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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

  1. AH: acute hospitals; PH: psychiatric hospitals; LTCH: long-term care hospitals.
  2. *Statistical significant based on Related Samples Wilcoxon Signed Rank test (p < 0.05).
  3. **Information on improvement strategies was missing for 8 out of 111 hospitals; The AHRQ’s guideline was followed of considering an absolute difference of ≥ 5% in the proportion of positive ratings as potentially indicating a meaningful difference.