title: Improving patient safety culture in general practice: an interview study.
abstract: BACKGROUND
  When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an intervention for improving safety culture.
  
  
  OBJECTIVE
  To gain insight into how two interventions affected patient safety culture in everyday practice.
  
  
  METHODS
  After conducting a randomised control trial of two interventions, this was a qualitative study conducted in 30 general practices to aid interpretation of the previous quantitative findings.
  
  
  METHODS
  Interviews were conducted at practice locations (n = 27) with 24 GPs and 24 practice nurses. The theory of communities of practice--in particular, its concepts of a domain, a community, and a practice--was used to interpret the findings by examining which elements were or were not present in the participating practices.
  
  
  RESULTS
  Communal awareness of the problem was only raised after getting together and discussing patient safety. The combination of a questionnaire and workshop enhanced the interaction of team members and nourished team feelings. This shared experience also helped them to understand and develop tools and language for daily practice.
  
  
  CONCLUSIONS
  In order for patient safety culture to improve, the safety culture questionnaire was more successful when accompanied by a practice workshop. Initial discussion and negotiation of shared goals during the workshop fuelled feelings of coherence and belonging to a community wishing to learn about enhancing patient safety. Team meetings and day-to-day interactions enhanced further liaison and sharing, making patient safety a common and conscious goal.
authors.affiliation: PI Research Quality and Safety in general practice, head of students education of general practice, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Natasha J
authors.initials: NJ
authors.lastname: Verbakel
authors.affiliation: Researcher at the Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Antoinette A
authors.initials: AA
authors.lastname: de Bont
authors.affiliation: PI Research Quality and Safety in general practice, head of students education of general practice, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Verheij
authors.affiliation: EMGO+ Institute, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
authors.affiliation: PI Research Quality and Safety in general practice, head of students education of general practice, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Dorien L M
authors.initials: DL
authors.lastname: Zwart
mesh_terms: D001291:Attitude of Health Personnel; D055317:Evidence-Based Practice; D058006:General Practice / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D015279:Organizational Culture; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012308:Risk Management; D011795:Surveys and Questionnaires
keywords: intervention; interview study; patient safety; primary health care; safety; safety culture