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

Abstract

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 of quantitative surveys of staff and qualitative interviews with hospital leadership. Secondary data analysis was performed for previous surveys.SettingThis study was conducted in a tertiary care teaching multisite hospital in Riyadh, Saudi Arabia.ParticipantsOne thousand hospital staff participated in the survey. Thirty-one executive board members and directors and four focus groups of frontliners were qualitatively interviewed.Primary and secondary outcome measuresTwelve safety culture dimensions were assessed to study the patient safety culture as perceived by the healthcare professionals. An additional semi-structured interview was conducted to identify organisational factors, changes, and barriers affecting the patient safety culture. Furthermore, suggestions to improve patient safety were proposed.ResultsComparing the results revealed a general positive trend in scores from 2012 to 2019. The areas of strength included teamwork within and across units, organisational learning, managerial support, overall perception of safety and feedback and communication about error. Non-punitive response to error, staffing and communication and openness consistently remain the lowest-scoring composites. Interview results revealed that organisational changes may have influenced the answers of the participants on some survey composites.ConclusionsPatient safety is a moving target with areas for improvement that are continuously identified. Effective quality improvement initiatives can lead to visible changes in the patient safety culture in a hospital, and consistent leadership commitment and support can maintain these improvements.

Striving for Performance Excellence: Ten Years’ Experience & Impact of Accreditation on Quality, Safety, and Overall Performance in King Saud University Medical City (KSUMC) – A Mixed-Methods Study

“…Regular assessments of patient safety cultures are central to quality improvement in hospitals and often an integral component of accreditation requirements [25,26]. Results from the current study showed that the average score on that composite consistently and signi cantly decreased since the rst accreditation cycle in 2011.…”

“…Organizational changes that result from accreditation may contribute to greater managerial autonomy which have been linked to improvement in quality and patient outcomes. Managerial support can improve staff involvement in accreditation and evidence shows that managerial commitment can facilitate organizational change and successful implementation of initiatives such as accreditation [16,25].…”

Barriers and enablers in implementing an electronic incident reporting system in a teaching hospital: A case study from Saudi Arabia

“…Moreover, other studies highlighted the importance of promoting 'Just Culture' or non-punitive culture among staff to promote incident reporting and ultimately increase patient safety. 28,29,32,[35][36][37] Our study revealed that less experienced or junior staff were reporting more incidents using the eOVR and had significantly lower scores on Satisfaction and System Usability. This trend of the junior staff to be more likely to report and to use the incident reporting system than senior staff was observed in other studies.…”

“…However, this low representation of other HCPs was not different from similar studies where the majority of employees in healthcare organizations are nurses. 37,42 Moreover, the total sample of 1029 respondents still reflected a large representation of the hospital staff.…”

Development and Validation of the Veterans Health Administration Patient Safety Culture Survey

“…Understanding the dimensions that drive improvements in PSC and which ones are more sensitive to change are important areas to explore. Research looking at PSC in one medical center over 8 years identified visible leadership and support and a dedicated event reporting system as facilitating PSC changes: while most dimensions improved, punitive response to error did not change 38 . The broad use of a patient safety strategy was shown to relate to improvement in both PSC as reductions in adverse events 5 .…”