RT Journal Article
SR Electronic
T1 Effects of a team-based assessment and intervention on patient safety culture in general practice: an open randomised controlled trial
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 35
OP 46
DO 10.1136/bmjqs-2013-001899
VO 23
IS 1
A1 B Hoffmann
A1 V Müller
A1 J Rochon
A1 M Gondan
A1 B Müller
A1 Z Albay
A1 K Weppler
A1 M Leifermann
A1 C Mießner
A1 C Güthlin
A1 D Parker
A1 G Hofinger
A1 F M Gerlach
YR 2014
UL http://qualitysafety.bmj.com/content/23/1/35.abstract
AB Background The measurement of safety culture in healthcare is generally regarded as a first step towards improvement. Based on a self-assessment of safety culture, the Frankfurt Patient Safety Matrix (FraTrix) aims to enable healthcare teams to improve safety culture in their organisations. In this study we assessed the effects of FraTrix on safety culture in general practice. Methods We conducted an open randomised controlled trial in 60 general practices. FraTrix was applied over a period of 9 months during three facilitated team sessions in intervention practices. At baseline and after 12 months, scores were allocated for safety culture as expressed in practice structure and processes (indicators), in safety climate and in patient safety incident reporting. The primary outcome was the indicator error management. Results During the team sessions, practice teams reflected on their safety culture and decided on about 10 actions per practice to improve it. After 12 months, no significant differences were found between intervention and control groups in terms of error management (competing probability=0.48, 95% CI 0.34 to 0.63, p=0.823), 11 further patient safety culture indicators and safety climate scales. Intervention practices showed better reporting of patient safety incidents, reflected in a higher number of incident reports (mean (SD) 4.85 (4.94) vs 3.10 (5.42), p=0.045) and incident reports of higher quality (scoring 2.27 (1.93) vs 1.49 (1.67), p=0.038) than control practices. Conclusions Applied as a team-based instrument to assess safety culture, FraTrix did not lead to measurable improvements in error management. Comparable studies with more positive results had less robust study designs. In future research, validated combined methods to measure safety culture will be required. In addition, more attention should be paid to evaluation of process parameters. Implemented actions and incident reporting may be more appropriate target endpoints. Trial registration German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) No. DRKS00000145