Patient Safety Culture in European Hospitals: A Comparative Mixed Methods Study

Abstract

Background: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. Purpose: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. Design: A comparative mixed methods study with a convergent parallel design. Methods: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. Results: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. Conclusions: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy.

Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis

“…The current study findings about staffing across professions are relevant to the context and culture of the health sector in each country in Latin America. Similar to other studies [ 34 , 138 , 139 , 140 ], nurses were more concerned about staffing than physicians. This finding may be explained by most countries having as many or more physicians than nurses per 1000 people, despite nurses being responsible for staffing hospitals for 24 h each day of the year.…”

“…In the current review, statistically significant differences were observed during the meta-analysis for the perception of patient safety culture across the different professional groups. Adequate clinical staffing in a hospital is essential for achieving improved clinical outcomes [ 130 , 131 , 132 ] and a more favorable patient safety culture [ 34 , 58 ]. The perception of patient safety has been related to the availability of adequate staffing [ 133 ].…”

“…Despite differences in theoretical foundations [ 31 ] and conceptual frameworks [ 32 ], the instruments similarly focus on measuring seven dimensions of patient safety culture including leadership support, staff attitudes, communication openness, safety systems, incident reporting, organizational learning: continuous improvement, and teamwork [ 33 ]. The patient safety culture instrument most often used for research across contexts, cultures, and countries is the HSOPSC [ 34 ], which originates from the Surveys on Patient Safety Culture™ program to advance the scientific understanding of patient safety culture in healthcare [ 35 ]. Since the release of the HSOPSC 1.0 in 2004, the survey has been translated into 56 languages and dialects for cross-cultural application in more than 100 countries [ 36 ].…”

“…The range between these cut points is considered adequate but requires improvement. Spider diagrams can be used to compare dimensions and composite scores for the HSOPSC 1.0, where perception responses are classified by the percent of positive responses as “excellent” (>90), “good” (70–89), “adequate” (50–69), “fair” (26–49), or ”poor” (<26) [ 34 ]. Since the HSOPSC 2.0 scores were observed to be higher than the scores of the HSOPSC 1.0 during pilot studies [ 60 ], guidance was provided for version transition, including score interpretation and comparative analysis [ 61 ].…”

Patient Safety Culture and Its Associated Factors: A Situational Analysis among Nurses in Katsina Public Hospitals, Northwest Nigeria

“…However, the issue of understaffing in healthcare facilities is a global problem, as many studies have also revealed evidence of poor staffing in many countries. These include research conducted on patient safety culture and associated factors in hospitals in the Jima zone in southwest Ethiopia [ 42 ], Saudi Arabi [ 43 ], Lebanon [ 31 ], Sweden, Spain, Hungary, and Croatia [ 44 ]. This finding was further attested by a logistic regression analysis in the present study, which showed that an increase in the negative perception of staffing composite has the odds of 3.15 to a negative perception of the overall patient safety culture.…”