title: Does lean management improve patient safety culture? An extensive evaluation of safety culture in a radiotherapy institute.
abstract: OBJECTIVE
  The importance of a safety culture to maximize safety is no longer questioned. However, achieving sustainable culture improvements are less evident. Evidence is growing for a multifaceted approach, where multiple safety interventions are combined. Lean management is such an integral approach to improve safety, quality and efficiency and therefore, could be expected to improve the safety culture. This paper presents the effects of lean management activities on the patient safety culture in a radiotherapy institute.
  
  
  METHODS
  Patient safety culture was evaluated over a three year period using triangulation of methodologies. Two surveys were distributed three times, workshops were performed twice, data from an incident reporting system (IRS) was monitored and results were explored using structured interviews with professionals. Averages, chi-square, logistical and multi-level regression were used for analysis.
  
  
  RESULTS
  The workshops showed no changes in safety culture, whereas the surveys showed improvements on six out of twelve dimensions of safety climate. The intention to report incidents not reaching patient-level decreased in accordance with the decreasing number of reports in the IRS. However, the intention to take action in order to prevent future incidents improved (factorial survey presented β: 1.19 with p: 0.01).
  
  
  CONCLUSIONS
  Due to increased problem solving and improvements in equipment, the number of incidents decreased. Although the intention to report incidents not reaching patient-level decreased, employees experienced sustained safety awareness and an increased intention to structurally improve. The patient safety culture improved due to the lean activities combined with an organizational restructure, and actual patient safety outcomes might have improved as well.
authors.affiliation: Hasselt University, Faculty of Business Economics, Martelarenlaan 42, BE3500 Hasselt, Belgium. Electronic address: pascale.simons@uhasselt.be.
authors.forename: Pascale A M
authors.initials: PA
authors.lastname: Simons
authors.affiliation: MAASTRO Clinic, Maastricht, The Netherlands; Dept. of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre, The Netherlands. Electronic address: ruud.houben@maastro.nl.
authors.forename: Ruud
authors.initials: R
authors.lastname: Houben
authors.affiliation: Hasselt University, Faculty of Medicine, Hasselt, Belgium. Electronic address: annemie.vlayen@uhasselt.be.
authors.forename: Annemie
authors.initials: A
authors.lastname: Vlayen
authors.affiliation: Hasselt University, Faculty of Medicine, Hasselt, Belgium. Electronic address: johan.hellings@uhasselt.be.
authors.forename: Johan
authors.initials: J
authors.lastname: Hellings
authors.affiliation: MAASTRO Clinic, Maastricht, The Netherlands; Dept. of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre, The Netherlands. Electronic address: madelon.pijls@maastro.nl.
authors.forename: Madelon
authors.initials: M
authors.lastname: Pijls-Johannesma
authors.affiliation: Hasselt University, Faculty of Business Economics, Martelarenlaan 42, BE3500 Hasselt, Belgium. Electronic address: wim.marneffe@uhasselt.be.
authors.forename: Wim
authors.initials: W
authors.lastname: Marneffe
authors.affiliation: Hasselt University, Faculty of Business Economics, Martelarenlaan 42, BE3500 Hasselt, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium. Electronic address: dominique.vandijck@uhasselt.be.
authors.forename: Dominique
authors.initials: D
authors.lastname: Vandijck
mesh_terms: D001291:Attitude of Health Personnel; D019091:Critical Pathways / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D015279:Organizational Culture; D061214:Patient Safety; D024382:Professional Role; D018787:Radiation Oncology; D017751:Safety Management / Q000458:organization & administration*; D011795:Surveys and Questionnaires
keywords: Culture change; Incident reporting; Interviews; Lean management; Patient safety culture