‘What effect do safety culture interventions have on health care workers in hospital settings?’ A systematic review of the international literature

Abstract

Introduction: Interventions designed to improve safety culture in hospitals foster organisational environments that prevent patient safety events and support organisational and staff learning when events do occur. A safety culture supports the required health workforce behaviours and norms that enable safe patient care, and the well-being of patients and staff. The impact of safety culture interventions on staff perceptions of safety culture and patient outcomes has been established. To-date, however, there is no common understanding of what staff outcomes are associated with interventions to improve safety culture and what staff outcomes should be measured. Objectives: The study seeks to examine the effect of safety culture interventions on staff in hospital settings, globally. The research questions are: How is safety culture defined in studies with interventions that aim?What effects do interventions to improve safety culture have on staff?What intervention features, safety culture domains or other factors explain these effects?What staff outcomes and experiences are identified? Methods and Analysis: A mixed methods systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches will be conducted using the electronic databases of MEDLINE, EMBASE, CINAHL, Health Business Elite, and Scopus. Returns will be screened in Covidence according to inclusion and exclusion criteria. The mixed-methods appraisal tool (MMAT) will be used as a quality assessment tool. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials and non-randomised studies of interventions will be employed to verify bias. Synthesis will follow the Joanna Briggs Institute methodological guidance for mixed methods reviews, which recommends a convergent approach to synthesis and integration. Discussion: This systematic review will contribute to the international evidence on how interventions to improve safety culture may support staff outcomes and how such interventions may be appropriately designed and implemented.

Effect of interventions to improve safety culture on healthcare workers in hospital settings: a systematic review of the international literature

“…Following our protocol, 4 we conducted a mixed-methods systematic review 22 23 of published literature guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). 24 Studies were included if they had been published since 2000, specifically in peerreviewed journals (table 1).…”

“…75 Two studies 39 47 undertook qualitative work and viewed culture change as more long term and complex. Overall, the heterogeneity observed in the wider literature 4 was reflected in the sample.…”

“…Safety culture was defined diversely across studies as safety climate, safety culture or patient safety culture. 4 Twelve studies did not cite a definition. Eighteen studies drew on the Hospital Survey on Patient Safety Culture 7 (HSOPSC) safety culture definition and 20 on the Safety Attitudes Questionnaire 8 (SAQ) safety climate definition.…”

“…Fostering a supportive safety culture is increasingly recognised as a strategy to strengthen learning in healthcare systems. [1][2][3] Safety culture is a complex and varied concept 4 but can be broadly defined as organisational beliefs, values and behaviours for patient safety. [5][6][7] The concept can form a valued component of high-performance organisations.…”

“…8 A major focus of safety culture in healthcare is on reducing patient harm and learning from events when they occur. 4 At national and organisational levels, methods for learning from events are incorporated into incident management frameworks, thereby strengthening systems through policy. 9 10 Hospital interventions to build a safety culture often seek to support staff learning.…”