Assessing patient safety culture in New Zealand primary care: a pilot study using a modified Manchester Patient Safety Framework in Dunedin general practices

Abstract

INTRODUCTION: Patient safety is a major concern, both in hospitals and in primary care settings. The current focus internationally is on the prospect of improving patient safety through cultural transformation. There are no tools designed to assess and strengthen safety culture in New Zealand (NZ) general practices, but a United Kingdom (UK) group have developed a tool—the Manchester Patient Safety Framework (MaPSaF)—to assess safety culture in UK Primary Care Trusts. We aimed to modify the MaPSaF and test its acceptability and utility in the NZ primary care setting. METHODS: We modified the MaPSaF to suit the NZ context and then used it in 12 Dunedin general practices at baseline and at three months. Participants were all practice personnel present in the practice on the day. Participants rated their practice individually on each of the nine MaPSaF dimensions of safety culture, then discussed the dimensions and their scores and chose a practice-wide consensus score for each dimension in turn. These discussions were recorded, transcribed and analysed to determine acceptability and utility of the modified framework in NZ practices. FINDINGS: The framework process took about one hour. Most participants found the process acceptable and useful. The framework directed team discussion about patient safety issues and facilitated communication and prompted some practices to make changes. Some participants from smaller practices deemed the systems advocated in the framework superfluous. CONCLUSION: The framework can be adapted and used in NZ practices to stimulate learning about safety culture and to facilitate team communication. KEYWORDS: Family practice; patient safety; primary care; safety culture

Maturity models and safety culture: A critical review

“…Measurement tool should be able to discriminate between dissimilar safety culture. J., Bennett, V., Hopkinson, J., Holroyd, J., Wilde, E., Bates, S., Bell, N. and 1,2,4,5,6,7,8,10,11,12,13,14,15,16,17,19,20,21,22,23,25,47 28,29,30,31,32,33,34,35,37 Interview 1,8,14,19,31,32 2,6,7,8,12,13,31,34 2,6,14,18,19,20,34 Matrix 1,…”

“…Inter-rater reliability 34 2,4,14,16,18,19,20 Accident analysis 29 6,36,34,39 No reported 41 4, 10, 11, 14, 16, 19, 20, 21, 22, 23, 25, 30, 33, 37 12, 21, 22, 23, 25, 29 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 33 48 14, 15, 16, 17, 19, 20, 21, 22, 23, 25, 28, 29, 30, 31, 32, 33, 34, 35, 37, 41 Maturity model application 18, 24, 26, 40 4 Maturity model validation 36, 39 2…”

“…Publications with evidence that was carried out Frequency Publications without evidence that was carried out Frequency Reliability 2,3,13,17,27,28,31,34,35,38,41 11 1,4,5,6,7,8,9,10,11,12,14,15,16,18,19,20,21,30…”

Ethics: 'Woe is me!': New Zealand's non-punitive regulatory environment

“…Furthermore, there are no tools designed to measure safety culture in these settings, although a UK safety culture tool has recently been adapted and tested in New Zealand general practices. 33 Although it is not possible to say definitively what the culture in primary care …there is no evidence to suggest that New Zealand's punitive regulatory environment is inhibiting openness and learning or fostering a culture of blame in primary care settings. The culture in these settings has never been assessed.…”

Editiorial: The relativistic, naturalistic nature of ethics and other issues

“…8 Wallis and Dovey have modified a framework which could be introduced into New Zealand (NZ) general practices to facilitate learning about improving patient safety and team communication, but acknowledge that this uses resources and practices would require some incentive to adopt this. 9 Ashworth and Thomson cite inadequate funding as a significant barrier to the delivery of long-term condition management in rural NZ. 10 However, not only funding will be required for delivery of programmes which are effective in clinical improvements in people with health inequities and chronic illness.…”