de Oliveira Lima Helidea, da Silva Leopoldo Muniz, Tavares Leandro Reis, de Araújo Ana Claudia Lopes Fernandes, Moreira Laise Pereira, de Melo Silva Torres Vanessa, de Oliveira Fabiana Nogueira, Ho Anthony M-H, Simões Deborah, Mizubuti Glenio B, Vieira Joaquim Edson
IDOR- D'Or Institute for Research and Education - Rede D'Or, São Paulo, Brazil.
Department of Patient Safety and Quality Management, São Luiz Hospital (Itaim), Rede D´Or, Rua Alceu de Campos Rodrigues, 229, São Paulo, SP, Brazil.
Isr J Health Policy Res. 2025 Jun 4;14(1):27. doi: 10.1186/s13584-025-00690-8.
Enhancing security and dependability of health systems necessitates resource allocation, a well-defined infrastructure, and a steadfast commitment to ensuring its safety and stability over time. This study aimed to assess changes in patient safety culture over time (2014-2022) within a network of private hospitals in Brazil and to examine its association with the hospital accreditation process. The study utilized the Hospital Survey on Patient Safety Culture (HSOPSC) to measure healthcare professionals' perceptions of patient safety culture.
The HSOPSC questionnaire was distributed to 71 hospitals between 2014 and 2022 with 259,268 responders. Hospitals were classified as accredited (AH) or non-accredited (NAH). A linear mixed-effects regression model was used to analyze the trend of dimension scores over time, accounting for both fixed and random effects to accommodate within-hospital correlations and variations across time points.
Out of 12 dimensions analysed, 11 significantly improved, and one ("frequency of reported events") remained unchanged over time (p = 0.84). Two dimensions had < 50% positive responses: "communication openness" (47.13% [38.19-58.73]) and "nonpunitive response to errors" (41.24% [34.13-51.98]). Safety culture improved among AH across all, but "frequency of reported events" (p = 0.12), dimensions. Among NAH, "frequency of reported events" decreased over time (p = 0.008) while other dimensions remained unchanged.
Our results suggest an improvement in patient safety culture within this network of private hospitals in Brazil from 2014 to 2022. While accreditation appears to be associated with fostering a culture of safety over time, our study does not establish a causal relationship. Additionally, non-accredited hospitals tended to report fewer adverse events, which may indicate underreporting and missed opportunities for healthcare system improvement through adverse event analysis.
提高卫生系统的安全性和可靠性需要资源分配、明确的基础设施以及长期致力于确保其安全性和稳定性。本研究旨在评估巴西私立医院网络中患者安全文化随时间（2014 - 2022年）的变化，并考察其与医院认证过程的关联。该研究利用患者安全文化医院调查（HSOPSC）来衡量医疗专业人员对患者安全文化的认知。
2014年至2022年期间，HSOPSC问卷被分发给71家医院，共有259,268名受访者。医院被分为已认证（AH）或未认证（NAH）。使用线性混合效应回归模型分析维度得分随时间的趋势，同时考虑固定效应和随机效应，以适应医院内部的相关性和不同时间点的变化。
在分析的12个维度中，11个维度有显著改善，1个维度（“报告事件的频率”）随时间保持不变（p = 0.84）。两个维度的积极回应率低于50%：“沟通开放性”（47.13% [38.19 - 58.73]）和“对错误的非惩罚性反应”（41.24% [34.13 - 51.98]）。在所有维度中，已认证医院的安全文化均有所改善，但“报告事件的频率”维度除外（p = 0.12）。在未认证医院中，“报告事件的频率”随时间下降（p = 0.008），而其他维度保持不变。
我们的结果表明，2014年至2022年期间，巴西这个私立医院网络中的患者安全文化有所改善。虽然认证似乎与随着时间推移培养安全文化相关，但我们的研究并未确立因果关系。此外，未认证医院报告的不良事件往往较少，这可能表明报告不足以及通过不良事件分析改进医疗系统的机会被错失。
