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Patient safety dialogue: evaluation of an intervention aimed at achieving an improved patient safety culture
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2011 (English)In: Journal of patient safety, ISSN 1549-8425, Vol. 7, no 4, 185-92 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Patient Safety Dialogue, a local intervention inspired by walk round-style approaches, was implemented in 2005 in a Swedish county council to achieve a positive patient safety culture in health care. This paper evaluates the results and changes after 5 years of the Patient Safety Dialogue in 50 departments (37 medical and 13 psychiatric) in 3 hospitals.

METHODS: The patient safety culture maturity was rated on 5 levels that correspond with the Manchester Patient Safety Assessment Framework. The assessment was based on information supplied by the departments and discussions between clinical leaders and staff members with special patient safety assignments and representatives from a patient safety unit. Three patient safety areas were assessed: hospital-acquired infections, outcome measurements, and general patient safety. Each department was assessed 3 times: at baseline and at follow-ups at 18 and 36 months. Average scores were calculated for each of the 3 safety areas on all occasions. The departments were classified into 3 types of trajectories on the basis of the development of their scores over time.

RESULTS: More than two-thirds of the departments attained higher scores in round 3 than in round 1. Seventy-eight percent of the departments in the general patient safety area were categorized as continuously improving or developing, compared with 68% for outcome measurement and 50% for hospital-acquired infection. Approximately one-third was categorized as nonimproving, with scores in round 3 lower than or equal to the scores in round 1. The medical departments had higher scores than the psychiatric departments in all rounds.

CONCLUSIONS: Most of the 50 departments were evaluated to have improved their patient safety culture during the 5 years of the Patient Safety Dialogue, suggesting that the intervention is effective in supporting an improved patient safety culture. However, one-third of the departments did not improve during the 5-year study period.

Place, publisher, year, edition, pages
Informa , 2011. Vol. 7, no 4, 185-92 p.
Keyword [en]
Safety, culture, program evaluation, safety management
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-72593DOI: 10.1097/PTS.0b013e318230e702PubMedID: 21952549OAI: oai:DiVA.org:liu-72593DiVA: diva2:460200
Available from: 2011-11-29 Created: 2011-11-29 Last updated: 2013-10-25Bibliographically approved
In thesis
1. Measures of Patient Safety: Studies of Swedish Reporting Systems and Evaluation of an Intervention Aimed at Improved Patient Safety Culture
Open this publication in new window or tab >>Measures of Patient Safety: Studies of Swedish Reporting Systems and Evaluation of an Intervention Aimed at Improved Patient Safety Culture
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Unsafe health care delivery results in millions of patients suffering from injuries or death worldwide. A Swedish study estimated the prevalence of preventable adverse events as high as 8.6% in hospital care, which demonstrates that patient safety is no less a problem in Sweden than elsewhere. Reporting of adverse events has become an integral part of patient safety work. The aim of reporting is to identify patient safety problems and provide background data and information for efforts to improve patient safety. However, adverse events in health care can be captured and measured using different methods and stored in disparate systems that are not fully integrated. This makes it difficult to obtain a complete coherent picture of the frequency and nature of various types of adverse events. Another difficulty is to distinguish between adverse events and accepted complications of medical care.

The overall aim of this thesis is to generate knowledge for improved understanding of how patient safety can be measured in terms of reporting adverse events and improved by targeting patient safety culture with an intervention implemented in a Swedish county council. Three research questions have been derived from the aim: (1) To what extent can analysis of patient claims contribute to an understanding of the magnitude of the patient safety problem? (2) To what extent do data captured from different reporting systems in Sweden differ? (3) To what extent can a structured intervention that fosters learning on patient safety issues and encourages leadership commitment improve the patient safety culture in a Swedish county council from a five-year perspective?

The research is based on studies of three national reporting systems: Lex Maria to the National Board of Health and Welfare; patient claims to the County Councils´ Mutual Insurance Company; and medical data reported to the National Swedish Spine Register (Swespine). Data have also been assembled as part of an evaluation within the Patient Safety Dialogue intervention.

This thesis indicates that different Swedish reporting systems provide disparate views and have many discrepancies regarding data quality and coverage of adverse events. Patient claims seem to be an important source of information that can complement information from incident reporting systems and quality registries in health care to provide an understanding of the magnitude of the patient safety problem.

The research also shows that a structured intervention that fosters learning on patient safety issues and encourages leadership commitment can improve the culture of patient safety. However, a longer period of time and focused efforts might be required to achieve improvements across all departments within a Swedish county council.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 85 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1267
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72594 (URN)978-91-7393-043-7 (ISBN)
Public defence
2012-01-13, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-11-29 Created: 2011-11-29 Last updated: 2011-12-16Bibliographically approved

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Öhrn, AnnicaRutberg, HansNilsen, Per

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