BMJ Qual Saf doi:10.1136/bmjqs-2011-000286
  • Original research

Factors predicting change in hospital safety climate and capability in a multi-site patient safety collaborative: a longitudinal survey study

Open Access
  1. Charles Vincent
  1. Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
  1. Correspondence to Dr Jonathan Benn, Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Rm 506, 5th Floor Wright Fleming Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; j.benn{at}
  1. Contributors JB, SB and CV designed the original study protocol. All coauthors contributed to the design of the data collection tools and measures. APd, APo, SB and JB conducted data collection. APd and APo completed data entry and cleaning. JB conducted the statistical analysis and developed the first and revised drafts of the article with substantial contributions from APd, APo and CV. JB acts as the guarantor.

  • Accepted 27 March 2012
  • Published Online First 5 May 2012


Objective The study had two specific objectives: (1) To analyse change in a survey measure of organisational patient safety climate and capability (SCC) resulting from participation in the UK Safer Patients Initiative and (2) To investigate the role of a range of programme and contextual factors in predicting change in SCC scores.

Design Single group longitudinal design with repeated measurement at 12-month follow-up.

Setting Multiple service areas within NHS hospital sites across England, Wales, Scotland and Northern Ireland.

Participants Stratified sample of 284 respondents representing programme teams at 19 hospital sites.

Intervention A complex intervention comprising a multi-component quality improvement collaborative focused upon patient safety and designed to impact upon hospital leadership, communication, organisation and safety climate.

Measures A survey including a 31-item SCC scale was administered at two time-points.

Results Modest but significant positive movement in SCC score was observed between the study time-points. Individual programme responsibility, availability of early adopters, multi-professional collaboration and extent of process measurement were significant predictors of change in SCC. Hospital type and size, along with a range of programme preconditions, were not found to be significant.

Conclusion A range of social, cultural and organisational factors may be sensitive to this type of intervention but the measurable effect is small. Supporting critical local programme implementation factors may be an effective strategy in achieving development in organisational patient SCC, regardless of contextual factors and organisational preconditions.


  • Funding This work was supported by funding from the Health Foundation and the National Institute for Health Research (NIHR).

  • Competing interests None.

  • Ethics approval Approval provided by the Leicestershire, Northamptonshire & Rutland Research Ethics Committee 2.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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