A facilitator's reflection on the democratizing potential of emancipatory practice development.

Emancipatory practice development (ePD) is a practitioner-led research methodology which enables workplace transformation. Underpinned by the critical paradigm, ePD works through facilitation and workplace learning, with people in their local context on practice issues that are significant to them. Its purpose is to embed safe, person-centred learning cultures which transform individuals and workplaces. In this article, we critically reflect on a year-long ePD study in an acute care hospital ward. We explore the challenges of practice change within systems, building collective strength with frontline collaborations and leadership to sustain new learning cultures. Our work advances practice development dialogue through working closely with the underpinning theories. Our critique analyses how ePD can enact and sustain change within a complex system. We argue that ePD works to strengthen safety cultures by challenging antidemocratic practices through communicative action. By opening communicative spaces, ePD enables staff to collectively deliberate and reach consensus. Their raised awareness supports staff to resist ways of working which conspire against safe patient care. Sustainability of practice change is fostered by the co-operative democracies created within the frontline team and meso level enablement. We conclude that the democratising potential of ePDt generates staff agency at the frontline.

Employees' pro-environmental behavior in an organization: a case study in the UAE.

This study investigates the factors influencing employees' pro-environmental behavior (PEB) within organizations in the United Arab Emirates (UAE), a nation with a strong policy focus on sustainability. Utilizing a questionnaire-based survey of 146 employees in an automotive division of a UAE company and structural equation modeling (SEM), the research examines the impact of green entrepreneurial orientation, green leadership, environmental commitment, and Green Human Resource Management (GHRM) on employees' willingness to engage in eco-friendly practices at work. The findings reveal that GHRM and green leadership significantly influence employees' green entrepreneurial orientation, which in turn, alongside environmental commitment, positively impacts PEB. These results emphasize the importance of integrating sustainability into organizational culture, leadership, and human resource practices to foster a workforce that actively participates in environmental initiatives, thereby contributing to the development of sustainable communities and enhancing stakeholder engagement. The study provides valuable insights into the specific factors that drive PEB in the UAE context, where national policies prioritize sustainability, highlighting that the importance of implementing green practices and promoting a supportive environment encourages employees and stakeholders to embrace environmental sustainability. The research also sheds light on the role of green entrepreneurial orientation, suggesting that empowering employees to develop innovative environmental solutions can be a key driver of PEB. The SEM analysis also confirmed the positive impact of GHRM and green leadership on green entrepreneurial orientation. Additionally, green entrepreneurial orientation and environmental commitment were found to significantly influence PEB. These results have practical implications for organizations in the UAE and beyond, emphasizing that by integrating eco-friendly practices and fostering stakeholder engagement, organizations can enhance their environmental performance, strengthen their reputation, and attract environmentally conscious customers and employees, contributing to the development of sustainable communities.

Organizational Health Literacy as a supportive tool for the effective implementation of the 2013/59/EURATOM Directive in Italy.

INTRODUCTION: Since 2013, European countries have transposed the 2013/59/EURATOM Directive that lays down basic safety standards for protection against dangers arising from exposure to ionising radiation. In the years between the issuance of the European Directive and its formal transposition, Italian researchers investigated solutions to renew the technological, educational, and organizational culture in radiology departments. SCOPE: This article proposed a reflection on the contribution of Organizational Health Literacy (OHL) to implement Legislative Decree 101/2020 in the practice of Italian radiology departments. RESULTS: By implementing OHL principles, examinations with exposure to ionizing radiation and related informative processes could be personalized based on patients' knowledge, abilities, and competencies, as well as on the services' provision. These principles can be in fact integrated with the organizational, training, and management requirements set by the Directive. CONCLUSIONS: According with the state-of-the-art, decision-makers and health managers could support the application of OHL principles in Italian radiology departments.

Strengthening a culture of research dissemination: A narrative report of research day at King Faisal Hospital Rwanda, a tertiary-level teaching hospital in Rwanda.

