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BMC Primary Care
Published in: BMC Primary Care 1/2019

Open Access 01-12-2019 | Care | Research article

Effectiveness of an educational intervention to improve the safety culture in primary care: a randomized trial

Authors: Clara González-Formoso, Ana Clavería, M.J. Fernández-Domínguez, F.L. Lago-Deibe, Luis Hermida-Rial, Antonio Rial, Francisco Gude-Sampedro, Salvador Pita-Fernández, Victoria Martín-Miguel

Published in: BMC Primary Care | Issue 1/2019

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Abstract

Background

Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region.

Methods

Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported.
We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants’ demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome.

Results

Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (− 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39–3.35), and by 13.75 (2.41–354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable.

Conclusion

A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged.

Trial registration

It was retrospectively registered with (ISRCTN41911128, 31/12/2010).
Appendix
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Literature
1.
Kohn LT, Donaldson CJ, editors. To err is human: building a safer health system. Washington DC: National Academy Press; 2000.
2.
Berry JC, Davis JT, Bartman T, et al. Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system. J Patient Saf. 2016. Epub ahead of print.
3.
Singer SJ, Gaba DM, Geppert JJ, et al. The culture of safety: results of an organization-wide survey in 15 California hospitals. Qual Saf Heal Care. 2003;12(2):112–8.CrossRef
4.
Weaver SJ, Lubomksi LH, Wilson RF, et al. Promoting a culture of safety as a patient safety strategy: a systematic review. Ann Intern Med. 2013 Mar 5;158(5 Pt 2):369–74.CrossRef
5.
6.
7.
Institute of Medicine. Preventing medication errors: quality chasm series. Washington: DNAP; 2004.
8.
Astier-Peña MP, Torijano-Casalengua ML, Olivera-Cañadas G, et al. Are Spanish primary care professionals aware of patient safety? Eur J Pub Health. 2015;25(5):781–7.CrossRef
9.
Astier-Peña MP, Torijano-Casalengua ML, Olivera-Cañadas G. Setting priorities for patient safety in primary care. Aten Primaria. 2016;48(1):3–7.CrossRef
10.
Kirkman MA, Sevdalis N, Arora S, et al. The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review. BMJ Open. 2015;5(5):e007705.CrossRef
11.
Cooke M, Ironside PM, Ogrinc GS. Mainstreaming quality and safety: a reformulation of quality and safety education for health professions students. BMJ Qual Saf. 2011;20(Suppl 1):i79–82.CrossRef
12.
Ahmed M, Arora S, Baker P, et al. Building capacity and capability for patient safety education: a train-the-trainers programme for senior doctors. BMJ Qual Saf. 2013 Aug;22(8):618–25.CrossRef
13.
Doyle P, VanDenKerkhof EG, Edge DS, et al. Self-reported patient safety competence among Canadian medical students and postgraduate trainees: a cross-sectional survey. BMJ Qual Saf. 2015;24(2):135–41.CrossRef
14.
Ginsburg LR, Tregunno D, Norton PG. Self-reported patient safety competence among new graduates in medicine, nursing and pharmacy. BMJ Qual Saf. 2013;22(2):147–54.CrossRef
15.
González-Formoso C, Martín-Miguel MV, Fernández-Domínguez MJ, et al. Adverse events analysis as an educational tool to improve patient safety culture in primary care: a randomized trial. BMC Fam Pract. 2011;12:12-50.
16.
17.
Aranaz J, Aibar C, Limón R, Mira JJJ, Vitaller J, Agra Y, et al. A study of the prevalence of adverse events in primary healthcare in Spain. Eur J Public Health [Internet]. 2012;22(6):921–5.CrossRef
18.
19.
