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Abstract Medical interventions are, by their nature, high risk procedures. Recent researches suggests that levels of harm range from 3 – 25% in acute care (Health Foundation, 2011 A), and the number of patient deaths associated with hospital care is more than 400,000 a year. The toll is estimated to be much higher in developing countries (James, 2013). Many researchers concluded that 80% of errors result from system failures rather than individual errors (Reason, 2000). Good clinical practice means providing care that is safe and effective without doing harm. This requires proper identification and acceptance of errors through sound safety culture. Safety culture has become a significant issue for healthcare organizations striving to improve patient safety (Kennedy, 2001). Dr. James Reason identified four components for safety culture, namely; just culture which balances between no blame and accountability, reporting culture, flexibility culture and learning culture. Other elements include leadership, communication and teamwork (Reason, 1998). Accreditation is defined by Joint Commission International (JCI) as “a process in which an entity, separate and distinct from the healthcare organization, usually non-governmental, assesses the healthcare organization to determine if it meets a set of standards requirements designed to improve quality of care” (JCI, 2011). Accreditation standards offer healthcare organizations a systematic way of organizing operations for optimal efficiency and effectiveness (Haakstad, 2001). Does accreditation improve patient safety culture? In one study, staff participation in an accreditation process was found to have promoted a quality and safety culture by better integrating different professional groups e.g., doctors, nurses and allied health professionals. Researchers also found that accreditation focused all staffs attention on a common quality improvement goal (Greenfield et al., 2011; Hinchcliff et al., 2013). However, researches focused on the impact of accreditation on patient safety and quality of care as a whole yet little attention was given to measuring its impact on patient safety culture directly. The Objective of the current study is to: Compare patient safety culture between an accredited and nonaccredited hospital. Identify factors affecting patient safety culture in both hospitals. The current study is a comparative descriptive study carried out in two hospitals; one accredited “Dar Al Shefaa” and one nonaccredited “Al Qahira Al Fatimya”. The two hospitals were matched regarding administrative type, bed capacity and provided level of care. The study included healthcare providers working in the two selected hospitals excluding administrative staff and laborers. The sample size was estimated to be 182 subjects in each hospital to detect a difference up to at least 15%. Study tool was an Arabic version of the validated self-administrated questionnaire; Hospital Survey on Patient Safety Culture designed by the Agency for Healthcare Research and Quality (AHRQ) to assess hospital staff opinions about patient safety issues, medical errors and event reporting. It was pilot tested, revised and then released in November 2004. It consists of 12 dimensions of patient safety culture in addition to outcome variables (Sorra and Nieva, 2004). The collected sample was 312 questionnaires from both hospitals, the sample included physicians, nurses, pharmacists,technicians and chemists. Different departments were represented in the sample. Main study findings show that accreditation is the only significant independent variable, with the accredited hospital having odds of 3.83 higher than the non-accredited to have 50% or more total score of safety culture (95% CI 2.1-6.9). More than 75% of respondents from the accredited hospital scored ≥50% total safety culture versus only 43.8% from the non-accredited hospital, with difference of 32.2% (p<0.001).Also respondents working in accredited hospital were more likely to report an Excellent/ very good grade accounting for 93% versus 57.6% in the non-accredited hospital (p<0.001). The accredited hospital scores are significantly higher than those of the non-accredited hospital regarding all dimensions of patient safety culture except for the dimension “Staffing” where both hospitals scores are low. Also both hospital scores are low regarding “Non Punitive Response to Errors” although the statistical difference between them is highly significant (p<0.001). There is no statistical significant difference between the studied hospitals regarding the outcome measure “Number of Events Reported”. Areas of strengths (score in the accredited hospital are “Teamwork within Units” (82.9), “Organizational Learning and Continuous Improvement” (78.4) and “Feedback and Communication about Error” (76.1), while areas of improvement (score ≤ 50%) are “Staffing” (41.4) and “Non Punitive Response to Errors” (35.3). The non-accredited hospital shows no areas of strengths while areas of improvement are 8 out of 12 namely; “Non Punitive Response to Errors” (19.1), “Staffing” (42.2), “Management Support for Patient. |