Assessment of patient safety culture in Palestinian public hospitals

Exploring medical and nursing students' perceptions about a patient safety course: a qualitative study

BACKGROUND

Educating health professionals on patient safety can potentially reduce healthcare-associated harm. Patient safety courses have been incorporated into medical and nursing curricula in many high-income countries and their impact has been demonstrated in the literature through objective assessments. This study aimed to explore student perceptions about a patient safety course to assess its influence on aspiring health professionals at a personal level as well as to explore differences in areas of focus between medical and nursing students.

METHODS

A dedicated patient safety course was introduced for year III medical and year II and IV nursing students at the Aga Khan University (2021-2022). As part of a post-course assessment, 577 participating students (184 medical and 393 nursing) wrote reflections on the course, detailing its influence on them. These free-text responses were thematically analyzed using NVivo.

RESULTS

The findings revealed five major themes: acquired skills (clinical, interpersonal), understanding of medical errors (increased awareness, prevention and reduction, responding to errors), personal experiences with patient safety issues, impact of course (changed perceptions, professional integrity, need for similar sessions, importance of the topic) and course feedback (format, preparation for clinical years, suggestions). Students reported a lack of baseline awareness regarding the frequency and consequences of medical errors. After the course, medical students reported a perceptional shift in favor of systems thinking regarding error causality, and nursing students focused on human factors and error prevention. The interactive course format involving scenario-based learning was deemed beneficial in terms of increasing awareness, imparting relevant clinical and interpersonal skills, and changing perspectives on patient safety.

CONCLUSIONS

Student perspectives illustrate the benefits of an early introduction of dedicated courses in imparting patient safety education to aspiring health professionals. Students reported a lack of baseline awareness of essential patient safety concepts, highlighting gaps in the existing curricula. This study can help provide an impetus for incorporating patient safety as a core component in medical and nursing curricula nationally and across the region. Additionally, patient safety courses can be tailored to emphasize areas identified as gaps among each professional group, and interprofessional education can be employed for shared learning. The authors further recommend conducting longitudinal studies to assess the long-term impact of such courses.

Practices Used to Improve Patient Safety Culture Among Healthcare Professionals in a Tertiary Care Hospital

Introduction

A patient safety culture primarily refers to the values, beliefs, attitudes, and behaviors within a healthcare setup in a community that assists in prioritizing patient safety and encouraging the reporting of errors and near-misses in that facility. There is a direct impact of patient safety culture on how well patient safety and quality improvement programs work. The aim of this cross-sectional descriptive study was to investigate the practices to improve patient safety culture and adverse event reporting practices among healthcare professionals in a tertiary care hospital located in Mirpur Azad Jammu and Kashmir.

Methods

In the non-probability convenience sampling of this cross-sectional study, Divisional Headquarters Teaching Hospital in Mirpur, Azad Kashmir used the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture Hospital Survey to collect data about the perceptions of healthcare professionals regarding patient safety culture within their hospital to assess the trends of patient safety culture by obtaining longitudinal data. A pre-validated questionnaire that has undergone a rigorous trial of testing to maximize the reliability and accuracy of the outcomes was distributed among clinical staff (healthcare professionals who interact with patients on a daily basis, such as nurses, doctors, pharmacists, and laboratory technicians) and administrative staff (medical superintendent, deputy medical superintendent, assistant medical superintendent, heads of departments).

Results

A total of 312 questionnaires were returned (response rate, 76%). The study found that the dimension "supervisor/manager expectation and action promoting safety" had the highest positive response rate (65.16%), and "nonpunitive response" had the lowest (27.4%). Higher scores in "nonpunitive response to error" were associated with lower rates of medication errors, pressure ulcers, and surgical site infections, and higher scores in "frequency of event reporting" were associated with lower rates of medication errors, pressure ulcers, falls, hospital-acquired infections, and urinary tract infections.

Conclusion

We suggest that in order for hospital staff to continue providing excellent, clinically safe treatment, a well-structured hospital culture promoting patient safety is necessary. Moreover, further study is needed to determine strategies to improve patient safety expertise and awareness, and lower the frequency of adverse occurrences.

Patient Safety Culture: A Healthcare Provider's Prospect

INTRODUCTION AND OBJECTIVE

Safe care is a challenge around the globe, especially in developing countries. In resource-limited settings achieving patient safety is an additional complexity. Patient safety is now considered a significant public health concern worldwide. Despite a vital role in delivering quality care, little attention has been given to describe healthcare professionals' perceptions of the patient safety culture in Pakistan. This study aimed to assess the patient safety culture at a tertiary care public hospital in Lahore from the perspectives of doctors and nurses.

METHODS

During this cross-sectional study, data were collected from 290 nurses and doctors using a validated safety assessment survey tool of the Hospital Survey of Patient Safety Culture (HSOPSC). The respondent's demographic characteristics and study variables influencing patient safety culture were presented, and a chi-square test was applied to identify the variables influencing patient safety.

RESULTS

A total of 114 medical doctors (39.3%) and 176 registered nurses (60.7%) participated in assessing patient safety culture (PSC) across tertiary care public healthcare centers in Lahore. The dimensions of organizational learning and continuous improvement (90.6%) and teamwork within units (86.6%) were the highest. Other dimensions include feedback and communication about the error (71.8%), teamwork across units (74.9%), management support for patient safety (67.3%), supervisor/manager expectations, and actions promoting patient safety (64.6%), communication openness (64.5%), overall perceptions of patient safety (65.3%), frequency of events reported (58.7%), and handoffs and transitions (60.9%) showed moderate status. The dimensions of staffing (35.8%) and non-punitive response to errors (39.1%) had the lowest score.

CONCLUSIONS

The present public hospital survey results revealed that medical staff working in a healthcare setting have a less positive perception of patient safety culture.

Patient Safety Culture: Effects on Errors, Incident Reporting, and Patient Safety Grade

OBJECTIVES

This study mainly examines the effects of patient safety culture dimensions on 4 outcomes (self-reported errors, witnessing errors, incident reporting, and patient safety grade).

METHODS

The data were collected using the Turkish version of the Safety Attitudes Questionnaire, which consists of 6 dimensions (teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions). Of 1679 personnel working in 6 hospitals in Ankara, 860 were randomly selected. The data were analyzed using descriptive statistics, the Spearman correlation coefficient, and binary logistic regression analyses.

RESULTS

The response rate was 62.7%. When the overall patient safety culture score increased by 1 point; the probability of witnessing an error was 2 times lower (P < 0.001), the probability of incident reporting was 4.22 times higher (P < 0.001), and the probability of assessing the patient safety grade as excellent was 29.86 times higher (P < 0.001). The teamwork climate was negatively related to making errors and witnessing errors (P < 0.001). The safety climate and working conditions were positively related to incident reporting and patient safety grade (P < 0.001). Job satisfaction was negatively related to incident reporting (P < 0.001). Perceptions of management were positively related to making errors and patient safety grade (P < 0.001).

CONCLUSIONS

The patient safety culture scores were positively correlated with incident reporting and patient safety grade but negatively correlated with the occurrence of errors. Each dimension of the patient safety culture, except stress recognition, affected different outcomes. Therefore, managers should focus on different dimensions of patient safety culture to improve different outcomes.

