Evolution of Culture on Patient Safety in the Clinical Setting of a Spanish Mutual Insurance Company: Observational Study between 2009 and 2017 Based on AHRQ Survey

Background: Patient safety (PS) is a key factor in reducing or even eradicating adverse incidents and events. Many health organizations promote strategies to improve PS, while also pointing out the importance of measuring it. For more than eight years, our institution has developed strategies focused on improving PS-culture among our personnel. The goal of this paper is to analyze the PS-culture between the years 2009 and 2017. Methods: A cross-sectional survey focused on PS, and developed by the American Agency for Healthcare Research and Quality (AHRQ), was conducted in 2009 and in 2017 among all healthcare workers at Mutualia, anonymously and voluntarily. Results: The overall response rate was similar in both 2009 and 2017 (37.2% and 38.5%, respectively). The average rating obtained showed a significant improvement over the period (7.7 vs. 8.1; p < 0.05). Itemizing by question, the main strengths were found in management support, organizational learning and continuous improvement, and, especially, in teamwork. Regarding weaknesses, the two lowest scores were those which refer to the balance between clinical safety and workload and the freedom to question the decisions made by superiors. Conclusions: The results obtained from the PS-surveys show that the overall PS-culture in our institution has increased, suggesting that the strategies focused on the improvement of PS-culture were well adopted among our personnel. The overall score places Mutualia at similar levels to those reached by the AHRQ and Spanish National Health System.