Introduction There is a growing awareness of the importance of safety culture and a more positive patient safety culture is believed to be related to fewer adverse events in hospitals. The aim of this study was to investigate whether safety culture changed during a five years period with active safety management in a Dutch paediatric university hospital.

Methods A survey was undertaken amongst paediatricians and specialised nurses by means of the Hospital Survey on Patient Safety Culture (HSOPSC) in 2009, 2011 and 2013. The study took place at the Emma Children’s Hospital, Amsterdam.

Results In 2009, 2011 and 2013 we collected 269, 232 and 310 surveys, representing response rates of 66%, 57% and 61% respectively. The HSOPSC consists of 40 questions, covering 11 dimensions. We found the following significant differences between 2009 and 2013, presented in positive ratings:

1. ‘teamwork within hospital units’: 90% - 90% - 82%

2. ‘frequency of event reporting’: 51% - 55% - 57%

3. ‘feedback about error’: 67% - 61% - 72%

4. ‘staffing’: 45% - 58% - 51%

5. ‘overall perceptions of safety’: 48% - 52% - 55%

Ratings in the other dimensions were unchanged. Highest scores were seen on the dimension ‘teamwork within hospital units’ (90%, 90% and 82%) and lowest scores on the dimension ‘teamwork across hospital units’ (23%, 23% and 24%).

Conclusion An ongoing patient safety programme improves some aspects in the culture, but other items stay a concern and demand more focused intervening.