A multilevel model of patient safety culture: cross-level relationship between organizational culture and patient safety behavior in Taiwan's hospitals

Combination Relationship between Features of Person-Centered Care and Patient Safety Activities of Nurses Working in Small-Medium-Sized Hospitals: A Cross-Sectional Study

Perceived safety culture and nursing work environment are considered important prerequisites for a patient safety activity. Patient safety is also associated with person-centered care; however, few studies apply the person-centered care framework which includes staff attributes and care environment. This study aimed to examine the canonical correlations of person-centered care factors, including professional self-concept, patient safety culture, nursing work environment, and patient safety activities of nurses working in small-medium-sized hospitals. A cross-sectional survey was used. Participants included 171 nurses from seven small-medium-sized hospitals in Busan metropolitan city, in Korea. Data were analyzed using descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's correlation coefficients, and canonical correlations. Two significant canonical variates were found. First, better professional self-concept, a positive patient safety culture, and better nursing work environment were associated with better patient safety care activities. Second, a negative patient safety culture and healthy nursing work environment were associated with a lack of communication between medical staff. Person-centered framework factors such as staff attributes and care environment were positively associated with patient safety activities. Based on the results, nurses in small-medium-sized hospitals should be highly aware of their professional self-concept. Moreover, nurses should be equipped with psychological safety and a healthy work environment to enhance patient safety activities.

An exploratory survey study of disorder and its association with safety culture in four hospitals

Background

Signs of disorder in neighbourhoods (e.g., litter, graffiti) are thought to influence the behaviour of residents, potentially leading to violations of rules and petty criminal behaviour. Recently, these premises have been applied to the hospital context, with physical and social disorder found to have a negative association with patient safety. Building on these results, the present study investigates whether physical and social disorder differ between hospitals, and their relationship to safety culture.

Methods

We conducted a cross sectional survey with Likert-style and open response questions administered in four Australian hospitals. All staff were invited to participate in the pilot study from May to September 2018. An analysis of variance (ANOVA) was used to examine differences in disorder by hospital, and hierarchical linear regression assessed the relationship of physical and social disorder to key aspects of safety culture (safety climate, teamwork climate). Open responses were analysed using thematic analysis to elaborate on manifestations of hospital disorder.

Results

There were 415 survey respondents. Significant differences were found in perceptions of physical disorder across the four hospitals. There were no significant differences between hospitals in levels of social disorder. Social disorder had a significant negative relationship with safety and teamwork climate, and physical disorder significantly predicted a poorer teamwork climate. We identified five themes relevant to physical disorder and four for social disorder from participants’ open responses; the preponderance of these themes across hospitals supported quantitative results.

Conclusions

Findings indicate that physical and social disorder are important to consider in attempting to holistically understand a hospital’s safety culture. Interventions that target aspects of physical and social disorder in a hospital may hold value in improving safety culture and patient safety.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07930-6.

Healthcare professional's perception of patient safety assessed by the hospital survey on patient safety culture in Taiwan: a systematic review

Purpose

Safety activities have been initiated in healthcare organizations in Taiwan, but little is known about the performance and trends of safety culture on a timely basis. This study aims to comprehensively review the articles that have conducted two worldwide patient safety culture instruments (HSPSC and SAQ) in Taiwan to provide the extent of existing knowledge about healthcare professionals' perception related to patient safety.

Design/methodology/approach

The Web of Science, Medline (Pubmed) and Embas were used as the database to search papers related to the patient safety culture in Taiwan from 2008 to June 30, 2019.

Findings

Twenty-four relative articles in total were found and further investigations confirmed that the regular assessment of patient safety culture among hospital staff is essentially important for healthcare organizations to reduce the rates of medical errors and malpractice. Moreover, the elements influencing patient safety culture may vary due to the difference in job positions, age, experience in organization and cultural settings.

Research limitations/implications

The summary of findings enables healthcare administrators and practitioners to understand key components of patient safety culture for continuous improvement in medical quality.

Originality/value

Assessing the safety culture in healthcare organizations is a foundation to achieve excellent medical quality and service. The implications of this study could be useful for hospitals to establish a safer environment for patients.

