The Association Between Patient Safety Culture and Accreditation at Primary Care Centers in Kuwait: A Country-Wide Multi-Method Study

Purpose: A culture of patient safety is essential for the continual improvement of service and reducing errors. This study aims to examine how the scores of patient safety culture items impact accreditation compliance percentages in primary care settings in Kuwait. Methods: A cross-sectional and a retrospective quantitative approaches were used on 5288 employees at 75 primary healthcare centers across Kuwait. Patient safety culture questionnaires were distributed to clinical and administrative staff with at least one year of experience. We also examined the percentages of compliance with accreditation standards by the studied centers. Participant socio-demographic and setting demographic data were studied using univariate (means, standard deviations, frequencies, percentages) and bivariate (Student's t-tests, ANOVA F-tests, Mann-Whitney U-test, Kruskal-Wallis H-test, Spearman correlation) analyses to examine how trends in the patient safety culture items and accreditation compliance differ across the primary healthcare center demographic groups. The relationship between patient safety culture composites and percentages of accreditation compliance was investigated. To predict the factors for accreditation compliance, we used multivariate regression analysis. Results: The responses of 5288 employees (response rate= 76.5%) from 75 centers were included. Our analysis revealed that the demographics of the setting affected the accreditation compliance percentage more than the percentages of patient safety culture positive ratings. Furthermore, the composites "Patient Care Tracking/Follow-up", "Communication about Error", "Organizational Learning" and "Overall Perceptions of Patient Safety & Quality" had statistically significant weak-to-moderate positive correlations (r = 0.272-0.373) with percentage scores for compliance with various accreditation standards. Regression analysis indicated that the patient safety culture items accounted for 35% to 38% of the variability in accreditation compliance scores. Conclusion: The safety practices adopted by a primary healthcare center reflect its culture, and this has an impact on its accreditation performance. Our interpretation of the findings is expected to help healthcare leaders to better understand the relationship between safety culture and performance and to develop realistic reform strategies.