The impact of hospital accreditation on patient safety culture in the health services implementation at Sanglah General Hospital, Bali

Putu May Indrayani , Pande Putu Januraga, Surya Negara

Putu May Indrayani
Polyclinic of Surgery, Sanglah General Hospital. Email:

Pande Putu Januraga
Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University

Surya Negara
Department of Obstetrics and Gynecology, Faculty of Medicine, Udayana University/Sanglah General Hospital
Online First: December 30, 2021 | Cite this Article
Indrayani, P., Januraga, P., Negara, S. 2021. The impact of hospital accreditation on patient safety culture in the health services implementation at Sanglah General Hospital, Bali. Public Health and Preventive Medicine Archive 9(2): 108-115. DOI:10.15562/phpma.v9i2.364

Background and purpose: Hospital accreditation is carried out to evaluate hospitals' performance in providing patients with excellent and safe health services. One aspect of service quality is patient safety culture. This study aims to determine the impact of hospital accreditation on patient safety culture in health service implementation at the Sanglah General Hospital in Denpasar City, Bali Province.

Methods: This study used a qualitative research design. In-depth interviews were conducted to 11 informants consisting of hospital management, clinicians and nurses which were chosen purposively  since they were directly related to the assessment and supervision of health service providers at Sanglah Hospital. The interview guide was  based on the Modified Manchester Patient Safety Framework (MaPSaF). Data were analyzed with a thematic approach.

Results: The interview results show that the ten dimensions of patient safety culture had been implemented well but still need to be improved in the dimensions of giving priority to safety, system errors and responsibilities, recording incidents and best practices, learning and influencing change, also education and training of staff and teamwork. The maturity level of patient safety culture at Sanglah Hospital is at generative culture in four dimensions and at proactive culture on the six dimensions of patient safety culture.

Conclusion: Accreditation had a positive impact on the maturity level of patient safety culture at a proactive level, mainly changes in knowledge, attitudes, and behavior in health service providers. However, in its implementation, there were still constrained on infrastructure, time, and energy.


Mandawati M, Fu’adi MJ, Jaelan J. Impact of hospital accreditation: qualitative study to nurses in RSUD KRT Setjonegoro of Wonosobo. Nurscope. 2018; 4(1): 23-29.

Morello RT, Lowthian JA, Barker AL, McGinnes R, Dunt D, Brand C. Strategies for improving patient safety culture in hospitals: a systematic review. BMJ Quality & Safety. 2013; 22(1): 11-18.

Wardalia N, Dewi A. Peran akreditasi klinik dalam implementasi budaya keselamatan pasien di Klinik Firdaus Yogyakarta [The role of clinic accreditation in implementation of patient safety culture in Firdaus Clinic Yogyakarta] [Thesis]. Muhammadiyah Yogyakarta University. 2018.

Hodgen A, Ellis L, Churruca K, Bierbaum M. Safety culture assessment in health care: a review of the literature on safety culture assessment modes. Australian Commission on Safety and Quality in Health Care [Internet]. 2017. 1-65. Available from:

Kusbaryanto. Peningkatan mutu rumah sakit dengan akreditasi [Increasing hospital quality by accreditation]. Mutiara Med. 2010; 10(1): 86-89.

Astika A. Assessing patient safety culture in the hospital: a pilot study using a Modified Manchester Patient Safety Framework (MaPSaF). J Medicoeticolegal dan Manaj Rumah Sakit. 2017; 6(3): 159-168.

Wallis K, Dovey S. Assessing patient safety culture in New Zealand primary care: a pilot study using a modified Manchester Patient Safety Framework in Dunedin general practices. J Prim Health Care. 2011; 3(1): 35-40.

Parker D, Lawrie M, Hudson P. A framework for understanding the development of organisational safety culture. Saf Sci. 2006; 44(6): 551-562.

Davis H. The Royal Wolverhampton Hospitals: Trust Board Report. NHS Trust [Internet]. 2011. Available from:

Stavropoulou C, Doherty C, Tosey P. How effective are incident-reporting systems for improving patient safety? a systematic literature review. Milbank Q. 2015; 93(4): 826-866.

Agustina D. Safety culture assessment: a tool for improving patient safety in hospital. J Medicoeticolegal dan Manaj Rumah Sakit. 2018; 7(2): 127-135.

Rajasoorya C. Clinical ward rounds-challenges and opportunities. Ann Acad Med Singap. 2016; 45(4): 152-156.

Iskandar H, Maksum H, Nafisah N. Faktor penyebab penurunan pelaporan insiden keselamatan pasien rumah sakit [Factors influencing the decrease in hospital patient safety incident reporting]. J Kedokt Brawijaya. 2014; 28(1): 72-77.

Yasmi Y, Thabrany H. Faktor-faktor yang berhubungan dengan budaya keselamatan pasien di Rumah Sakit Karya Bhakti Pratiwi Bogor Tahun 2015 [Factors associated with patient safety culture in Karya Bhakti Pratiwi Bogor Hospital 2015]. J Administasi Rumah Sakit. 2018; 4(2): 98-109.

Jenita A, Arief YS, Misbahatul E. Analisis faktor yang berhubungan dengan pelaporan insiden keselamatan pasien pada perawat [Analysis of factors related to the reporting of patient safety incidents among nurses]. Fundam Manag. 2019; 2(1): 7-15.

Article Views      : 278
PDF Downloads : 131