BACKGROUND: There are significant gaps in research output and authorship in low- and middle-income countries. Research dissemination events have the potential to help bridge this gap through knowledge transfer, institutional collaboration, and stakeholder engagement. These events may also have an impact on both clinical service delivery and policy development. King Faisal Hospital Rwanda (KFH) is a tertiary-level teaching hospital located in Kigali, Rwanda. To strengthen its research dissemination, KFH conducted an inaugural Research Day (RD) to disseminate its research activities, recognize staff and student researchers at KFH, define a research agenda for the hospital, and promote a culture of research both at KFH and in Rwanda. METHODS: RD was coordinated by an interdisciplinary committee of clinical and non-clinical staff at KFH. Researchers were encouraged to disseminate their research across all disciplines. Abstracts were blind reviewed using a weighted rubric and ranked by overall score. Top researchers were also awarded and recognized for their work, and equity and inclusion was at the forefront of RD programming. RESULTS: RD had over 100 attendees from KFH and other public, private, and academic institutions. Forty-seven abstracts were submitted from the call for abstracts, with the highest proportion studying cancer (17.02%) and sexual and reproductive health (10.64%). Thirty-seven researchers submitted abstracts, and most of the principal investigators were medical doctors (35.14%), allied health professionals (27.03%), and nurses and midwives (16.22%). Furthermore, 30% of principal investigators were female, with the highest proportion of them being nurses and midwives (36.36%). CONCLUSION: RD is an effective way to disseminate research in a hospital setting. RD has the potential to strengthen the institution's research agenda, engage the community in ongoing projects, and provide content-area support to researchers. Equity and inclusion should be at the forefront of research dissemination, including gender equity, authorship representation, and the inclusion of interdisciplinary health professionals. Stakeholder engagement can also be utilized to strengthen institutional research collaboration for greater impact.

Association between patient safety culture and professional quality of life among nursing professionals.

OBJECTIVE: To analyze the association between patient safety culture and professional quality of life in nursing professionals. METHOD: Correlational study carried out in a hospital in Salvador, Bahia, Brazil, with 180 participants. The data were collected through the Hospital Survey on Patient Safety Culture and Professional Quality of Life Scale and analyzed with correlation tests. RESULTS: The use of the Quality of Professional Life model, which encompasses Compassion Satisfaction, Burnout and Traumatic Stress, showed that a better assessment of the safety culture was negatively associated with Burnout. Regarding the dimensions of culture, better evaluations of the general perception of safety, teamwork and staffing were negatively associated with Burnout and Traumatic Stress. Higher Burnout was negatively associated with better handoffs and greater Traumatic Stress was positively associated with error communication. CONCLUSION: Higher levels of Burnout were associated with worse perception of safety culture and worse teamwork evaluations; staffing and general perception of safety were associated to a higher level of Burnout and Traumatic Stress, which emphasizes the importance of investment in these areas.

Patient safety culture in the Operating Room of an emergency hospital in Amazonas: perspectives from the healthcare team.

INTRODUCTION: The concept of safe care permeates health institutions around the world, however, it is necessary to understand the safety culture of an institution to improve the provision of safety to patients and professionals. METHODOLOGY: Cross-sectional study with a quantitative approach. The sample was made up of 119 health professionals who made up the multidisciplinary team at the surgical center from August to September 2021, where data collection took place. The Hospital Survey on Patient Safety Culture (HSOPSC) instrument was used to evaluate the twelve dimensions that make up patient safety culture. Data analysis was carried out using descriptive statistics, to evaluate the reliability of the responses to the HSOPSC instrument, the Cronbachs Alpha test was used. RESULTS: Of the twelve dimensions evaluated, there was no dimension considered strong for patient safety in the unit. The dimensions with potential for patient safety were "Expectations and actions of the supervisor/manager to promote patient safety"; "Teamwork within units" and "Organizational learning - continuous improvement", while all other dimensions were evaluated as weak for patient safety. 39.50% of participants consider patient safety in the unit to be regular, despite this, 89.91% of participants reported not having made any event notifications in the last 12 months. CONCLUSION: The study highlighted the need to strengthen all dimensions of the patient safety culture by the team at the hospital studied, as none of them were identified as strong.

Patient safety culture perceptions among dentists in the eastern region of Saudi Arabia.

