Evolution of patient safety culture in Belgian acute, psychiatric and long-term care hospitals

Background: In Belgium, the federal government launched a national program to support hospitals for implementing quality and patient safety strategies. One of the main objectives in the federal program is the development of a safety culture. The purpose of this study was to examine to what extent the hospitals’ safety culture evolved after participating in the federal program and to explore predictor variables of safety culture. Methods: In a cross-sectional follow-up design, safety culture was measured in the Belgian acute, psychiatric and long-term care hospitals using validated translations of the Hospital Survey on Patient Safety Culture in Flemish and French. For both nationwide measurements, hospitals were invited to participate in a benchmark research organized by an academic institution (in 2008 and 2012). Generalized Estimating Equations models were fitted to examine the effect of predictor variables on safety culture perceptions. Results: The Belgian safety culture database contains data from 115 827 respondents from 176 hospitals. For 111 hospitals that participated in both benchmarks it was possible to calculate changes in safety culture. The response rate for the second measurement (52.2%) was comparable to the response rate in the first measurement (51.0%). Improvements were observed for most safety culture dimensions with a major significant improvement for ‘Management support for patient safety’. Although ‘Handoffs and transitions’ and ‘Frequency of events reported’ were key areas within the federal program, a decline was observed for these dimensions. Work area, staff position, language (regional context of hospital), hospital type and hospital statute were found to have important effects on safety culture perceptions. Hospital size and work experience, showed to have less effect on safety culture scores. Conclusions: Large comparative safety culture databases allow identifying patterns and trends. Our findings on variations in safety culture perceptions between types of hospitals, hospital units and professional groups implicate the need for a tailor-made approach for safety culture improvement. Future research should focus on enriching the evidence of the effectiveness of safety culture strategies and linking of safety culture and outcomes of care in order to assess the practical validity of safety culture surveys.