20/01/2022
Patient safety culture may not be a consistently stable concept across national boarders even in regions of the world such as the European Union due to diverse cultures, differing health system characteristics, and varied professional practice contexts. This was the first mixed methods study to compare patient safety culture in four different countries in the European Union. Despite an early record of robust legislative achievements in patient safety, the European Union has produced no new regulations for nearly a decade. Nurses in this study generally reported working in hospitals with unfavorable safety cultures, with many punitive characteristics in some countries. Inadequate nurse staffing was observed to be a serious problem for most hospitals, yet many participants seemed to accept this reality. The findings from this study suggest patient safety needs to re-emerge as an important health policy concern for the European Union.
Congratulations to Dr. Nina Granel and her team of researchers for this substantial work resulting in a significant contribution to the patient safety culture literature. The publication information including citation and abstract are provided below.
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Granel-Giménez, N., Palmieri, P. A., Watson-Badia, C. E., Gómez-Ibáñez, R., Leyva-Moral, J. M., & Bernabeu-Tamayo, M. D. (2022). Patient safety culture in European hospitals: A comparative mixed methods study. International Journal of Environmental Research and Public Health, 19(2), 939. https://doi.org/10.3390/ijerph19020939
BACKGROUND: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries.
PURPOSE This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden.
STUDY DESIGN: A comparative mixed methods study with a convergent parallel design.
METHODS: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 hours of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data.
RESULTS: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia.
CONCLUSIONS: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy.
