Patient Safety Culture and the Ability to Improve: A Proof of Concept Study on Hand Hygiene

Abstract

OBJECTIVE To investigate whether the safety culture of a hospital unit is associated with the ability to improve. DESIGN Qualitative investigation of safety culture on hospital units following a before-and-after trial on hand hygiene. SETTING VU University Medical Center, a tertiary-care hospital in the Netherlands. METHODS With support from hospital management, we implemented a hospital-wide program to improve compliance. Over 2 years, compliance was measured through direct observation, twice before, and 4 times after interventions. We analyzed changes in compliance from baseline, and selected units to evaluate safety culture using a positive deviance approach: the hospital unit with the highest hand hygiene compliance and 2 units that showed significant improvement (21% and 16%, respectively) were selected as high performing. Another 2 units showed no improvement and were selected as low performing. A blinded, independent observer conducted interviews with unit management, physicians, and nurses, based on the Hospital Survey on Patient Safety Culture. Safety culture was categorized as pathological (lowest level), reactive, bureaucratic, proactive, or generative (highest level). RESULTS Overall, 3 units showed a proactive or generative safety culture and 2 units had bureaucratic or pathological safety cultures. When comparing compliance and interview results, high-performing units showed high levels of safety culture, while low-performing units showed low levels of safety culture. CONCLUSIONS Safety culture is associated with the ability to improve hand hygiene. Interventions may not be effective when applied in units with low levels of safety culture. Although additional research is needed to corroborate our findings, the safety culture on a unit can benefit from enhancement strategies such as team-building exercises. Strengthening the safety culture before implementing interventions could aid improvement and prevent nonproductive interventions. Infect Control Hosp Epidemiol 2017;38:1277-1283.

The relationship between safety management and patient safety culture in Cancer Treatment Centers

“…By analyzing the information in Table 6, the correlation between the status of operating room standards and safety culture was evaluated positively. This result is consistent with the paper by , Safazadeh and Zarei, Behzadi et al [29], And Caris et al [25]. In explaining this result, it can be said that the operating room is a sector that pursues specific goals, and since this sector is particularly concerned with people's health and the community is particularly sensitive to it, safety performance and safety culture in This unit has a great role to play.…”

“…The results showed that continuous training and development, support from hospital management, managerial / supervisory expectations, error feedback and communication, teamwork, and hospital handover were among the predictors of patient safety culture. Caris et al [25] examined patient safety culture using the HSOPSC questionnaire. The results of their work showed that organizational learning and continuous improvement are accompanied by negative attitude of nurses and need to create a positive safety culture with free communication, mutual belief, shared understanding of the importance of safety and taking preventive measures in this regard.…”

Was Pflichtfortbildung mit „Pflicht“ und „Fortbildung“ zu tun hat

“…Caris und Kollegen berichteten 2017 davon, dass sich bei "niedrig-qualitativer" Sicherheitskultur durch Händehygiene-Programme nur unbefriedigende Verbesserungen auf entsprechenden Stationen erzielen ließen. Dahingegen wiesen Stationen mit hoch-qualitativer Sicherheitskultur deutliche Compliance-Steigerungen auf [40].…”

Suboptimal infection prevention and control in the healthcare culture

“…2,3 To date guidelines, policy, and education initiatives have broadly yielded little sustained behavioural change. 4,5,6 Studies however do support performance being impacted by culture in healthcare. 7,8 The influence of the healthcare culture on infection control practice has not been explored 9 even though studies show association between patient outcomes and culture.…”

“…7,8 The influence of the healthcare culture on infection control practice has not been explored 9 even though studies show association between patient outcomes and culture. 4,3,10 This paper discusses the cultural milieu of infection prevention and control (IPC) practice and embedded norms, proposing a cultural shift is mandatory to address suboptimal IPC practice. not for citation purposes Suboptimal infection prevention and control in the healthcare culture Cioffi each other.…”