title: Patient safety culture in China: a case study in an outpatient setting in Beijing.
abstract: OBJECTIVE
  To investigate the patient safety culture in an outpatient setting in Beijing and explore the meaning and implications of the safety culture from the perspective of health workers and patients.
  
  
  METHODS
  A mixed methods approach involving a questionnaire survey and in-depth interviews was adopted. Among the 410 invited staff members, 318 completed the Hospital Survey of Patient Safety Culture (HSOPC). Patient safety culture was described using 12 subscale scores. Inter-subscale correlation analysis, ANOVA and stepwise multivariate regression analyses were performed to identify the determinants of the patient safety culture scores. Interviewees included 22 patients selected through opportunity sampling and 27 staff members selected through purposive sampling. The interview data were analysed thematically.
  
  
  RESULTS
  The survey respondents perceived high levels of unsafe care but had personally reported few events. Lack of 'communication openness' was identified as a major safety culture problem, and a perception of 'penalty' was the greatest barrier to the encouragement of error reporting. Cohesive 'teamwork within units', while found to be an area of strength, conversely served as a protective and defensive mechanism for medical practice. Low levels of trust between providers and consumers and lack of management support constituted an obstacle to building a positive patient safety culture.
  
  
  CONCLUSIONS
  This study in China demonstrates that a punitive approach to error is still widespread despite increasing awareness of unsafe care, and managers have been slow in acknowledging the importance of building a positive patient safety culture. Strong 'teamwork within units', a common area of strength, could fuel the concealment of errors.
authors.affiliation: China Health Program, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Chaojie
authors.initials: C
authors.lastname: Liu
authors.affiliation: Peking University Third Hospital, Beijing, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Peking University Third Hospital, Beijing, China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Peking University Third Hospital, Beijing, China.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Peking University Third Hospital, Beijing, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Wang
mesh_terms: D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002681:China; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007400:Interprofessional Relations; D019982:Organizational Case Studies; D015279:Organizational Culture; D010045:Outpatients / Q000523:psychology*; D061214:Patient Safety; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers
keywords: Ambulatory Care; Patient Safety; Safety Culture