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Lassoued L, Gharssallah I, Tlili MA, Sahli J, Kouira M, Abid S, Chaieb A, Khairi H. Impact of an educational intervention on patient safety culture among gynecology-obstetrics' healthcare professionals. BMC Health Serv Res 2024; 24:704. [PMID: 38840130 PMCID: PMC11151572 DOI: 10.1186/s12913-024-11152-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND In recent years, patient safety has begun to receive particular attention and has become a priority all over the world. Patient Safety Culture (PSC) is widely recognized as a key tenet that must be improved in order to enhance patient safety and prevent adverse events. However, in gynecology and obstetrics, despite the criticality of the environment, few studies have focused on improving PSC in these units. This study aimed at assessing the effectiveness of an educational program to improve PSC among health professionals working in the obstetric unit of a Tunisian university hospital. METHODS We conducted a quasi-experimental study in the obstetric unit of a university hospital in Sousse (Tunisia). All the obstetric unit's professionals were invited to take part in the study (n = 95). The intervention consisted of an educational intervention with workshops and self-learning documents on patient safety and quality of care. The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture. Normality of the data was checked using Kolmogorov-Smirnov test. The comparison of dimensions' scores before and after the intervention was carried out by the chi2 test. The significance level was set at 0.05. RESULTS In total, 73 participants gave survey feedback in pre-test and 68 in post-test (response rates of 76.8% and 71.6, respectively). Eight dimensions improved significantly between pre- and post-tests. These dimensions were D2 "Frequency of adverse events reported" (from 30.1 to 65.6%, p < 0.001), D3 "Supervisor/Manager expectations and actions promoting patient safety" (from 38.0 to 76.8%, p < 0.001), D4 "Continuous improvement and organizational learning" (from 37.5 to 41.0%, p < 0.01), D5 "Teamwork within units" (from 58.2 to 79.7%, p < 0.01), D6 "Communication openness" (from 40.6 to 70.6%, p < 0.001), and D7 "Non-punitive response to error" (from 21.1 to 42.7%, p < 0.01), D9 "Management support for patient safety" (from 26.4 to 72.8%, p < 0.001), and D10 "Teamwork across units" (from 31.4 to 76.2%, p < 0.001). CONCLUSIONS Educational intervention, including workshops and self-learning as pedagogical tools can improve PSC. The sustainability of the improvements made depends on the collaboration of all personnel to create and promote a culture of safety. Staff commitment at all levels remains the cornerstone of any continuous improvement in the area of patient safety.
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Affiliation(s)
- Latifa Lassoued
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Ines Gharssallah
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Mohamed Ayoub Tlili
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie.
- Department of Nursing Administration, College of Nursing, University of Hail, Hail, Saudi Arabia.
| | - Jihene Sahli
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
| | - Mouna Kouira
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Skender Abid
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Anouar Chaieb
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
| | - Hedi Khairi
- Université de Sousse, Faculté de Médecine de Sousse, Sousse, LR12ES03, 4000, Tunisie
- Service de Gynécologie Obstétrique CHU Farhat Hached, Sousse, 4000, Tunisie
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Chang MW, Kung CT, Yu SF, Wang HT, Lin CL. Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach. Healthcare (Basel) 2023; 11:healthcare11040471. [PMID: 36833005 PMCID: PMC9957007 DOI: 10.3390/healthcare11040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
The implementation of competency-based medical education (CBME) focuses on learners' competency outcomes and performance during their training. Competencies should meet the local demands of the healthcare system and achieve the desired patient-centered outcomes. Continuous professional education for all physicians also emphasizes competency-based training to provide high-quality patient care. In the CBME assessment, trainees are evaluated on applying their knowledge and skills to unpredictable clinical situations. A priority of the training program is essential in building competency development. However, no research has focused on exploring strategies for physician competency development. In this study, we investigate the professional competency state, determine the driving force, and provide emergency physicians' competency development strategies. We use the Decision Making Trial and Evaluation Laboratory (DEMATEL) method to identify the professional competency state and investigate the relationship among the aspects and criteria. Furthermore, the study uses the PCA (principal component analysis) method to reduce the number of components and then identify the weights of the aspects and components using the ANP (analytic network process) approach. Therefore, we can establish the prioritization of competency development of emergency physicians (EPs) with the VIKOR (Vlse kriterijumska Optimizacija I Kompromisno Resenje) approach. Our research demonstrates the priority of competency development of EPs is PL (professional literacy), CS (care services), PK (personal knowledge), and PS (professional skills). The dominant aspect is PL, and the aspect being dominated is PS. The PL affects CS, PK, and PS. Then, the CS affects PK and PS. Ultimately, the PK affects the PS. In conclusion, the strategies to improve the professional competency development of EPs should begin with the improvement from the aspect of PL. After PL, the following aspects that should be improved are CS, PK, and PS. Therefore, this study can help establish competency development strategies for different stakeholders and redefine emergency physicians' competency to reach the desired CBME outcomes by improving advantages and disadvantages.