OBJECTIVE: Safe patient care can help reduce treatment costs, morbidity, and mortality. This study aimed to assess dentists' perceptions of patient safety culture and related factors in the Eastern region of Saudi Arabia. METHODS: This cross-sectional study used a sample of 271 dental professionals working in private and public dental hospitals and clinics in the Eastern region of Saudi Arabia. The Safety Attitude Questionnaire (SAQ), a validated tool consisting of 36 items on a 5-point Likert scale, was used to assess dentists' perceptions of patient safety culture. The score of SAQ ranges from 0 to 100 and a cut-off ≥ 75 is considered a positive attitude toward patient safety culture. RESULTS: There were 53.9% males and 46.1% females in the study with a mean age of 35.56 ± 6.87 years. Almost half of the participants (52%) attended a course on patient safety and 22.1% experienced medical error in the last month. The mean score of the SAQ of the sample was 65.14 ± 13.03 and the patient safety score was significantly related to the marital status (P = 0.041), attendance of patient safety course (P < 0.001), and experience of medical error (P = 0.008). The highest mean score (73.27 ± 20.11) was for the job satisfaction domain, followed by the safety climate domain (67.69 ± 16.68), and working conditions domain (66.51 ± 20.43). About one-quarter of the participants (22.5%) demonstrated positive attitudes toward patient safety culture. Multiple logistic regression analysis showed that dental professionals who attended a patient safety course were 4.64 times more likely to demonstrate positive attitudes toward patient safety than those who did not attend a course (P < 0.001). CONCLUSION: This study showed that patient safety culture was significantly related to the attendance of safety courses, marital status, and experiencing medical error. About one out of four dental professionals demonstrated a positive attitude towards patient safety culture which was significantly associated with the attendance of the safety course.

Revolutionising health and social care: innovative solutions for a brighter tomorrow - a systematic review of the literature.

BACKGROUND: In an era marked by rapid technological advancements, changing demographics, and evolving healthcare needs, the landscape of health services has been undergoing a profound transformation. Innovation has emerged as a central force driving change in the healthcare sector, as stakeholders across the globe strive to enhance the quality, accessibility, and efficiency of healthcare services. OBJECTIVE: Within this dynamic context, this systematic literature review explored the barriers and driving forces behind successful health service innovation. METHODS: A comprehensive systematic literature review was conducted using the Griffith University Library search engine and databases that included PubMed, ProQuest, Web of Science, Scopus, and CINHAL. To achieve the study goal, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the associated PRISMA checklist guided the review and reporting method. RESULTS: Findings from this review identified a need for a universal definition of health innovation that encompasses the unique complexities and challenges within this context. In our comprehensive analysis of healthcare innovation, we have uncovered pivotal findings that underscore the indispensable nature of a well-structured framework. CONCLUSIONS: To succeed in fostering innovation within the health and social care sectors, it is imperative to establish an overarching organisational culture that meticulously addresses the following key components: team challenges; communication and collaboration; governance goals and authentic leadership, environmental engagement; and innovation endurance. Through systematic analysis of existing literature, this review offers a definition of health innovation, covering its conceptual foundations, determinants, and barriers, and provides a framework for creating an innovative culture.

Patient safety culture and associated factors of regional public hospitals in Addis Ababa.

BACKGROUND: Patient safety culture is the result of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment, style, and proficiency of health providers' safety management. Globally, millions of adverse events occur annually, with a significant burden on low- and middle-income countries. The burden of injuries and other harm to patients from adverse events is likely one of the top 10 causes of death and disability worldwide. This study aimed to assess patient safety culture and its associated factors in regional public hospitals in Addis Ababa. METHODS: An institution-based cross-sectional study was conducted among 494 healthcare professionals working at regional public hospitals in Addis Ababa. The data were collected using a pretested structured self-administered questionnaire from June 3 to July 30, 2023. The data were entered into Epi info version 7.2 and exported to SPSS version 26.0 for analysis. Binary logistic regression analysis was used to determine the associations between the patient safety culture (dependent variables) and socio-demographic factors, health care providers and system's. Multicollinearity was checked using VIF, and the adequacy of the final model was assessed using the Hosmer and Lemeshow goodness-of-fit test. RESULT: Overall, 48.8% (95% CI: 44.3-53.1) of participants had a good patient safety culture, for a response rate of 93.3%. Factors significantly associated with patient safety culture, as identified through factor analysis, included having 6-10 years of experience (AOR = 1.81, 95% CI = 1.13-2.88), having more than 11 years of experience (AOR = 3.49, 95% CI = 1.27-9.56), reporting adverse events (AOR = 2.47, 95% CI = 1.37-4.45), participating in patient safety programs (AOR = 3.64, 95% CI = 1.91-6.92), and working in obstetrics and pediatric wards (AOR = 0.47, 95% CI = 0.23-0.94) and (AOR = 0.21, 95% CI = 0.097-0.44), respectively. CONCLUSION: The overall level of patient safety culture in regional public hospitals was low (< 75%). Factors such as having 6 or more years of experience, reporting adverse events, participating in patient safety programs, and working in obstetrics and pediatric wards were significantly associated with patient safety culture.

