A theory-driven, longitudinal evaluation of the impact of team training on safety culture in 24 hospitals

Abstract

BackgroundEffective teamwork facilitates collective learning, which is integral to safety culture. There are no rigorous evaluations of the impact of team training on the four components of safety culture—reporting, just, flexible and learning cultures. We evaluated the impact of a year-long team training programme on safety culture in 24 hospitals using two theoretical frameworks.MethodsWe used two quasi-experimental designs: a cross-sectional comparison of hospital survey on patient safety culture (HSOPS) results from an intervention group of 24 hospitals to a static group of 13 hospitals and a pre-post comparison of HSOPS results within intervention hospitals. Dependent variables were HSOPS items representing the four components of safety culture; independent variables were derived from items added to the HSOPS that measured the extent of team training, learning and transfer. We used a generalised linear mixed model approach to account for the correlated nature of the data.Results59% of 2137 respondents from the intervention group reported receiving team training. Intervention group HSOPS scores were significantly higher than static group scores in three dimensions assessing the flexible and learning components of safety culture. The distribution of the adoption of team behaviours (transfer) varied in the intervention group from 2.8% to 31.0%. Adoption of team behaviours was significantly associated with odds of an individual reacting more positively at reassessment than baseline to nine items reflecting all four components of safety culture.ConclusionsTeam training can result in transformational change in safety culture when the work environment supports the transfer of learning to new behaviour.

The patient safety culture: a systematic review by characteristics of Hospital Survey on Patient Safety Culture dimensions

“…Regarding their participants, 26 (78.8%) of the 33 studies stated that these were mainly nurses [16-19, 21-30, 32, 36-42, 44-47], in proportions ranging from 27% [38] to 80% [28]. Five studies did not give the demographic characteristics of the sample [20,31,35,43,48].…”

“…-- [28,40,42,44,45]; (iv) four studies evaluated the effects on PSC of investments in improving the quality and safety of healthcare at hospitals [17,20,38,48]; (v) two studies investigated associations between safety culture and outcome variables [21,32] and (vi) one study [46] evaluated safety culture among hospital staffs and made comparisons with studies in other countries.…”

“…The main safety culture dimensions that scored highest percentages of positive responses in the studies and, therefore, are classified as strong or developed dimensions, were: (i) 'Teamwork within units' (78-89%) [20, 23, 26-28, 37, 38, 41, 45, 46] (ii) 'Organisational learning-continuous improvement' (71-88%) [17,20,21,26,33,37,38,40,41,45,46]. In studies that estimated dimension scores from 0 to 5, the strongest dimensions were: (i) 'Teamwork within units' (3.78-3.89) [18,22,24,32]; (ii) 'Communication openness' (3.72-3.78) [18,22,32] and (iii) 'Supervisor/manager expectations and actions promoting patient safety' (3.58-3.82) [18,24] (Table 3).…”

Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial

“…18 Team effort seems crucial for patient safety. [34][35][36][37] However, as the MaPSaF is extensive, the SCOPE results were integrated in the workshop, both focusing the discussion and tailoring it to the participating practice. Hereby, the workshop became comprehensive and manageable.…”

Confronting Safety Gaps Across Labor and Delivery Teams

“…38 However, outcomes do not capture buy-in and optimism, invaluable in creating lasting improvement, and teamwork training alone is typically not successful without clinician and administrative buy-in. 39,40 Establish the infrastructure for cultural change with a program that provides local control of improvement targets within a broader context of safety learning and evaluation. 41 Evaluate cultural norms and change over time by administering a safety culture survey in addition to traditional outcomes-monitoring.…”