Evaluación de la cultura de seguridad del paciente en los hospitales brasileños a través del HSOPSC: revisión de alcance

Prieto, Marcela Moreira Nascimento; Fonseca, Renata Elizabete Pagotti da; Zem-Mascarenhas, Silvia Helena

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (06) • 2021 • https://doi.org/10.1590/0034-7167-2020-1315 copiar

Evaluación de la cultura de seguridad del paciente en los hospitales brasileños a través del HSOPSC: revisión de alcance

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

describir, a partir de la literatura, las características de la cultura de seguridad del paciente en los hospitales brasileños que aplicaron el Hospital Survey on Patient Safety Culture.

Métodos:

esta es una revisión de alcance. Se realizaron búsquedas en las bases de datos LILACS, PuBMed, SciELO, CINAHL, Web of Science, Scopus y el Banco de Disertaciones y Tesis CAPES en septiembre y octubre de 2020.

Resultados:

se identificaron 36 estudios. Nueve estudios identificaron áreas fortalecidas como: “trabajo en equipo dentro de las unidades”, “expectativas del supervisor/jefe y acciones que promuevan la seguridade”, “aprendizaje organizacional”, “apoyo a la gestión hospitalaria para la seguridad del paciente” y “frecuencia de notificación de eventos”. Como área crítica, la dimensión “respuesta no punitiva al error” se evidenció en 30 de los 36 estudios.

Conclusiones:

la identificación de áreas de fortaleza y áreas críticas de la cultura de seguridad es relevante para incentivar la mejora de los problemas de seguridad del paciente en una institución.

Descriptores:
Seguridad del Paciente; Cultura Organizacional; Calidad de la Atención de Salud; Hospitales; Indicadores de Calidad de la Atención de Salud

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Marcela Moreira Nascimento Prieto E-mail: celamn@gmail.com

