SAMSA: A tool for improved health, quality of care through integration of work environment and patient safety management at work.

Research problem and specific questionsCan a structured method for daily reflection and evaluation of work, that integrates the work environment and patient safety perspective, lead to improved working conditions, reduced sick leave and improved quality of care?

Integrated work environment and patient safety management (IWEPSM) is suggested to be an important key to manage the challenges faced by the health care services.

As several working conditions have shown to negatively impact both employee health and quality of care, an integration could result in improved resource efficiency as well as a better working environment and quality of care.Data and methodThe study uses a stepped wedge cluster-controlled study with open cohort (SWD).

The workplace acts a cluster. The design is suitable in intervention studies where all clusters could benefit from the intervention.

The SWD is designed with four steps, with 3 clusters crossing over from control to intervention group at each step, in total 12 clusters. All clusters starts up as controls. Primary outcomes (sick leave and quality of care) will be collected using register data.

Secondary outcomes are measured using questionnaires, collected at baseline, 12 and at 18 months, as well as monthly using text messages.

Generalised Linear Mixed Model will be used to evalute the effect using intention to treat principle as well as per protocol. A cost-effectiveness study is planned for.

A process evaluation is conducted to study for example feasability, using focus groups interviews, questionnaire data and documents.

Mixed method analyses will be conducted.Plan for project realisationThe project will be conducted in close collaboration with representatives from the health care services to ensure the methods feasabiliy.

Reqruitment of participating workplaces is made possible through close collaboration between health care representatives and the project group. Basline measurement will be conducted in December 2023 with first intervention clusters in March 2024.

The data collection will end in June 2025.RelevanceThe need of a more IWEPSM have been highligted by several national stakeholders within health care services. Useful tools that supports an integrated way of working have especially been asked for. The project target this identified need.

Also, the study is considered to generated knowledge on how work-related stress may be prevented at organisational level, an area where little knowledge exists.