Yes / Purpose: To summarize studies that have examined patient safety culture (PSC) in maternity units and describe the different purposes, study designs and tools reported in these studies, whilst highlighting gaps in the literature. Methodology: Peer-reviewed studies published in English during 1961-2016 across eight electronic databases were subjected to a narrative literature review. Findings: Among 100 articles considered, 28 met the inclusion criteria. The main purposes for studying PSC were: (a) assessing intervention effects on PSC (n= 17); and (b) assessing PSC level (n=7). Patient safety culture was mostly assessed quantitatively using validated questionnaires (n=23). The Safety Attitude Questionnaire was the most commonly used questionnaire (n=17). Intervention varied from a single action lasting five weeks to a more comprehensive package lasting more than four years. The time between the baseline and the follow-up assessment varied from six months up to 24 months. No study reported measurement or intervention costs, and none incorporated the patient’s voice in assessing PSC. Practical Implications: Assessing PSC in maternity units is feasible using validated questionnaires. Interventions to enhance PSC have not been rigorously evaluated. Future studies should report PSC measurement costs, adopt more rigorous evaluation designs, and find ways to incorporate the patient’s voice. Originality/Value: This review summarized studies examining PSC in a highly important area and highlighted main limitations that future studies should consider.

Il est préconisé de développer le climat de sécurité (CS) pour améliorer la sécurité des soins. Dans cette thèse, nous essaierons de préciser l’utilisation du concept de CS pour l’évaluation d'interventions d’amélioration de la sécurité des soins.Les objectifs des travaux présentés étaient d’élaborer un questionnaire de CS en français et d’évaluer l’impact de l’analyse de vignettes d’événements indésirables associés aux soins (EIAS) sur le CS d’unités de soins en milieu hospitalier.Ces travaux ont montré la faisabilité de mesurer le CS avec une version française du questionnaire américain, le Hospital Survey On Patient Safety Culture (HSOPSC). Ils ont permis de proposer une version française aux performances psychométriques suffisantes. Ils ont montré l’importance du rôle de l’encadrement, de l’organisation apprenante et du travail d’équipe entre services. La version française de l’HSOPSC a été utilisée pour évaluer l’effet de l’analyse de vignettes d’EIAS. Testée dans un essai contrôlé randomisé en clusters, cette intervention a amélioré les perceptions des professionnels sur l’organisation apprenante et l’amélioration continue, sans modifier les autres dimensions.Face à la difficulté de modifier dans un temps court l’ensemble des dimensions, le CS devrait être utilisé pour caractériser le contexte d'implémentation des interventions afin de les adapter et de mieux en comprendre l’impact, plutôt que pour servir de critère de résultat.Les pistes de recherche sont d’étudier la pérennité d’une intervention au-delà de son évaluation initiale au travers du maintien ou du développement de la culture de sécurité ; et d’étudier les perceptions des patients en matière de sécurité de soins / It is recommended to develop the safety climate (SC) to improve patient safety. In this thesis, we will try to clarify the use of the CS concept for the evaluation of interventions aiming to improve patient safety.The objectives of the articles presented were to develop a French version of a SC questionnaire and to assess the impact of a vignette-based analysis of adverse events (AEs) on the SC of care units.The studies demonstrated the feasibility of measuring the SC with a French version of the American questionnaire, the Hospital Survey On Patient Safety Culture (HSOPSC). They made it possible to propose a French version with sufficient psychometric performance. They showed the importance of the role of supervision, the organisational learning and teamwork between units. The French version of the HSOPSC was used to evaluate the effect of the vignette-based analysis of AEs. Tested in a randomized controlled cluster trial, this intervention improved professionals' perceptions of the organisational learning and continuous improvement, without modifying other dimensions.Given the difficulty of modifying all dimensions in a short period of time, SC should be used to characterize the context in which interventions are implemented in order to adapt them and better understand their impact, rather than being used as an outcome criterion.The research areas are to study the sustainability of an intervention beyond its initial evaluation through the maintenance or development of a safety culture; and to study patients' perceptions of care safety

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