When Illegitimate Tasks Threaten Patient Safety Culture: A Cross-Sectional Survey in a Tertiary Hospital

Objectives: The current study investigates the prevalence of illegitimate tasks in a hospital setting and their association with patient safety culture outcomes, which has not been previously investigated. Methods: We conducted a cross-sectional survey in a tertiary referral hospital. Patient safety culture outcomes were measured using the Hospital Survey on Patient Safety Culture questionnaire; the primary outcome measures were a low safety rating for the respondent's unit and whether the respondent had completed one or more safety event reports in the last 12 months. Analyses were adjusted for hospital department and staff member characteristics relating to work and health. Results: A total of 2,276 respondents answered the survey (participation rate: 35.0%). Overall, 26.2% of respondents perceived illegitimate tasks to occur frequently, 8.1% reported a low level of safety in their unit, and 60.3% reported having completed one or more safety event reports. In multivariable analyses, perception of a higher frequency of illegitimate tasks was associated with a higher risk of reporting a low safety rating and with a higher chance of having completed event reports. Conclusion: The prevalence of perceived illegitimate tasks was rather high. A programme aiming to reduce illegitimate tasks could provide support for a causal effect of these tasks on safety culture outcomes.

Comparing patient safety culture in primary, secondary and tertiary hospitals in Ghana

Objective

This study compared patient safety culture among health professionals in tertiary, secondary and primary hospitals.

Design

We conducted a cross-sectional survey among thirteen primary, secondary and tertiary hospitals in Ghana. A structured questionnaire was administered to 1,656 health professionals. Data were analysed using descriptive statistics and One-Way Analysis of Variance (ANOVA).

Setting

This study was conducted in the Greater Accra, Bono and Upper East regions, representing the southern, middle and northern ecological zones, respectively.

Participants

Health professionals.

Main outcome measures

The primary outcome was patient safety culture.

Results

Five patient safety culture dimensions were rated moderate positive response, while five were rated high positive response. We found a statistically significant difference in patient safety culture across primary, secondary and tertiary hospitals (p < 0.05). For instance, the mean difference between tertiary and secondary hospitals was statistically significant (p < 0.05). Additionally, the mean difference between tertiary and primary hospitals was statistically significant (p < 0.05). There was also a significant difference in the means between secondary and primary hospitals (p < 0.05).

Conclusion

This study has demonstrated a variation in patient safety culture across Ghana's tertiary, secondary and primary hospitals. Therefore, healthcare managers and professionals should prioritise patient safety.

Funding

This work was supported by the University of Ghana [UGRF/13/MDG-001/2019-2020].

Patient Safety Culture in the Southern Region of Saudi Arabia: A Survey among Community Pharmacies

Measuring patient safety culture in the community pharmacy can help with identifying areas for development. The current study is a descriptive, cross-sectional, electronic survey conducted among pharmacists working in community pharmacies located in the southern region of Saudi Arabia. The community pharmacy version of the "Pharmacy Survey on Patient Safety Culture" (PSOPSC) was used to collect data. The positive response rate (PRR) was calculated as per the guidance provided by the Agency for Healthcare Research and Quality (AHRQ). Based on the PRR, two least-achieved items (<25%) were taken for further analysis to identify the possible predictors. A sum of 195 pharmacists were included in this study and most of them were working in chain pharmacies. The highest PRRs were observed with teamwork (94.99), and patient counseling (94.13), followed by physical space and environment (93.07). The lowest PRRs were observed with staffing, work pressure, and pace (47.70), followed by communication openness (72.60). Specific characteristics, such as experience and the number of working hours, are significantly related to a poor PRR. The current study results indicate that the scope for improving patient safety exists in various areas of community pharmacies. However, it is necessary to prioritize the need based on a positive response rate.

Palestinian Patients with Cancer at King Hussein Cancer Center

Background

The Palestinian Ministry of Health (MoH) routinely refers Palestinian patients with cancer to King Hussein Cancer Center (KHCC), the largest cancer center in the Middle East.

Aims

We aimed to describe the characteristics of Palestinian patients with cancer.

Methods

We performed a retrospective chart review of all Palestinian patients with cancer who were treated at KHCC during 2018 and 2019, of which demographic and clinical characteristics were presented.

Results

We initially started with 521 cases, out of which 41 (7.9%) cases were excluded due to misdiagnosis as malignant on pathology review. We included 480 patients with a confirmed diagnosed of cancer. Most patients were adults (88.8%) with a mean age of 50.0 ± 15.0 years ranging from 19 to 87 years. The most common cancer sites in adult men, who comprised 46.9% of the cohort were the hematolymphoid system (23.5%), followed by the digestive system (17.5%), and lung and pleura (11.5%). In women (53.1%), the most common cancer sites were the breast (46.0%), followed by the digestive system (15.0%), and the hematolymphoid system (10.2%). Children and adolescents accounted for 11.3% of the total cases, among which the hematolymphoid system was the most common cancer site (50%), followed by the brain (14.8%). About 36.0% of all patients presented with advanced-stage disease (i.e., distant metastasis).

Conclusion

The most common cancer sites in our cohort are generally similar to data from the Palestinian territories. Many patients presented with advanced-stage disease, which signals the need for awareness campaigns and screening programs. Benign tumors are misdiagnosed in many patients as cancer. The limited resources and facilities including human resources remain important challenges to the proper and timely diagnosis and management of cancer among Palestinians living in the Palestinian Territories.

Predictors and outcomes of patient safety culture: a cross-sectional comparative study

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.

Relationship between depressive symptoms, burnout, job satisfaction and patient safety culture among workers at a university hospital in the Brazilian Amazon region: cross-sectional study with structural equation modeling

BACKGROUND

Workplaces can be sources of mental distress. In healthcare services, this can also affect patients.

OBJECTIVE

To assess the prevalence of and factors associated with depressive symptoms, burnout, job satisfaction and patient safety culture and the relationships between these constructs, among healthcare workers.

DESIGN AND SETTING

Cross-sectional study in a university hospital in Manaus, Brazil.

METHODS

Randomly selected workers were interviewed based on Brazilian-validated tools. We calculated the prevalence ratio (PR) and 95% confidence interval (CI) of depressive symptoms and burnout using Poisson regression with robust variance; and the β-coefficient of safety culture and job satisfaction using linear regression. Outcome relationships were assessed using partial least-squares structural equation modeling.

RESULTS

300 professionals were included; 67.3% were women. The prevalence of depressive symptom was 19.0% (95% CI: 14.5; 23.5%) and burnout, 8.7% (95% CI: 5.2; 12.3%). Lack of work stability increased depression (PR = 1.88; 95% CI: 1.17; 3.01) and burnout (PR = 2.17; 95% CI: 1.03; 4.57); and reduced job satisfaction (β = -11.93; 95% CI: -18.79; -5.07). Depressive symptoms and burnout were positively correlated, as also were job satisfaction and safety culture (P < 0.001); job satisfaction was negatively correlated with burnout (P < 0.001) and depression (P = 0.035).

CONCLUSION

Impermanent employment contracts increased depression and burnout and reduced job satisfaction. Job satisfaction reduced poor mental health outcomes and increased safety culture. Job satisfaction and safety culture were directly proportional (one construct increased the other and vice versa), as also were depression and burnout. Better working conditions can provide a virtuous cycle of patient safety and occupational health.

