Table 3 Strategies for improving safety culture
From: Evolution of patient safety culture in Belgian acute, psychiatric and long-term care hospitals
| Dimensions | % of improvement or decline (p-values) | N hospitals with ≥ 5% improvement** (of which N hospitals with targeted strategies) | Examples of interventions targeting safety culture as indicated by participating hospitals | ||
|---|---|---|---|---|---|
| AH (n = 69) | PH (n = 34) | LTCH (n = 8) | |||
| D1: Supervisor/manager expectations and actions promoting safety | +2.8* (0.000) | +2.6 (0.245) | +4.4 (0.093) | 32 (2) | Improvement of communication between management and units |
| D2: Organizational learning–continuous improvement | +3.9* (0.000) | -1.0 (0.293) | +3.2 (0.484) | 41 (6) | In-hospital patient safety campaign; registration of incidents; raising awareness (posters, dashboard); organizational structural change by implementation of care teams which are accountable for quality and safety; medical record review by quality team; constitution of a patient safety committee; multidisciplinary analysis of events; audits of hospitals units and feedback; encouraging incident reporting |
| D3: Teamwork within units | +1.3* (0.002) | +2.6 (0.084) | +2.3 (0.327) | 29 (5) | Designation of unit team leaders; triage on emergency care; optimizing of hospital unit briefings; implementation of safe surgery checklist |
| D4: Communication openness | +2.7* (0.000) | +1.0 (0.281) | +7.2 (0.093) | 33 (4) | Communication plan on quality and safety issues; alignment of communication between hospital management and units; presence of hospital management during team meetings |
| D5: Feedback and error communication | +0.9* (0.045) | +0.8 (0.422) | +2.5 (0.674) | 28 (9) | Feedback of incident reporting; communication of specific patient safety issues (e.g. hemovigilance); mandatory education of new staff on patient safety; discussion of feedback incident reports with units on regular basis in order to implement improvements; patient safety column in hospital magazine; patient safety dashboard via intranet; designation of incident administrator |
| D6: Non-punitive response to error | +4.1* (0.000) | +4.1 (0.150) | +6.6* (0.025) | 49 (14) | Involvement of head nurses in feedback and discussion of events; patient safety committee is responsible for communication of patient safety issues to hospital management and hospital staff; education on incident reporting; stimulating a culture of openness and reporting; ending blame and shame culture; drafting a patient safety organogram to enlarge involvement of all hospital committees; sensibilization of head nurses in non-blaming job evaluations; assignment of external company as responsible for incident registration and data processing |
| D7: Staffing | +2.2 (0.066) | +0.5 (0.966) | +9.9 (0.069) | 41 (4) | Support of mobile teams to reduce high workloads; international recruitment of nurses; enhancement of medical staff; clinical receptionists; coaching of new staff; implementation of two night shifts on geriatric, oncology on respiratory units; additional administrative support for nursing care |
| D8: Management support for patient safety | +8.5* (0.000) | +3.6* (0.041) | +6.5 (0.401) | 66 (15) | Communication of safety culture data; elaboration of a hospital-wide safety plan with SMART objectives for each hospital unit; patient safety on agenda of board meetings; development of patient safety charter; establishment of a patient safety committee; reorganization of quality and safety policy; head physician in lead of root cause analysis of incidents; discussion of patient safety indicators on board meeting; patient safety committee is accountable for incident reporting system; organization of patient safety symposium; organization-wide patient safety campaign |
| D9: Teamwork across units | +1.7* (0.039) | +0.6 (0.231) | +4.6 (0.484) | 34 (5) | Mapping and improving transfer processes; examining for all hospital units which information is needed; implementation and evaluation of electronic medical record; exchanging hospital staff across units if necessary |
| D10: Handoffs and transitions | -2.0* (0.018) | -4.5 (0.064) | -4.3 (1.000) | 15 (5) | Mapping and improving transfer processes; implementation and evaluation of electronic medical record; implementation and evaluation of protocols for patient identification wrist bands; implementation of nursing transfer checklist |
| O1: Overall perceptions of patient safety | +4.6* (0.000) | +0.5 (0.898) | +0.6 (0.726) | 43 (4) | Hospital-wide patient safety campaign; elaboration of hospital-wide procedure book; implementation of targeted actions based on incident reporting; safety walk rounds; elaboration of accreditation processes; patient safety alert weeks; assigning quality labels to hospital units |
| O2: Frequency of events reported | -2.0* (0.000) | -3.7 (0.110) | +2.8 (0.271) | 18 (3) | Designation of responsible persons for analyzing incidents; raising awareness on reporting specific types of adverse events; sensibilization campaigns for incident reporting on each unit |