The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study

Abstract

BackgroundPatient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety.MethodsA repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions.ResultsAt the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital.ConclusionThe result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.

Analysis of incidents notified in a general hospital

“…The hospital professionals in the scenario of this research, through spontaneous notifications, indicated the main causes for the occurrence of incidents were factors related to noncompliance with the routine/protocol and also outlined actions that they consider pertinent to avoid recurrence of incidents, such as: modifications to the routine/protocol, and provide orientation and training. The national and international literature on the subject corroborates these findings (1)(2)(3)6,8,22) . Human resources and quality management managers should be in continuous contact with the hospital staff in order to obtain feedback on patient safety in terms of training and management of teams.…”

“…Although it has not been predominant, work overload must be prevented, which requires a detailed and dynamic analysis of the peculiarities of each sector (6) , in addition to adequate staffing (2) . Studies in Sweden (1) and Iran (3) have shown that cultural change is a challenge and takes up time in the hospital routine. The practice of permanent education, in this context, allows a reflection on the various issues that are present in the daily practice.…”

“…It is also important for the institution to provide technologies that favor this improvement. These recommendations are indicated in national (2,8) and international studies (1,3) , collaborating to prevent incidents and their recurrence (3) .…”

“…Safety has a particular relevance in health care and, in this sense, the patient safety culture in an institution has a great impact on the quality of care (1) . Hospital institutions are increasingly concerned about ensuring quality care for their clients.…”

Cultura de segurança do paciente em três hospitais brasileiros com diferentes tipos de gestão

“…Evidenciou-se que "respostas não punitivas" e "dimensionamento de pessoal" foram classificadas como fortalezas, além do "trabalho em equipe dentro/entre das unidades", "aprendizado organizacional/melhoria continuada" e "comunicação aberta". Em levantamento realizado com 45 hospitais na Holanda, 622 nos Estados Unidos e 74 em Taiwan revela-se que a principal dimensão carente de melhoria é de problemas em mudanças de turno e transições entre unidades/serviços, assim como relatam que existe grandes diferenças nas outras dimensões entre os países estudados 27 . Quando foi analisado cada hospital separadamente, percebeu-se que apenas o hospital privado conseguiu atingir níveis de fortaleza (>75%) na análise de respostas positivas (Tabela 3).…”