Patient Safety Culture in Hospitals Across Countries
Patient Safety Culture in Hospitals Across Countries
Objective It is believed that in order to reduce the number of adverse events, hospitals have to stimulate a more open culture and reflective attitude towards errors and patient safety. The objective is to examine similarities and differences in hospital patient safety culture in three countries: the Netherlands, the USA and Taiwan.
Design This is a cross-sectional survey study across three countries. A questionnaire, the Hospital Survey on Patient Safety Culture (Hospital SOPS), was disseminated nationwide in the Netherlands, the USA and Taiwan.
Setting The study was conducted in 45 hospitals in the Netherlands, 622 in the USA and 74 in Taiwan.
Participants A total of 3779 professionals from the participating hospitals in the Netherlands, 196 462 from the USA and 10 146 from Taiwan participated in the study.
Main Outcome Measures The main outcome measures of the study were 12 dimensions of patient safety culture, e.g. Teamwork, Organizational learning, Communication openness.
Results Most hospitals in all three countries have high scores on teamwork within units. The area with a high potential for improvement in all three countries is Handoffs and transitions. Differences between countries exist on the following dimensions: Non-punitive response to error, Feedback and communication about error, Communication openness, Management support for patient safety and Organizational learning—continuous improvement. On the whole, US respondents were more positive about the safety culture in their hospitals than Dutch and Taiwanese respondents. Nevertheless, there are even larger differences between hospitals within a country.
Conclusions Comparison of patient safety culture data has shown similarities and differences within and between countries. All three countries can improve areas of their patient safety culture. Countries can identify and share best practices and learn from each other.
Many experts on patient safety believe that full disclosure of adverse events, without blame, leads to a reduction in medical errors. Still, in many organizations, there is a blame culture in which health-care professionals are afraid of reporting errors because of liability concerns or the fear of being seen as incompetent by colleagues. Consequences are underreporting and the fact that the expected learning from adverse events and near misses does not take place on a broad scale.
One of the recommendations of the Institute of Medicine in the USA, the Department of Health in the UK and a consortium of field parties (e.g. associations of nurses, doctors and hospitals) in the Netherlands to reduce adverse events is to stimulate a more open culture and reflective attitude towards errors and adverse events. Patient safety culture can be described as: The product of individual and group values, attitudes, perceptions, competencies, and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organization's health and safety management.
Others have argued that the safety culture of an organization develops in several stages from pathological ('we are doing fine, there are no safety concerns') to generative ('patient safety is the first priority in everything we do'). Based on empirical research, differences have been found in organizational culture between countries, and in safety culture between hospitals, hospital units and different health-care professions.
The aim of this article is to examine patient safety culture in hospitals in three countries, the Netherlands, the USA and Taiwan, and to diagnose common and country-specific strengths and weaknesses. The following are the research questions of this article: (i) What is the patient safety culture in hospitals in the three countries? (ii) Are there any differences across these countries and how can these differences be explained?
Abstract and Introduction
Abstract
Objective It is believed that in order to reduce the number of adverse events, hospitals have to stimulate a more open culture and reflective attitude towards errors and patient safety. The objective is to examine similarities and differences in hospital patient safety culture in three countries: the Netherlands, the USA and Taiwan.
Design This is a cross-sectional survey study across three countries. A questionnaire, the Hospital Survey on Patient Safety Culture (Hospital SOPS), was disseminated nationwide in the Netherlands, the USA and Taiwan.
Setting The study was conducted in 45 hospitals in the Netherlands, 622 in the USA and 74 in Taiwan.
Participants A total of 3779 professionals from the participating hospitals in the Netherlands, 196 462 from the USA and 10 146 from Taiwan participated in the study.
Main Outcome Measures The main outcome measures of the study were 12 dimensions of patient safety culture, e.g. Teamwork, Organizational learning, Communication openness.
Results Most hospitals in all three countries have high scores on teamwork within units. The area with a high potential for improvement in all three countries is Handoffs and transitions. Differences between countries exist on the following dimensions: Non-punitive response to error, Feedback and communication about error, Communication openness, Management support for patient safety and Organizational learning—continuous improvement. On the whole, US respondents were more positive about the safety culture in their hospitals than Dutch and Taiwanese respondents. Nevertheless, there are even larger differences between hospitals within a country.
Conclusions Comparison of patient safety culture data has shown similarities and differences within and between countries. All three countries can improve areas of their patient safety culture. Countries can identify and share best practices and learn from each other.
Introduction
Many experts on patient safety believe that full disclosure of adverse events, without blame, leads to a reduction in medical errors. Still, in many organizations, there is a blame culture in which health-care professionals are afraid of reporting errors because of liability concerns or the fear of being seen as incompetent by colleagues. Consequences are underreporting and the fact that the expected learning from adverse events and near misses does not take place on a broad scale.
One of the recommendations of the Institute of Medicine in the USA, the Department of Health in the UK and a consortium of field parties (e.g. associations of nurses, doctors and hospitals) in the Netherlands to reduce adverse events is to stimulate a more open culture and reflective attitude towards errors and adverse events. Patient safety culture can be described as: The product of individual and group values, attitudes, perceptions, competencies, and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organization's health and safety management.
Others have argued that the safety culture of an organization develops in several stages from pathological ('we are doing fine, there are no safety concerns') to generative ('patient safety is the first priority in everything we do'). Based on empirical research, differences have been found in organizational culture between countries, and in safety culture between hospitals, hospital units and different health-care professions.
The aim of this article is to examine patient safety culture in hospitals in three countries, the Netherlands, the USA and Taiwan, and to diagnose common and country-specific strengths and weaknesses. The following are the research questions of this article: (i) What is the patient safety culture in hospitals in the three countries? (ii) Are there any differences across these countries and how can these differences be explained?
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