Patient safety management systems, activities and work environments related to hospital-level patient safety culture: A cross-sectional study

Improvement in patient safety culture requires constant attention. This study aimed to identify hospital-level elements related to patient safety culture, such as patient safety management systems, activities and work environments. Two questionnaire surveys were administered to hospitals in Japan in 2015 and 2016. The first survey aimed to determine which hospitals would allow their staff to respond to a questionnaire survey. The second survey aimed to measure the patient safety culture in those hospitals. Patient safety culture was assessed using the Hospital Survey on Patient Safety Culture (HSOPS). The relationship of hospital-level patient safety culture with the aforementioned elements in each hospital was analyzed. The response rate to the first survey was 22% (721/3270), and 40 eligible hospitals were selected from the respondents. The second survey was administered to healthcare workers in those 40 hospitals, and the response rate was 94% (3768/4000). The proportion of respondents who had 7 or more days off each month was related to the scores of 7 composites and the Patient Safety Grade of HSOPS. Both the presence of a mission statement describing patient safety and the proportion of respondents who participated in in-house patient safety workshops at least twice annually were related to the scores of 5 composites and the Patient Safety Grade of HSOPS. Our study suggests that the number of days off each month, the presence of a hospital patient safety mission statement, and the participation rate in in-house patient safety workshops might be key factors in creating a good patient safety culture within each hospital.