A Practical Method for Monitoring Patient Safety Culture: Applying Net Promoter Score and Lot Quality Assurance Sampling

Abstract

RATIONALE: Patient safety culture is a key component of health care quality, yet its integration into routine monitoring systems is often limited. Existing assessments tend to focus on cross-sectional snapshots rather than providing practical, process-level information that can support continuous improvement in integrated health care organisations. AIMS AND OBJECTIVES: To design and pilot a practical method for monitoring patient safety culture across key care processes within an integrated health care area, using Net Promoter Score (NPS) and Lot Quality Assurance Sampling (LQAS) to identify strengths, weaknesses, and improvement priorities. METHOD: A descriptive cross-sectional study was conducted in six care processes (primary care, outpatient consultation, hospitalisation, emergencies, surgery, and supportive care). Patient safety culture was assessed using validated AHRQ instruments (HSOPS and MOSPS), administered via structured telephone interviews. NPS was used to summarise favourable and unfavourable perceptions into a single polarity score. LQAS was applied to classify each process into acceptable or unacceptable results and to identify priority improvement lots. A process-level monitoring plan was developed based on dimensions with critical NPS values and rejected lots. RESULTS: A total of 126 professionals participated (88% response rate). Safety-culture perceptions varied substantially across processes. 'Teamwork within units' emerged as a consistent strength, while 'work pressure and pace' and 'staffing' were frequent concerns. NPS showed 93% concordance with AHRQ classifications. LQAS identified 132 rejected lots (49.5%), including 25 (9.4%) flagged as high-priority weaknesses. CONCLUSION: The combined use of NPS and LQAS offers a practical, scalable approach for monitoring patient safety culture at the process level. This method supports prioritisation, resource allocation, and the integration of safety-culture information into routine governance and improvement activities.