Patient safety culture in Iranian teaching hospitals: baseline assessment, opportunities for improvement and benchmarking

Background

Patient safety culture is an essential factor in determining the ability of hospitals to treat and reduce patient risks. Healthcare professionals, especially nurses, play an important role in patient safety because they are responsible for direct and ongoing patient care. Few studies in Iran examine the patient safety culture in Iranian teaching hospitals, particularly from the perspective of nursing staff. This research assessed patient safety culture in teaching hospitals in Iran from the nurses’ point of view and compared the outcomes with similar regional and global studies. Furthermore, the study identified the factors influencing patient safety culture and its association with outcomes.

Methods

A cross-sectional study was accomplished in thirty-two teaching hospitals in five provinces of Iran. A total of 2295 nurses were chosen through convenience sampling. Collection data were done using the Hospital Survey of Patient Safety Culture (HOPSC) from October 2018 and September 2019. We analyzed the data using descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis.

Results

The results demonstrated the overall percentage of positive response rate for the HOPSC tool (36.4%). The average percentage of positive responses among all dimensions ranged from 27.1% in “Staffing” to 53.8% in “Teamwork across Hospital Units”. Benchmarking analysis shows that Iranian hospitals are equal or better performance than the benchmark on several composites compared to regional and global findings. The results of multiple linear regression analysis showed that the age, gender, total years of experience in nursing, work area or unit, work hours, and size of the hospital were significant predictors of the perceptions patient safety culture of nurses (p <  0.05).

Conclusions

This is one of few studies that examine nurses’ perceptions of patient safety culture in public hospitals in Iran. Although the results of the present study showed that the results of Iran were at or better than the many composites in Jordan, Turkey, KSA, and the Philippines. The findings confirmed that all 12 dimensions can be considered as areas requiring improvement, and these results demonstrated that there was a severe shortage in patient safety culture among the included hospitals.

Patient safety attitude among healthcare workers at different levels of healthcare in Sharqia Governorate, Egypt

Background

Patient safety (PS) has been identified as a significant healthcare challenge. A good safety attitude helps healthcare workers (HCWs) to decrease medical errors.

Aim

This study aimed to assess the PS attitude and identify its determinants among HCWs.

Setting

This study was conducted in Sharqia Governorate at different levels of health care.

Methods

This was a comparative cross-sectional study that involved240 HCWs selected after using a multistage cluster sampling technique from Sharqia Governorate.In ordertto assess the respondents’ attitudes towards PS, the modified Chinese Safety Attitudes Questionnaire (CSAQ) was used.

Results

The scale with the highest percentage of positive responses, on average, was safety climate (49.59%). The study found a statistically significant association between the level of health care and mean scores of ‘teamwork climate, perception of management, job satisfaction, working conditions, and stress recognition’ and the overall CSAQ score. In regression analysis, the highest degree of education and job type were significant predictors of PS attitude among the HCWs under study (p = 0.031 and 0.011, respectively).

Conclusion

According to the study’s findings, PS is low among HCWs in both healthcare units and hospitals, with a significantly higher score among hospital workers than among primary care workers. All PS composites need improvement starting with regular assessment of PS culture along with continuous monitoring.

Psychometric Properties of the Latin American Spanish Version of the Hospital Survey on Patient Safety Culture Questionnaire in the Surgical Setting

OBJECTIVE

The Hospital Survey on Patient Safety Culture (HSPSC) was designed to assess staff views on patient safety and has been translated and validated into several languages and settings. This study developed a Latin American Spanish version of the HSPSC for use in perioperative settings and examines its psychometric properties.

METHODS

After translation and adjustments, a web-based questionnaire was administered to all health care personnel at operating room in a public university-affiliated hospital in Popayán, Colombia. Descriptive statistics, internal reliability, confirmatory and exploratory factor analysis, and intercorrelations among survey composites were calculated.

RESULTS

Confirmatory factor analysis showed inadequate model fit for the original 12-factor structure of the HSPSC. Rather, a 9-factor, 36-item instrument showed acceptable factor loadings, internal consistency, and psychometric properties. Five factors were formed with minor changes. Adjusted factors emerged, like "staffing and work pressure" and "supervisor/manager expectations and actions promoting patient safety," "organizational learning-continuous improvement," and "hospital management support for safety," as well as "repeated errors and perception of safety." Internal consistency for each remaining composite met or exceeded a Cronbach α value of 0.60.

CONCLUSIONS

Psychometric analyses provided overall support for 9 of the 12 initial factors of patient safety culture. Our findings suggest that more validation studies need to be conducted before applying safety dimensions from the original HSPSC to perioperative settings only. By providing this initial tool, we hope to stimulate further studies and the patient safety research agenda in this part of the world.

Patient safety culture in burn care units from the perspectives of healthcare providers: across-sectional study

Creating a positive patient safety culture is a key step in the improvement of patient safety in healthcare settings. PSC is a set of shared attitudes, beliefs, and perceptions about PS among healthcare providers. This study aimed to assess PSC in burn care units from the perspectives of healthcare providers. This cross-sectional descriptive study was conducted in 2020 in the units of a specialty burn center. Participants were 213 healthcare providers recruited to the study through a census. A demographic questionnaire and the Hospital Survey on Patient Safety Culture were used for data collection. Data were managed using the SPSS16 software and were summarized using the measures of descriptive statistics. The mean of positive responses to PSC items was 51.22%, denoting a moderate-level PSC. The lowest and the highest dimensional mean scores were related to the no punitive response to error dimension (mean: 12.36%) and the teamwork within departments dimension (mean: 73.25%), respectively. Almost half of the participants (49.3%) reported acceptable PS level in their workplace and 69.5% of them had not reported any error during the past twelve months before the study. Given the great vulnerability of patients with burn injuries in clinical settings, improving PSC, particularly in the no punitive response to error dimension, is essential to encourage healthcare providers for reporting their errors and thereby, to enhance PS. For quality care delivery, healthcare providers in burn care units need a safe workplace, adequate managerial support, a blame-free PSC, and an incentive error reporting system to readily report their errors.

The association between experience of hospital accreditation and nurses' perception of patient safety culture in South Korean general hospitals: a cross-sectional study

Background

Hospital accreditation programs can positively affect nurses’ perceptions of patient safety culture. However, no previous research has identified the association between experience of hospital accreditation and nurses’ perception of patient safety culture in general hospitals. This study aims to examine 1) the level of perception of each area of patient safety culture in nurses working in general hospitals and 2) the relationship between experience of hospital accreditation and nurses’ overall perceptions of safety in Korean general hospitals.

Methods

A cross-sectional survey design was used, with a convenience sample of 310 nurses from six general hospitals. Nurses were asked to complete the self-reported Korean version of the Hospital Survey on Patient Safety Culture and the experience of hospital accreditation. A hierarchical multiple regression analysis was used to examine the associations between hospital accreditation experience and perception of patient safety culture.

Results

The patient safety composites with the highest positive response were the frequency of events reported (90.6) and supervisor/manager expectations promoting patient safety (69.4%). The composites with the lowest scores were non-punitive responses to errors (22.9%) and organizational learning/continuous improvement (35.5%). Hierarchical multiple regression analysis showed that the experience of hospital accreditation had a very small increase on overall perceptions of safety (β = 0.097, p = 0.023).

Conclusions

This study found that general hospital nurses’ experience of hospital accreditation had very weak relationship with their overall perceptions of patient safety. Therefore, a longitudinal study is needed to confirm the influence of hospital accreditation on nurses’ patient safety culture in general hospitals.

Patient safety culture in surgical centers: nursing perspectives

OBJECTIVE

To analyze patient safety culture in the different spheres of management in the perspective of the nursing team providing services in surgical centers.

