Changes in Patient Safety Culture after Restructuring of Intensive Care Units: Two Cross-Sectional Studies.

Objectives: Compare changes in registered nurses' perception of the patient safety culture in restructured and not restructured intensive care units during a four-year period.Methodology/design: Two cross-sectional surveys were performed, in 2008/2009 (time 1) and 2012/2013 (time 2). During a period of 0-3 years after time 1, three of six hospitals merged their general and medical intensive care units (restructured). The other hospitals maintained their structure of the intensive care units (not restructured).Setting: Intensive care units in hospitals at one Norwegian hospital trust.Outcome measure: The safety culture was measured with Hospital Survey on Patient Safety Culture.Results: At times 1 and 2, 217/302 (72%) and 145/289 (50%) registered nurses participated. Restructuring was negatively associated with change in the safety culture, in particular, the dimensions of the safety culture within the unit level. The dimensions most vulnerable for restructuring were manager expectations and actions promoting safety, teamwork within hospital units and staffing.Conclusion: In this study, the restructuring of intensive care units was associated with a negative impact on the safety culture. When restructuring, the management should be particularly aware of changes in the safety culture dimensions manager expectations and actions promoting safety, teamwork within hospital units and staffing. (C) 2015 The Authors. Published by Elsevier Ltd.