Author/Year/Country	Title	Population/Sample	Interventions	Outcomes
Notaro KAM, et al. (2019)⁽¹⁰10 Notaro KAM, Corrêa AR, Tomazoni A, Rocha PK, Manzo BF. Cultura de segurança da equipe multiprofissional em Unidades de Terapia Intensiva Neonatal de hospitais públicos. Rev Latino-Am Enfermagem. 2019;27:e3167. https://doi.org/10.1590/1518-8345.2849.3167 https://doi.org/10.1590/1518-8345.2849.3... ⁾ Brazil	Cultura de segurança da equipe multiprofissional em Unidades de Terapia Intensiva Neonatal de hospitais públicos	Five hundred fourteen health professionals	Cross-sectional, survey study. The HSOPSC was used.	No dimension was considered strengthened. The dimension non-punitive response to error was classified as a critical area.
Kawamoto AM, et al. (2016)⁽¹¹11 Kawamoto AM, Oliveira JLC, Tonini NS, Nicola AL. Liderança e cultura de segurança do paciente: percepções de profissionais em um hospital universitário. Rev Pesqui: Cuid Fundam. 2016;8(2):4387-98. https://doi.org/10.9789/2175-5361.2016.v8i2.4387-4398 https://doi.org/10.9789/2175-5361.2016.v... ⁾ Brazil	Liderança e cultura de segurança do paciente: percepções de profissionais em um hospital universitário	Seventy-six health professionals	Descriptive-exploratory, quantitative research. The HSOPSC was used.	Most participants demonstrated a perception of a safety culture favorable to immediate leadership and unfavorable to hospital management.
Schuh LX, et al. (2020)⁽¹²12 Schuh LX, Krug SBF, Possuelo L. Cultura de segurança do paciente em unidades de urgência/emergência. Rev Pesqui: Cuid Fundam [Internet]. 2020[cited 2020 Nov 25];12:616-21. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1097372 https://pesquisa.bvsalud.org/portal/reso... ⁾ Brazil	Cultura de segurança do paciente em unidades de urgência/emergência	One hundred twelve nursing professionals	Cross-sectional quantitative study. The HSOPSC was used.	The dimensions "expectations about your supervisor" and "actions promoting safety and teamwork within the units" were considered as areas of strength.
Souza VS, et al. (2015)⁽¹³13 Souza VS, Kawamoto AM, Oliveira JLC, Tonini NS, Fernandes LM, Nicola AL. Errors and adverse events: the interface with health professionals’ safety culture. Rev Bras Enferm. 2019;72(2):498-505. https://doi.org/10.5380/ce.v20i3.40687 https://doi.org/10.5380/ce.v20i3.40687... ⁾ Brazil	Errors and adverse events: the interface with health professionals' safety culture	Seventy-one health professionals	Descriptive, quantitative study. The HSOPSC was used.	Most participants demonstrated a perception of a safety culture unfavorable to communication about failures and pointed to a punitive culture.
Silva ACAB, Rosa DOS (2016)⁽¹⁴14 Silva ACAS, Santa Rosa DO. Cultura de segurança do paciente em organização hospitalar. Cogitare Enferm. 2016;21(N.esp): 01-10. https://doi.org/10.5380/ce.v21i5.45583 https://doi.org/10.5380/ce.v21i5.45583... ⁾ Brazil	Cultura de segurança do paciente em organização hospitalar	One hundred twenty-eight nursing professionals	Survey study. The HSOPSC was used.	The dimensions with the most negative responses were non-punitive response and support from management and communication about error. There were no strengthened dimensions.
Cruz EDA, et al (2018)⁽¹⁵15 Cruz EDA, Rocha DJM, Mauricio AB, Ulbrich FS, Batista J, Maziero EC. Cultura de segurança entre profissionais de saúde em hospital de ensino. Cogitare Enfermagem. 2018;23(1) https://doi.org/10.5380/ce.v23i1.50717 https://doi.org/10.5380/ce.v23i1.50717... ⁾ Brazil	Cultura de segurança entre profissionais de saúde em hospital de ensino	Six hundred forty-five health professionals	Survey study. The HSOPSC questionnaire was used.	No dimension was considered strengthened. A higher rate of positive responses was obtained in the dimension non-punitive responses to error.
Serrano ACFF, et al. (2019)⁽¹⁶16 Serrano ACFF, Santos DF, Matos SS, Goveia VR, Mendoza IYQ, Lessa AC. Avaliação da cultura de segurança do paciente em um hospital filantrópico REME Rev Min Enferm [Internet]. 2019[cited 2020 Nov 25];23:e-1183. Available from: https://cdn.publisher.gn1.link/reme.org.br/pdf/e1183.pdf https://cdn.publisher.gn1.link/reme.org.... ⁾ Brazil	Avaliação da cultura de segurança do paciente em um hospital filantrópico	Two hundred nine health professionals	Quantitative, cross-sectional study. The HSOPSC was used.	No dimension was considered to be strengthened. The dimensions with the lowest percentage of positive responses were "non-punitive responses", "professionals and general perception of safety".
