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Involvement in Root Cause Analysis and Patient Safety Culture Among Hospital Care Providers

Boussat, Bastien MD*†; Seigneurin, Arnaud MD, PhD*†; Giai, Joris MD; Kamalanavin, Kevin MSc§; Labarère, José MD, PhD*†∥; François, Patrice MD, PhD*†

doi: 10.1097/PTS.0000000000000456
Original Article: PDF Only

Background The experience feedback committee (EFC) is a tool designed to involve medical teams in patient safety management, through root cause analysis within the team.

Objective The aim of the study was to determine whether patient safety culture, as measured by the Hospital Survey on Patient Safety Culture (HSOPS), differed regarding care provider involvement in EFC activities.

Methods Using the original data from a cross-sectional survey of 5064 employees at a single university hospital in France, we analyzed the differences in HSOPS dimension scores according involvement in EFC activities.

Results Of 5064 eligible employees, 3888 (76.8%) participated in the study. Among the respondents, 440 (11.3%) participated in EFC activities. Experience feedback committee participants had a more developed patient safety culture, with 9 of the 12 HSOPS dimension scores significantly higher than EFC nonparticipants (overall effect size = 0.31, 95% confidence interval = 0.21 to 0.41, P < 0.001). A multivariate analysis of variance indicated that all 12 dimension scores, taken together, were significantly different between EFC participants and nonparticipants (P < 0.0001), independently of sex, hospital department, and healthcare profession category. The largest differences in scores related to the “feedback and communication about error,” “organizational learning,” and “Nonpunitive response to error” dimensions. The analysis of the subgroup of professionals who worked in a department with a productive EFC, defined as an EFC implementing at least five actions per year, showed a higher patient safety culture level for seven of the 12 HSOPS dimensions (overall effect size = 0.19, 95% confidence interval = 0.10 to 0.27, P < 0.001).

Discussion and Conclusions Participation in EFC activities was associated with higher patient safety culture scores. The findings suggest that root cause analysis in the team's routine may improve patient safety culture.

From the *Quality of Care Unit, Grenoble University Hospital; †TIMC UMR 5525 CNRS, Université Grenoble Alpes, Grenoble; ‡Service de Biostatistique, Hospices Civils de Lyon, Laboratoire de Biométrie et Biologie Evolutive, UMR 5558 CNRS, Lyon; §Department of Political Science, Institute of Political Studies; and ∥INSERM CIC 1406, Grenoble, France.

Correspondence: Bastien Boussat, MD, Service d' Evaluation Médicale, Pavillon Taillefer, CHU CS 10-217, F-38043, Grenoble Cedex, France (e-mail:

The authors disclose no conflict of interest.

This work was supported by a grant from the French Ministry of Health (Programme de recherche sur la performance du système de soins-PREPS 12-026-0001).

This work was developed within the framework of the Grenoble Alpes Data Institute, which is supported by the French National Research Agency under the “Investissements d'avenir” program (ANR-15-IDEX-02).

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