Interventions to improve the safety culture in an anaesthetic department

Background and Goal of Study:
True patient safety can only be achieved in a healthcare culture that fully embraces patient safety. Currently there is little information about the safety culture within Dutch hospitals. We assessed the safety culture within our anaesthetic department to target the direction of cultural changes that might be needed to further improve patient safety. 

Materials and Methods: 
The instrument used to evaluate the safety culture was developed by the Dutch Institute for healthcare research.1 This instrument describes 8 dimensions that are important to manage safety: Priority and responsibility of patient safety, incident reporting, resource allocation, communication, teamwork, personnel, competency and compliance. For every dimension there are 5 cultural levels of safety: pathological, reactive, calculative, proactive and generative. A Patient Safety Board was instituted to coordinate the improvement process. After the first assessment we targeted identified deficits. For example, we improved our difficult airway trolleys, incident reporting and we defined a fit-to-fly for personnel. Two years later we evaluated our safety culture again and aimed that 80% of staff would perceive at least a proactive safety culture.

Results and Discussion:
Hundred and twelve members of staff completed the survey in 2014 and 151 in 2016. A proactive safety culture was perceived by 73% of staff in domain 1, 67% in domain 2, 60% in domain 3, 40% in domain 4, 50% in domain 5, 51% in domain 6, 23% in domain 7 and 46% in domain 8. For domains 4,5,7 and 8 the percentage of staff perceiving a proactive safety culture was the same as in 2014. For domain 1 and 3 there were a 6% and 4% increase respectively, and for domains 2 and 6 there were a 9% and 4% decrease respectively. These domains should be targeted for further interventions.  The instrument used for this study is a quality assessment instrument and not a meter, therefore, the validity of this instrument cannot be expressed in a measure. 

Conclusion:
Performing an assessment of safety culture within a department can reveal and help target specific deficits within the culture of patient safety. It can also increase awareness of patient safety issues amongst staff. Despite our interventions we did not achieve a perceived proactive safety culture by 80% of staff. 

References:
V. Struben, C. Wagner, Ontwikkeling van een Instrument voor Zelf Evaluatie van de Patiëntveiligheidscultuur, NIVEL 2006