The Royal New Zealand College of General Practitioners

‘Safety culture’ is a relatively new concept in the health sector and refers to the shared attitudes, beliefs, values and assumptions that underlie how people perceive and act on safety issues. As attitudes influence actions, and actions can either cause or prevent safety incidents, the attitude that the practice team has towards safety issues influences the safety of patients in the practice.

How to use the NZ-MaPSaF in your practice

The MaPSaF process takes about an hour - do it over morning tea or lunch. All practice staff available should participate in the process, including doctors, nurses, reception staff, and any other ancillary staff.

Each participant should have a copy of the ‘NZ-MaPSaF (General Practice) Dimensions’ and an evaluation sheet. The NZ-MaPSaF describes nine dimensions of safety culture, and for each dimension provides five descriptions. All participants, individually and without discussion, read the five descriptions for each dimension and then choose the one description (A, B, C, D or E) that they think best describes the situation in their practice. Try and do this in 20 minutes, allowing 2 – 3 minutes per dimension. You may find that some descriptions don’t fit or that some bits from several descriptions fit. Just do your best to choose a score, remember the value of the process lies in the discussion and the team based reflection not in the score. If you really can’t decide between 2 of the descriptions, tick both.

When everyone has finished scoring it is time for the group discussion. Go around the group one by one and discuss each dimension and the score chosen and the reason for choosing that score. After the discussion, choose a consensus score for each dimension.

The NZ-MaPSaF talks about ‘patient safety incidents’. These are defined as ‘any unintended or unexpected incident that could have or did lead to harm to one or more patients’. We are talking here about events that happen, or could happen, every day in general practice. For example incorrect prescriptions, lost referral letters, missing test results, incorrect discharge letters, mislaid phone messages, delayed diagnoses, privacy breaches etc. We are not just talking about the rare and terrible events like ‘chopping off the wrong leg’ or ‘injecting lethal doses of the wrong drug’.

The NZ-MaPSaF process is not about apportioning blame, nor is it about comparing the safety culture in your practice with that in another. Your self-rated scores can not be compared with those of another practice but can be used as a before and after comparison within your own practice to see if the discussion about safety stimulated by the NZ-MaPSaF tool has precipitated any change in the practice. The value of using the NZ-MaPSaF tool lies in the discussion and the learning, not in the scores. For example, sometimes when using the NZ-MaPSaF a subsequent time, you may choose a lower score for your practice for one of the Dimensions but nevertheless have greater understanding about the dimensions of patient safety and thus a more mature safety culture in your practice.