The predictive role of resilience and the ethical climate of hospital in the fatigue of surgical technologists working in operating rooms.

BACKGROUND: Fatigue in surgical technologists is of paramount importance and is known as a priority because it can be regarded as a threat to the nurse's health and patient's safety. The fatigue level of healthcare workers can be affected by some factors, while the role of part of these factors is less known. This study aimed to determine the predictive role of resilience and the hospital ethical climate in the fatigue of surgical technologists working in operating rooms (ORs). METHODS: This is a cross-sectional study conducted on 217 surgical technologists working in ORs of hospitals affiliated with Shiraz University of Medical Sciences. Data were collected using Connor-Davidson's Resilience scale, Olson's Hospital Ethical Climate Survey, and the Multidimensional Fatigue Inventory, and then analyzed using Pearson's correlation coefficient and multiple regression analysis. RESULTS: 87.1% and 12.9% of surgical technologists reported low and high fatigue, respectively. All fatigue subscales had significant and negative relationships with resilience (p < 0.05). Moreover, the relationship between fatigue and ethical climate was significant (p = 0.02). The multiple linear regression model showed the predictive role of resilience in fatigue (ß=-0.29, P < 0.001). According to the model, 10% of the change of fatigue was related to resilience and ethical climate. CONCLUSION: The present study demonstrated the relationship between resilience and ethical climate with fatigue. Moreover, resilience was a predictor of the surgical technologists' fatigue, so that their fatigue decreased with increasing resilience. However, future studies are recommended to determine other factors influencing fatigue in surgical technologists.

Effect of the data-informed platform for health intervention on the culture of data use for decision-making among district health office staff in North Shewa Zone, Ethiopia: a cluster-randomised controlled trial.

BACKGROUND: Similar to other low and middle-income countries, Ethiopia faces limitations in using local health data for decision-making.We aimed to assess the effect of an intervention, namely the data-informed platform for health, on the culture of data-based decision making as perceived by district health office staff in Ethiopia's North Shewa Zone. METHODS: By designating district health offices as 'clusters', a cluster-randomised controlled trial was implemented. Out of a total of 24 districts in the zone, 12 districts were allocated to intervention arm and the other 12 in the control group arms. In the intervention arm district health office teams were supported in four-monthly cycles of data-driven decision-making over 20 months. This support included: (a) defining problems using a health system framework; (b) reviewing data; (c) considering possible solutions; (d) value-based prioritizing; and (e) a consultative process to develop, commit to, and follow up on action plans. To measure the culture of data use for decision-making in both intervention and control arms, we interviewed 120 health management staff (5 per district office). Using a Likert scale based standard Performance of Routine Information System Management tool, the information is categorized into six domains:- evidence-based decision making, emphasis on data quality, use of information, problem solving, responsibility and motivation. After converting the Likert scale responses into percentiles, difference-in-difference methods were applied to estimate the net effect of the intervention. In intervention districts, analysis of variance was used to summarize variation by staff designation. RESULTS: The overall decision-making culture in health management staff showed a net improvement of 13% points (95% C.I:9, 18) in intervention districts. The net effect of each of the six domains in turn was an 11% point increase (95% C.I:7, 15) on culture of evidence based decision making, a 16% point increase (95% C.I:8, 24) on emphasis on data quality, a 20% point increase (95% C.I:12, 28) on use of information, a 21% point increase (95% C.I:13, 29) on problem solving, and a 10% point increase (95% C.I:4, 16) on responsibility and motivation. In terms of variation by staff designation within intervention districts, statistically significant differences were observed only for problem solving and responsibility. CONCLUSION: The data-informed platform for health strategy resulted in a measurable improvement in data use and structured decision-making culture by using existing systems, namely the Performance Monitoring Team meetings. The intervention supported district health offices in identifying and solving problems through a structured process. After further research, DIPH intervention could also be applied to other health administration and facility levels. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT05310682, Dated 25/03/ 2022.

Influences of Leadership, Organizational Culture, and Hierarchy on Raising Concerns About Patient Deterioration: A Qualitative Study.

