Table 7 'Institution-Wide use of Cultural Assessment'

PSI 7: Institution-Wide use of Cultural Assessment
Origin: PSI by SimPatIE
Dimension Description
Description of Specific
Aspects of Patient Safety
Focus of the works of patient safety has shifted over the time from
investigation of the epidemiology of adverse events and
introduction of innovations aimed at prevention to investigation of
shared attitudes, beliefs, values and assumptions that underlie how
people perceive and act upon safety. It is thought important to try
to grasp these shared characteristics to initiate fundamental and
sustained changes to patient safety.
Thus cultural surveillance is important in developing patient
safety.
Aim of the PSI This PSI aims at surveillance of the use of regular yearly cultural
assessment within the hospital.
Level of Determination of
Patient Safety
Safety is assessed at the aggregate institutional level.
Source(s) PSI is by SimPatIE.
Extent of Clinically Testing We found no evidence for the use of an indicator for monitoring
the frequency of the use of culture assessments.
It is an acknowledged fact in the literature, that measuring the
safety gives the management/organisations a baseline for
developing the culture. Results of regular measures give the
management/organisations the opportunity to plan and carry out
adequate changes to develop patient safety.
A systematic literature review of ten studies was conducted to
review the evidence for a relationship between organisational
culture and health care performance. The reviewer’s found a
considerable variation in the design, study setting, and quality of
reporting and aspects of culture/performance considered.
Researchers of four of the studies found supportive evidence for
an association between culture and performance are linked (19).
A recent study revealed that the overall unit based safety climate
significantly predicted nurse back injuries, medication errors and
urinary tract infections. A more positive safety culture was
associated with fewer incidents (20).
Numerous articles give a general introduction and presentation to
evaluation of safety culture within health care (21-24). Also in
recent years a large number of quantitative tools with differing
characteristics have been developed to access the generic concept
of culture (22;25-27). The instruments vary in focus, aim, method,
application and validity. Not surprisingly, there is not one best
SImPatIE WP4 – Catalogue of Patients Safety Indicators
20
instrument, as they all have strengths and weaknesses. The
important thing is for organisations to select the instrument that is
most appropriate for their purposes and validated in a relevant
setting.
Evidence of Clinically use of
Standards
Though cultural assessment is in use in numerous hospitals in
Europe, we have not found specific scientific evidence describing
use of cultural assessment as a PSI.
PSI category Institution-Wide PSI.
Data definitions The yearly number of units assessing the patient safety culture per
total number of units in the hospital.
Numerator Description The yearly number of units assessing patient safety culture using a
quantitative measure
Denominator Description Total number of units in the hospital
Data Source Yearly observational cross-sectional survey on the unit wise use
of cultural assessment. The instrument chosen must be suitable,
and it must be validated in a relevant setting.
Identifying the institutional
context
The assessment of patient safety culture is important in general
organisational and clinical improvement policies.
Care Setting The PSI applies for institution-wide high quality culture related to
patient safety.
Professionals Responsible for
heath care
Not applicable as all hospital staff form, interact and influence the
safety culture.
Lowest Level of Health Care
Delivery Addressed
Individual clinical units or departments.
Allowance for Patient
Factors
Not applicable.
Stratification by Vulnerable
Populations
Not applicable.
Standard of Comparison Yearly monitoring. Comparison with the previous measures.
Benchmarking.
Scoring Frequencies are counted by observation.