Process evaluation of the effects of patient safety auditing in hospital care (part 2).

objectiveTo identify factors that explain the observed effects of internal auditing on improving patient safety. DESIGN SETTING AND

participantsA process evaluation study within eight departments of a university medical centre in the Netherlands. INTERVENTION(S): Internal auditing and feedback for improving patient safety in hospital care. MAIN OUTCOME MEASURE(S): Experiences with patient safety auditing, percentage implemented improvement actions tailored to the audit results and perceived factors that hindered or facilitated the implementation of improvement actions.

resultsThe respondents had positive audit experiences, with the exception of the amount of preparatory work by departments. Fifteen months after the audit visit, 21% of the intended improvement actions based on the audit results were completely implemented. Factors that hindered implementation were short implementation time: 9 months (range 5-11 months) instead of the 15 months' planned implementation time; time-consuming and labour-intensive implementation of improvement actions; and limited organizational support for quality improvement (e.g. insufficient staff capacity and time, no available quality improvement data and information and communication technological (ICT) support).

conclusionsA well-constructed analysis and feedback of patient safety problems is insufficient to reduce the occurrence of poor patient safety outcomes. Without focus and support in the implementation of audit-based improvement actions, quality improvement by patient safety auditing will remain limited.