<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2504-3145</journal-id>
<journal-title><![CDATA[Portuguese Journal of Public Health]]></journal-title>
<abbrev-journal-title><![CDATA[Port J Public Health]]></abbrev-journal-title>
<issn>2504-3145</issn>
<publisher>
<publisher-name><![CDATA[Escola Nacional de Saúde Pública]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2504-31452022000200081</article-id>
<article-id pub-id-type="doi">10.1159/000525147</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Improvements in patient safety structures and culture following implementation of a national public program: an observational study in three Brazilian hospitals]]></article-title>
<article-title xml:lang="pt"><![CDATA[Melhorias na estrutura e cultura de segurança do paciente após implantação de um programa público nacional: Um estudo observacional em três hospitais brasileiros]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Andrade]]></surname>
<given-names><![CDATA[Luiz Eduardo Lima de]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Saturno-Hernández]]></surname>
<given-names><![CDATA[Pedro Jesús]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Melo]]></surname>
<given-names><![CDATA[Laiza Oliveira Mendes de]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gama]]></surname>
<given-names><![CDATA[Zenewton André da Silva]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Federal University of Rio Grande do Norte  ]]></institution>
<addr-line><![CDATA[Natal ]]></addr-line>
<country>Brazil</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,National Institute of Public Health Centro de Investigación en Evaluación y Encuestas ]]></institution>
<addr-line><![CDATA[Cuernavaca ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Federal University of Rio Grande do Norte  ]]></institution>
<addr-line><![CDATA[Santa Cruz ]]></addr-line>
<country>Brazil</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Federal University of Rio Grande do Norte Department of Public Health ]]></institution>
<addr-line><![CDATA[Natal ]]></addr-line>
<country>Brazil</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>08</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>08</month>
<year>2022</year>
</pub-date>
<volume>40</volume>
<numero>2</numero>
<fpage>81</fpage>
<lpage>90</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2504-31452022000200081&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2504-31452022000200081&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2504-31452022000200081&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Objective:  The aim of this study was to observe and describe the changes in the structures for patient safety (PS) and PS culture (PSC) at the level of health facilities, following the implementation of the National Patient Safety Program (NPSP).  Methods:  An observational, longitudinal, and descriptive study including follow-up of changes in structure and activities for PS and assessments of PSC before and 15 months after the NPSP enforcement. Three Brazilian hospitals with different management logistics participated in the study (federal public, state public, and private). PSC was measured using the AHRQ&#8217;s instrument, adapted and validated for the Brazilian context (Hospital Survey on Patient Safety Culture [HSOPSC]). Changes in structure and activities to improve PS were mapped against the NPSP objectives. Changes in PSC were assessed by the hospital and discussed considering a change theory based on the literature.  Results:  Structural changes occurred in all hospitals but at a different pace and extension. A PS unit, adoption of some PS protocols, and training on PS occurred in the three hospitals. PSC significantly improved in all facilities. Public hospitals had the worst baseline PSC but showed greater improvements. The state hospital presented few structural changes and soon had the lowest ratings of PSC.  Conclusions:  This study demonstrates that external regulatory initiatives can trigger, even if unevenly, actions promoting PS and relevant internal structural changes, which in turn seem to increase awareness and improvement in PSC.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Objetivo:  Observar e descrever as mudanças na estrutura da Segurança do paciente (SP) e da Cultura de Segurança do Paciente (CSP) no nível das unidades de saúde, após a implantação do Programa Nacional de Segurança do Paciente (PNSP).  Métodos:  Estudo observacional, longitudinal e descritivo com acompanhamento das mudanças na estrutura e atividades da SP e avaliações da CSP antes e quinze meses após a aplicação do PNSP. Participaram no estudo três hospitais brasileiros com diferentes logísticas de gestão (público federal, público estadual e privado). A CSP é medida por meio do instrumento Hospital Survey on Patient Safety Culture (HSOPS), adaptado e validado para o contexto brasileiro. As mudanças na estrutura e atividades para aumentar a SP são mapeadas em relação aos objetivos do PNSP. As alterações na CSP são avaliadas por hospital e discutidas à luz de uma teoria de mudança baseada na literatura.  Resultados:  Mudanças estruturais ocorreram em todos os hospitais, mas em ritmo e extensão diferentes. Uma Unidade de SP, adoção de alguns protocolos de SP e treino em SP ocorreram nos três hospitais. A CSP melhorou significativamente em todas as instalações. Os hospitais públicos tiveram a pior CSP inicial, mas mostraram maiores melhorias. O hospital estadual, apresentou poucas mudanças estruturais, logo teve as classificações mais baixas da CSP.  Conclusões:  Este estudo demonstra que iniciativas regulatórias externas podem desencadear, mesmo que de uma forma desigual, ações promotoras da SP e mudanças estruturais internas relevantes, que por sua vez parecem aumentar a conscientização e melhoria na CSP.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Government regulation]]></kwd>
<kwd lng="en"><![CDATA[Health policy]]></kwd>
<kwd lng="en"><![CDATA[Patient safety]]></kwd>
<kwd lng="en"><![CDATA[Quality of healthcare]]></kwd>
<kwd lng="en"><![CDATA[Organizational culture]]></kwd>
<kwd lng="pt"><![CDATA[Regulação governamental]]></kwd>
<kwd lng="pt"><![CDATA[Política de saúde]]></kwd>
<kwd lng="pt"><![CDATA[Segurança do paciente]]></kwd>
<kwd lng="pt"><![CDATA[Qualidade da assistência à saúde]]></kwd>
<kwd lng="pt"><![CDATA[Cultura organizacional]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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