The impact of accreditation for excellence on patient safety culture in an Italian hospital

Background The promotion of safety culture in hospital care is a requisite to reduce errors and to continuously improve the quality of care. Alongside patient safety programs, a quantitative evaluation of the safety culture in hospitals is essential to understand strengths and weaknesses of the system and to set up future investments. Therefore, Udine Academic Hospital (UAH) joined the Patient Safety Collaborative Alliance (PaSCAl) national survey in order to assess safety climate and evaluate the impact on it of the Joint Commission International (JCI) accreditation process. Methods The PaSCAl survey is based on a questionnaire made by the Agency for Healthcare Research and Quality (AHRQ), made by 52 items grouped in 12 areas. Sampled wards (medical, surgical and diagnostic) could differ between years. The survey was done in 2009 and 2015 with a sampled workforce of 793 and 587 respectively. The delivery was both electronic and paper based. The surveys were set before and after the first JCI accreditation (2010) and the second round (2014). Results Response rates increased from 16.6% (132/793) to 21.9% (129/587). 10 areas out of 12 had better scores. A significant (p < 0.05) increase of favorable opinions after the accreditation was found in the perception of patient safety (+16.1%); feedback and communication (+12.0%); adverse event reporting (+23.6%); teamwork between units (+12.7%). In 2015 no area was statistically far from the national benchmark, while previously patient safety (-11.1%) and teamwork between units (-14.7%) were significantly worse. Conclusions The questionnaire inquired the trust put by workforce in the hospital management and their wards. Before accreditation, key weaknesses were shown. Significant improvements on reporting culture were achieved. Education, followed by standardization of procedures and communication were the main efforts by our management. A “silos” mindset and a blaming attitude towards errors are still open challenges. Key messages: The analysis of patient safety culture is a useful tool to monitor the effects of patient safety programs on workforce attitudes Among other strategies, accreditation for excellence can help increase patient safety culture in the context of public hospitals