title: Are health systems changing in support of patient safety? A multi-methods evaluation of education, attitudes and practice.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the effects of a health system-wide safety improvement program (SIP) three to four years after initial implementation.
  
  
  METHODS
  The study employs multi-methods studies involving questionnaire surveys, focus groups, in-depth interviews, observational work, ethnographic studies, documentary analysis and literature reviews with regard to the state of New South Wales, Australia, where 90,000 health professionals, under the auspices of the Health Department, provide healthcare to a seven-million population. After enrolling many participants from various groups, the measurements included: numbers of staff trained and training quality; support for SIP; clinicians' reports of safety skills acquired, work practices changed and barriers to progress; RCAs undertaken; observation of functioning of teams; committees initiated and staff appointed to deal with adverse events; documentation and computer records of reports; and peak-level responses to adverse events.
  
  
  RESULTS
  A cohort of 4 per cent of the state's health professionals has been trained and now applies safety skills and conducts RCAs. These and other senior professionals strongly support SIP, though many think further culture change is required if its benefits are to be more fully achieved and sustained. Improved information-handling systems have been adopted. Systems for reporting adverse incidents and conducting RCAs have been instituted, which are co-ordinated by NSW Health. When the appropriate structures, educational activities and systems are made available in the form of an SIP, measurable systems change might be introduced, as suggested by observations of the attitudes and behaviours of health practitioners and the increased reporting of, and action about, adverse events.
  
  
  CONCLUSIONS
  Few studies into health systems change employ wide-ranging research methods and metrics. This study helps to fill this gap.
authors.affiliation: Centre for Clinical Governance Research, University of New South Wales, Sydney, Australia. j.braithwaite@unsw.edu.au
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Braithwaite
authors.forename: Mary T
authors.initials: MT
authors.lastname: Westbrook
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Travaglia
authors.forename: Rick
authors.initials: R
authors.lastname: Iedema
authors.forename: Nadine A
authors.initials: NA
authors.lastname: Mallock
authors.forename: Debbi
authors.initials: D
authors.lastname: Long
authors.forename: Peter
authors.initials: P
authors.lastname: Nugus
authors.forename: Rowena
authors.initials: R
authors.lastname: Forsyth
authors.forename: Christine
authors.initials: C
authors.lastname: Jorm
authors.forename: Marjorie
authors.initials: M
authors.lastname: Pawsey
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D017144:Focus Groups; D019538:Health Care Surveys; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D019300:Medical Errors / Q000517:prevention & control; D009313:National Health Programs; D009517:New South Wales; D009936:Organizational Innovation; D015397:Program Evaluation; D017751:Safety Management / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires