Changing patient safety culture in China: a case study of an experimental Chinese hospital from a comparative perspective.

BACKGROUND: The World Health Organization highlights that patient safety interventions are not lacking but that the local context affects their successful implementation. Increasing attention is being paid to patient safety in Mainland China, yet few studies focus on patient safety in organizations with mixed cultures. This paper evaluates the current patient safety culture in an experimental Chinese hospital with a Hong Kong hospital management culture, and it aims to explore the application of Hong Kong's patient safety strategies in the context of Mainland China. METHODS: A quantitative survey of 307 hospital staff members was conducted using the Hospital Survey on Patient Safety Culture questionnaire. The findings were compared with a similar study on general Chinese hospitals and were appraised with reference to the Manchester Patient Safety Framework. RESULTS: Lower scores were observed among participants with the following characteristics: males, doctors, those with more work experience, those with higher education, and those from the general practice and otolaryngology departments. However, the case study hospital achieved better scores in management expectations, actions and support for patient safety, incident reporting and communication, and teamwork within units. Its weaknesses were related to non-punitive responses to errors, teamwork across units, and staffing. CONCLUSIONS: The case study hospital contributes to a changing patient safety culture in Mainland China, yet its patient safety culture remains mostly bureaucratic. Further efforts could be made to deepen the staff's patient safety culture mind-set, to realize a "bottom-up" approach to cultural change, to build up a comprehensive and integrated incident management system, and to improve team building and staffing for patient safety.

Orthodontic treatment of anterior open bite.

OBJECTIVE: To review the currently available treatment options of anterior open bite. METHODS: Search all major dental journals and literature on treatment and management of anterior open bite. Medline search (1960-2006). Literature and data on treatment and management of anterior open bite with keywords 'open bite', 'anterior open bite', 'orthodontic treatment', 'long face', 'vertical dentoalveolar problem' and 'vertical skeletal problem'. RESULTS: Over 50 articles were found and relevant information and data were reviewed by the authors. It was found that the multifactorial nature of anterior open bite makes its management difficult and various treatment modalities are being used. Clinicians must be able to diagnose the problem and choose the best treatment. CONCLUSION: Successful treatment of anterior open bite greatly relies on both diagnosis and therapeutics. Although there are many different treatment modalities available, stability after treatment is still a critical issue as evidence on long term stability of various treatment options is lacking. Thus, clinicians should pay more attention during retention phase and long-term studies on post-treatment changes and stability should be encouraged.