The relationship between patient safety culture and the implementation of organizational patient safety defences at emergency departments

VAN NOORD I, DE BRUIJNE MC, TWISK JWR

Int J Qual Health Care 22: 162–169 [PMID: 20382661]

Objective: The objective of this study was to investigate the association between 11 patient safety culture dimensions and the implementation of 7 organizational patient safety defences: a resident orientation program, the training, the skills assessment of residents, the presence of protocols, the review of patient records, the structured monitoring and the review of radiodiagnostics results.

Design: Data were gathered within a cross-sectional, retrospective survey. Setting: Emergency departments (EDs) in the Netherlands. Participants: Thirty-three EDs of non-academic hospitals, which belong to the clientele of Dutch largest medical liability insurer. Main outcome measures: Implementation of the separate organizational patient safety defences (0 = insufficient/sufficient, 1 = good).

Results: Analyses showed that several culture dimensions were negatively or positively associated with the implementation of the patient safety defences. A culture in which hospital handoffs and transitions were perceived adequate was related to less frequent implementation of four of seven organizational patient safety defences, whereas a culture with well-perceived hospital management support for patient safety predicted more frequent implementation of four of seven organizational patient safety defences: the structured monitoring, the review of radiodiagnostics results, the resident orientation program and the review of patient records. The perception of a hospital management supporting patient safety was associated with more frequent application of four of the seven organizational defences for patient safety: the presence of protocols, the review of radiodiagnostics results, the resident orientation program and the review of patient records.

Conclusions: Results suggest that well-perceived culture dimensions might inhibit improvements by lack of a sense of urgency as well as facilitate improvements by inducing feelings of support for organizational changes and improvements. The influence of patient safety culture appeared to be not always as straightforward as it seems to be in advance.

Although the study took place at the emergency departments, we comment it because it poses a design that may be of interest in primary care to investigate the relationship between the culture of patient safety and the effective implementation of organizational defences that assure it.


Posted by José Angel Maderuelo
English version by Erika Céspedes