METHOD

Cross-sectional study with 200 nursing professionals, in three surgical centers of Piauí state - one municipal, one federal, and one state - from January to August 2016 through the application of the instrument Hospital Survey on Patient Safety Culture.

RESULTS

The first surgical center did not present a strengthened patient safety culture; the others presented the dimension "Organizational learning - continuous improvement" (80.6%/75.6%) and "Frequency of reported events" (76.2%) as strengthened areas. In the first, the safety score "average" was prevalent, whereas participants of the second and third judged patient safety as "very good". Most participants of the three surgical centers (80.0%) reported no adverse event in the previous 12 months.

CONCLUSION

The state and federal surgical centers obtained the best patient safety scores when compared to the municipal surgical center. Therefore, for a more effective and safe care, the strengthened dimensions in each type of management should be enhanced and the weakened ones should be improved.

Assessment of Patient Safety Culture Among Doctors, Nurses, and Midwives in a Public Hospital in Afghanistan

INTRODUCTION

The first step to improve the safety of patients in hospitals is to evaluate safety culture. Therefore, the patient safety culture in doctors, nurses and midwives should be reviewed regularly. The aim of the study was to determine the current state of patient safety culture among physicians, nurses and midwives at the Estiqlal Hospital in Kabul to promote an effective safety culture.

METHODS

This cross-sectional descriptive study was conducted from January to March 2020 among doctors, nurses, and midwives at the Esteqlal Specialized Hospital in Kabul. In that study, the data were collected through a survey of hospital. Among the 267 employees invited to participate, 267 (100%) completed the surveys. Descriptive statistics have been used to adjust frequency distribution tables and inferential statistics to identify differences in variable relationships. The independent sample T-test and one-way 'ANOVA ' were used to check variations between groups, and SPSS version 25 was used for data analysis.

RESULTS

The findings of this study have shown that organizational learning and non-punitive response to errors have had the highest and lowest scores. Eight out of 12 dimensions of patient safety culture scored lower. Four dimensions of patient safety culture scored the highest. Overall, patient safety culture dimensions were low and poor (44%). This means the patient safety culture at the hospital was poor.

CONCLUSION

The safety culture of the patients at the hospital was inappropriate, particularly in the eight dimensions of the patient safety culture, immediate intervention was necessary. The study emphasizes the creation of a desirable organizational climate, the need for staff involvement in various levels of decision-making, the creation of a culture of error reporting and recognizing the causing factors, and promoting a patient safety culture.

Perception of Patient Safety Culture among Hospital Staff

Introduction

A patient safety culture (PSC) is a complex phenomenon, representing an essential part of the organizational culture and refers to the shared values, conceptions and beliefs which contribute to the formation and encouragement of safe behavioural models in a health organization. With this study, the authors wanted to delineate the attitude of hospital staff in Bulgaria regarding PSC and to document to whether attitudes differ between physicians and other healthcare professionals (HCPs).

Methods

A national cross-sectional survey among 384 HCPs was conducted using an online version of the Bulgarian version of Hospital Survey on Patient Safety Culture (B-HSOPSC). The data was analysed with descriptive statistics, non-parametric Mann-Whitney U and x 2 tests.

Results

The physicians represented 37.50% (144) of the sample and other HCPs 62.50% (240). Respondents from governmental/municipal hospitals prevailed (53.6%). The dimensions “Staffing” and “Non-punitive response to error” were most problematic, as their percentage of positive response rates (PRRs) were lowest. However, “Handoffs and transitions” and “Supervisor/manager expectations and actions promoting safety“ showed the highest mean values in both physicians and other HCPs. From all participants, 76.0% have never reported an adverse event or error.

Conclusion

The results of the study show that all respondents demonstrate a positive attitude regarding PSC. A comparison of the mean values and that of PRRs in the dimensions did not show any group differences, according to the type of staff position, i.e. physicians or other HCPs.

Assessing Patient Safety Culture in Hospital Settings

The current knowledge about patient safety culture (PSC) in the healthcare industry, as well as the research tools that have been used to evaluate PSC in hospitals, is limited. Such a limitation may hamper current efforts to improve patient safety worldwide. This study provides a systematic review of published research on the perception of PSC in hospitals. The research methods used to survey and evaluate PSC in healthcare settings are also explored. A list of academic databases was searched from 2006 to 2020 to form a comprehensive view of PSC's current applications. The following research instruments have been applied in the past to assess PSC: the Hospital Survey on Patient Safety Culture (HSPSC), the Safety Attitudes Questionnaire (SAQ), the Patient Safety Climate in Health Care Organizations (PSCHO), the Modified Stanford Instrument (MSI-2006), and the Scottish Hospital Safety Questionnaire (SHSQ). Some of the most critical factors that impact the PSC are teamwork and organizational and behavioral learning. Reporting errors and safety awareness, gender and demographics, work experience, and staffing levels have also been identified as essential factors. Therefore, these factors will need to be considered in future work to improve PSC. Finally, the results reveal strong evidence of growing interest among individuals in the healthcare industry to assess hospitals' general patient safety culture.

Areas of Potential Improvement for Hospitals' Patient-Safety Culture in Western Ethiopia

Background

Patient-safety culture is an important component of health-care quality and currentlyan issue of high concern globally. In Ethiopia, little is known about patient-safety culture in hospitals. We assessed the patient-safety culture and associated factors among health-care workers in public hospitals of East Wollega Zone, western Ethiopia.

Methods

This institution-based cross-sectional study was conducted among 421 health-care workers selected using simple random sampling from March 4 to March 29, 2019. A standardized measuring 12 patient safety–culture components was used for data collection. Data were cleaned and entered into EpiData version 3.1 and analysis done using SPSS version 25 (IBM). Bivariate and multivariate linear regression analyses were performed. Significance was set at 95% CI and p<0.05, and unstandardized β-coefficients were used to measure extent of association.

Results

This study revealed that the level of patient-safety culture was 49.2% and patient safety culture–component scores ranged from 29.2% for nonpunitive responses to error to 77.9% for teamwork within a hospital unit. Age ≥45 years (β=13.642, CI: 5.324–21.959; p=0.001), 1–5 years’ experience at the current hospital (β=5.559, 95% CI 2.075–9.042; p=0.002), and working in general hospitals (β=11.988, 95% CI 7.233–16.743; p<0.001) and primary hospitals (β=6.408, 95% CI 2.192–10.624; p=0.003) were factors associated with better scores on patient-safety culture.

Conclusion

Overall scores for patient-safety culture were low. Improving the current state of patient safety in public hospitals would require tailored interventions to address low-scoring components, such as nonpunitive responses to error.

A National Study of Patient Safety Culture in Hospitals in Sweden

Objective

Using the Hospital Survey on Patient Culture, our aim was to investigate the patient safety culture in all Swedish hospitals and to compare the culture among managers, physicians, registered nurses, and enrolled nurses and to identify factors associated with high overall patient safety.

Methods

The study used a correlational design based on cross-sectional surveys from health care practitioners in Swedish health care (N = 23,781). We analyzed the associations between overall patient safety (outcome variable) and 12 culture dimensions and 5 background characteristics (explanatory variables). Simple logistic regression analyses were conducted to determine the bivariate association between each explanatory variable and the outcome variable. The explanatory variables were entered to determine the multivariate associations between the variables and the outcome variable.

