Evidence map›Paper›PMID 41547948›Full record

ArticleImplementation science communications2026

Enhancing adoption of patient safety culture assessments in Brazil: a strategy informed by CFIR and ERIC.

Zenewton André da Silva Gama, Magda Machado de Miranda Costa, Heiko Thereza Santana, Natália Gentil Linhares, Evan M Benjamin, Katherine E A Semrau

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Article in Implementation science communications, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Zenewton André da Silva GamaDepartment of Collective Health, Federal University of Rio Grande do Norte, Natal, RN, Brazil. zenewton.gama@ufrn.br.ORCID http://orcid.org/0000-0003-0818-9680
Magda Machado de Miranda CostaAgência Nacional de Vigilância Sanitária, Brasília, DF, Brazil.
Heiko Thereza SantanaGradate Program in Quality Management in Health Services (QualiSaúde), Federal University of Rio Grande do Norte, Natal, RN, Brazil.
Natália Gentil LinharesBachelor of Science in Nursing, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
Evan M BenjaminAriadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Katherine E A SemrauAriadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRegular assessments of Patient Safety Culture (PSC) are recommended by the World Health Organization to strengthen healthcare systems. In Brazil, despite national campaigns, hospital adherence to PSC assessments has remained low. This study aimed to design a tailored implementation strategy to improve the uptake of PSC assessments in Brazilian hospitals, addressing the key barriers faced in previous national efforts.

methodsWe conducted a sequential exploratory mixed-methods study in three phases. First, a qualitative survey with 82 patient safety center coordinators identified perceived barriers and facilitators to implementing PSC assessments. Then, a quantitative survey with 297 coordinators prioritized the most relevant barriers. Finally, we used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementation Change (ERIC) to guide the design of a tailored implementation strategy aligned with the prioritized barriers.

resultsThe main barriers included insufficient dissemination of PSC assessments, lack of training for staff, resistance to completing the survey, the excessive length of the questionnaire, and technical limitations of the data collection platform. The co-design implementation strategy includes 16 actions such as improving communication, offering training, adapting the technology platform, and revising roles and responsibilities within hospitals. These actions were aligned with the identified barriers and aim to enhance organizational readiness, reduce complexity, and promote engagement.

conclusionsOur findings highlight critical factors limiting the adoption of PSC assessments in Brazil and offer a data-driven, context-sensitive implementation strategy to overcome them. These results provide actionable recommendations for policymakers, healthcare managers, and regulators aiming to strengthen patient safety culture in large-scale, resource-constrained health systems.

Indexed as

BrazilGovernmental regulationHospitalsImplementation scienceOrganizational culturePatient safety

Identifiers

PMID41547948
PMCPMC12895655

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.