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

Objective: To identify factors that explain the observed effects of internal auditing on improving patient safety.

Design setting and participants: A 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.

Results: The 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).

Conclusions: A 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.