling of helplessness in the face of the prevailing organization culture'. Participants discussed supports exiting in the intensive care unit that shape medication safety, the barriers that impede safe medication management, the solutions to improve medication safety and the creation of a better medication safety culture. The methods used allowed participants to visualise sound practices as well as key safety issues, reflect on their day-to-day work, re-think potential improvements, and enact changes to improve medication safety and medication safety culture. However, the patient safety culture is also marked by administrative pressure. The hospital needs to adopt participatory management, where the health professionals can act together with the organisational leaders to promote a just culture. The participatory photographic research methods from the field of ecological restoration provided participants with a tool to promote patient safety culture and engage policy change dialogue. However, it will be important in future restorative research to track-specific safety outcomes over time to assess the cost-benefit of the adoption of participatory management models.