Patient Safety Culture in European Hospitals: A Comparative Mixed Methods Study.

Area of Science:

• Healthcare Management
• Patient Safety
• Cross-cultural Studies

Background:

• Inadequate health systems and leadership hinder the development of robust safety cultures, impacting patient safety and preventing adverse events.
• While patient safety culture is widely studied, the link between clinician perceptions and actual practices, especially across different countries, remains underexplored.
• There is a need for mixed-methods research to deepen the understanding of safety culture, with limited comparative studies available internationally.

Purpose of the Study:

• To compare the patient safety culture in hospitals across four European countries: Croatia, Hungary, Spain, and Sweden.
• To examine safety culture from the perspective of nurses working in these diverse healthcare settings.
• To identify variations and commonalities in safety culture perceptions and practices among participating nations.

Main Methods:

• A comparative mixed-methods study employing a convergent parallel design.
• Data collection involved surveys (n=538) using the Hospital Survey on Patient Safety Culture (HSOPSC), in-depth interviews (n=24), and non-participant workplace observations (147 hours).
• Nurses from internal medicine, surgical, and emergency departments in two public hospitals per country participated; data were analyzed using descriptive/inferential statistics and content analysis.

Main Results:

• Overall safety culture perceptions ranged from 'adequate' (Sweden) to 'adequate' to 'poor' (Croatia, Hungary, Spain), with discrepancies between survey and qualitative data.
• Teamwork within units was the most positive dimension, but qualitative data revealed inconsistencies in support, respect, and teamwork in Croatia and Hungary.
• Staffing and workload were identified as critical areas for improvement across all countries, despite Sweden and Spain having higher nurse-to-patient ratios.

Conclusions:

• Despite EU membership, most safety culture dimensions in the studied hospitals require enhancement, with perceptions often ranging from adequate to poor.
• Incongruent perceptions and practices across countries suggest that national culture and health system structures influence safety culture.
• Significant improvements are needed in patient safety culture, particularly concerning staffing and workload, to foster more robust and consistent safety practices.