Results

The highest rated culture dimensions were “teamwork within units” and “nonpunitive response to error,” and the lowest rated dimensions were “management support for patient safety” and “staffing.” The multivariate analysis showed that long professional experience (>15 years) was associated with increased probability for high overall patient safety. Compared with general wards, the probability for high overall patient safety was higher for emergency care but lower for psychiatric care. The probability for high overall patient safety was higher for both enrolled nurses and physicians compared with managers.

Conclusions

The safety culture dimensions of the Hospital Survey on Patient Culture contributed far more to overall patient safety than the background characteristics, suggesting that these dimensions are very important in efforts to improve the overall patient safety culture.

Physicians' and Nurses' Perceptions of and Attitudes Toward Incident Reporting in Palestinian Hospitals

OBJECTIVES

Underreporting of incidents that happen in health care services undermines the ability of the systems to improve patient safety. This study assessed the attitudes of physicians and nurses toward incident reporting and the factors influencing reporting in Palestinian hospitals. It also examined clinicians' views about the preferred features of incident reporting system.

METHODS

Cross-sectional self-administered survey of 475 participants, 152 physicians and 323 nurses, from 11 public hospitals in the West Bank; response rate, 81.3%.

RESULTS

There was a low level of event reporting among participants in the past year (40.3%). Adjusted for sex and age, physicians were 2.1 times more likely to report incidents than nurses (95% confidence interval, 1.32-3.417; P = 0.002). Perceived main barriers for reporting were grouped under lack of proper structure for reporting, prevalence of blame, and punitive environment. The clinicians indicated fear of administrative sanctions, social and legal liability, and of their competence being questioned (P > 0.05). Getting help for patients, learning from mistakes, and ethical obligation were equally indicated motivators for reporting (P > 0.05). Meanwhile, clinicians prefer formal reporting (77.8%) of all type of errors (65.5%), disclosure of reporters (52.7%), using reports to improve patient safety (80.3%), and willingness to report to immediate supervisors (57.6%).

CONCLUSION

Clinicians acknowledge the importance of reporting incidents; however, prevalence of punitive culture and inadequate reporting systems are key barriers. Improving feedback about reported errors, simplifying procedures, providing clear guidelines on what and who should report, and avoiding blame are essential to enhance reporting. Moreover, health care organizations should consider the opinions of the clinicians in developing reporting systems.

Patient safety attitudes among critical care nurses: A case study in North Cyprus

INTRODUCTION

Patient safety has become a crucial priority in quality healthcare. Adverse events and serious errors involving critically ill patients are common and can be potentially life-threatening. Thus, this study aimed to examine patient safety attitudes among critical care nurses.

METHODS

This cross-sectional study was conducted in two hospitals in North Cyprus. Eighty nurses working in critical care units participated in the study. Following ethical approval, data were collected between September and October 2018, using the Demographic Characteristics Questionnaire and Safety Attitudes Questionnaire.

FINDINGS

Nurses' overall scores regarding patient safety attitudes were found to be negative. The highest positive rate was for safety climate, followed by perception of management, teamwork, working conditions, job satisfaction, and stress recognition, respectively. There were significant differences among working conditions, perception of management, and stress recognition based on participants' positions and event reporting.

CONCLUSION

Our findings indicate safety culture needs to be improved in the hospitals included in the study. Healthcare managers and decision-makers should foster patient safety culture through in-service education, management support, institutional regulations, and updated guidelines.

The effect of education around ethical principles on nurses' perception to patient safety culture in an Iranian mental health inpatient unit: a pilot study

Background & objectives

Patient safety is a crucial factor in the provision of quality healthcare and is therefore a global health concern. It is an area in which ethical concerns and high-quality clinical practice are inextricably linked. This study investigates the effect of education around ethical principles on nurses’ perception of patient safety in a psychiatric unit.

Materials & methods

This pre- and post-test descriptive study was conducted in a mental health inpatient unit in a hospital in Tehran, capital of Iran, in 2018. A total of 33 nurses, selected by census sampling, participated in the study. Data was collected using a demographics questionnaire and Hospital Survey on Patient Safety Culture (HSOPSC), and was analyzed with SPSS21.

Results

The mean score of patient safety was 116.85 ± 9.98 before the educational intervention, 143.58 ± 7.21 immediately after intervention, and 153.12 ± 9.47 1 month after intervention. The rate of error report by most participants over the past 12 months was 3–5 and 6–10 events before intervention, and 6–10 events immediately after and 1 month after intervention. Also, 42.4% of the participants assessed patient safety after intervention as very good and 36.4% assessed it as acceptable and very good 1 month after intervention whereas most of the participants (45.5%) assessed patient safety as acceptable before intervention.

Conclusion

Education on ethical principles exerts a positive effect on nurses’ perception of patient safety culture. Thus, it is recommended as an effective method of promoting nurses’ perception of this variable. In this way, healthcare quality and enhanced patient safety can be achieved.

Assessment of patient safety culture among paramedical personnel at general and district hospitals, Fayoum Governorate, Egypt

Background

Healthcare is a high-risk industry that requires regular assessment of patient safety climate within healthcare organizations. This addresses the organizational cultural issues and explores the association between organizational climate and patient outcomes. This study aimed to assess patient safety culture among paramedical health employees at Fayoum general and district hospitals and to determine factors affecting their perception of patient safety.

Methods

A descriptive cross-sectional study was conducted at the general hospital and four district hospitals in Fayoum Governorate, Egypt, among 479 paramedical healthcare workers. The standardized Hospital Patient Safety scale (HSOPSC) that composed of 12 safety culture dimensions was used.

Results

The mean total safety score varies according to the participant’s position and work area. The total patient safety score was 46.56%. No dimension reported score above 75%. The highest mean composite scores were for organizational learning and continuous improvement (65.36%) and teamwork within hospital units (63.09%). The lowest reported score was for communication openness (17.9%). More perception of safety dimensions was seen in females than males, participants in direct contact with patients, and those with work experience less than 10 years.

Conclusion and recommendations

Overall, the degree of patient safety is low at Fayoum public hospitals. No dimension scored above 75%, and 7 out of 12 dimensions scored less than 50%. Hence, continuous monitoring and updating of the ways of incident reporting is highly recommended. This may be done through setting up a web-based incident reporting system accessible for 24 h.

Patient safety culture in Hungarian hospitals

PURPOSE

The Hospital Survey on Patient Safety Culture (HSOPSC) is a rigorously designed tool for measuring inpatient safety culture. The purpose of this paper is to develop a cross-cultural HSOPSC for Hungary and determine its strengths and weaknesses.

DESIGN/METHODOLOGY/APPROACH

The original US version was translated and adapted using existing guidelines. Healthcare workers (n=371) including nurses, physicians and other healthcare staff from six Hungarian hospitals participated. Answers were analyzed using exploratory factor analyses and reliability tests.

FINDINGS

Positive responses in all dimensions were lower in Hungary than in the USA. Half the participants considered their work area "acceptable" regarding patient safety. Healthcare staff worked in "crisis mode," trying to accomplish too much and too quickly. The authors note that a "blame culture" does not facilitate patient safety improvements in Hungary.

PRACTICAL IMPLICATIONS

The results provide valuable information for promoting a more positive patient safety culture in Hungary and for evaluating future strategies to improve patient safety.

ORIGINALITY/VALUE

Introducing a validated scale to measure patient safety culture in Hungary improves healthcare quality.

