A case study exploration of patient safety culture within an Acute NHS Trust, utilising Open Systems Theory

Background: The prevention of errors and adverse effects from
healthcare in hospitals is a global priority. The beliefs, values, and norms of an organisation can support patient safety and influence staff behaviours.
Aim: To understand perceptions of, and influences on, patient safety culture within an Acute NHS Trust in England.
Method: A case study of one acute NHS hospital Trust with embedded units of analysis (two medical wards). Semi-structured interviews were conducted with 16 staff at different levels of the Trust. Documentary analysis included patient safety metrics and organisational safety documents.
Theoretical framework: Open Systems Theory.
Findings: There were differing perceptions at the different levels about acceptable levels of risk and the compromises needed to manage pressures. There was a lack of opportunities for interaction and dialogue to establish common values around patient safety. Micro level staff perceived that a balance had to be struck between maintaining quality of care and reporting patient safety. There was little internal or externally
facing examination and interrogation of safety metrics that would convey a commitment to a positive patient safety culture.
Conclusions: A more nuanced understanding of how a system
contributes to patient safety has emerged and some of the factors that act as enablers of, or barriers to, a positive patient safety culture. Staff at all levels believed that patient safety was important but patient safety culture was more about measurement of events and avoidance of specific measurable harms than a clearly articulated set of values about safety.
Recommendations: Organisations should regularly evaluate the
effectiveness of patient safety feedback loops so clinical staff voices, including healthcare assistants, become part of meso/macro level decision-making regarding how safe patient throughput can be managed. Healthcare organisations should recognise the role that shift co-ordinators play in keeping patients safe at ward level by providing training for junior
nurses to step into this role. Safety training at all levels is necessary to create a shared dialogue about risk, safety, reporting and learning so organisations should embrace the safety syllabus and training for NHS staff that was introduced in May 2021 and ensure staff have protected time for this training.