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Improving Patient Safety Culture in Primary Care

A Systematic Review

Verbakel, Natasha J. MSc; Langelaan, Maaike PhD; Verheij, Theo J. M. MD, PhD; Wagner, Cordula PhD; Zwart, Dorien L. M. MD, PhD

doi: 10.1097/PTS.0000000000000075
Review Article

Background Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which effect interventions have on the safety culture.

Objectives To review literature on the use of interventions that effect patient safety culture in primary care.

Methods Searches were performed in PubMed, EMBASE, CINAHL, and PsychINFO on March 4, 2013. Terms defining safety culture were combined with terms identifying intervention and terms indicating primary care. Inclusion followed if the intervention effected patient safety culture, and effect measures were reported.

Results The search yielded 214 articles from which two were eligible for inclusion. Both studies were heterogeneous in their interventions and outcome; we present a qualitative summary. One study described the implementation of an electronic medical record system in general practices as part of patient safety improvements. The other study facilitated 2 workshops for general practices, one on risk management and another on significant event audit. Results showed signs of improvement, but the level of evidence was low because of the design and methodological problems.

Conclusions These studies in general practice provide a first understanding of improvement strategies and their effect in primary care. As the level of evidence was low, no clear preference can be determined. Further research is needed to help practices make an informed choice for an intervention.

From the *Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht; †Nivel, Netherlands Institute for Health Services Research, Utrecht; and ‡EMGO+ Institute, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.

Correspondence: Natasha J. Verbakel, UMCU, Julius Center t.a.v. N.J. Verbakel Huispostnummer 6.131P.O. Box 85500 3508 GA Utrecht, The Netherlands (e-mail:

The authors disclose no conflict of interest.

Funding: the Dutch Ministry of Health, Welfare and Sport.

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