Assessing the Perceptions of the Health Care Workforce Toward the Patient Safety Culture in Vietnamese Hospitals

The main objective of this study was to use the translated version of Hospital Survey on Patient Safety Culture, the English-Vietnamese Hospital Survey on Patient Safety Culture (E-V HSOPSC), to assess the patient safety culture in Vietnamese hospitals and examine the extent to which safety attitudes vary between staff, hospitals, and health care systems. In addition, this study aimed to evaluate the psychometric properties of the instrument in Vietnamese dataset. We evaluated whether patient safety culture contributes to establish a positive patient safety culture—the cornerstone of a quality health care. In May 2015, the E-V HSOPSC was conducted with 1500 staff from 10 hospitals in Vietnam. The respondents were asked to return the completed surveys after a 3-month period. Before assessing the perceptions of health care workforce toward organizational safety culture, a confirmatory factor analysis, construct validity, and reliability were performed using SPSS and Amos 23.0. A total of 1116 questionnaires were eligible for data analysis. The outcomes from factor analysis verified the fitness and validity of the instrument. The positive response rate across 12 safety culture dimensions in the questionnaire ranged from 30% (Hospital Handoffs and Transitions) to 77% (Teamwork within Hospital Units). Overall, the mean positive score was 58.9%, which was slightly lower than of the United States. The safety was graded as “Very Good” by 52.6% of respondents in Vietnam. The E-V HSOPSC was appropriate to assess the patient safety culture in Vietnam, because the instrument provided adequate evidence of validity and reliability and patient safety culture strengths and deficiencies.

Hospital Survey on Patient Safety Culture (HSPSC): a systematic review of the psychometric properties of 62 international studies

OBJECTIVE

To carry out a systematic review of the psychometric properties of international studies that have used the Hospital Survey on Patient Safety Culture (HSPSC).

DESIGN

Literature review and an analysis framework to review studies.

SETTING

Hospitals and other healthcare settings in North and South America, Europe, the Near East, the Middle East and the Far East.

DATA SOURCES

A total of 62 studies and 67 datasets made up of journal papers, book chapters and PhD theses were included in the review.

PRIMARY AND SECONDARY OUTCOME MEASURES

Psychometric properties (eg, internal consistency) and sample characteristics (eg, country of use, participant job roles and changes made to the original version of the HSPSC).

RESULTS

Just over half (52%) of the studies in our sample reported internal reliabilities lower than 0.7 for at least six HSPSC dimensions. The dimensions 'staffing', 'communication openness', 'non-punitive response to error', 'organisational learning' and 'overall perceptions of safety' resulted in low internal consistencies in a majority of studies. The outcomes from assessing construct validity were reported in 60% of the studies. Most studies took place in a hospital setting (84%); the majority of survey participants (62%) were drawn from nursing and technical staff. Forty-two per cent of the studies did not state what modifications, if any, were made to the original US version of the instrument.

CONCLUSIONS

While there is evidence of a growing worldwide trend in the use of the HSPSC, particularly within Europe and the Near/Middle East, our review underlines the need for caution in using the instrument. Future use of the HSPSC needs to be sensitive to the demands of care settings, the target population and other aspects of the national and local healthcare contexts. There is a need to develop guidelines covering procedures for using, adapting and translating the HSPSC, as well as reporting findings based on its use.

Patient safety culture among European cancer nurses-An exploratory, cross-sectional survey comparing data from Estonia, Germany, Netherlands, and United Kingdom

Aim

To explore the differences in perceived patient safety culture in cancer nurses working in Estonia, Germany, the Netherlands, and the United Kingdom.

Design

An exploratory cross‐sectional survey.

Methods

In 2018, 393 cancer nurses completed the 12 dimensions of the Hospital Survey on Patient Safety Culture.

Results

The mean score for the overall patient safety grade was 61.3. The highest rated dimension was “teamwork within units” while “staffing” was the lowest in all four countries. Nurses in the Netherlands and in the United Kingdom, scored higher on “communication openness”, the “frequency of events reported”, and “non‐punitive response to errors”, than nurses from Estonia or Germany. We found statistically significant differences between the countries for the association between five of the 12 dimensions with the overall patient safety grade: overall perception of patient safety, communication openness, staffing, handoffs and transitions and non‐punitive response to errors.

Conclusion

Patient safety culture, as reported by cancer nurses, varies between European countries and contextual factors, such as recognition of the nursing role and education have an impact on it. Cancer nurses’ role in promoting patient safety is a key concern and requires better recognition on a European and global level.

Impact

Cancer Nursing Societies in any country can use these data as an indication on how to improve patient care in their country. Recognition of cancer nursing as a distinct specialty in nursing will help to improve patient safety.

Health professionals' perception of patient safety culture in a university hospital in São Paulo: A cross-sectional study applying the Hospital Survey on Patient Safety Culture

BACKGROUND

Patient safety culture is part of the organizational profile of healthcare institutions and is associated with better quality of care.

OBJECTIVE

To assess patient safety culture in a university hospital.

DESIGN AND SETTING

Hospital-based cross-sectional study conducted in a public university hospital in São Paulo, Brazil, between September and December 2015.

METHODS

We randomly selected 68 sectors of the hospital, to include up to 5 employees from each sector, regardless of length of experience. We used the validated Brazilian version of the Hospital Survey on Patient Safety Culture (HSOPS) via an electronic interface. We calculated the percentage of positive responses for each dimension of the HSOPS and explored the differences in age, experience, occupation and educational level of respondents using the chi-square test.

RESULTS

Out of 324 invited respondents, 314 (97%) accepted the invitation and were surveyed. The sample presented predominance of women (72%), nursing staff (45%) and employees with less than six years' experience at the hospital (60%). Nine out of the 12 dimensions showed percentages of positive responses below 50%. The worst results related to "nonpunitive response to errors" (16%). A better safety culture was observed among more experienced staff, nurses and employees with a lower educational level. In the previous year, no events were reported by 65% of the participants.

CONCLUSIONS

The patient safety culture presented weaknesses and most of professionals had not reported any event in the previous year. A policy for improvement and cyclical assessment is needed to ensure safe care.

The patient safety culture: a systematic review by characteristics of Hospital Survey on Patient Safety Culture dimensions

Purpose

To learn the weaknesses and strengths of safety culture as expressed by the dimensions measured by the Hospital Survey on Patient Safety Culture (HSOPSC) at hospitals in the various cultural contexts. The aim of this study was to identify studies that have used the HSOPSC to collect data on safety culture at hospitals; to survey their findings in the safety culture dimensions and possible contributions to improving the quality and safety of hospital care.

Data sources

Medline (via PubMed), Web of Science and Scopus were searched from 2005 to July 2016 in English, Portuguese and Spanish.

Study selection

Studies were identified using specific search terms and inclusion criteria. A total of 33 articles, reporting on 21 countries, was included.

Data extraction

Scores were extracted by patient safety culture dimensions assessed by the HSOPSC. The quality of the studies was evaluated by the STROBE Statement.

Results

The dimensions that proved strongest were 'Teamwork within units' and 'Organisational learning-continuous improvement'. Particularly weak dimensions were 'Non-punitive response to error', 'Staffing', 'Handoffs and transitions' and 'Teamwork across units'.

Conclusion

The studies revealed a predominance of hospital organisational cultures that were underdeveloped or weak as regards patient safety. For them to be effective, safety culture evaluation should be tied to strategies designed to develop safety culture hospital-wide.

