Background: Our multicenter academic health system has developed an outreach organization focused on helping international healthcare systems develop patient safety culture and improve hospital quality to meet international quality and safety standards. We established a relationship with a 500-bed comprehensive community hospital in Southern China to activate improvement efforts in clinical care and administrative work. The project was led by quality leaders from Hospital Medicine and Nursing.

Purpose: Gap assessments identified that a major barrier in prior efforts to improve quality and patient safety at the Southern China hospital was the perceived inadequate safety culture by staff. Insecurity about raising concerns thwarted efforts to identify safety threats and develop solutions.

Description: An anonymous survey was conducted at the Southern China hospital in 2019 using the Agency for Healthcare Research and Quality (AHRQ) hospital survey version 1.0. 54% of staff participated, including physicians, nurses, technicians, and administrators. Perceived deficiencies in quality and safety were identified. The areas rated most poorly were hospital management support for patient safety (50% positive perception), non-punitive response to error (32%), staffing (29%), teamwork across units (41%), frequency of safety events reported (52%), and communication openness across hospital hierarchy (55%). Each of these scores were substantially below average compared to AHRQ survey from U.S. hospitals. We deployed a multifaceted intervention to enhance the patient safety culture at the hospital. The interventions consisted of (1) educational programs about patient safety culture for hospital leadership, (2) multidisciplinary quality improvement workshops to enhance partnership among departments, (3) developing an anonymous submission portal for safety concerns in the hospital intranet, (4) conducting interdisciplinary patient safety event reviews with our health system experts to adopt a non-punitive method of discovering errors, and (5) developing recruitment plans for critical staffing shortages. In 2020, a second survey was conducted using the AHRQ Hospital Survey version 2.0. The questions were grouped in similar categories as version 1.0, and comparisons were made to the 2019 results. Perceived deficiencies in hospital management support for patient safety improved from 50% to 59% positive perception, non-punitive response to error to 36%, staffing to 33%, teamwork across units to 45%, and communication openness among staff across hospital hierarchy to 57%. However, perceived frequency of safety events reported decreased to 48% (Table 1).

Conclusions: Our international application of quality and patient safety concepts identified commonalities across cultures and challenges to institute new safety norms in a novel environment. In China, we successfully implemented initiatives that improved teamwork-related processes, while found difficulties in impacting a healthcare organization’s response to provider errors or have hospital leadership devote resources to staffing. We found that methods of cultural transformation in quality and safety can be shared across different countries and healthcare systems. A validated safety culture survey such as the ARHQ Hospital Survey can spark a conversation of change throughout healthcare organizations internationally, bringing clinicians and administrators from diverse backgrounds together to improve safety culture and patient care.

IMAGE 1: Table 1. AHRQ Hospital Survey Part 1

IMAGE 2: Table 1. AHRQ Hospital Survey Part 2