Exploring the Development of Safety Culture among Physicians with Text Mining of Patient Safety Reports: A Retrospective Study.

Background: Safety culture development is essential for patient safety in healthcare institution. Perceptions of patient safety and cultural changes are shown up in patient safety reports, however, were rarely investigated. The aim of this study was to investigate the perception of physicians and to explore the development of safety culture using quantitative content analysis for patient safety reports.

Methods: A retrospective analysis of free descriptions of harmful patient safety reports submitted by physicians was performed. Natural language processing and text analysis were conducted using the 'KH Coder'. A co-occurrence analysis was performed in each period to identify and analyze the safety concepts. The study period was grouped into three for comparison.

Results: The patient safety reports from physicians were collected between April 2004 and March 2020. Of these, 3351 reports were harmful; 839 reports were included in period 1, 1016 reports in period 2, and 1496 reports in period 3. Natural language processing identified 316 307 words in the free descriptions of 3351 reports. We identified seven concepts from the cluster in co-occurrence analysis as follows: 'explanation of adverse event to patients and families,' 'central venous catheter,' 'intraoperative procedure and injury,' 'minimally invasive surgery,' 'life-threatening events,' 'blood loss,' and 'medical emergency team and critical care.' These seven concepts showed significant differences among the three periods, except for 'blood loss'. The 'explanation of adverse event to patients and families' decreased in proportion from 11.3% to 8.8% (p<0.05). The 'central venous catheter' decreased from 17.3% to 11.3% (p<0.01). Meanwhile, 'minimally invasive surgeries' and 'intraoperative procedures' increased from 3.9% to 12.9% (p<0.01) and from 10.8% to 14.6% (p<0.05), respectively. Focusing on patients' events, 'life-threatening events' decreased from 13.0% to 8.1% (p<0.01); however, 'medical emergency teams and critical care' increased from 3.3% to 10.6% (p<0.01).

Conclusion: Free description in patient safety reports is useful for evaluating the safety culture. Co-occurrence analysis revealed multiple concepts of physicians' perceptions. Quantitative content analysis revealed changes in perceptions and attitudes, and a disclosure policy of adverse events and priority of patient care appeared with the development of safety culture.