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A nationwide Hospital Survey on Patient Safety Culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan
  1. Annemie Vlayen1,
  2. Johan Hellings1,2,
  3. Neree Claes1,
  4. Hilde Peleman3,
  5. Ward Schrooten1,4
  1. 1Hasselt University, Faculty of Medicine, Patient Safety Group, Diepenbeek, Belgium
  2. 2ICURO, Brussels, Belgium
  3. 3Federal Service Public Health, Brussels, Belgium
  4. 4Ziekenhuis Oost-Limburg, Genk, Belgium
  1. Correspondence to Annemie Vlayen, Hasselt University, Faculty of Medicine, Patient Safety Group, Agoralaan, Building D, Room D58, Diepenbeek 3590, Belgium; annemie.vlayen{at}


Objective To measure patient safety culture in Belgian hospitals and to examine the homogeneous grouping of underlying safety culture dimensions.

Methods The Hospital Survey on Patient Safety Culture was distributed organisation-wide in 180 Belgian hospitals participating in the federal program on quality and safety between 2007 and 2009. Participating hospitals were invited to submit their data to a comparative database. Homogeneous groups of underlying safety culture dimensions were sought by hierarchical cluster analysis.

Results 90 acute, 42 psychiatric and 11 long-term care hospitals submitted their data for comparison to other hospitals. The benchmark database included 55 225 completed questionnaires (53.7% response rate). Overall dimensional scores were low, although scores were found to be higher for psychiatric and long-term care hospitals than for acute hospitals. The overall perception of patient safety was lower in French-speaking hospitals. Hierarchical clustering of dimensions resulted in two distinct clusters. Cluster I grouped supervisor/manager expectations and actions promoting safety, organisational learning–continuous improvement, teamwork within units and communication openness, while Cluster II included feedback and communication about error, overall perceptions of patient safety, non-punitive response to error, frequency of events reported, teamwork across units, handoffs and transitions, staffing and management support for patient safety.

Conclusion The nationwide safety culture assessment confirms the need for a long-term national initiative to improve patient safety culture and provides each hospital with a baseline patient safety culture profile to direct an intervention plan. The identification of clusters of safety culture dimensions indicates the need for a different approach and context towards the implementation of interventions aimed at improving the safety culture. Certain clusters require unit level improvements, whereas others demand a hospital-wide policy.

  • Organisational culture
  • benchmarking
  • patient safety
  • cluster analysis
  • assessment
  • health policy
  • organization
  • patient safety
  • safety culture

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  • Additional appendices are published online only. To view these files please visit the journal online (

  • Funding This research was funded by Limburg Sterk Merk, Universiteitslaan 1, 3500 Hasselt, Belgium. The participating hospitals were partially funded by the Federal government program on quality and safety in healthcare.

  • Competing interests None to declare.

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