Lopez ECMS, et al. (2020)⁽¹⁷17 Lopez ECMS, Cruz EDA, Alpendre FT, Batista J. Cultura de segurança do paciente em unidades cirúrgicas de hospitais de ensino. REME Rev Min Enferm [Internet]. 2020[cited 2020 Nov 25];24:e-1298. Available from: https://cdn.publisher.gn1.link/reme.org.br/pdf/e1298.pdf https://cdn.publisher.gn1.link/reme.org.... ⁾ Brazil	Cultura de segurança do paciente em unidades cirúrgicas de hospitais de ensino	Three hundred eighty-one medical and nursing professionals	Survey, cross-sectional study. The HSOPSC was used.	The dimension "teamwork within the units" was identified as strengthened in the private hospital; in the others, no dimension showed a strong culture.
Macedo TR, et al. (2016)⁽¹⁸18 Macedo TR, Rocha PK, Tomazoni A, Souza S, Anders JC, Davis K. Cultura de segurança do paciente na perspectiva da equipe de enfermagem de emergências pediátricas. Rev Esc Enferm USP. 2016;50(5):756-62. https://doi.org/10.1590/s0080-623420160000600007 https://doi.org/10.1590/s0080-6234201600... ⁾ Brazil	Cultura de segurança do paciente na perspectiva da equipe de enfermagem de emergências pediátricas	Seventy-five nursing team professionals	Descriptive, quantitative, cross-sectional survey study. The HSOPSC was used.	No dimension was considered strengthened. The areas identified as critical were non-punitive response and support from the hospital administration for patient safety.
Tomazoni A et al. (2014)⁽¹⁹19 Tomazoni A, Rocha PK, Souza S, Anders JC, Malfussi HFC. Cultura de segurança do paciente em unidades de terapia intensiva neonatal: perspectivas da equipe de enfermagem e médica. Rev Latino-Am Enfermagem. 2014;22(5):755-63. https://doi.org/10.1590/0104-1169.3624.2477 https://doi.org/10.1590/0104-1169.3624.2... ⁾ Brazil	Cultura de segurança do paciente em unidades de terapia intensiva neonatal: perspectivas da equipe de enfermagem e médica	One hundred forty-one medical and nursing professionals	Quantitative and survey study. The HSOPSC was used.	There was a difference in relation to the shorter working time in the hospital and working time in the unit with a higher number of positive responses.
Pinheiro MP (2015)⁽²⁰20 Pinheiro MP. Segurança do paciente: diagnóstico e intervenções da educação permanente em um hospital universitário[Dissertação]. Rio de Janeiro. Universidade Federal do Estado do Rio de Janeiro; 2015.⁾ Brazil	Segurança do paciente: diagnóstico e intervenções da educação permanente em um hospital universitário	Two hundred three nursing professionals	Descriptive-exploratory study, with a quantitative approach. The HSOPSC was used.	No dimension was considered strengthened. The most critical dimensions were non-punitive response, support of hospital management and shift crossings.
Fassarella CS et al. (2018)⁽²¹21 Fassarella CS, Camerini FG, Henrique DM, Almeida LF, Figueiredo MCB. Avaliação da cultura de segurança do paciente: estudo comparativo em hospitais universitários. Rev Esc Enferm USP. 2018;52:e03379. https://doi.org/10.1590/s1980-220x2017033803379 https://doi.org/10.1590/s1980-220x201703... ⁾ Brazil Portugal	Avaliação da cultura de segurança do paciente: estudo comparativo em hospitais universitários	One hundred ninety-five nurses	Survey, cross-sectional, comparative, quantitative study. The HSOPSC was used.	Of the 12 dimensions of safety culture measured in a Brazilian hospital, eight dimensions were considered fragile and amenable to improvement.
Moretão DIC (2019)⁽²²22 Moretão DIC. A cultura de segurança do paciente em unidades cirúrgicas de um hospital de ensino da rede pública de saúde[Dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais; 2019.⁾ Brazil	A cultura de segurança do paciente em unidades cirúrgicas de um hospital de ensino da rede pública de saúde	Two hundred forty-six healthcare team professionals	Mixed study, with descriptive-exploratory design. The HSOPSC was used.	No dimension was considered strengthened. The area considered more fragile was non-punitive responses to errors.
Fassarella CS, et al. (2019)⁽²³23 Fassarella CS, Silva LD, Camerini FG, Figueiredo MCAB. Cultura de segurança dos enfermeiros entre os serviços de um hospital universitário. Rev Bras Enferm. 2019;72(3):767-73. https://doi.org/10.1590/0034-7167-2018-0376 https://doi.org/10.1590/0034-7167-2018-0... ⁾ Brazil	Cultura de segurança dos enfermeiros entre os serviços de um hospital universitário	One hundred ninety-five nurses	Cross-sectional and quantitative study. The HSOPSC was applied.	A significant difference was identified between the services for five dimensions of safety culture.
