Figure 6
The figure starts with a text box positioned in the bottom center titled “External factors, Environment or Society, National and European”. The points listed below the title read as follows: “Patient safety legislation and policy (National and European)”, “Litigation, mitigation climate, medico-legal framework”, “Occupational health and safety policy and legislation”, and “Education and training”. An upward arrow points from the text box to a table positioned directly above. The table is titled “Healthcare system” and comprises 4 rows and 5 columns. The first row displays the column headers from left to right as follows: Column 1: No header, Column 2: Structures, Column 3: Processes, Column 4: Outputs, and Column 5: Outcomes. The row-wise entries in the table are as follows: Row 2: Level: MACRO LEVEL (national); Structures: Professional associations, Trade unions, Regulatory authorities; Processes: Licensing, Accreditation of healthcare services; Outputs: Governance, Quality in healthcare; Outcomes: Trust in the healthcare system, Safe and effective care. Row 3: Level: MESO LEVEL (organisation); Structures: Healthcare institutions, Human resources, Management; Processes: Quality management, Occupational health and safety, Support; Outputs: Organisational safety, Effectiveness, Reputation, Guidelines, Third victims; Outcomes: Safe and effective patient care. Row 4: Level: MICRO LEVEL (clinical); Structures: Patients, Families, Healthcare professionals; Processes: Patient and family care, Support, Disclosure procedures; Outputs: Reduced adverse events, Impacts on victims; Outcomes: Patient safety, Healthcare professional safety. A long rectangular text box is positioned on the right side. The text within the box reads, “Just or fair culture, Safety-generating culture (across the healthcare system); Patient safety culture (micro and meso level)”. Individual double-headed horizontal arrows connect this text box to the “Healthcare system” table and the “External factors” text box.Framework for integrated safety across healthcare systems. Source: Authors’ own work