Shift schedule realignment and patient safety culture Made Indra Wijaya and Abd Rahim Mohamad Faculty of Medicine, University of Cyberjaya (UoC), Cyberjaya, Malaysia, and Muhammad Hafizurrachman Sekolah Tinggi Ilmu Kesehatan Indonesia Maju (STIKIM), Jakarta, Indonesia Abstract Purpose – The purpose of this paper is to assess the association between shift schedule realignment and patient safety culture. Design/methodology/approach – Using difference in differences model, BIMC Hospitals and Siloam Hospital Bali were compared before and after shift schedule realignment to test the association between shift schedule realignment and patient safety culture. Findings – Shift schedule realignment was associated with a significant improvement in staffing (coefficient 1.272; 95% CI 0.842 – 1.702; p o0.001), teamwork within units (coefficient 1.689; 95% CI 1.206 – 2.171; p o0.001), teamwork across units (coefficient 1.862; 95% CI 1.415 – 2.308; p o0.001), handoffs and transitions (coefficient 0.999; 95% CI 0.616 – 1.382; p o0.001), frequency of error reported (coefficient 1.037; 95% CI 0.581 – 1.493; p o0.001), feedback and communication about error (coefficient 1.412; 95% CI 0.982 – 1.841; p o0.001) and communication openness (coefficient 1.393; 95% CI 0.968 – 1.818; p o0.001). Practical implications – With positive impact on patient safety culture, shift schedule realignment should be considered as quality improvement initiative. It stretches the compressed workload suffered by staff while maintaining 40 h per week in accordance with applicable laws and regulations. Originality/value – Shift schedule realignment, designed to improve patient safety culture, has never been implemented in any Indonesian private hospital. Other hospital managers might also appreciate knowing about the shift schedule realignment to improve the patient safety culture. Keywords Indonesia, Patient safety culture, Shift schedule, Difference in differences Paper type Research paper Introduction Patient safety in hospitals has obtained considerable attention following the Institute of Medicine report “To Err Is Human: Building a Safer Health System”(Cho et al., 2016; Hessels et al., 2016; Van Den Kerkhof et al., 2017). The idea of patient safety culture initiated from safety studies in high-risk industries, such as nuclear industry and aviation (Brown et al., 2018; Clinics and North, 2015; Macdonald and Sevdalis, 2017). Deufel et al. described safety culture as the behavior, perceptions, attitudes and values related to safety which are shared among employees (Deufel et al., 2017). Similarly, Ralston and Yuen explained patient safety culture as individual and collective behavior, perceptions, attitudes and values that establish the commitment to an organization’s safety management (Ralston and Yuen, 2018). A hospital with a “safety culture” is transparent and objective with staff when adverse events occur, learns from errors and analyze what went wrong and what needed to be done to prevent it from happening again rather than naming, blaming, shaming and stigmatizing individuals (Hall et al., 2016; Koyle et al., 2017; St. Onge and Parnell, 2015). Patient safety culture is a complicated framework which includes numerous composites that influences patient safety behavior. According to the Agency of Healthcare Research and Quality (AHRQ), safety culture necessitates a comprehension on the perceptions, attitudes and values regarding what is essential in the hospital and what manners and behavior associated with patient safety are reinforced and encouraged (Chen and Li, 2010; Chera et al., 2014; Sorra and Dyer, 2010). Thus, it is essential for hospital managers to assess Received 16 April 2019 Revised 9 December 2019 Accepted 9 December 2019 The current issue and full text archive of this journal is available on Emerald Insight at: https://www.emerald.com/insight/0952-6862.htm Shift schedule realignment International Journal of Health Care Quality Assurance Vol. 33 No. 2, 2020 pp. 145-157 © Emerald Publishing Limited 0952-6862 DOI 10.1108/IJHCQA-04-2019-0080 145