Table 2.

Theme 1 (organizational culture, safety and quality mindset) summary, illustrated with participant quotations.

Theme 1: organizational culture, safety and quality mindset
Sub-theme: organizational culture, safety and quality mindset
“…A very good patient safety culture, it is an important focus at every level. Leaders set an example by making patient safety the highest priority.” (Participant 13) ‘So, although within that national body bowel screening in Wales, there wasn’t, I wasn’t able to push that forward because the culture, they didn’t understand the importance of it.’ (Participant 20) ‘Patient safety sits in the realm of clinical care, and they’re not experts on clinical care. They are experts on managing a budget, ‘cause that’s what they’ve done historically. So, and that’s just a general statement, I know Boards now have people of the board that have got clinical backgrounds and they have board sub-committees for clinical governance.’ (Participant 1) ‘I think one of the major factors is the leadership on yeah, because of that, have a successful model or they have been successful in improving quality and efficiency.’ (Participant 23) ‘Where we have managers that also have the political background those managers are really involved because they have the time, they have the political power behind them.’ (Participant 11)
Sub-theme: staff engagement
‘Changing a culture, you know, engagement with staff, yeah, routinely..’ (Participant 28) ‘The majority of my colleagues who are specialised in this area, patient safety, the main problem is the culture of safety, the lack of the culture of safety…there is a power distance between the nurses and doctors, between doctors themselves, nurses themselves and the executive team, the Board.’ (Participant 17) ‘Yeah, I think it’s, it’s gotta be bottom up. I think memos from health departments don’t help.’ (Participant 2) ‘It’s important not to dictate, but to empower/champion. Frontline clinicians need to have buy-in.’ (Participant 12) ‘So for me, I think when you involve everybody in that, if you can assess – know where you’re start from, help them in develop strategies and implement them. What you realise is there’s some local ownership of the program. And then they can recommend it the way that would fit their context.’ (Participant 24) ‘To cultivate positive attitudes and behaviours relating to patient safety, organisations should focus on promoting common values.’ (Participant 6)
Sub-theme: endorsement of quality
‘But, you know, what they experience, what they see, you know…the support for them and their wellbeing and having the sort of types of opportunities for reflective practice that enables them just to try and make sense and then stay connected.’ (Participant 8) ‘Yes, yes, yes, we really need to have a culture change. We see very many people who want to cover these errors because they want to retain their hospital name to be one of the best or the best respected in their field.’ (Participant 18) ‘In my organisation they always said they’re not blaming culture or organisations…yes, but I guess in reality, it’s their own perspective that they are afraid to be blamed…’ (Participant 15) “That pre, for the 6–12 months pre-accreditation survey, probably 6 months, yes. All the resources home in on that. And everybody sees it, and so they see, they become even more cynical. Some organisations try to make it ‘this is just the way we do business around here, this is part of business as usual rather than an event’. And that takes a while to shift that culture….So…just because you say that ‘this is business as usual and not an event’, if people see things happening that look like you’re getting ready for an event, then they go: ‘well, I hear what you’re saying but that’s not what I’m seeing…‘They cram for an exam…they leave it to the last minute, cram and then their capacity to keep anything going or to sustain it diminishes significantly after their surveyors leave the organisation.’ (Participant 1) ‘There’s an emphasis in Wales and the UK on a just culture… And just recognising the support that’s needed when people make mistakes…they need to be supported in the same way that the patients or the person at the receiving end of the mistake needs to be supported.’ (Participant 20)