title: Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care: a qualitative study.
abstract: BACKGROUND
  Patient safety culture emerges from the shared assumptions, values and norms of members of a health care organization, unit, team or other group with regard to practices that directly or indirectly influence patient safety. It has been argued that organizational culture is an amalgamation of many cultures, and that subcultures should be studied to develop a deeper understanding of an organization's culture. The aim of this study was to explore subcultures among registered nurses and nurse assistants in Sweden in terms of their assumptions, values and norms with regard to practices associated with patient safety.
  
  
  METHODS
  The study employed an exploratory design using a qualitative method, and was conducted at two hospitals in southeast Sweden. Seven focus group interviews and two individual interviews were conducted with registered nurses and seven focus group interviews and one individual interview were conducted with nurse assistants. Manifest content analysis was used for the analysis.
  
  
  RESULTS
  Seven patient safety culture domains (i.e. categories of assumptions, values and norms) that included practices associated with patient safety were found: responsibility, competence, cooperation, communication, work environment, management and routines. The domains corresponded with three system levels: individual, interpersonal and organizational levels. The seven domains consisted of 16 subcategories that expressed different aspects of the registered nurses and assistants nurses' patient safety culture. Half of these subcategories were shared.
  
  
  CONCLUSIONS
  Registered nurses and nurse assistants in Sweden differ considerably with regard to patient safety subcultures. The results imply that, in order to improve patient safety culture, efforts must be tailored to both registered nurses' and nurse assistants' patient safety-related assumptions, values and norms. Such efforts must also take into account different system levels. The results of the present study could be useful to facilitate discussions about patient safety within and between different professional groups.
authors.affiliation: Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, SE- 581 83 Sweden ; Department of Health and Development, County Council of Östergötland, Linköping, SE- 581 91 Sweden.
authors.forename: Marita
authors.initials: M
authors.lastname: Danielsson
authors.affiliation: Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, SE- 581 83 Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Nilsen
authors.affiliation: Department of Health and Development, County Council of Östergötland, Linköping, SE- 581 91 Sweden.
authors.forename: Annica
authors.initials: A
authors.lastname: Ohrn
authors.affiliation: Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, SE- 581 83 Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Rutberg
authors.affiliation: Department of Health and Development, County Council of Östergötland, Linköping, SE- 581 91 Sweden.
authors.forename: Jenni
authors.initials: J
authors.lastname: Fock
authors.affiliation: Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, SE- 581 83 Sweden.
authors.forename: Siw
authors.initials: S
authors.lastname: Carlfjord
keywords: Nurses; Patient safety; Qualitative research; Safety culture