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Affiliation(s)
- Meng-Wei Chang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Chang Gung Medical Education Research Centre (CG-MERC), Taoyuan 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Shan-Fu Yu
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Hui-Ting Wang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Chang Gung Medical Education Research Centre (CG-MERC), Taoyuan 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei 111, Taiwan
- Correspondence:
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Mrayyan MT. Predictors and outcomes of patient safety culture: a cross-sectional comparative study. BMJ Open Qual 2022; 11:e001889. [PMID: 35798501 PMCID: PMC9263941 DOI: 10.1136/bmjoq-2022-001889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Developing a safety culture in hospitals improves patient safety-related initiatives. Limited recent knowledge about patient safety culture (PSC) exists in the healthcare context. AIMS This study assessed nurses' reporting on the predictors and outcomes of PSC and the differences between the patient safety grades and the number of events reported across the components of PSC. METHODS A cross-sectional comparative research design was conducted. The Strengthening the Reporting of Observational Studies in Epidemiology (https://www.strobe-statement.org/index.php?id=available-checklists) guided the study. The researcher recruited a convenience sample of 300 registered nurses using the hospital survey on patient safety culture, with a response rate of 75%. RESULTS Nurses reported PSC to be 'moderate'. Areas of strength in PSC were non-punitive responses to errors and teamwork within units. Areas that needed improvements were the supervisor's/manager's expectations and actions in promoting safety and communication openness. Some significant correlations were reported among PSC components. Significant differences in means were observed for patient safety grades in six out of the ten PSC components and one outcome item. Organisational learning/continuous improvement, hospital handoffs and transitions, years of experience in the current hospital, the supervisor's/manager's expectations and actions in promoting safety and gender predicted PSC. Of the outcomes, around half of the sample reported a 'very good' patient safety grade, and 'no events' or 'one to two events' only were reported, and nurses 'agreed' on the majority of items, which indicates a positive perception about the overall PSC in the hospitals. In addition, nurses 'most of the time' reported the events when they occurred. PSC components correlated significantly and moderately with PSC outcomes. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE PSC was moderate with an overall positive nurses' perceptions. PSC's strengths should be maintained, and areas of improvement should be prioritised and immediately tackled. Assessing PSC is the first step in improving hospitals' overall performance and quality of services, and improving patient safety practices is essential to improving PSC and clinical outcomes.
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Affiliation(s)
- Majd T Mrayyan
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
- Advanced Nursing Department, Faculty of Nursing, Isra University, Amman, Jordan
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Aouicha W, Tlili MA, Sahli J, Mtiraoui A, Ajmi T, Said Latiri H, Chelbi S, Ben Rejeb M, Mallouli M. Patient safety culture as perceived by operating room professionals: a mixed-methods study. BMC Health Serv Res 2022; 22:799. [PMID: 35725613 PMCID: PMC9210674 DOI: 10.1186/s12913-022-08175-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Routine assessments of patient safety culture within hospitals have been widely recommended to improve patient safety. Experts suggested that mixed-methods studies can help gain a deeper understanding of the concept. However, studies combining quantitative and qualitative approaches exploring patient safety culture are still lacking. This study aimed to explore patient safety culture as perceived by operating room professionals of two university hospitals in Sousse, Tunisia. Methods Based on a mixed-methods approach, a cross-sectional survey followed by semi-structured interviews were conducted over a period of two months (December 2019 to January 2020). This study took place in all the operating rooms of two public university hospitals in the district of Sousse, Tunisia. To collect data for this survey, the French version of the Hospital Survey On Patient Safety Culture was used. For interviews, 13 participants were selected purposively using a critical case sampling approach and a topic guide was prepared. Anonymity and confidentiality were respected. Results Overall, twelve operating rooms, with different surgical specialties, were included in the study. Survey feedback was provided by 297 professionals representing a response rate of 85.6%. Concerning patient safety culture, the 10 dimensions had low scores (below 50%) and were considered “to be improved”. The highest score was found in ‘teamwork within units’ (45%). Whereas, the lowest scores were allocated to ‘non-punitive response to error’ (22.9%), followed by “frequency of adverse event reported” (25.6%) and “communication openness” (26.3%). Per qualitative data, participants provided a more detailed picture of patient safety issues such as underreporting, absence of an effective reporting system, lack of freedom of expression, and an existing blame culture in operating rooms. Conclusions The findings of this study showed a concerning perception held by participants about the lack of a patient safety culture in their operating rooms. It seems essential to design, implement and evaluate strategies that promote a positive patient safety culture and obliterate punitive climate in operating rooms. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08175-z.