Patient safety culture at a surgical center: the nursing perception

OBJECTIVE

To analyze the safety culture of the patient from the perception of the nursing team of a surgical center.

METHOD

This is a cross-sectional and analytical study with 92 professionals from the nursing of a surgical center of a hospital in Teresina-PI, the data were collected from January to June of 2016, through the Hospital Survey on Patient Safety Culture questionnaire. In the analysis and interpretation of the data the guidelines of the AHRQ were followed.

RESULTS

The evaluation of patient safety by the professionals was "Regular" (48.9%). The dimension of the safety culture with the most positive result was "Organizational learning-continuous improvement" (58.7%), and with least positive results were "Opening for communication" (32.3%) and "Feedback and communication about errors" (32.6%).

CONCLUSION

There are problematic areas in the safety culture of the sector, which shows that this culture needs to be better developed, with special attention to the dimensions of the culture that presented a less positive evaluation.

Are public hospitals reforming efficiently in West Bank?

BACKGROUND

The structure, function, and capacity of the health care system in the Occupied Palestinian Territories (OPT) had been largely shaped by the complex political history of the country. Since the establishment of the Palestinian Authority in 1994, the reform efforts were subsidized much by the international aids to rebuild the country's institutional capacity. No previous studies have provided a realistic evaluation of Palestinian achievements in the conduct of public healthcare, we examine the relative productive efficiency of public hospitals (their managers' success in the usage of resources) during 2010-2015 within West Bank and Jordan. Then, we estimate the efficiency of policies within which managers operate (the program efficiency) across the two countries.

METHODS

We employ the Data Envelopment Analysis (DEA) models to distinguish between within-country managerial efficiencies and public policy "program" efficiencies across the two countries. The study follows two key steps, the first step evaluates managerial efficiencies and explores trends in performance within each country. Then, we examine the program efficiencies across the two countries.

RESULTS

Public hospitals improved their year-specific overall efficiency from 75 to 80% in the West Bank and from 78 to 86% in Jordan in 2010 and 2015 respectively. Changes in efficiency are driven by scale effects in West Bank and by managerial enhancements in Jordan. Program efficiency in West Bank outperformed Jordan during 2010-2012, there was no significant difference in mean program efficiencies between the two countries during 2013-2015.

CONCLUSIONS

This work addresses a gap in the DEA literature by empirically investigating the efficiency of public hospitals as distinct from program efficiency in a developing country, namely, Palestine. Findings stimulate hospital managers to enhance potential improvements, policymakers to allocate resources, and international donors to focus on the right adoption of new technology to get better benefits from their considerable investments in public hospitals.

Evaluation of patient safety culture: comparative study in university hospitals

ABSTRACT Objective: To conduct a benchmarking comparison of the composites of patient safety culture based on the evaluation of Brazilian and Portuguese nurses working in university hospitals. Method: Quantitative, cross-sectional, comparative survey. Data collected between April and December 2014, in two teaching hospitals, applying the instrument Hospital Survey on Patient Safety Culture, in the versions translated and adapted to the countries. Results: 762 nurses distributed in four services participated in the study, 195 Brazilians and 567 Portuguese. Seven of the 12 composites of safety culture showed significant differences between hospitals. The highlights were those related to: “management support for patient safety” (±17); “handoffs and transitions” (±15); “teamwork across units” (±14); and “overall perceptions of patient safety” (±10). Conclusion: The dimension that had the highest significant difference between the studied institutions was “management support for patient safety”. These data may support the managers of the study hospitals, enabling continuous improvements and advancements.

Palestinian doctors' views on patient-centered care in hospitals

BACKGROUND

Understanding the perceived importance of Patient-Centered Care (PCC) among Palestinian doctors and how the provider and other clinical characteristics may impact their views on PCC is essential to determine the extent to which PCC can be implemented. This study investigates the provision of PCC among hospital doctors in a developing and unstable country, namely, Palestine.

METHODS

This descriptive, cross-sectional research employed self-report survey among 369 Palestinian doctors working in hospitals in 2016. Respondents completed the Provider-Patient Relationship Questionnaire (PPRQ) and were asked to rate the importance of 16 PCC subjects in a context-free manner. Then they scored the existence of eight contextual attributes in their workplace.

RESULTS

Although 71.4% of the participants got training in communication, only 45% of the participants knew about PCC. 48.8% of doctors considered the "exchange of information" with patients most important PCC component. Clustering identified three groups of doctors: 32.4% of doctors reported good perceptions of PCC, 47.5% moderate; and 20.1% poor. Older, married, and specialist doctors and those familiar with PCC are more likely classified in the "good" cluster. Results revealed a significant difference between doctors' views based on their gender, experience, marital status, previous knowledge about PCC, and type of hospital in favor of males, experienced, married, familiar with PCC, and doctors in private hospital respectively. The level of job interest, nurses' cooperation, the tendency of patients to hide information, and doctor's friendly style were positively related with more perceived importance of PCC.

CONCLUSION

We identified benchmark doctors who perceive the high relative importance of PCC. Our results highlighted knowledge gaps and training weaknesses among doctors in public and private hospitals in respect to their views on PCC. Decision makers may invest in the determined contextual predictors to enhance attitudes towards PCC. This work doesn't address patients' views on PCC.

Patient safety culture among nurses at a tertiary government hospital in the Philippines

AIM

To assess the patient safety culture (PSC) among nurses at a government hospital BACKGROUND: Culture of patient safety is acknowledged as a critical component to the quality of health care. Despite the increasing curiosity on PSC, little studies are available in the Philippine context.

METHODS

A descriptive, cross-sectional, single-center study using total population sampling technique was conducted. PSC was assessed using the Hospital Survey on Patient Safety Culture (HSOPSC) among Registered Nurses. Descriptive statistics were employed to express demographic data and composites of safety culture.

RESULTS

292 nurses completed the survey, yielding a response rate of 86.65%. Of the 12 composites evaluated, Teamwork within Units (91.50%) was the highest positively-rated followed by Organizational Learning - Continuous Improvement (86.89%) while Nonpunitive Response to Error (17.65%) was the least positively-rated. Most (71.48%) of the respondents had not reported any event within the past 12 months. Majority (45%) reported that the overall patient safety grade of the hospital was very good and no one thought that it was failing.

CONCLUSIONS

This study showed that nurses value Teamwork within Units and Organizational Learning-Continuous Improvement as important aspects of PSC. Nonpunitive Response to Error was the area that requires improvement. Determining PSC level should be a continuous process. The first step should be obtaining the support of the administration and assuming a non-punitive approach to those who make and report medical errors. If the problem of personnel not reporting events is to be resolved, any barriers to reporting should be identified and addressed.

Assessment of patient safety culture in private and public hospitals in Peru

Objective

To assess the patient safety culture in Peruvian hospitals from the perspective of healthcare professionals, and to test for differences between the private and public healthcare sectors. Patient safety is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of healthcare delivery.

Design

A non-random cross-sectional study conducted online.

Setting

An online survey was administered from July to August 2016, in Peru. This study reports results from Lima and Callao, which are the capital and the port region of Peru.

Participants

A total of 1679 healthcare professionals completed the survey. Participants were physicians, medical residents and nurses working in healthcare facilities from the private sector and public sector.

Main outcomes

Assessment of the degree of patient safety and 12 dimensions of patient safety culture in hospital units as perceived by healthcare professionals.

