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El-Jardali et al. BMC Health Services Research 2011, 11:45 http://www.biomedcentral.com/1472-6963/11/45

RESEARCH ARTICLE

Open Access

Predictors and outcomes of patient safety culture in hospitals
Fadi El-Jardali1*, Hani Dimassi2, Diana Jamal1, Maha Jaafar1, Nour Hemadeh3
Abstract
Background: Developing a patient safety culture was one of the recommendations made by the Institute ofMedicine to assist hospitals in improving patient safety. In recent years, a multitude of evidence, mostly originating from developed countries, has been published on patient safety culture. One of the first efforts to assess the culture of safety in the Eastern Mediterranean Region was by El-Jardali et al. (2010) in Lebanon. The study entitled “The Current State of Patient Safety Culture: a studyat baseline” assessed the culture of safety in Lebanese hospitals. Based on study findings, the objective of this paper is to explore the association between patient safety culture predictors and outcomes, taking into consideration respondent and hospital characteristics. In addition, it will examine the correlation between patient safety culture composites. Methods: Sixty-eight hospitals and 6,807respondents participated in the study. The study which adopted a cross sectional research design utilized an Arabic-translated version of the Hospital Survey on Patient Safety Culture (HSOPSC). The HSOPSC measures 12 patient safety composites. Two of the composites, in addition to a patient safety grade and the number of events reported, represented the four outcome variables. Bivariate and mixedmodel regression analyses were used to examine the association between the patient safety culture predictors and outcomes. Results: Significant correlations were observed among all patient safety culture composites but with differences in the strength of the correlation. Generalized Estimating Equations for the patient safety composite scores and respondent and hospital characteristics againstthe patient safety grade and the number of events reported revealed significant correlations. Significant correlations were also observed by linear mixed models of the same variables against the frequency of events reported and the overall perception of safety. Conclusion: Event reporting, communication, patient safety leadership and management, staffing, and accreditation were identified as majorpatient safety culture predictors. Investing in practices that tackle these issues and prioritizing patient safety is essential in Lebanese hospitals in order to improve patient safety. In addition, further research is needed to understand the association between patient safety culture and clinical outcomes.

Background Developing a patient safety culture was one of the recommendations made bythe Institute of Medicine to assist hospitals in improving patient safety [1,2]. Assessing the organization’s existing safety culture is the first stage of developing a safety culture [3]. Patient safety culture assessments, required by international accreditation organizations, allow healthcare organizations to
* Correspondence: fe08@aub.edu.lb 1 Department of Health Management and Policy, Facultyof Health Sciences, American University of Beirut, Beirut, Lebanon Full list of author information is available at the end of the article

obtain a clear view of the patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture [4], help care giving units identify their existing patient safety problems [5], and benchmark their scores with otherhospitals [6]. According to literature, the major predictors of a positive patient safety culture in healthcare organizations specifically hospitals include communication founded on mutual trust, good information flow, shared perception of the importance of safety, organizational learning, commitment from management and leadership, and the presence of a non-punitive approach to incident and...