The Association Between Cognitive Medical Errors and Their Contributing Organizational and Individual Factors

BACKGROUND

Examining cognitive medical errors (MEs) and their contributing factors is vital in health systems research, as it provides baseline data that can be used to develop appropriate interventions to prevent and/or minimize errors. The primary aim of this study was to investigate the association between cognitive MEs and hospitals' organizational factors and the individual psychological and functional factors.

METHODS

This cross-sectional study was conducted in three main hospitals in Northern Jordan. A proportional sampling technique was employed to decide the number of participants from each hospital. Data from physicians and nurses (n=400) were collected using a self-administered questionnaire, which was developed based on pertinent literature review. Exploratory and confirmatory factor analyses were conducted to validate the study instrument. The relationships between the variables were analyzed through structural equation modeling (SEM) using AMOS. Multi-group analysis was also performed to examine the differences in the participants' perceptions towards the respective variables between the three selected hospitals.

RESULTS

Our results showed a non-significant negative association between MEs and hospital organizational factors. Also, the SEM analysis showed a positive significant correlation between MEs and psychological and functional factors, whereby excessive workload, complexity of tasks, stress, sleep deprivation, and fatigue were found to be predictors of MEs occurrence. In comparison to the results from the university hospital, the multi-group analysis results from the governmental public hospital and the private hospital showed a significant impact of psychological and functional factors on MEs.

CONCLUSION

To reduce the occurrence of MEs in hospitals, there is a need to enhance organizational safety culture. Efforts should be directed at both organizational and individual levels. Also, it is essential that health decision makers develop strategies to reduce work-related stress and improve healthcare staff well-being, as work stress may cause cognitive impairments among healthcare workers and hence threaten patients' safety.

Team Resource Management Perception Under Managerial Coaching Skills and Organizational Climate: Cross-Level Analysis in Taiwan's Hospitals

There is growing recognition of the importance of teamwork and integration of resources in the health care industry. This article studied the influence of organizational climate and managerial coaching skills on team perception of team resource management (TRM) and coaching techniques in selected hospitals in Taiwan. Structural survey method was used to measure the relationship between organizational climate, managerial coaching skills, and team perception of TRM. The participants of this research were 530 administrative staff from 12 hospitals in Taiwan. Cross-level relationship between organizational climate (group level), managerial coaching skills (individual level), and team perception of TRM (individual level) was examined. The results revealed that organizational climate had a significant influence on team perception of TRM. Second, recognition of managerial coaching skills shaped team perception during TRM implementation. Third, organizational climate had a moderating effect on the relationship between managerial coaching skills and team perception of TRM. The study concluded that positive organizational climate and good managerial coaching skills contribute to effective team management and development. Thus, it is important for health care organizations to understand the importance of coaching and mentoring and create a workplace that makes learning, growth, and adaptation possible across different departments and functional teams.

Safety Culture and Patient Safety Outcomes in East Asia: A Literature Review

This review examined associations between safety culture aspects and patient safety outcomes in East Asian hospitals and identified relevant research priorities. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, 16 articles were identified for review. Patient safety nursing activity was the most commonly investigated outcome in relation to safety culture aspects. Among safety culture aspects, feedback and communication, frequency of event reporting, teamwork within units, and managers’ support for patient safety were most significantly related to patient safety outcomes. Areas for further research include the use of theory or theoretical frameworks, consensus upon the scoring strategies for computation of safety culture scores, and selecting appropriate units of analysis and statistical analyses. Finally, researchers should examine relations between unit-specific and nation-specific safety culture and patient safety outcomes, given the influence of cultural attitudes and behaviors on patient safety.

The attitudes of nursing students and clinical instructors towards reporting irregular incidents in the medical clinic

Despite efforts to increase patient safety, medical incidents and near misses occur daily. Much is still unknown about this phenomenon, especially due to underreporting. This study examined why nursing students and clinical instructors underreport medical events, and whether they believe that changes within their institutions could increase reporting. 103 third- and fourth-year nursing students and 55 clinical instructors completed a validated questionnaire. The results showed that about one-third of the instructors and one-half of the nursing students believed that circumstances and lack of awareness, and fear of consequences, lead to underreporting. Both nursing students and clinical instructors ranked "fear of consequences" as the main reason for not reporting, yet students ranked this higher than their instructors. Moreover, both groups believed that incident reporting could be increased following changes in the clinical field, mainly by increasing awareness and knowledge. A large percentage of participants also wrote that they do not report errors that are the result of circumstances and lack of awareness, mainly fear of consequences. Therefore, hospitals and academic institutions may need to create a more accepting organizational climate. Moreover, institutions that allow incident reports to be submitted anonymously and that take educational (not disciplinary) action, may increase incident reporting.

