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Kane J, Munn L, Kane SF, Srulovici E. Defining Speaking Up in the Healthcare System: a Systematic Review. J Gen Intern Med 2023; 38:3406-3413. [PMID: 37670070 PMCID: PMC10682351 DOI: 10.1007/s11606-023-08322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Communication issues have been shown to contribute to healthcare errors. For years healthcare professionals have been told to "speak up." What "speak up" means is unclear, as it has been defined and operationalized in many ways. Thus, this study aimed to systematically review the literature regarding definitions and measurements of speaking up in the healthcare system and to develop a single, comprehensive definition and operationalization of the concept. METHODS PubMed, CINAHL, PsychoInfo, and Communication/Mass Media Complete databases were searched from 1999 to 2020. Publications were included if they mentioned speaking up for patient safety or any identified synonyms. Articles that used the term speaking up concerning non-health-related topics were excluded. This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 294 articles met the inclusion criteria, yet only 58 articles focused on speaking up. While the most common synonym terms identified were "speak up" and "raise concern," only 43 articles defined speaking up. Accordingly, a modified definition was developed for speaking up-A healthcare professional identifying a concern that might impact patient safety and using his or her voice to raise the concern to someone with the power to address it. DISCUSSION Speaking up is considered important for patient safety. Yet, there has been a lack of agreement on the definition and operationalization of speaking up. This review demonstrates that speaking up should be reconceptualized to provide a single definition for speaking up in healthcare.
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Affiliation(s)
- Julia Kane
- School of Nursing, Fayetteville State University, Fayetteville, NC, USA
| | - Lindsay Munn
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shawn F Kane
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Einav Srulovici
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
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2
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Segura-García MT, Castro Vida MÁ, García-Martin M, Álvarez-Ossorio-García de Soria R, Cortés-Rodríguez AE, López-Rodríguez MM. Patient Safety Culture in a Tertiary Hospital: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2329. [PMID: 36767694 PMCID: PMC9916148 DOI: 10.3390/ijerph20032329] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Patient safety (PS) culture is the set of values and norms common to the individuals of an organization. Assessing the culture is a priority to improve the quality and PS of hospital services. This study was carried out in a tertiary hospital to analyze PS culture among the professionals and to determine the strengths and weaknesses that influence this perception. A cross-sectional descriptive study was carried out. The AHRQ Questionnaire on the Safety of Patients in Hospitals (SOPS) was used. A high perception of PS was found among the participants. In the strengths found, efficient teamwork, mutual help between colleagues and the support of the manager and head of the unit stood out. Among the weaknesses, floating professional templates, a perception of pressure and accelerated pace of work, and loss of relevant information on patient transfer between units and shift changes were observed. Among the areas for improvement detected were favoring feedback to front-line professionals, abandoning punitive measures and developing standardized tools that minimize the loss of information.
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Affiliation(s)
- María Teresa Segura-García
- Subdirectorate of Nursing, Hospital Universitario Poniente, Servicio Andaluz de Salud, 04700 El Ejido, Almería, Spain
| | - María Ángeles Castro Vida
- Pharmacy Service, Hospital Universitario Poniente, Servicio Andaluz de Salud, 04700 El Ejido, Almería, Spain
| | - Manuel García-Martin
- Intensive Care Unit, Hospital Universitario Poniente, Servicio Andaluz de Salud, 04700 El Ejido, Almería, Spain
| | | | | | - María Mar López-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 La Cañada, Almería, Spain
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3
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Timofeyev Y, Dremova O, Jakovljevic M. The impact of transparency constraints on the efficiency of the Russian healthcare system: systematic literature review. J Med Econ 2023; 26:95-109. [PMID: 36537319 DOI: 10.1080/13696998.2022.2160608] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is an ongoing debate among researchers and policy-makers on how to make transparency a powerful tool of healthcare systems. This study addresses how the availability and accessibility of information about medical services to the general population affects healthcare outcomes in Russia. A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviewing and Meta-Analysis (PRISMA) guidelines. Transparency indicators of health facilities used in the world's most efficient healthcare systems are also reviewed. Although the increase of transparency in the Russian healthcare system is considered as a tool for improving its efficiency, very little has been done to improve the actual level of transparency. The existing institutional specifics of the Russian healthcare system impose serious restrictions on acceptable levels of transparency. In the reviewed empirical Russian studies, transparency is often viewed simplistically as either information available on the websites of medical organizations or issues related to the amount of accessible indicators of compulsory medical statistical reporting. The novelty of this study consists in (a) reviewing the most recent studies on the topic and (b) including studies in Russian in the analysis. We elaborate on general and specific policy implications for improving transparency-driven outcomes in the Russian healthcare system.
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Affiliation(s)
| | | | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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4
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The relationship between patient safety culture and patient safety competency with adverse events: a multicenter cross-sectional study. BMC Nurs 2022; 21:292. [PMID: 36319970 PMCID: PMC9628064 DOI: 10.1186/s12912-022-01076-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background Patient safety culture and patient safety competency could be associated with adverse events (AEs). This study aimed to investigate the associations between nurses’ perceptions of patient safety culture, patient safety competency, and AEs. Methods A cross-sectional study was carried out among 338 nurses employed in three university hospitals in Qom, Iran between 17 August 2021 and 12 November 2021. Data were collected using three questionnaires: patient safety culture, patient safety competency, and AEs. Data were analyzed using SPSS-21 software. A multiple logistic regression model was used to analyze the data. Results The results of this study showed that medication errors were significantly associated with “frequency of events reported” (OR = 0.706, P = 0.012), “supervisor/manager expectations and actions promoting patient safety” (OR = 0.733, P = 0.048), and “management support for patient safety” (OR = 0.755, P = 0.012). Pressure ulcers were significantly associated with “supervisor/manager expectations and actions promoting patient safety” (OR = 0.729, P = 0.039), “handoffs and transition” (OR = 0.707, P = 0.034), and “comfort speaking up about patient safety” (OR = 0.614, P = 0.016). Falls were significantly associated with “teamwork within units” (OR = 0.735, P = 0.031), “feedback and communication about error” (OR = 0.756, P = 0.046), and “handoffs and transition” (OR = 0.660, P = 0.012). The use of restraints for ≥8 hr. was significantly associated with “management support for patient safety” (OR = 0.701, P = 0.021). Conclusions According to the results of this study, AEs are associated with some dimensions of patient safety culture and patient safety competency. Further research is needed to confirm these findings and identify interventions to reduce the occurrence of AEs.