Sanchis DZ, et al. (2020)⁽²⁴24 Sanchis DZ, Haddad MCFL, Girotto E, Silva AMR. Cultura de segurança do paciente: percepção de profissionais de enfermagem em instituições de alta complexidade. Rev Bras Enferm. 2020;73(5):e20190174. https://doi.org/10.1590/0034-7167-2019-0174 https://doi.org/10.1590/0034-7167-2019-0... ⁾ Brazil	Cultura de segurança do paciente: percepção de profissionais de enfermagem em instituições de alta complexidade	Four hundred sixty-seven nursing professionals	Descriptive and quantitative study. The HSOPSC was used.	Safety culture was considered fragile, especially openness to communications and non-punitive responses to errors.
Tomazoni A, et al. (2015)⁽²⁵25 Tomazoni A, Rocha PK, Kusahara DM, Souza AIJ, Macedo TR. Avaliação da cultura de segurança do paciente em terapia intensiva neonatal. Texto Contexto Enferm. 2015;24(1):161-9. https://doi.org/10.1590/0104-07072015000490014 https://doi.org/10.1590/0104-07072015000... ⁾ Brazil	Avaliação da cultura de segurança do paciente em terapia intensiva neonatal	One hundred forty-one professionals (nursing and medical team)	Quantitative and survey study. The HSOPSC was used.	No dimension was considered strengthened. As a critical area, non-punitive response and support from hospital management were identified.
Galvão TS, et al. (2018)⁽²⁶26 Galvão TF, Lopes MCC, Oliva CCC, Araújo MEA, Silva MT. Cultura de segurança do paciente em um hospital universitário. Rev Latino-Am Enfermagem. 2018;26:e3014. https://doi.org/10.1590/1518-8345.2257.3014 https://doi.org/10.1590/1518-8345.2257.3... ⁾ Brazil	Cultura de segurança do paciente em um hospital universitário	Three hundred eighty-one health professionals	Cross-sectional study with data collection through HSOPSC.	No dimension was considered to be strengthened. Nine dimensions had low positivity, with emphasis on "non-punitive responses".
Pedroni VS, et al (2020)⁽²⁷27 Pedroni VS, Gouveia HG, Vieira LB, Wegner W, Oliveira ACS, Santos MC, et al . Cultura de segurança do paciente na área materno-infantil de hospital universitário. Rev Gaúcha Enferm. 2020;41(spe):e20190171. https://doi.org/10.1590/1983-1447.2020.20190171 https://doi.org/10.1590/1983-1447.2020.2... ⁾ Brazil	Cultura de segurança do paciente na área materno-infantil de hospital universitário	Forty-one professionals (nurses and doctors)	Cross-sectional study using HSOPSC.	The action of supervisors/bosses was considered a fortress; communication, on the other hand, was considered a weakness.
Andrade LEL et al (2018)⁽²⁸28 Andrade LEL, Lopes JM, Souza FMCM, Vieira JRF, Farias LPC, Santos CCM, et al . Cultura de segurança do paciente em três hospitais brasileiros com diferentes tipos de gestão. Ciênc Saúde Coletiva. 2018;23(1):161-72. https://doi.org/10.1590/1413-81232018231.24392015 https://doi.org/10.1590/1413-81232018231... ⁾ Brazil	Cultura de segurança do paciente em três hospitais brasileiros com diferentes tipos de gestão	One hundred fifteen health professionals	Cross-sectional observational study. The HSOPSC was used.	The type of hospital management, service unit, position and amount of report of adverse events were associated with the overall note of patient safety.
Santiago THR, Turrini RNT (2015)⁽²⁹29 Santiago THR, Turrini RNT. Cultura e clima organizacional para segurança do paciente em Unidades de Terapia Intensiva. Rev Esc Enferm USP. 2015;49(Spe):123-30. https://doi.org/10.1590/S0080-623420150000700018 https://doi.org/10.1590/S0080-6234201500... ⁾ Brazil	Cultura e clima organizacional para segurança do paciente em Unidades de Terapia Intensiva	Eighty-eight health and administrative professionals	Cross-sectional study. The HSOPSC and the other questionnaire were used.	The dimension non-punitive response to error was considered a critical area. The strengths were supervisor expectations and organizational learning for continuous improvement.
Batista J, et al. (2019)⁽³⁰30 Batista J, Cruz EDA, Alpendre FT, Paixão DPSS, Gaspari AP, Mauricio AB. Cultura de segurança e comunicação sobre erros cirúrgicos na perspectiva da equipe de saúde. Rev Gaúcha Enferm. 2019;40(spe):e20180192. https://doi.org/10.1590/1983-1447.2019.20180192 https://doi.org/10.1590/1983-1447.2019.2... ⁾ Brazil	Cultura de segurança e comunicação sobre erros cirúrgicos na perspectiva da equipe de saúde	One hundred fifty-eight health professionals	Survey study. The HSOPSC was used.	No dimension was considered to be strengthened. There was a difference, with less negative perception of nursing in relation to medicine in the dimensions "return of information and communication about error" and "frequency of reporting events".
