Safety of care is a public health priority. There are in France
2.6 serious adverse events (AEs) preventable 1,000 patientdays,
between 120 and 190,000 preventable AEs during hospitalization
each year [1]. In addition to the solutions adopted
as new regulatory texts, development of standards and the
assessment and training of professionals, safety culture of
care allows a collective awareness to make the safety of care
a priority. In other words, it allows each professional to always
have in mind the question of the impact of its decisions and
actions on the safety of care.
Because emergency medicine is a risky activity, the culture of
safety was estimated from the different actors of the Emergency
Department (ED). There are several tools to measure
safety culture of care. The French translation of the Hospital
Survey On Patient Safety Culture (HSOPSC) [3] recommended
by the french Haute Autorité de Santé [4] was used.
This questionnaire has been validated in several other countries
[5-10]. It allows to estimate the safety culture of care
across ten dimensions. This has given us paths for
action to improve the safety of care.
The direct assessment showed a Gaussian distribution quotes
(Figure 1) with a mean value equal to 5.3 ± 2.1 on 10. HSOPSC
explores the culture of safety in ten dimensions, each evaluated
by 3-6 different issues. They are the overall perception
of safety (50% positive response, confidence interval 95%
(CI95: 40-60), frequency of reporting adverse events (60%,
CI95: 50-69), relationships with supervisors (82%, CI95: 73-
88), learning organization and continuous improvement of
service (feedback) (59%, CI95: 49-68), teamwork (86%, CI95:
78-91), freedom of expression (67%, CI95: 57-75), not repression
of error (49%, CI95: 39-59), human resources (39%, CI95:
30-49), safety management (32%, CI95: 24-42) and teamwork
between departments.
The response rate is very high, superior to those found in the
literature.
Safety culture of care is generally unsatisfactory with only
half of positive responses on the general criterion. A recent
international study, with response rates between 52% and
87% showed between 49% and 64% of positive responses on
this criterion [6]. 63% [CI: 52-72%] of agents believe that the
security level of care is “acceptable” and 20% [CI: 13-30%]
“very good” (Figure 1). We found in the literature a rate of
62% acceptable in Dutch hospitals, 43% in Japan, 46% in Taiwan
and 22% in hospitals Americans (45% of the respondents
felt very good) [6, 8]. Dimensions “reporting errors or adverse
events” and “feedback” are related with a positive response
rate of respectively 60% and 59%. The dimension “freedom
of expression” is penalized by the fact that agents do not feel
free to question the decisions of their superiors. Other negative
points are the dimensions beyond the perimeter of the
ED (non-punitive response, human resources, safety management
and teamwork between departments) with the lowest
rate of positive responses, less than 50%. These low scores
highlight a strategic deficit institution of safety culture of care,
with a low level of bureaucratic maturity.
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