EVOLUTION OF PATIENT SAFETY CULTURE IN BELGIAN HOSPITALS AFTER IMPLEMENTING A NATIONAL PATIENT SAFETY PLAN

Abstract

Introduction: Within a 5-year federal program on quality and safety (2007–2012), the Belgian government provided a framework for implementing quality and safety strategies in the acute, psychiatric and long-term care hospitals with attention to three pillars: structure, processes and outcome measurement. One of the main objectives in the federal program was the development of a safety culture.

This research sought to examine to what extent the hospitals' safety culture evolved after participating in the federal program and to what extent safety culture could be explained by predictor variables.

Methods: In order to measure safety culture within the Belgian hospitals, the Hospital Survey on Patient Safety Culture (HSPSC) was selected since it covers a broad range of patient safety aspects and previous research demonstrated good psychometric properties of the Dutch and French versions. The HSPSC includes 42 items that assess safety culture on 12 dimensions.

Between 2007 and 2009, 88% of all Belgian hospitals (180 out of 205) entered the federal program and conducted a baseline organization-wide safety culture measurement. In 2011, 91% of the hospitals (179 out of 197) conducted a second safety culture measurement. In order to track changes in safety culture after a period of three years, hospitals were invited to participate in a follow-up comparative research, organized by a neutral academic institution. Generalized Estimating Equations models were fitted to examine any existing relationships between safety culture predictor variables and each of the 12 safety culture dimensions.

Results: The Belgian safety culture benchmark database includes 115 827 records drawn from 176 hospitals. Of those, 147 hospitals conducted a first measurement (53.6% response rate) and 140 hospitals repeated the measurement after three years (50.6% response rate). A comparative report was provided to each hospital, including its position on each dimension, to facilitate internal assessment and learning in the patient safety improvement process.