Measures of patient safety culture from the perspective of health workers can be used – along with patient-reported experiences of safety and traditional patient safety indicators (see section on “Safe acute care – surgical complications and obstetric trauma”) – to give a holistic perspective of the state of safety in health systems.
A positive patient safety culture for health workers results in shared perceptions of the importance of safety, increased transparency and trust, and higher levels of shared responsibility, along with improved confidence in organisational and national safety initiatives. A growing body of research has found that a positive patient safety culture is associated with better health outcomes and patient experiences, as well as improved organisational productivity and staff satisfaction. Improved models of patient safety governance and investment in improving the patient safety culture have a substantial and lasting impact on outcomes (G20 Health & Development Partnership, 2021[1]).
Figure 6.17 and Figure 6.18 illustrate two domains of the Hospital Survey on Patient Safety Culture (HSPSC), which asks hospital staff to provide information on aspects of their work environment and whether they are conducive to good patient safety. Figure 6.17 shows staff perceptions of whether important patient care information is transferred across hospital units and during shift changes. Positive perceptions from staff on safety of handoffs and transitions range widely across countries, with an over 20 percentage point difference for HSPSC – both version 1.0 and version 2.0. Figure 6.18 shows staff perceptions that staffing levels and the work pace are adequate. Across all staff types, positive perceptions on staffing and work pace are relatively high in Türkiye, the United States, the Netherlands and Colombia (around 50% or more with positive perceptions across different types) but low in Mexico, Belgium and Switzerland. There is a clear disconnect between perceptions among management and frontline staff in most countries. On average, 57% of physicians and nurses in hospitals perceived staff levels and work pace to be unsafe, compared to 51% of management staff.
Patient perspectives are also critical to make health systems safer and more people‑centred. According to the Commonwealth Fund International Health Policy Survey 2020, the proportion of patients reporting experiences of medical mistakes in the past two years varied between about 6% in France and New Zealand and above 10% in the United States, Germany and Norway in 2020. Among hospitalised patients, the proportion of adult patients who experienced patient safety incidents during their last hospitalisation ranged between 4% in Latvia and 17% in Belgium (Figure 6.19). It should be noted that a larger proportion of patients are likely to have experienced medical mistakes because patients may not report physical harm if they are not immediately recognisable (unlike pain and infection), and if they are not informed of their occurrence by a provider. In Belgium, the high rate based on its pilot data collection could be due to selection bias based on more frequent responses by patients who had experiences of unsafe care than others who received safe care, and higher awareness of patient safety among the population, since patients report a wide range of patient safety incidents, including issues related to behaviours. Hence, caution is needed when interpreting cross-country variations in patient experiences of safety, and further research is needed to improve data comparability.
