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  1. Vlayen Annemie,
  2. Hellings Johan,
  3. Schrooten Ward,
  4. Garcia Barrado Leandro,
  5. Haelterman Margareta,
  6. Peleman Hilde
  1. Hasselt University, Diepenbeek, Belgium


Introduction Within a 5-year federal program on quality and safety (2007–2012), the Belgian government provided a framework for implementing quality and safety strategies in the acute, psychiatric and long-term care hospitals with attention to three pillars: structure, processes and outcome measurement. One of the main objectives in the federal program was the development of a safety culture.

This research sought to examine to what extent the hospitals' safety culture evolved after participating in the federal program and to what extent safety culture could be explained by predictor variables.

Methods In order to measure safety culture within the Belgian hospitals, the Hospital Survey on Patient Safety Culture (HSPSC) was selected since it covers a broad range of patient safety aspects and previous research demonstrated good psychometric properties of the Dutch and French versions. The HSPSC includes 42 items that assess safety culture on 12 dimensions.

Between 2007 and 2009, 88% of all Belgian hospitals (180 out of 205) entered the federal program and conducted a baseline organization-wide safety culture measurement. In 2011, 91% of the hospitals (179 out of 197) conducted a second safety culture measurement. In order to track changes in safety culture after a period of three years, hospitals were invited to participate in a follow-up comparative research, organized by a neutral academic institution. Generalized Estimating Equations models were fitted to examine any existing relationships between safety culture predictor variables and each of the 12 safety culture dimensions.

Results The Belgian safety culture benchmark database includes 115 827 records drawn from 176 hospitals. Of those, 147 hospitals conducted a first measurement (53.6% response rate) and 140 hospitals repeated the measurement after three years (50.6% response rate). A comparative report was provided to each hospital, including its position on each dimension, to facilitate internal assessment and learning in the patient safety improvement process.

Trending of data was possible for 111 hospitals, which participated twice in the benchmark initiative. The evolution of safety culture on 12 dimensions is presented by type of hospital in figure 1.

Figure 1

Evolution of safety culture on 12 dimensions (acute, psychiatric and long-term care hospitals)

Blue boxplots represent the first measurement; green boxplots represent the second measurement. Dimensions: D1: Supervisor/manager expectations and actions promoting safety. D2: Organizational learning–continuous improvement. D3: Teamwork within units. D4: Communication openness. D5: Feedback and error communication. D6: Non-punitive response to error. D7: Staffing. D8: Management support for patient safety. D9: Teamwork across units. D10: Handoffs and transitions. O1: Overall perceptions of patient safety. O2: Frequency of events reported.

Work area, staff position, language, hospital type and statute were found to have important effects on safety culture perceptions. Hospital size and work experience, such as period working in the hospital, unit or profession, showed to have less effect on safety culture scores.

Discussion The Belgian safety culture research proves that large comparative patient safety databases allow to identifying patterns and trends and to offer high key areas for improvement. Within the Belgian hospitals, a higher attention should be paid to the transmission of patient care information and reporting of (near) incidents. Also, ‘Staffing’ showed to be an area that requires the attention of the federal authorities. The positive evolution on the dimension of ‘Management support for patient safety’ shows the increasing attention of the hospital management towards patient safety and this is considered as an important precondition for improving safety culture in the Belgian hospitals.

Declaration of competing interests None.

  • Patient safety
  • Mortality (standardized mortality ratios)
  • Patient education

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