Involvement in Root Cause Analysis and Patient Safety Culture Among Hospital Care Providers.

BACKGROUND: The experience feedback committee (EFC) is a tool designed to involve medical teams in patient safety management, through root cause analysis within the team. OBJECTIVE: The aim of the study was to determine whether patient safety culture, as measured by the Hospital Survey on Patient Safety Culture (HSOPS), differed regarding care provider involvement in EFC activities. METHODS: Using the original data from a cross-sectional survey of 5064 employees at a single university hospital in France, we analyzed the differences in HSOPS dimension scores according involvement in EFC activities. RESULTS: Of 5064 eligible employees, 3888 (76.8%) participated in the study. Among the respondents, 440 (11.3%) participated in EFC activities. Experience feedback committee participants had a more developed patient safety culture, with 9 of the 12 HSOPS dimension scores significantly higher than EFC nonparticipants (overall effect size = 0.31, 95% confidence interval = 0.21 to 0.41, P < 0.001). A multivariate analysis of variance indicated that all 12 dimension scores, taken together, were significantly different between EFC participants and nonparticipants (P < 0.0001), independently of sex, hospital department, and healthcare profession category. The largest differences in scores related to the "feedback and communication about error," "organizational learning," and "Nonpunitive response to error" dimensions. The analysis of the subgroup of professionals who worked in a department with a productive EFC, defined as an EFC implementing at least five actions per year, showed a higher patient safety culture level for seven of the 12 HSOPS dimensions (overall effect size = 0.19, 95% confidence interval = 0.10 to 0.27, P < 0.001). DISCUSSION AND CONCLUSIONS: Participation in EFC activities was associated with higher patient safety culture scores. The findings suggest that root cause analysis in the team's routine may improve patient safety culture.

The contribution of open comments to understanding the results from the Hospital Survey on Patient Safety Culture (HSOPS): A qualitative study.

INTRODUCTION: To develop high-quality and safe healthcare, a good safety culture is an important feature of healthcare-providing structures. The objective of this study was to analyze the qualitative data of the comments section of a Hospital Survey on Patient Safety (HSOPS) questionnaire to clarify the answers given to the closed questions. METHOD: Using the original data from a cross-sectional survey of 5,064 employees at a single university hospital in France, we conducted a qualitative study by analyzing the comments of a HSOPS survey and conducting in-depth interviews with 19 healthcare providers. We submitted the comments and the interviews to a thematic analysis. RESULTS: A total of 3,978 questionnaires were returned, with 247 comments collected. The qualitative analysis identified several structural failures. The main categories of the open comments were concordant with the lowest dimension scores found in the quantitative analysis. The most frequently reported failures were related to the staffing and hospital management support dimensions. The healthcare professionals perceived the lack of resources, including understaffing, as the major barrier to the development of a patient safety culture. Concrete organizational issues related to hospital handoffs and risk coordination were identified, such as transfers from the emergency departments and the lack of feedback following self-reporting of incidents. CONCLUSION: The analysis of the open comments complemented the HSOPS scores, increasing the level of detail in the description of the hospital's patient safety culture. Combined with a classical quantitative approach used in HSOPS-based surveys, the qualitative analysis of open comments is useful to identify organizational weaknesses within the hospital.