BACKGROUND: Raising concerns is essential for the early detection and appropriate response to patient deterioration. However, factors such as hierarchy, leadership, and organizational culture can impact negatively on the willingness to raise concerns. OBJECTIVES: This study aims to delve into how leadership, organizational cultures, and professional hierarchies in healthcare settings influence healthcare workers, patients, and caregivers in raising concerns about patient deterioration and their willingness to do so. METHODS: The study used a qualitative approach, conducting focus group discussions (N = 27), utilizing authentic audio-visual vignettes to prompt discussions about raising concerns. Deductive thematic analysis was employed to explore themes related to hierarchy, leadership, and organizational culture. RESULTS: Positive leadership that challenged traditional professional hierarchies by embracing multidisciplinary teamwork, valuing the input of all stakeholders, and championing person-centered practice fostered a positive working culture. This culture has the potential to empower clinical staff, patients, caregivers, and family members to confidently raise concerns. Staff development, clinical supervision, and access to feedback, all underpinned by psychological safety, were viewed as facilitating the escalation of concerns and, subsequently, have the potential to improve patient safety. CONCLUSIONS: This study offers crucial insights into the intricate dynamics of leadership, hierarchy, and organizational culture, and their profound impact on the willingness of staff and patients to voice concerns in healthcare settings. Prioritizing the recommendations of this study can contribute to reducing avoidable deaths and elevating the quality of care in healthcare settings.

High Reliability in a Safety Net Hospital Leading to Operational Excellence.

OBJECTIVE: The objective of this work was to establish sustainable systems for quality improvement in an Academic Medical Center and Safety Net Hospital. METHOD: High reliability principles of leadership engagement, a culture of safety, and sustainable performance improvement were used. Target areas for improvement were clinical outcomes for patients, public reputation scores, and lower cost of care. The system was based on annual focused goals with specific targets, improvement teams, transparent scorecards, and data driven work. Program visibility was championed by leaders. Consistent education on quality, safety, efficiency, and effectiveness for all employees created buy-in. Data review and accountability tracked progress, helped resource allocation, and defined next steps. RESULTS: In the first 5 years, all patient quality and safety metrics improved between 10% and 60%. This improvement resulted in higher CMS Star Ranking and Leapfrog patient safety grade. The next phase included maximizing value by expanding into hospital operations and finance with a focus on improved clinical documentation and reduced length of stay and cost of care. Clinical documentation improvement led to a 15% increase in comorbidity capture. This positively impacted reported outcomes and hospital payment by appropriate risk adjustment. Length of stay was addressed with a new care coordination program and physician-driven utilization review. CONCLUSIONS: High reliability principles are applicable in a resource limited healthcare system. Improved clinical and operational results were achieved through goal setting, improvement teams, and data driven projects leading to creation of an office of operational excellence.

Connor Davidson resilience scores, perceived organizational support and workplace violence among emergency nurses.

BACKGROUND: Workplace violence can threaten the physical and mental health of emergency nurses, increasing their mobility and burnout rates. However, little research has focused on how to mitigate the negative effects of workplace violence. OBJECTIVES: To investigate the relationships among resilience scores, perceived organizational support, and workplace violence and to explore the mediating role of perceived organizational support in the relationship between resilience scores and workplace violence among emergency nurses. RESEARCH DESIGN: A quantitative, cross-sectional study. METHODS: From June to July 2023, 466 valid questionnaires were collected via the WeChat app Credamo Seeing Numbers. Participants were assessed using the Connor-Davidson Resilience Scale, the Perceived Organizational Support Scale, and the Fear of Future Violence at Work Scale. ETHICAL CONSIDERATION: The study was approved by the Ethics Committee of Hunan Normal University (No. 2023-389). FINDINGS: The Connor-Davidson resilience scores of emergency nurses were negatively associated with workplace violence and positively associated with emergency nurses' perceived organizational support. Emergency nurses' perceived organizational support was negatively associated with workplace violence. Perceived organizational support moderated the relationship between Connor-Davidson resilience scores and workplace violence among emergency nurses to some extent. DISCUSSION: High levels of Connor-Davidson resilience scores can mitigate the negative effects of workplace violence. Perceived organizational support can increase with increasing levels of Connor-Davidson resilience scores. When nurses face workplace violence, support from the organization can, on the one hand, reduce the negative impacts of stress and, on the other hand, elicit positive emotions. CONCLUSION: To mitigate the effects of workplace violence on emergency nurses, interventions aimed at both internal and external organizational conditions must be developed to establish a supportive environment that can increase emergency nurses' Connor-Davidson resilience scores and sense of perceived organizational support, and decrease workplace violence.