Clavería A, González-Formoso C, Martín-Miguel V, Fernández-Domínguez MJ, Lago-Deibe FI. Validation of the survey on patient safety culture (SOPS) in primary health care. A Coruña: 36° Congreso SEMFYC; 2016.
20.
Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014 Jan;348:g1687.CrossRef
21.
Moher D, Hopewell S, Schulz KF, Montori V, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869.CrossRef
22.
Henderson AR. Testing experimental data for univariate normality. Clin Chim Acta. 2006;366(1–2):112–29.CrossRef
23.
24.
25.
26.
27.
28.
Stasinopoulos D, Rigby R. Generalized additive models for location scale and shape (GAMLSS) in R. J Stat Softw. 2007;23(7):1–46.CrossRef
29.
30.
31.
Hutchinson A, Young TA, Cooper KL, et al. Trends in healthcare incident reporting and relationship to safety and quality data in acute hospitals: results from the National Reporting and learning system. Qual Saf Heal Care. 2009;18(1):5–10.CrossRef
32.
Howell A-M, Burns EM, Bouras G, et al. Can patient safety incident reports be used to compare hospital safety? Results from a quantitative analysis of the English National Reporting and learning system data. PLoS One. 2015;10(12):e0144107.CrossRef
33.
Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Heal Care. 2003;12(suppl 2):ii17–23.
34.
Verbakel NJ, Langelaan M, Verheij TJ, et al. Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial. Br J Gen Pract. 2015;65(634):e319–29.CrossRef
35.
Hoffmann B, Müller V, Rochon J, et al. Effects of a team-based assessment and intervention on patient safety culture in general practice: an open randomised controlled trial. BMJ Qual Saf. 2014;23(1):35–46.CrossRef
36.
Shaw TJ, Pernar LI, Peyre SE, et al. Impact of online education on intern behaviour around joint commission national patient safety goals: a randomised trial. BMJ Qual Saf. 2012;21(10):819–25.CrossRef
37.
38.
Saturno PJ, Da Silva Gama ZA, de Oliveira-Sousa SL, et al. Analysis of the patient safety culture in hospitals of the Spanish National Health System. Med Clin (Barc). 2008;131(Suppl):18–25.CrossRef
39.
Reiman T, Pietikäinen E, Oedewald P. Multilayered approach to patient safety culture. Qual Saf Health Care. 2010 Oct;19(5):e20.PubMed
40.
Conry MC, Humphries N, Morgan K, et al. A 10 year (2000-2010) systematic review of interventions to improve quality of care in hospitals. BMC Health Serv Res. 2012;12(1):275.CrossRef
41.
Gaal S, Verstappen W, Wensing M. What do primary care physicians and researchers consider the most important patient safety improvement strategies? BMC Health Serv Res. 2011;11:102.
42.
Jha V, Buckley H, Gabe R, et al. Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in training. BMJ Qual Saf. 2015;24(1):21–30.CrossRef
43.
Wong BM, Etchells EE, Kuper A, et al. Teaching quality improvement and patient safety to trainees: a systematic review. Acad Med. 2010;85(9):1425–39.CrossRef
45.
44.
Ahmed M, Arora S, Tiew S, et al. Building a safer foundation: the lessons learnt patient safety training programme. BMJ Qual Saf. 2014;23(1):78–86.CrossRef
46.
47.
Pronovost PJ, Miller MR, Wachter RM, et al. Perspective: physician leadership in quality. Acad Med. 2009;84(12):1651–6.CrossRef
48.
Ahmed M, Arora S, McKay J, et al. Patient safety skills in primary care: a national survey of GP educators. BMC Fam Pract. 2014;15(1):206.CrossRef
Metadata
Title
Effectiveness of an educational intervention to improve the safety culture in primary care: a randomized trial
Authors
Clara González-Formoso
Ana Clavería
M.J. Fernández-Domínguez
F.L. Lago-Deibe
Luis Hermida-Rial
Antonio Rial
Francisco Gude-Sampedro
Salvador Pita-Fernández
Victoria Martín-Miguel
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Primary Care / Issue 1/2019
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0901-8

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