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Purpose The purpose of this paper is to assess the association between shift schedule realignment and patient safety culture. Design/methodology/approach Using difference in differences model, BIMC Hospitals and Siloam Hospital Bali were compared before and after shift schedule realignment to test the association between shift schedule realignment and patient safety culture. Findings Shift schedule realignment was associated with a significant improvement in staffing (coefficient 1.272; 95% CI 0.842 – 1.702; p<0.001), teamwork within units (coefficient 1.689; 95% CI 1.206 – 2.171; p<0.001), teamwork across units (coefficient 1.862; 95% CI 1.415 – 2.308; p<0.001), handoffs and transitions (coefficient 0.999; 95% CI 0.616 – 1.382; p<0.001), frequency of error reported (coefficient 1.037; 95% CI 0.581 – 1.493; p<0.001), feedback and communication about error (coefficient 1.412; 95% CI 0.982 – 1.841; p<0.001) and communication openness (coefficient 1.393; 95% CI 0.968 – 1.818; p<0.001). Practical implications With positive impact on patient safety culture, shift schedule realignment should be considered as quality improvement initiative. It stretches the compressed workload suffered by staff while maintaining 40 h per week in accordance with applicable laws and regulations. Originality/value Shift schedule realignment, designed to improve patient safety culture, has never been implemented in any Indonesian private hospital. Other hospital managers might also appreciate knowing about the shift schedule realignment to improve the patient safety culture.

Purpose The purpose of this paper is to improve the Siloam Hospitals’ (SHs) patient satisfaction index (PSI) and overcome Indonesia’s geographical barriers. Design/methodology/approach The topic was selected for reasons guided by the Institute of Healthcare Improvement virtual breakthrough series collaborative (VBSC). Subject matter experts came from existing global quality development in collaboration with sales and marketing, and talent management agencies/departments. Patient satisfaction (PS) was measured using the SH Customer Feedback Form. Data were analysed using Friedman’s test. Findings The in-patient (IP) department PSI repeated measures comparison during VBSC, performed using Friedman’s test, showed a statistically significant increase in the PSI, χ2 = 44.00, p<0.001. Post hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction applied, which resulted in a significant increase between the baseline and action phases (Z=3.317, p=0.003) between the baseline and continuous improvement phases (Z=6.633, p<0.001), and between the action and continuous improvement phases (Z=3.317, p=0.003), suggesting that IP PSI was continuously increasing during all VBSC phases. Like IP PSI, the out-patient department PSI was also continuously increasing during all VBSC phases. Research limitations/implications The VBSC was not implemented using a control group. Factors other than the VBSC may have contributed to increased PS. Practical implications The VBSC was conducted using virtual telecommunication. Although conventional breakthrough series might result in better cohesiveness and commitment, Indonesian geographical barriers forced an alternative strategy, which is much more cost-effective. Originality/value The VBSC, designed to improve PS, has never been implemented in any Indonesian private hospital group. Other hospital groups might also appreciate knowing about the VBSC to improve their PSI.