Assessment of Patient Safety Culture Among Citizens: A Survey Study

Objectives: Public engagement in quality and safety improvement is crucial in health care. To have an effective participation, it appears essential to align knowledge, language, and values among users and workers. Present study is aimed to assess patient safety culture and knowledge among a representative sample of Italian citizens, with/without chronic medical conditions. Methods: A semistructured, self-administered questionnaire was distributed through email to a nationally representative population database (DOXA, Milan, Italy). The email response rate was 21% out of 5678 emails sent. The sample consisted of 1200 individuals, of whom 400 had severe chronic conditions requiring regular hospital visits (referred to as “patients”) and 800 did not have such conditions (referred to as “citizens”). Descriptive and inferential statistical analyses were done, comparing subjects with/without chronic medical conditions across various demographic variables. Main investigation areas: fundamentals and best practice of patient safety, sources of information, attitudes towards telemedicine and clinical trials, participation to health care improvement and identification of relevant experiences. Results: Findings revealed limited knowledge of patient safety fundamentals, clinical trials and telemedicine, and better knowledge of patient safety practices. No significant differences emerged between patients and citizens regarding the understanding of medical error (60.8% patients versus 64.1% citizens) and adverse event (17.8% patients versus 15.9% citizens). The only significant difference concerning good practices relates to the interference of food with therapy (82.3% patients versus 72.5% citizens). The patient safety responsibility is attributed mainly to physicians (68% patients versus 66% citizens), then to management (48% patients versus 49% citizens) and nurses (41% patients versus 42% citizens). No statistically significant differences were found between citizens with/without chronic diseases; being over 44 years and/or having high-level education were associated with better culture. Structured citizen engagement is not widespread in the country. Conclusions: Effective strategies for cultivating health care quality and safety culture among citizens are needed, as well as enhancing and monitoring medical information, especially in view of telemedicine and artificial intelligence.