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Background: Despite patient safety being recognized as an important healthcare issue in the European Union, there has been variable implementation of patient safety initiatives in Central and Eastern Europe (CEE)., Objective: To assess the status of patient safety initiatives in countries in CEE; to describe a process of engagement in Poland, which can serve as a template for the implementation of patient safety initiatives in primary care., Methods: A mixed methods design was used. We conducted a review of literature focusing on publications from CEE, an inventory of patient safety initiatives in CEE countries, interviews with key informants, international survey, review of national reporting systems, and pilot demonstrator project in Poland with implementation of patient safety toolkits assessment., Results: There was no published patient safety research from Albania, Belarus, Greece, Latvia, Lithuania, Romania, or Russia. Nine papers were found from Bulgaria, Croatia, the Czech Republic, Poland, Serbia, and Slovenia. In most of the CEE countries, patient safety had been addressed at the policy level although the focus was mainly in hospital care. There was a dearth of activity in primary care. The use of patient improvement strategies was low., Conclusion: International cooperation as exemplified in the demonstrator project can help in the development and implementation of patient safety initiatives in primary care in changing the emphasis away from a blame culture to one where greater emphasis is placed on improvement and learning.

Background: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture., Objective: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care., Methods: Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care., Results: The two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events., Conclusion: Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care.

The first aim of the present study was to investigate the applicability of the two-factor structure (perceptual-motor skills by 11 items, e.g., "fluent driving"; safety skills by 9 items, e.g., "conforming to the speed limits") of the Driver Skill Inventory (DSI) among British, Dutch, Finnish, Greek, Iranian, and Turkish drivers. It was also hypothesized that the combination of self reported high ratings of perceptual-motor skills and low ratings of safety skills creates a serious risk for dangerous driving and road accident involvement. The second aim of this study was, therefore, to investigate this asymmetric relationship between perceptual-motor and safety skills in traffic penalties and accident involvement. Two hundred and forty two drivers were chosen from each of the six countries, matched for age and sex. The results of exploratory factor analyses together with target rotation showed that the two-factor structure of DSI found in "safe" Northern and Western European countries were highly congruent. However, the safety skills factor of DSI in Greece, Iran, and Turkey was relatively incongruent in spite of high factor similarity found in perceptual-motor skills. The asymmetric relationship between perceptual-motor and safety skills on traffic penalties was found in Finland and Turkey. A negative relationship between safety skills and the number of accidents was found both in Greece and Iran while a positive relationship between perceptual-motor skills and the number of accidents was found only in Iran.

Recent reports of 'road rage' in the British media give the impression that driver aggression is escalating. In order to understand this phenomenon we need to know what it is about driving that provokes motorists to feel anger and then to go on to express that anger in the form of aggression. A postal questionnaire survey of more than 2500 drivers was carried out in three European countries: Britain, Finland and the Netherlands. The study had three main aims: (a) to discover how angry, if at all, a range of situations on the road make drivers, (b) to find out how many drivers are likely to react aggressively to those situations, and (c) to investigate individual and/or cultural differences in terms of anger and/or aggressive responses among motorists. Results indicate that the same types of behaviour provoke anger and aggression in all three countries, and that traffic density may play a role.