Results

Only 18% of healthcare professionals assess the degree of patient safety in their unit of work as excellent or very good. Significant differences are observed between the patient safety grades in the private sector (37%) compared to the public sub-sectors (13-15%). Moreover, in all patient safety culture dimensions, healthcare professionals from the private sector give more favorable responses for patient safety, than those from the public sub-systems. The most significant difference in support comes from patient safety administrators through communication and information about errors.

Conclusions

Overall, the degree of patient safety in Peru is low, with significant gaps that exist between the private and the public sectors.

Developing a conceptual framework for patient safety culture in emergency department: A review of the literature

Patient safety culture is a critical component of modern health care. However, the high-paced, unpredictable nature of the emergency department (ED) environment may impact adversely on it. The aim of this paper is to explore the concept of patient safety culture as it may apply to emergency health care, and to propose a conceptual framework that could form the basis for interventions designed to improve it. This is a systematic review of the literature. A search was undertaken of common electronic bibliographic databases using key words such as safety culture, safety climate, and Emergency Department. Articles were analysed for consistent themes with the aim to construct a conceptual framework. Ten articles met the inclusion criteria that specifically examined safety culture in the ED. Synthesis of the literature resulted in the emergence of three overarching themes of ED practice found to impact on safety culture in the ED. These were the dimensions of patient safety culture, the factors influencing it, and the interventions for improving it. A conceptual framework was constructed that identifies elements that significantly impact the patient safety culture in the ED. This framework may assist managers and researchers to take a comprehensive approach to build an effective safety culture in ED setting.

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.

Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates

Objective

Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses.

Design, setting, participants, intervention

A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort.

Main outcome measures

Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions.

Results

A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents 'agreed/strongly agreed' that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures.

Conclusions

Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity.

Hospital survey on patient safety culture (HSOPS): variability of scoring strategies

Objective

To assess the variability of safety culture dimension scores and their associated rankings depending on three different scoring strategies using the Hospital Survey On Patient Safety Culture (HSOPS).

Design

Cross-sectional study using a self-administered questionnaire.

Setting

The study was conducted in an 1836-bed acute-care French university hospital with an annual volume of 135 999 stays, between April 2013 and November 2014.

Participants

All caregivers and technical-administrative staff with at least 6 months of employment, spending at least half of their working time in the hospital, were asked to participate.

Intervention

None.

Main outcome measure

The variability of the HSOPS results using three different scoring methods: the percentage of positive responses recommended by the Agency for Healthcare Research and Quality, the averaged individual means and the averaged individual sums.

Results

The response rate was 78.6% (n = 3978). The percentage of positive responses resulted in lower scores compared to averaged individual means and averaged individual sums in the six least developed dimensions, and gave more widely spread scores and greater 95CIs in the six most developed dimensions. Department rankings also varied greatly depending on the scoring methods.

Conclusion

The values of the HSOPS scores and their corresponding rankings greatly depended on the computation method. This finding shows how important it is to agree on the use of the same scoring strategies, before broadly comparing results within and across organizations.

Measuring the efficiency of Palestinian public hospitals during 2010-2015: an application of a two-stage DEA method

Background

While health needs and expenditure in the Occupied Palestinian Territories (OPT) are growing, the international donations are declining and the economic situation is worsening. The purpose of this paper is twofold, to evaluate the productive efficiency of public hospitals in West Bank and to study contextual factors contributing to efficiency differences.

Methods

This study examined technical efficiency among 11 public hospitals in West Bank from 2010 through 2015 targeting a total of 66 observations. Nationally representative data were extracted from the official annual health reports. We applied input-oriented Data Envelopment Analysis (DEA) models to estimate efficiency scores. To elaborate further on performance, we used Tobit regression to identify contextual factors whose impact on inefficient performance is statistically significant.

Results

Despite the increase in efficiency mean scores by 4% from 2010 to 2015, findings show potential savings of 14.5% of resource consumption without reducing the volume of the provided services. The significant Tobit model showed four predictors explaining the inefficient performance of a hospital (p <  0.01) are: bed occupancy rate (BOR); the outpatient-inpatient ratio (OPIPR); hospital’s size (SIZE); and the availability of primary healthcare centers within the hospital’s catchment area (PRC). There is a strong effect of OPIPR on efficiency differences between hospitals: A one unit increase in OPIPR will lead a decrease of 19.7% in the predicted inefficiency level holding all other factors constant.

Conclusion

To date, no previous studies have examined the efficiency of public hospitals in the OPT. Our work identified their efficiency levels for potential improvements and the determinants of efficient performance. Based on the measurement of efficiency, the generated information may guide hospitals’ managers, policymakers, and international donors improving the performance of the main national healthcare provider. The scope of this study is limited to public hospitals in West Bank. For a better understanding of the Palestinian market, further research on private hospitals and hospitals in Gaza Strip will be useful.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3228-1) contains supplementary material, which is available to authorized users.

Nurses' Perceptions of Patient Safety Culture in Three Hospitals in Saudi Arabia

PURPOSE

To assess the present patient safety culture of three general hospitals in Saudi Arabia, as perceived by nurses.

DESIGN

This study utilized a descriptive, cross-sectional design.

METHODS

A convenience sample of 351 nurses working in three general hospitals in the central region of Saudi Arabia was surveyed in this study using the Hospital Survey of Patients' Safety Culture (HSOPSC) from October 2016 to April 2017.

RESULTS

From the 12 composites of the HSOPSC, the nurses perceived only the following two patient safety areas as strengths: teamwork within units and organizational learning-continuous improvement. Six areas of patient safety were identified as weaknesses, namely overall perception of patient safety, handoffs and transitions, communication openness, staffing, frequency of events reported, and nonpunitive response to errors. Nationality, educational attainment, hospital, length of service in the hospital, work area or unit, length of service in the current work area or unit, current position, and direct patient contact or interaction were significant predictors of the nurses' perceived patient safety culture.

CONCLUSIONS

The findings in this study clarify the current status of patient safety culture in three hospitals in the Kingdom of Saudi Arabia.

CLINICAL RELEVANCE

The present findings should be considered by policymakers, hospital leaders, and nurse executives in creating interventions aimed at improving the patient safety culture in hospitals. A multidimensional network intervention targeting the different dimensions of patient safety culture and involving different organizational levels should be implemented to improve patient safety.

Patient safety culture as a quality indicator for a safe health system: Experience from Almadinah Almunawwarah, KSA

Objectives

Safety culture assessments allow healthcare organisations to get a clear understanding of those aspects of patient safety requiring urgent attention and highlight safety culture strengths and weaknesses. This study aimed to evaluate the extent to which the culture supports patient safety at a hospital in KSA.

Methods

A cross-section analytical observational study was conducted at King Fahad Hospital in Almadinah Almunawwarah, KSA.

Results

After the survey, the staff felt less certain about the patient safety culture inside the institution. The greatest positive scores were obtained for teamwork within units, safety culture composites, feedback, communication about error, management expectations, actions promoting patient safety, organisational learning, and continuous improvement. However, none of these features achieved a positive score of 75% or more as an area of strength. The rest of the aspects were negatively ranked as areas for probable development, with the lowest scores obtained for non-punitive reaction to error, staffing, hospital handoff and transition, communication openness, and hospital management support for patient safety.

Conclusion

Commitment to quality care as an outcome is certainly correlated with patient safety. There is a strong need to improve and promote applicable policies to improve the culture of patient safety in hospitals. The development of strong management competence to promote an environment of open consultation and administrative wisdom will contribute to improving patient safety culture.