The effect of workforce diversity on organizational performance with the mediation role of workplace ethics: Empirical evidence from food and beverage industry.

This study examines the effect of workforce diversity on organizational performance in the Ethiopian food and beverage sector. It incorporates workplace ethics as a mediator to explain in detail the complex relationship between workforce diversity and organizational performance. The study uses a quantitative design, in which data is collected from a random sample of 359 employees from stratified random firms. A Structural Equation Model (SEM) result verified the viability of three of the four proposed hypotheses. Organizational performance is not directly affected by workforce diversity. But it directly changes in response to the change in workplace ethics. Besides, workplace ethics mediate the relationship between workforce diversity and organizational performance. This implies a more advanced relationship exists between diversity and performance, involving effects transitions via workplace ethics, than what this study initially proposed. Thus, an approach to improving firm performance involves reinforcing good workplace ethics practices. Organizations can mitigate the negative impact of workforce diversity on workplace ethics by creating a more inclusive and ethical workplace. This includes providing training on diversity and inclusion and promoting a culture of respect and understanding.

Clinical Nurse Peer Review: A Process That Works for the Nurse and the Organization.

Clinical peer review is a strategy that engages nurses in elevating not only the safety of patients but also their influence on practice. There is little guidance in the literature about how to operationalize peer review in a way that promotes just culture. In a postpandemic era, where nurse engagement and retention are low, this article describes how to implement and measure the impact of clinical peer review on practice trends and empower nurses to influence system-wide change.

Implementation of Full Practice Authority for Nurse Practitioners in Massachusetts: Impact of Organizational Climate on Practice Change.

OBJECTIVE: The aim of this study was to examine the relationship between nurse practitioner (NP) organizational climate and the implementation of full practice authority (FPA) for NPs. BACKGROUND: In 2021, Massachusetts passed FPA for NPs. Most NPs did not experience changes to their practice. It is unknown whether NP organizational climate impacts implementation of FPA. METHODS: A Web-based survey was distributed to NPs in Massachusetts. RESULTS: Response rate was 50.3% (N = 147). Practice remained unchanged for most. Organizations with more favorable climates experienced more rapid implementation of FPA, resulting in improved efficiency (P = 0.049) and timeliness (P = 0.007) of care. Nurse practitioners outside hospital systems were more likely to report favorable organizational climates and positive change to their practice after FPA. CONCLUSIONS: Organizations that facilitate implementation of FPA are likely to experience improvement in efficiency and timeliness of patient care. Nursing leadership, especially within hospital-based organizations, can help achieve these benefits by improving the organizational climate for NPs.

Safety climate in the operating room in the pre-pandemic and pandemic period of COVID-19: A mixed method study.

INTRODUCTION: To verify whether the COVID-19 pandemic has had an impact on the safety climate based on the perception of the multiprofessional team in the operating room and to analyze the domains of the safety climate during the pre-pandemic and pandemic period of COVID-19, demonstrating the intersections of quantitative and qualitative approaches. METHODS: Mixed-method research using a convergent approach strategy, carried out in the operating room of a university hospital, located in Rio de Janeiro, Brazil. The nature of the quantitative phase was cross-sectional, and the nature of the qualitative phase was descriptive. We used the Pillar Integration Process to integrate the data. This research considered the pre-pandemic period was defined as before March 2020 and for the pandemic period, the 2nd and 3rd global waves. Research was approved by the institution's board management and ethics committee. RESULTS: 145 health professionals participated in the quantitative approach, and 20 in the qualitative approach. The impact of the COVID-19 pandemic was highlighted in the domains 'Perceived stress' (p-value = 0.017); 'Working conditions' (p-value = 0.040). Six categories emerged from the qualitative analysis, namely: Stress and professional performance due to COVID-19; Patient safety protocols in the operating room; Responsibility for patient safety, lack of effective communication and performance feedback; Biosafety of the professional staff in the operating room; Security culture maturity; Fair culture, organizational learning, and reporting mistakes. As a result of the data integration, 6 pillars were identified: Perception of communication in the operating room; Evolution of safety culture; Overview of protocol management and implementation; Fair organizational culture; Perception of stress due to COVID-19; Perception of professional performance due to COVID-19. CONCLUSIONS: The impact that COVID-19 had on the safety climate in the operating room is evident. It underlines the need to implement strategies that support the solidification of attitudes aimed at patient safety, even in emergencies.