Carmo, JMA et al. (2020)⁽³¹31 Carmo JMA, Mendoza IYQ, Goveia VR, Souza KV, Manzo BF, Guimarães GL. Cultura de segurança do paciente em unidades hospitalares de ginecologia e obstetrícia: estudo transversal. Rev Bras Enferm. 2020;73(5):e20190576. https://doi.org/10.1590/0034-7167-2019-0576 https://doi.org/10.1590/0034-7167-2019-0... ⁾ Brazil	Cultura de segurança do paciente em unidades hospitalares de ginecologia e obstetrícia: estudo transversal	Three hundred one health professionals	Descriptive, cross-sectional, quantitative study. The HSOPSC was used.	Of the 12 dimensions of patient safety culture, none was considered strengthened.
Abreu IM, et al. (2019)⁽³²32 Abreu IM, Rocha RC, Avelino FVSD, Guimarães DBO, Nogueira LT, Madeira MZA. Cultura de segurança do paciente em centro cirúrgico: visão da enfermagem. Rev Gaúcha Enferm. 2019;40(Spe):e20180198. https://doi.org/10.1590/1983-1447.2019.20180198 https://doi.org/10.1590/1983-1447.2019.2... ⁾ Brazil	Cultura de segurança do paciente em centro cirúrgico: visão da enfermagem	Ninety-two nursing professionals	Cross-sectional and analytical study. The HSOPSC was used.	The dimension of safety culture with the most positive result was "organizational learning", and with less positive results, it was "openness to communication and feedback" and "communication about errors".
Okuyama JHH, et al (2019)⁽³³33 Okuyama JHH, Galvão TF, Crozatti MTL, Silva MT. Health professionals’ perception of patient safety culture in a university hospital in São Paulo: a cross-sectional study applying the Hospital Survey on Patient Safety Culture. Sao Paulo Med J. 2019;137(3):216-22. https://doi.org/10.1590/1516-3180.2018.0430140319 https://doi.org/10.1590/1516-3180.2018.0... ⁾ Brazil	Health professionals' perception of patient safety culture in a university hospital in São Paulo: A cross-sectional study applying the Hospital Survey on Patient Safety Culture	Three hundred fourteen health professionals	Cross-sectional study. The HSOPSC was used.	Nine of the 12 dimensions presented percentages of positive responses below 50%. The worst results were related to "non-punitive response to errors".
Mello, JF; Barbosa, SFF (2013)⁽³⁴34 Mello JF, Barbosa SFF. Cultura de segurança do paciente em terapia intensiva: recomendações da enfermagem. Texto Contexto Enferm. 2013;22(4):1124-33. https://doi.org/10.1590/S0104-07072013000400031 https://doi.org/10.1590/S0104-0707201300... ⁾ Brasil	Cultura de segurança do paciente em terapia intensiva: recomendações da enfermagem	Ninety-seven nursing professionals	Quantitative, survey, cross-sectional and comparative study. The HSOPSC was used.	There were a greater number of recommendations for the dimensions "organizational learning" and "continuous improvement and general perception of patient safety".
Tavares APM et al. (2018)⁽³⁵35 Tavares APM, Moura ECC, Avelino FVSD, Lopes VCA, Nogueira LT. Cultura de segurança do paciente na perspectiva da equipe de enfermagem. Rev Rene. 2018;19:e3152. https://doi.org/10.15253/2175-6783.2018193152 https://doi.org/10.15253/2175-6783.20181... ⁾ Brazil	Cultura de segurança do paciente na perspectiva da equipe de enfermagem	Two hundred twenty-one nursing professionals	Cross-sectional study, survey type. The HSOPSC was used.	Teamwork within the units was an area of strength and the non-punitive response to errors constituted an area of improvement.
Tobias GC et al. (2016)⁽³⁶36 Tobias GC, Bezerra ANQ, Paranaguá TTB, Silva AEBC. Cultura de segurança em hospital de ensino: fortalezas e fraquezas percebidas por enfermeiros. Rev Enferm UFPE. 2016;10(3):1063-70. https://doi.org/10.5205/reuol.8702-76273-4-SM.1003201616 https://doi.org/10.5205/reuol.8702-76273... ⁾ Brazil	Safety culture in a teaching hospital: strengths and weaknesses perceived in nurses	One hundred seventeen nurses	Descriptive-exploratory study, with a quantitative approach. The HSOPSC was used.	The weaknesses were sacrifice of quality and safety at work, insufficient staffing, problems with shift change; and fear of punishment when reporting an incident. The strengths were teamwork, nurses' active work and managers' consideration of their suggestions.
Corona ARPD (2017)⁽³⁷37 Corona ARPD. Avaliação da cultura de segurança do paciente em hospital público de ensino de Mato Grosso do Sul[Tese]. São Paulo: Universidade de São Paulo; 2017.⁾ Brazil	Avaliação da cultura de segurança do paciente em hospital público de ensino de Mato Grosso do Sul	Three hundred ninety-seven health professionals	Cross-sectional quantitative descriptive-exploratory study. The HSOPSC was used.	No dimension of safety culture was considered an area of force. The hospital management's support to patient safety obtained the lowest score of positive answers.
