Open Access Open Badges Research article

The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study

Lena Burström1*, Anna Letterstål23, Marie-Louise Engström1, Anders Berglund14 and Mats Enlund1

Author Affiliations

1 Centre for Clinical Research, Uppsala University, Västmanlands County Hospital, Västerås, Sweden

2 Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden

3 Department of Medicine, Karolinska Institutet, Solna, Sweden

4 Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden

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BMC Health Services Research 2014, 14:296  doi:10.1186/1472-6963-14-296

Published: 9 July 2014



Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety.


A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions.


At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital.


The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.

Patient safety; Patient safety culture; Patient safety climate; Quality improvement; Team-work