From Reporting to Improving: How Root Cause Analysis in Teams Shape Patient Safety Culture

Abstract

Christos Tsamasiotis,1 Gaelle Fiard,2 Pierre Bouzat,3 Patrice François,1 Guillaume Fond,4 Laurent Boyer,4 Bastien Boussat1,5 1Department of Clinical Epidemiology, Grenoble-Alps University Hospital; Laboratory TIMC-IMAG, UMR 5525 Joint Research Unit, National Center for Scientific Research, Faculty of Medicine, Grenoble Alps University, Grenoble, France; 2Department of Urology, Grenoble Alpes University Hospital, CNRS, Grenoble INP, TIMC, Université Grenoble Alpes, Grenoble, France; 3Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Grenoble, University Grenoble Alpes; INSERM U1216, Grenoble Institut Neurosciences, Grenoble, France; 4AP-HM, Aix-Marseille University, School of Medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Marseille, France; 5O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, CanadaCorrespondence: Bastien Boussat, Service d’épidémiologie et évaluation médicale, CHU Grenoble-Alpes, Boulevard de la Chantourne, La Tronche, 38700, France, Tel [phone], Email [email protected]: Given the increasing focus on patient safety in healthcare systems worldwide, understanding the impact of Continuous Quality Improvement Programs (QIPs) is crucial. QIPs, including Morbidity and Mortality Conferences (MMCs) and Experience Feedback Committees (EFCs), have been identified as effective strategies for enhancing patient safety culture. These programs engage healthcare professionals in the identification and analysis of adverse events to foster a culture of safety (ie the product of individual and group value, attitudes, and perceptions about quality and safety). This study aimed to determine whether patient safety culture differed regarding care provider participation in MMCs and EFCs activities.Methods: A cross-sectional web-only survey was conducted in 2022 using the Hospital Survey on Patient Safety Culture (HSOPS) among 4780 employees at an 1836-bed, university-affiliated hospital in France. We quantified the mean differences in the 12 HSOPS dimension scores according to MMCs and EFCs participation, using Cohen d effect size. We performed a multivariate analysis of variance to examine differences in dimension scores after adjusting for background characteristics.Results: Of 4780 eligible employees, 1457 (30.5%) participated in the study. Among the respondents, 571 (39.2%) participated in MMCs or EFCs activities. Participants engaged in MMCs or EFCs reported significantly higher scores in six out of twelve HSOPS dimensions, particularly in “Nonpunitive response to error”, “Feedback and communication about error”, and “Organizational learning” (Overall effect size = 0.14, 95% confidence interval = 0.11 to 0.17, P< 0.001). Notably, involvement in both MMCs and EFCs was associated with higher improvements in patient safety culture compared to non-participation or singular involvement in either program. However, certain dimensions such as “Staffing”, “Hospital management support”, and “Hospital handoffs and transition” showed no significant association with MMCs or EFCs participation, highlighting broader systemic challenges.Conclusion: The study confirms the positive association between participation in MMCs or EFCs and an enhanced culture of patient safety, emphasizing the importance of such programs in fostering an environment conducive to learning, communication, and nonpunitive responses to errors. While MMCs or EFCs are effective in promoting certain aspects of patient safety culture, addressing broader systemic challenges remains crucial for comprehensive improvements in patient safety.Keywords: patient safety culture, quality improvement programs, morbidity and mortality conferences, experience feedback committees

Keywords

• patient safety culture
• quality improvement programs
• morbidity and mortality conferences
• experience feedback committees