Objective: To describe clinic stakeholder suggestions for improvements in patient safety in chiropractic teaching clinical settings.

Methods: We conducted a mixed-methods, cross-sectional survey to extend SafetyNET, a research project into patient safety culture in chiropractic. Our sample (n = 864) included clinic students, faculty, and staff from chiropractic programs from 4 different countries. We launched the Survey to Support Quality Improvement via REDCap, with respondents completing site-specific surveys in 6-week increments between May 2019 and November 2021. Open-ended questions elicited written suggestions to improve patient safety in 4 domains: education, clinical setting, communication, and leadership. Cross-institutional research teams conducted qualitative content analysis to identify relevant themes.

Results: Respondents (n = 460; 53.2%, of which 47.2% were female) included 386 students, 45 faculty, and 29 staff. We analyzed 166 to 225 unique responses consisting of short phrases to full paragraphs per question. Our analysis inspired an interactive Safety Compass Model of Patient Safety Culture in Chiropractic Teaching Clinics, which includes 8 themes. Accountability and Transparency were essential values for individuals and organizations. Safety Education on safety-related topics was counterbalanced by Safety Reporting structures and procedures. Educators teach Clinical Standards of patient safety, while communication patterns circulate Risk Mitigation processes. Clinic settings establish Patient-Centered environments, while leadership sustains the overall framework through Administrative Oversight.

Conclusion: Students, faculty, and staff stakeholders identified myriad opportunities to improve patient safety culture in chiropractic teaching clinics. Chiropractic teaching programs are encouraged to use the Safety Compass Model to identify and address areas for improvement in their own institutions.