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Abstract
Introduction Patient safety culture (PSC) plays a critical role in ensuring safe and quality care. Extensive PSC studies have been undertaken in hospitals. However, little is known about PSC in maternal and child health (MCH) institutions in China, which provide both population-based preventive services as well as individual care for patients.
Objectives This study aimed to develop a theoretical framework for conceptualising PSC in MCH institutions in China.
Methods The study was undertaken in six MCH institutions (three in Hebei and three in Beijing). Participants (n=118) were recruited through stratified purposive sampling: 20 managers/administrators, 59 care providers and 39 patients. In-depth interviews were conducted with the participants. The interview data were coded using both inductive (based on the existing PSC theory developed by the Agency for Healthcare Research and Quality) and deductive (open coding arising from data) approaches. A PSC framework was formulated through axial coding that connected initial codes and selective coding that extracted a small number of themes.
Results The interviewees considered patient safety in relation to six aspects: safety and security in public spaces, safety of medical services, privacy and information security, financial security, psychological safety and gap in services. A 12-dimensional PSC framework was developed, containing 69 items. While the existing PSC theory was confirmed by this study, some new themes emerged from the data. Patients expressed particular concerns about psychological safety and financial security. Defensive medical practices emerged as a PSC dimension that is associated with not only medical safety but also financial security and psychological safety. Patient engagement was also valued by the interviewees, especially the patients, as part of PSC.
Conclusions Although there are some common features in PSC across different healthcare delivery systems, PSC can also be context specific. In MCH settings in China, the meaning of ‘patient safety’ goes beyond the traditional definition of patients. General well-being, health and disease prevention are important anchor points for defining PSC in such settings.
- Health & safety
- Organisation of health services
- QUALITATIVE RESEARCH
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Footnotes
Contributors YYW and YW conceived and designed the study and oversaw the data collection. CL and WL participated in the design of the study and the development of the interview tools. HS participated in data collection and analyses. YYW led the data analyses and writing of the manuscript. CL guided the development research methodology and interpretation of the findings. As co-corresponding authors, YW and CL contributed equally to this study. All authors contributed to the drafting of the article and read and approved the final version of the manuscript.
Funding This study was funded by Beijing Municipal Education Commission, Beijing Key Disciplines(Maternal, Child and Adolescent Health).
Competing interests None declared.
Ethics approval Peking University Institutional Review Board; Peking University Third Hospital Medical Science Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The raw data supporting the conclusions of this article are included in the article as interview excerpts. The full interview transcripts remain the property of the Division of Maternal and Child Health, School of Public Health, Peking University, which are accessible by contacting the corresponding author at wangyan@bjmu.edu.cn.