# Exploring patient safety culture and opportunities for improvement: a mixed-methods study in a Dutch paediatric intensive care unit

## TL;DR

This study examines patient safety culture in a Dutch pediatric ICU over 14 years and identifies areas for improvement like communication and staffing.

## Contribution

The study provides a long-term analysis of safety culture trends and actionable strategies proposed by staff in a pediatric ICU.

## Key findings

- Patient safety culture improved overall from 2009 to 2023, but stress recognition and management perceptions still need improvement.
- Staff recommendations focused on communication, equipment, and staffing, including appointing a contact person for parents.
- Continuous investment in communication and workplace conditions is essential for sustained safety improvements.

## Abstract

Hospitals often face complex and life-threatening situations that heighten the risk of medical errors. Improving patient safety culture is important to reduce these errors. This study aims to identify trends in patient safety culture within a paediatric intensive care unit (PICU) and to explore strategies for improvement.

The study had a mixed-methods design, combining quantitative and qualitative methods, and was done at the PICU of Sophia Children’s Hospital (Rotterdam, The Netherlands). The Safety Attitudes Questionnaire (SAQ) was used to measure patient safety culture, with surveys administered in 2009, 2012, 2014, 2017, 2019 and 2023. Trends in patient safety culture over time were analysed. Additionally, staff members provided recommendations to improve patient safety, which were subsequently categorised into overarching themes. An expert panel was convened and interviews with staff members were conducted to further evaluate the most frequently mentioned recommendations and assess their relevance and feasibility for implementation.

From 2009 to 2023, patient safety culture demonstrated overall improvement. However, specific domains, including stress recognition, perceptions of management and working conditions, still show room for further improvement. Most recommendations identified through the SAQ fell within the themes of interprofessional communication, medical equipment and hospital working environment, and staffing. Concrete suggestions included appointing a dedicated contact person to improve communication with parents and establishing clear agreements to strengthen communication and teamwork within the PICU.

The patient safety culture at the PICU of Sophia Children’s Hospital improved over the years, although areas for improvement remain. Sustained improvements in patient safety culture require continuous investment in interprofessional communication, workplace conditions and staffing. This study not only highlights long-term trends but also presents actionable strategies proposed by staff to address persistent challenges. Effective implementation and ongoing evaluation of these interventions are essential to strengthen safety culture, enhance staff well-being and ultimately improve patient outcomes.