title: Assessing patient safety culture in hospitals across countries.
abstract: OBJECTIVE
  It is believed that in order to reduce the number of adverse events, hospitals have to stimulate a more open culture and reflective attitude towards errors and patient safety. The objective is to examine similarities and differences in hospital patient safety culture in three countries: the Netherlands, the USA and Taiwan.
  
  
  METHODS
  This is a cross-sectional survey study across three countries. A questionnaire, the Hospital Survey on Patient Safety Culture (Hospital SOPS), was disseminated nationwide in the Netherlands, the USA and Taiwan.
  
  
  METHODS
  The study was conducted in 45 hospitals in the Netherlands, 622 in the USA and 74 in Taiwan.
  
  
  METHODS
  A total of 3779 professionals from the participating hospitals in the Netherlands, 196 462 from the USA and 10 146 from Taiwan participated in the study.
  
  
  METHODS
  The main outcome measures of the study were 12 dimensions of patient safety culture, e.g. Teamwork, Organizational learning, Communication openness.
  
  
  RESULTS
  Most hospitals in all three countries have high scores on teamwork within units. The area with a high potential for improvement in all three countries is Handoffs and transitions. Differences between countries exist on the following dimensions: Non-punitive response to error, Feedback and communication about error, Communication openness, Management support for patient safety and Organizational learning--continuous improvement. On the whole, US respondents were more positive about the safety culture in their hospitals than Dutch and Taiwanese respondents. Nevertheless, there are even larger differences between hospitals within a country.
  
  
  CONCLUSIONS
  Comparison of patient safety culture data has shown similarities and differences within and between countries. All three countries can improve areas of their patient safety culture. Countries can identify and share best practices and learn from each other.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, Utrecht 3500 BN, The Netherlands. c.wagner@nivel.nl
authors.forename: C
authors.initials: C
authors.lastname: Wagner
authors.forename: M
authors.initials: M
authors.lastname: Smits
authors.forename: J
authors.initials: J
authors.lastname: Sorra
authors.forename: C C
authors.initials: CC
authors.lastname: Huang
mesh_terms: D003430:Cross-Sectional Studies; D003625:Data Collection; D006739:Hospital Administration; D006761:Hospitals / Q000592:standards*; D006801:Humans; D009426:Netherlands; D015279:Organizational Culture; D061214:Patient Safety; D011795:Surveys and Questionnaires; D013624:Taiwan; D014481:United States
keywords: general methodology; hospital care; patient safety; quality culture; quality management; setting of care; surveys