Evolution of patient safety culture in Belgian hospitals

4th International Improvement Science and Research Symposium 8 April 2014, Paris Evolution of patient safety culture in Belgian hospitals AnnemieVlayen, PhD Hasselt University, Faculty of Medicine &Life Sciences, Patient Safety Research Group, Belgium annemie.vlayen@uhasselt.be

The authors declare that there are no conflicts of interest Evolution of patient safety culture in Belgian hospitals after implementing a national patient safety plan Annemie Vlayen1, Johan Hellings1,2, Ward Schrooten1, Leandro Garcia Barrado3, Margareta Haelterman4and Hilde Peleman4 1 Hasselt University, Faculty of Medicine &Life Sciences, Patient Safety Research Group, Belgium 2 AZ Delta, Roeselare-Menen, Belgium 3 Hasselt University, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Belgium 4FPS Health, Food Chain Safety and Environment, Acute, chronic and Elderly Care Policy Unit, Brussels, Belgium

Facts & Figures Currently189 Belgianhospitals 104 acute 64 psychiatric 21 long-term care Flandria Dutch (Flemish) speaking 53% of hospitals Germanspeaking Brussels-Capital Bilingual 14% of hospitals • Wallonia • 33% of hospitals French speaking

BelgianFederal Program on QualityandSafety Pillar 3 Pillar 2 Pillar 1 STRUCTURE PROCESS OUTCOME Governmentfunding € 7.810.000/ year www.patient-safety.be

http://www.uhasseltq.be

Research questions • To what extent did the Belgian hospitals’ safety culture evolveafter participating in the federal program on quality and patient safety (after a period of three years)? • To what extent could variations in safety culture be explained by predictor variables? • Language (regional context) • Hospital characteristics (type of hospital, statute, hospital size) • Respondent characteristics (work area, staff position, work experience, numbers of hours worked per week) • Measurement occasion (first or second measurement) time effect?

Safety culture survey design • Participants:Belgian acute, psychiatricandlong-term care hospitalsparticipating in the Federal Program Qualityand Safety • Instrument:HospitalSurvey on Patient Safety Culture (AHRQ) Validatedversions in Dutch (Flemish) French German • Follow-up studydesign Benchmarking Benchmarking Benchmarking 2012 2008 2017 Baseline measurement Follow-up measurement Thirdmeasurement 180 out of 205 hospitals (88%) 179 out of 197 hospitals (91%) ? Vlayen A, Hellings J, Claes N, Peleman H, Schrooten W: A nationwide hospital survey on patient safety culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan. BMJ QualSaf2012, 21:760-767.

Hospital Survey on Patient Safety culture D1 Supervisor/manager expectations and actions promoting safety Unit level D2 Organizational learning–continuous improvement O2 Frequency of events reported Outcomedimensions O1 Overall perceptions of patient safety D3 Teamwork within units Safety Culture 12 dimensions (42 items) D4 Communication openness D10 Handoffs and transitions D5 Feedback and error communication D9 Teamwork across units D6 Non-punitive response to error D8 Management support for patient safety Hospital level D7 Staffing Vlayen A, Hellings J, Claes N, Peleman H, Schrooten W: A nationwide hospital survey on patient safety culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan. BMJ QualSaf2012, 21:760-767.

Comparative research: Methodology Data collection Comparative report Long-term care Electronic data entry Oddsratios ... Dendogram • Exclusion criteria • Entiresection incomplete • <1/2 items answered • All items scoredidentically • Respondent level • Hospital level • Unit group level • Professional group level Statistical analysis Benchmark database

Comparative research: Participants

Evolution of safety culture +8.5% Measurement 1 2

Evolution of safety culture

Evolution of safety culture Improvement > 5% Decrease > 5%

Variabilitybetweenhospital units 1 = Many different hospital units/ no specific unit 2 = Internalmedicine 3 = Surgical care units 4 =Operating theatre 5 = Gynaecology / obstetrics 6 = Pediatrics 7 = Intensive care units 8 = Emergency 9 = Rehabilitation 10 = Geriatrics 11= Psychiatrics 12 = Medical-technical services (diagnostics) 13 = Pharmacy Vlayen A, Schrooten W, Wami W, Aerts M, Claes N, BarradoGaricia L and Hellings J.Variability of patient safety culture in Belgian acute hospitals, Journal of Patient safety. 2013 Sep 27. [Epub]

Variabilitybetween professional groups 1 = Nurse 2 = Head nurse 3 = Nursing aid 4 = Physician 5 = Physicianhead of department 6 = Physicianassistant/ in training 7 = Pharmacist 8 = Assistant pharmacy 9 = Middle management 10 = Technician 11 = Therapist Vlayen A, Schrooten W, Wami W, Aerts M, Claes N, BarradoGaricia L and Hellings J.Variability of patient safety culture in Belgian acute hospitals, Journal of Patient safety. 2013 Sep 27. [Epub]

Lessonslearned • (Slight) positiveevolution of safety culture in Belgianhospitals • KeyProblemareas in Belgianhospitals • Handoffs and transitions • Staffing • Reporting of events + punitive response to error • Improvement for ‘Management support for patient safety’ • Large comparative safety culture databases allow identifying patterns and trends Tailor-made approach forimprovingsafety culture

Future approach • Need for implementation research to enriching evidence of the effectiveness of safety culture strategies • Needfor mixed-methodsdesign forevaluatingsafety culture: quantitative + qualitative approach • Need for integrating and linking of Quality and Safety data • Safety culture • Internalhospitalorganization of QualityandSafety → Governance • Leadershipstyles • Individualsafety performance of professionals (behavior) • Outcomes of care

Future approach Belgian Federal program on QualityandPatient Safety (2013-2017) themes: • Safety culture improvement • Communication •(Clinical) Leadership •Patientand family empowerment • High-risk medication • Identity-vigilance • Safe surgery • Transmural care More information on: www.patient-safety.be

References • Belgiansafety culture measurement tools, validationreportsand benchmark resultsavailablefrom: www.patient-safety.be • Vlayen A, Hellings J, Schrooten W, Garcia Barrado L, Haelterman M, Peleman H: EVOLUTION OF PATIENT SAFETY CULTURE IN BELGIAN HOSPITALS AFTER IMPLEMENTING A NATIONAL PATIENT SAFETY PLAN. BMJ QualSaf 2014;23:346-347 doi:10.1136/bmjqs-2014-002893.2 • VlayenA, Hellings J, Claes N, Peleman H, Schrooten W: A nation-widehospitalsurvey on patient safety culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan. BMJ QualSaf2012, 21:760-767. • VlayenA, Schrooten W, Wami W, Aerts M, Claes N, BarradoGaricia L and Hellings J.Variability of patient safety culture in Belgian acute hospitals, Journal of Patient safety. 2013 Sep 27. [Epub ahead of print]

Contact information Dr. AnnemieVlayen, PhD Hasselt University, Faculty of Medicine & Life Sciences, Patient Safety Research Group, Belgium annemie.vlayen@uhasselt.be

Evolution of patient safety culture in Belgian hospitals

Evolution of patient safety culture in Belgian hospitals

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