Does lean management improve patient safety culture? An extensive evaluation of safety culture in a radiotherapy institute.

PURPOSE The importance of a safety culture to maximize safety is no longer questioned. However, achieving sustainable culture improvements are less evident. Evidence is growing for a multifaceted approach, where multiple safety interventions are combined. Lean management is such an integral approach to improve safety, quality and efficiency and therefore, could be expected to improve the safety culture. This paper presents the effects of lean management activities on the patient safety culture in a radiotherapy institute. METHODS Patient safety culture was evaluated over a three year period using triangulation of methodologies. Two surveys were distributed three times, workshops were performed twice, data from an incident reporting system (IRS) was monitored and results were explored using structured interviews with professionals. Averages, chi-square, logistical and multi-level regression were used for analysis. RESULTS The workshops showed no changes in safety culture, whereas the surveys showed improvements on six out of twelve dimensions of safety climate. The intention to report incidents not reaching patient-level decreased in accordance with the decreasing number of reports in the IRS. However, the intention to take action in order to prevent future incidents improved (factorial survey presented β: 1.19 with p: 0.01). CONCLUSIONS Due to increased problem solving and improvements in equipment, the number of incidents decreased. Although the intention to report incidents not reaching patient-level decreased, employees experienced sustained safety awareness and an increased intention to structurally improve. The patient safety culture improved due to the lean activities combined with an organizational restructure, and actual patient safety outcomes might have improved as well.

[1]  J. Liker.  The Toyota Way , 2003 .

[2]  G. Baker,et al.  Assessment of safety culture maturity in a hospital setting. , 2010, Healthcare quarterly.

[3]  N. Claes,et al.  A nationwide Hospital Survey on Patient Safety Culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan , 2012, BMJ quality & safety.

[4]  Edgar H. Schein,et al.  Coming to a new awareness of organizational culture , 1984 .

[5]  Johan Hellings,et al.  Challenging patient safety culture: survey results. , 2007, International journal of health care quality assurance.

[6]  Todd Pawlicki,et al.  Quality and Safety in Radiotherapy , 2010 .

[7]  Dov Zohar,et al.  Thirty years of safety climate research: reflections and future directions. , 2010, Accident; analysis and prevention.

[8]  Ita G. G. Kreft,et al.  The Analysis of Factorial Surveys , 1991 .

[9]  Niraj L. Sehgal,et al.  AHRQ's Hospital Survey on Patient Safety Culture: Psychometric Analyses , 2009, Journal of patient safety.

[10]  Torsten B Neilands,et al.  The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research , 2006, BMC Health Services Research.

[11]  Laval Grimard,et al.  The management of radiation treatment error through incident learning. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[12]  V. Nieva,et al.  Safety culture assessment: a tool for improving patient safety in healthcare organizations , 2003, Quality & safety in health care.

[13]  M. D. Cooper.  Towards a model of safety culture , 2000 .

[14]  Lisa Wallander.  25 years of factorial surveys in sociology: A review , 2009 .

[15]  D. Dunt,et al.  Strategies for improving patient safety culture in hospitals: a systematic review , 2012, BMJ quality & safety.

[16]  G. Jasso.  Factorial Survey Methods for Studying Beliefs and Judgments , 2006 .

[17]  D Parker,et al.  Safety culture assessment in community pharmacy: development, face validity, and feasibility of the Manchester Patient Safety Assessment Framework , 2005, Quality and Safety in Health Care.

[18]  H. Davies,et al.  Assessing organisational culture for quality and safety improvement: a national survey of tools and tool use , 2009, Quality & Safety in Health Care.

[19]  E. Schein.  Organizational Culture and Leadership , 1991 .

[20]  Yan-li Nie,et al.  Hospital survey on patient safety culture in China , 2013, BMC Health Services Research.

[21]  David R. Thomas,et al.  A General Inductive Approach for Analyzing Qualitative Evaluation Data , 2006 .

[22]  Jason M Etchegaray,et al.  Comparing two safety culture surveys: Safety Attitudes Questionnaire and Hospital Survey on Patient Safety , 2012, BMJ quality & safety.

[23]  Peter H. Rossi,et al.  Measuring social judgments : the factorial survey approach , 1983 .

[24]  Claire Lemer,et al.  An international review of patient safety measures in radiotherapy practice. , 2009, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[25]  T. W. van der Schaaf,et al.  Near Miss Reporting as a Safety Tool , 1991 .