Multilevel Analysis of Individual, Organizational, and Regional Factors Associated With Patient Safety Culture: A Cross-Sectional Study of Maternal and Child Health Institutions in China

Supplemental digital content is available in the text.

The aim of this study was to assess patient safety culture (PSC) in maternal and child health (MCH) institutions in China and its individual, organizational, and regional variations.

Healthcare Professional's Perception of Patient Safety Measured by the Hospital Survey on Patient Safety Culture: A Systematic Review and Meta-Analysis

Objective

To assess the culture of patient safety in studies that employed the hospital survey on patient safety culture (HSOPS) in hospitals around the world.

Method

We searched MEDLINE, EMBASE, SCOPUS, CINAHL, and SciELO. Two researchers selected studies and extracted the following data: year of publication, country, percentage of physicians and nurses, sample size, and results for the 12 HSOPS dimensions. For each dimension, a random effects meta-analysis with double-arcsine transformation was performed, as well as meta-regressions to investigate heterogeneity, and tests for publication bias.

Results

59 studies with 755,415 practitioners surveyed were included in the review. 29 studies were conducted in the Asian continent and 11 in the United States. On average studies scored 9 out of 10 methodological quality score. Of the 12 HSOPS dimensions, six scored under 50% of positivity, with “nonpunitive response to errors” the lowest one. In the meta-regression, three dimensions were shown to be influenced by the proportion of physicians and five by the continent where survey was held.

Conclusions

The HSOPS is widely used in several countries to assess the culture of patient safety in hospital settings. The culture of culpability is the main weakness across studies. Encouraging event reporting and learning from errors should be priorities in hospitals worldwide.

Healthcare Workers: Occupational Health Promotion and Patient Safety

The purpose of the present study was to explore the relation of work-related risk factors and well-being among healthcare workers and the impact on patient safety, using the Health and Work Survey (INSAT) and Mental Health Continuum - Short Form (MHC-SF). A sample of 361 Portuguese healthcare workers participated in this study. The results indicate some significant work-related risk factors: for emotional well-being, Impossible to express myself (β = -0.977), Not having recognition by superiors (β = -1.028) and Have to simulate good mood and/or empathy (β = -1.007); for social well-being, Exposed to the risk of sexual discrimination (β = -2.088), Career progress is almost impossible (β = -1.518), and Have to hide my emotions (β = -2.307); finally for psychological well-being Exposed to the risk of sexual discrimination (β = -2.153), Career progress is almost impossible (β = -1.377), and Have to simulate good mood and/or empathy (β = -3.201). The results showed high levels of well-being despite the exposure of several risk factors at workplace. Regarding the work-related risk factors, the study showed that most of the participants are exposed to several risk factors at workplace (ranging from environmental risk factors, biological to physical), although psychosocial risk factors (work relations with superiors and colleagues, employment relations, and emotional demands) are the ones that most impact on well-being.

Interventionalists' perceptions on a culture of radiation protection

BACKGROUND

Occupational exposure to ionising radiation poses potential health risks to radiation workers unless adequate protection is in place. The catheterisation laboratory is a highly contextualised workplace with a distinctive organisational and workplace culture.

OBJECTIVE

This study was conducted to understand the culture of radiation protection (CRP).

METHODS

This study was a qualitative study and data were collected through 30 in-depth and 6 group interviews with 54 purposively selected South African interventionalists (interventional radiologists and cardiologists). The participants included a diversity of interventionalists who varied in sex, geographic location and years of experience with fluoroscopy. The transcribed data were analysed thematically using a deductive and inductive approach.

RESULTS

'Culture of radiation protection' emerged as a complex theme that intersected with other themes: 'knowledge and awareness of radiation', 'radiation safety practice', 'personal protective equipment (PPE) utilisation' and 'education and training'.

