title: The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study.
abstract: BACKGROUND
  Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety.
  
  
  METHODS
  A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions.
  
  
  RESULTS
  At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital.
  
  
  CONCLUSIONS
  The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.
authors.affiliation: Centre for Clinical Research, Uppsala University, Västmanlands County Hospital, Västerås, Sweden. lena.burstrom@ltv.se.
authors.forename: Lena
authors.initials: L
authors.lastname: Burström
authors.forename: Anna
authors.initials: A
authors.lastname: Letterstål
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Engström
authors.forename: Anders
authors.initials: A
authors.lastname: Berglund
authors.forename: Mats
authors.initials: M
authors.lastname: Enlund
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration; D061214:Patient Safety; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D013548:Sweden; D014218:Triage