Staying ahead of the curve: Navigating changes and maintaining gains in patient safety culture - a mixed-methods study Academic Article uri icon

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  • ObjectivesThis study examines how the results of the Hospital Survey on Patient Safety Culture changed between 2012 and 2019 and identifies organisational factors affecting these changes.DesignThe study combined the use of quantitative surveys of staff and qualitative interviews with hospital leadership. Secondary data analysis was performed for previous surveys.SettingThis study was conducted in a tertiary care teaching multisite hospital in Riyadh, Saudi Arabia.ParticipantsOne thousand hospital staff participated in the survey. Thirty-one executive board members and directors and four focus groups of frontliners were qualitatively interviewed.Primary and secondary outcome measuresTwelve safety culture dimensions were assessed to study the patient safety culture as perceived by the healthcare professionals. An additional semi-structured interview was conducted to identify organisational factors, changes, and barriers affecting the patient safety culture. Furthermore, suggestions to improve patient safety were proposed.ResultsComparing the results revealed a general positive trend in scores from 2012 to 2019. The areas of strength included teamwork within and across units, organisational learning, managerial support, overall perception of safety and feedback and communication about error. Non-punitive response to error, staffing and communication and openness consistently remain the lowest-scoring composites. Interview results revealed that organisational changes may have influenced the answers of the participants on some survey composites.ConclusionsPatient safety is a moving target with areas for improvement that are continuously identified. Effective quality improvement initiatives can lead to visible changes in the patient safety culture in a hospital, and consistent leadership commitment and support can maintain these improvements.


  • Titi, Maher Abdelraheim
  • Baksh, Maram Mohammed
  • Zubairi, Beena
  • Abdalla, Rawia Ahmad Mustafa
  • Alsaif, Faisal Abdullah
  • Amer, Yasser S
  • Jamal, Diana
  • El-Jardali, Fadi

publication date

  • March 2021