Neto AVL (2017)⁽³⁸38 Lima Neto AV. Percepção da cultura de segurança do paciente pelos enfermeiros de unidades de terapia intensiva[Dissertação]. Natal: Universidade Federal do Rio Grande do Norte; 2017.⁾ Brazil	Percepção da cultura de segurança do paciente pelos enfermeiros de unidades de terapia intensiva	Forty-five nurses	Descriptive and exploratory study with a mixed approach. The HSOPSC was used.	No dimension was considered strengthened. With regard to weaknesses and opportunities for improvement, the non-punitive responses to errors dimension and the personal dimension were emphasized.
Silva MF (2017)⁽³⁹39 Silva MF. Cultura de segurança da equipe de enfermagem no serviço de urgência e emergência [Dissertação]. Natal: Universidade Federal do Rio Grande do Norte; 2017.⁾ Brazil	Cultura de segurança da equipe de enfermagem no serviço de urgência e emergência	One hundred four nursing team professionals	Descriptive study with a mixed approach. The HSOPSC was used.	The dimensions "non-punitive responses to errors", "frequency of report of events" and "adequacy of professionals" were considered critical.
Rocha RC (2017)⁽⁴⁰40 Rocha RC. Cultura de segurança do paciente em centro cirúrgico: perspectiva da equipe de enfermagem [Dissertação]. Teresina: Universidade Federal do Piauí; 2017.⁾ 2020	Cultura de segurança do paciente em centro cirúrgico: perspectiva da equipe de enfermagem	Two hundred nursing professionals	Quantitative, descriptive study. The HSOPSC was used.	The municipal hospital did not present any strengthened area and the most deficient was an opening for communication. The state and federal hospitals presented areas of strength, and both presented the dimension non-punitive response as a critical area.
Rodrigues WVD (2016)⁽⁴¹41 Rodrigues WVD. Avaliação da Cultura de Segurança do Paciente entre profissionais de saúde de um hospital público [Dissertação]. São Paulo: Instituto Sírio-Libanês de Ensino e Pesquisa do Hospital Sírio-Libanês; 2016.⁾ Brazil	Avaliação da Cultura de Segurança do Paciente entre profissionais de saúde de um hospital público	One thousand two hundred seventy-three professionals of all areas	Cross-sectional, descriptive study. The HSOPSC was used.	No dimension was considered strengthened. Of the 12 dimensions assessed, 9 were characterized as fragile areas.
Cassago RM (2017)⁽⁴²42 Cassago RM. Avaliação da percepção da cultura de segurança do paciente com o questionário HSOPSC em um hospital público de São Paulo [Dissertação]. São Paulo: Instituto Sírio-Libanês de Ensino e Pesquisa do Hospital Sírio-Libanês; 2017.⁾ Brazil	Avaliação da percepção da cultura de segurança do paciente com o questionário HSOPSC em um hospital público de São Paulo	Four hundred eighty-eight professionals of all areas	Cross-sectional descriptive study The HSOPSC was used.	Six dimensions were considered critical. The overall result of culture indicates that professionals have a perception that institutional safety culture is globally fragile.
Félix RS (2017)⁽⁴³43 Félix RS. Cultura de segurança do paciente em uma maternidade na perspectiva de usuárias e equipe multiprofissional [Dissertação]. Santa Maria: Centro Universitário Franciscano; 2017.⁾ Brazil	Cultura de segurança do paciente em uma maternidade na perspectiva de usuárias e equipe multiprofissional	Sixty-two health team professionals	Cross-sectional study. The HSOPSC was used.	Areas of positive strength were not identified. The critical dimensions were management support and non-punitive responses to errors.
Andrade LEL (2016)⁽⁴⁴44 Andrade LEL. Evolução da cultura de segurança em hospitais antes e após a implantação do programa nacional de segurança do paciente [Dissertação]. Natal: Universidade Federal do Rio Grande do Norte; 2016.⁾ Brazil	Evolução da cultura de segurança em hospitais antes e após a implantação do Programa Nacional de Segurança do Paciente	Six hundred sixty-five health professionals, 215 in the first assessment and 450 in the second	Quasi-experimental design with a descriptive-analytical approach. The HSOPSC was used.	The hospitals had improved in 11 of the 12 assessed dimensions. The hospital that showed the greatest improvement was the state, followed by the federal and private.
Nicácio MC (2019)⁽⁴⁵45 Nicácio MC. Cultura de segurança da mulher no parto hospitalar: um estudo misto das percepções dos profissionais de enfermagem e médicos [Dissertação]. Rio de Janeiro: Universidade do Estado do Rio de Janeiro; 2019.⁾ Brazil	Cultura de segurança da mulher no parto hospitalar: um estudo misto das percepções dos profissionais de enfermagem e médicos	Twenty-six medical and nursing professionals	Mixed study, with explanatory sequential design. The HSOPSC was used.	No dimension was considered strengthened. The personal dimension was one of the critical points of security compromise.