CONCLUSION

Establishing and sustaining a CRP provides an opportunity to mitigate the potentially detrimental health effects of occupational radiation exposure. Education and training are pivotal to establishing a CRP. The time to establish a culture of radiation in the catheterisation laboratory is now.

Disentangling the roles of safety climate and safety culture: Multi-level effects on the relationship between supervisor enforcement and safety compliance

Despite increasing attention to contextual effects on the relationship between supervisor enforcement and employee safety compliance, no study has yet explored the conjoint influence exerted simultaneously by organizational safety climate and safety culture. The present study seeks to address this literature shortcoming. We first begin by briefly discussing the theoretical distinctions between safety climate and culture and the rationale for examining these together. Next, using survey data collected from 1342 employees in 32 Italian organizations, we found that employee-level supervisor enforcement, organizational-level safety climate, and autocratic, bureaucratic, and technocratic safety culture dimensions all predicted individual-level safety compliance behaviors. However, the cross-level moderating effect of safety climate was bounded by certain safety culture dimensions, such that safety climate moderated the supervisor enforcement-compliance relationship only under the clan-patronage culture dimension. Additionally, the autocratic and bureaucratic culture dimensions attenuated the relationship between supervisor enforcement and compliance. Finally, when testing the effects of technocratic safety culture and cooperative safety culture, neither safety culture nor climate moderated the relationship between supervisor enforcement and safety compliance. The results suggest a complex relationship between organizational safety culture and safety climate, indicating that organizations with particular safety cultures may be more likely to develop more (or less) positive safety climates. Moreover, employee safety compliance is a function of supervisor safety leadership, as well as the safety climate and safety culture dimensions prevalent within the organization.

A hybrid health service accreditation program model incorporating mandated standards and continuous improvement: interview study of multiple stakeholders in Australian health care

The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011-12 there were 47 group and individual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies; shifting of program content focus and details; different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance; continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from "malicious compliance" to "performance audits" to "quality improvement journeys". Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd.

How do hospitalization experience and institutional characteristics influence inpatient satisfaction? A multilevel approach

Over the last several years, interest in benchmarking health services’ quality—particularly patient satisfaction (PS)—across organizations has increased. Comparing patient experiences of care across hospitals requires risk adjustment to control for important differences in patient case-mix and provider characteristics. This study investigates the individual-level and organizational-level determinants of PS with public hospitals by applying hierarchical models. The analysis focuses on the effect of hospital characteristics, such as self-discharges, on overall evaluations and on across hospital variation in scores. Sociodemographics, admission mode, place of residence, hospitalization ward and continuity of care were statistically significant predictors of inpatient satisfaction. Interestingly, it was observed that hospitals with a higher percentage of Patients Leaving Against Medical Advice (PLAMA) received lower scores. The latter result suggests that the percentage of PLAMA may provide a useful measure of a hospital’s inability to meet patient needs and a proxy indicator of PS with hospital care.

Organizational safety culture and medical error reporting by Israeli nurses

PURPOSE

To investigate the association between patient safety culture (PSC) and the incidence and reporting rate of medical errors by Israeli nurses.

DESIGN

Self-administered structured questionnaires were distributed to a convenience sample of 247 registered nurses enrolled in training programs at Tel Aviv University (response rate = 91%).

METHODS

The questionnaire's three sections examined the incidence of medication mistakes in clinical practice, the reporting rate for these errors, and the participants' views and perceptions of the safety culture in their workplace at three levels (organizational, departmental, and individual performance). Pearson correlation coefficients, t tests, and multiple regression analysis were used to analyze the data.

FINDINGS

Most nurses encountered medical errors from a daily to a weekly basis. Six percent of the sample never reported their own errors, while half reported their own errors "rarely or sometimes." The level of PSC was positively and significantly correlated with the error reporting rate. PSC, place of birth, error incidence, and not having an academic nursing degree were significant predictors of error reporting, together explaining 28% of variance.

CONCLUSIONS

This study confirms the influence of an organizational safety climate on readiness to report errors. Senior healthcare executives and managers can make a major impact on safety culture development by creating and promoting a vision and strategy for quality and safety and fostering their employees' motivation to implement improvement programs at the departmental and individual level.

CLINICAL RELEVANCE

A positive, carefully designed organizational safety culture can encourage error reporting by staff and so improve patient safety.