title: Changes in patient safety culture after restructuring of intensive care units: Two cross-sectional studies.
abstract: OBJECTIVE
  Compare changes in registered nurses' perception of the patient safety culture in restructured and not restructured intensive care units during a four-year period.
  
  
  METHODS
  Two cross-sectional surveys were performed, in 2008/2009 (time 1) and 2012/2013 (time 2). During a period of 0-3 years after time 1, three of six hospitals merged their general and medical intensive care units (restructured). The other hospitals maintained their structure of the intensive care units (not restructured).
  
  
  METHODS
  Intensive care units in hospitals at one Norwegian hospital trust.
  
  
  METHODS
  The safety culture was measured with Hospital Survey on Patient Safety Culture.
  
  
  RESULTS
  At times 1 and 2, 217/302 (72%) and 145/289 (50%) registered nurses participated. Restructuring was negatively associated with change in the safety culture, in particular, the dimensions of the safety culture within the unit level. The dimensions most vulnerable for restructuring were manager expectations and actions promoting safety, teamwork within hospital units and staffing.
  
  
  CONCLUSIONS
  In this study, the restructuring of intensive care units was associated with a negative impact on the safety culture. When restructuring, the management should be particularly aware of changes in the safety culture dimensions manager expectations and actions promoting safety, teamwork within hospital units and staffing.
authors.affiliation: Department of Research, Innlandet Hospital Trust, Brumunddal, Norway; Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: anne.vifladt@sykehuset-innlandet.no.
authors.forename: Anne
authors.initials: A
authors.lastname: Vifladt
authors.affiliation: Department of Quality and Patient Safety, Innlandet Hospital Trust, Brumunddal, Norway. Electronic address: bjorg.simonsen@sykehuset-innlandet.no.
authors.forename: Bjoerg O
authors.initials: BO
authors.lastname: Simonsen
authors.affiliation: Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: stian.lydersen@ntnu.no.
authors.forename: Stian
authors.initials: S
authors.lastname: Lydersen
authors.affiliation: Department of Research, Innlandet Hospital Trust, Brumunddal, Norway; Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: per.farup@ntnu.no.
authors.forename: Per G
authors.initials: PG
authors.lastname: Farup
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009664:Norway; D009726:Nurses / Q000523:psychology*; D015279:Organizational Culture; D061214:Patient Safety; D017751:Safety Management
keywords: Intensive care units; Organisational culture; Patient safety; Patient safety culture; Restructuring