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Affiliation(s)
- Wiem Aouicha
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia.
| | - Mohamed Ayoub Tlili
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Jihene Sahli
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Ali Mtiraoui
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Thouraya Ajmi
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Houyem Said Latiri
- Department of Prevention and Care Safety, Sahloul University Hospital, Route de ceinture Sahloul city 4054, Sousse, Tunisia
| | - Souad Chelbi
- Faculty of Medicine of Sousse, Faculty of Medicine, University of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care Safety, Sahloul University Hospital, Route de ceinture Sahloul city 4054, Sousse, Tunisia
| | - Manel Mallouli
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
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Alshyyab MA, Borkoles E, Albsoul RA, Kinnear FB, FitzGerald G. Safety culture in emergency medicine: An exploratory qualitative study. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2022; 33:365-383. [PMID: 35213391 DOI: 10.3233/jrs-210031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Safety culture in Emergency Departments (EDs) requires special attention due to unique operational feature of the ED environment. Which may influence a culture of patients' safety in the ED. OBJECTIVE To identify the factors that influence patient safety culture in EDs. METHODS A qualitative study using semi-structured interviews with 12 ED staff was carried out in two Australian EDs. The data was thematically analysed to identify and describe the factors perceived by staff as influencing patient safety culture. RESULTS The findings revealed four super-ordinate themes and 19 categories. The themes were the following: (1) Environmental and Organisational; (2) Healthcare Professional (3) Managerial factors; and (4) Patients factors. CONCLUSIONS Safety culture in the ED is influenced by complex set of factors. The results of this study may help ED workers with improving patient safety culture and healthcare quality in the ED.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Erika Borkoles
- School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Rania Ali Albsoul
- Department of Family and Community Medicine, School of Medicine, Jordan University, Aman, Jordan
| | - Frances B Kinnear
- Emergency Department, The Prince Charles Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Alshyyab MA, FitzGerald G, Albsoul RA, Ting J, Kinnear FB, Borkoles E. Strategies and interventions for improving safety culture in Australian Emergency Departments: A modified Delphi study. Int J Health Plann Manage 2021; 36:2392-2410. [PMID: 34476834 DOI: 10.1002/hpm.3314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient safety and safety culture are critical for quality healthcare delivery in general and in Emergency Departments (EDs) in particular. The aim of this study is to identify strategies that may contribute to the improvement and maintenance of patient safety culture and which are considered most feasible in the ED environment. METHODS A two-step modified Delphi method with 11 experts' panel was performed to establish consensus. A list of potential expert participants with a background in patient safety culture in EDs was compiled through the professional networks of the supervisory team. Snowball sampling was used to identify additional possible participants. The expert panel included key leaders in the emergency medicine community in Queensland, Australia: patient safety experts and researchers, patient safety directors, and healthcare providers in an Australian ED The study ran from September 2018 to December 2018. The tool used in Round 1 in this study was developed through triangulating the outcomes of a review of literature, results from a survey of ED staff and findings from semi-structured interviews with key stakeholders in ED. The results from Round 1 informed the development of the Round 2 tool. The responses from the Delphi Round 1 tool were analysed as both qualitative data and quantitative data. The responses from the Delphi Round 2 tool were treated as quantitative data and analysed with the SPSS software. Consensus was calculated based on more than 80% agreement in collapsed categories 1 and 2 (or 4 and 5) of the five-point Likert scale. RESULTS Only six strategies out of 17 (35%) achieved consensus for both importance and feasibility. These strategies may therefore be considered the most important and feasible key strategies for improving safety culture in EDs. Seven strategies (41.1%) achieved consensus for importance, but not for feasibility and four strategies (23.55%) did not achieve consensus for either importance or feasibility. CONCLUSIONS This study offers practical solutions for safety culture improvement in the ED context. Six key strategies were seen as both important and feasible and these grouped into three main themes; leadership through agenda setting, operational management approaches to reinforce the agenda and commitment, and systems and structures to reinforce the agenda and monitor progress.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- Department of Public Health, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Gerard FitzGerald
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia
| | - Rania Ali Albsoul
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Joseph Ting
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Mater Health Services, Brisbane, Queensland, Australia
| | - Frances B Kinnear
- Emergency Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Erika Borkoles
- Department of Public Health, School of Medicine, Public Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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