Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial.
BACKGROUND
A constructive safety culture is essential for the successful implementation of patient safety improvements.


OBJECTIVE
To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture.


METHODS
A three-arm cluster randomised trial was conducted in a mixed method study, studying the effect of administering a patient safety culture questionnaire (intervention I), the questionnaire complemented with a practice-based workshop (intervention II) and no intervention (control) in 30 general practices in the Netherlands.


METHODS
The primary outcome, the number of reported incidents, was measured with a questionnaire at baseline and a year after. Analysis was performed using a negative binomial model. Secondary outcomes were quality and safety indicators and safety culture. Mixed effects linear regression was used to analyse the culture questionnaires.


RESULTS
The number of incidents increased in both intervention groups, to 82 and 224 in intervention I and II respectively. Adjusted for baseline number of incidents, practice size and accreditation status, the study showed that practices that additionally participated in the workshop reported 42 (95% confidence interval [CI] = 9.81 to 177.50) times more incidents compared to the control group. Practices that only completed the questionnaire reported 5 (95% CI = 1.17 to 25.49) times more incidents. There were no statistically significant differences in staff perception of patient safety culture at follow-up between the three study groups.


CONCLUSIONS
Educating staff and facilitating discussion about patient safety culture in their own practice leads to increased reporting of incidents. It is beneficial to invest in a team-wise effort to improve patient safety.
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Natasha J
NJ
Verbakel
Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Maaike
M
Langelaan
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Theo J M
TJ
Verheij
EMGO+ Institute, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
Cordula
C
Wagner
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Dorien L M
DL
Zwart
D000328:Adult; D003469:Culture; D005260:Female; D058006:General Practice / Q000379:methods*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D009426:Netherlands; D061214:Patient Safety; D012308:Risk Management / Q000379:methods*; D011795:Surveys and Questionnaires
general practice; improvement, intervention studies; patient safety; primary health care; safety culture