Interventions to enhance safety culture for nursing professionals in long-term care: A systematic review

Recognizing safety risks and promoting safe care is essential for care dependent people and should be an integral part of the overall preventive endeavors while providing care. The term 'safety culture' describes efforts regarding the acknowledgement and reduction of safety risks. Enhanced safety culture in health care organizations can be associated with a lower incidence of missed nursing care and adverse events.

Identify strategies to enhance safety culture in long-term care settings and describe factors facilitating or inhibiting the process from the available evidence.

This systematic review is a narrative description of intervention studies.

CINAHL and MEDLINE were searched in May 2020 using terms such as safety culture, safety climate, intervention development. Gray literature was searched between May and September 2020. An additional search in Cochrane Library was conducted in September 2022. Only intervention studies feasible to enhance the safety culture were included. Intervention study criteria were met when an organized, planned action to prevent or change a specific behavior took place and when this action was transparently and systematically evaluated. The screening, data extraction, and rating processes were conducted by two researchers independently. The ROBINS-I tool was utilized to assess the risk of bias of the studies.

Seven intervention studies were included, all evaluated with a critical risk of bias. Strategies found to enhance the safety culture in care settings include collegial exchange of experiences and learnings, integration of staff's perceptions, external facilitation, staff training, and a structured, multi-step procedure of the intervention process. Some studies were unable to show statistically significant enhancement in safety culture from the interventions implemented. Factors facilitating the implementation of interventions include good connections and trust between staff and managers, and the manager's active support of the project goals, as well as targeting achievable ideas considering time and resources. Time pressure, heavy workloads and high staff turnover may inhibit the process.

All included studies had a high risk of bias, and possible effects must be considered accordingly. Overall, there was considerable heterogeneity in interventions aiming to enhance safety culture. Despite these aspects, promising approaches are training staff's knowledge and competencies regarding open communication and teamwork as part of a multifaceted program. Future research would benefit from participative, carefully developed, comprehensively evaluated interventions for enhancing safety culture, specifically within in-home care settings.

The review was not pre-registered but described on the website of the Center for Quality in Care.

Participatory change management & staff training help ensure momentum & trust in endeavours to enhance safety culture in long-term care.