Developing and evaluating a proof-of-concept patient safety training programme for health workers in North Macedonia

Patient safety is a global health priority, yet formal training in patient safety principles for healthcare workers remains limited in many countries, particularly in low-resource or transitional health systems. Similar to other countries in South-Eastern Europe, North Macedonia faces patient safety challenges-including a prevailing blame culture and gaps in standard safety practices. We designed, delivered and evaluated a context-tailored patient safety training programme for healthcare workers in North Macedonia and assessed its impact on participants' immediate knowledge gains of key patient safety topics.

A 4-day interactive training workshop was developed following a situational analysis of national safety gaps. Day 1 included awareness-raising sessions for institutional managers. Eighty-five healthcare workers, physicians, nurses and midwives, participated in a 3-day workshop that followed. The curriculum covered priority patient safety domains, such as incident reporting, infection prevention, medication safety and surgical and obstetric safety, delivered through lectures and case-based group exercises. Immediate knowledge gains were measured using a 20-item multiple-choice test administered pretraining and post-training. Pre-training and post-training scores were analysed and compared.

Baseline knowledge was suboptimal with a mean pretest score of 37% of correct answers. Immediately after the training, overall knowledge improved markedly. The mean post-test score reached 72%, a gain of 35 percentage points. All topic areas showed significant knowledge gains. Large improvements were observed in domains with the lowest baseline scores-mean correct responses in surgical safety domain increased from 19% to 76%, in obstetric safety from 18% to 67% and in infection control domain from 31% to 87%.

This proof-of-concept quality improvement research initiative suggests that focused educational interventions could help address patient safety knowledge gaps. Sustaining and expanding such training, by integrating it into routine workforce development and licensing, may help strengthen patient safety culture and practices in similar settings.