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5
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Abuosi AA, Poku CA, Attafuah PYA, Anaba EA, Abor PA, Setordji A, Nketiah-Amponsah E. Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety. PLoS One 2022; 17:e0275606. [PMID: 36260634 PMCID: PMC9581362 DOI: 10.1371/journal.pone.0275606] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Recognizing the values and norms significant to healthcare organizations (Safety Culture) are the prerequisites for safety and quality care. Understanding the safety culture is essential for improving undesirable workforce attitudes and behaviours such as lack of adverse event reporting. The study assessed the frequency of adverse event reporting, the patient safety culture determinants of the adverse event reporting, and the implications for Ghanaian healthcare facilities. METHODS The study employed a multi-centre cross-sectional survey on 1651 health professionals in 13 healthcare facilities in Ghana using the Survey on Patient Safety (SOPS) Culture, Hospital Survey questionnaire. Analyses included descriptive, Spearman Rho correlation, one-way ANOVA, and a Binary logistic regression model. RESULTS The majority of health professionals had at least reported adverse events in the past 12 months across all 13 healthcare facilities. Teamwork (Mean: 4.18, SD: 0.566) and response to errors (Mean: 3.40, SD: 0.742) were the satisfactory patient safety culture. The patient safety culture dimensions were statistically significant (χ2 (9, N = 1642) = 69.28, p < .001) in distinguishing between participants who frequently reported adverse events and otherwise. CONCLUSION Promoting an effective patient safety culture is the ultimate way to overcome the challenges of adverse event reporting, and this can effectively be dealt with by developing policies to regulate the incidence and reporting of adverse events. The quality of healthcare and patient safety can also be enhanced when healthcare managers dedicate adequate support and resources to ensure teamwork, effective communication, and blame-free culture.
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Affiliation(s)
- Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Ghana
| | - Collins Atta Poku
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Research, Education, and Administration, School of Nursing and Midwifery, University of Ghana, Legon, Ghana
| | - Priscilla Y. A. Attafuah
- Department of Community Health Nursing, School of Nursing and Midwifery, University of Ghana, Legon, Ghana
| | - Emmanuel Anongeba Anaba
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana
| | - Patience Aseweh Abor
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Ghana
| | - Adelaide Setordji
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Ghana
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6
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Zabin LM, Zaitoun RSA, Abdullah AA. Patient safety culture in Palestine: university hospital nurses' perspectives. BMC Nurs 2022; 21:204. [PMID: 35902859 PMCID: PMC9335951 DOI: 10.1186/s12912-022-00987-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Understanding the perspectives of healthcare workers toward patient safety-related activities is critical in maintaining a healthy safety climate. The objectives of this research are 1) to examine the perception of Patient Safety Culture (PSC) at a university hospital in Palestine, and to highlight areas in need of improvement, and 2) to assess the relationship between the outcome dimensions (frequency of events reported, and overall perceptions of safety) and the other dimensions of PSC, and 3) to determine the relationship among selected demographic variables (gender, age, hospital tenure, work tenure, profession tenure, and hours worked per week) and nurses’ perceptions of PSC. Methods A cross-sectional study design was used with a convenience sample of 107 nurses. Nurses were asked by email to complete the Arabic version of the Hospital Survey of Patients’ Safety Culture (HSOPSC) using the SurveyMonkey® online account form within two weeks. The survey data were analyzed using descriptive and inferential statistics. Univariate and multiple regression were used to examine the relationships. Results The dimensions of patient safety with the highest positive response were organizational learning and continuous improvement (87%) and teamwork within units (86%). The dimension with the lowest positive score was the nonpunitive response to error (22%). Multiple regression revealed that the dimension of communication openness was a predictor of the overall perceptions of safety (β = 0.257, p = 0.019). In addition, the dimension of feedback and communication about error was a predictor of the frequency of the reported events (β = 0.334, p = 0.005). Furthermore, age was found to be a predictor of PSC (p < 0.05). Conclusions This study provides a general assessment of perceived safety among nurses in a hospital. However, we found that nurses negatively perceive a nonpunitive response to error. Therefore, strenuous efforts are required by hospital management to improve the culture of incident reporting.
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Affiliation(s)
- Loai M Zabin
- Department of Nursing, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Rasha S Abu Zaitoun
- Department of Nursing, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Abdullah A Abdullah
- Quality and Patient Safety Department, An-Najah National University Hospital, Nablus, 44839, Palestine
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Moghimian M, Farzi S, Farzi K, Tarrahi MJ, Ghasemi H, Jafari F, Bighamian S. Patient safety culture in burn care units from the perspectives of healthcare providers: across-sectional study. J Burn Care Res 2021; 43:841-845. [PMID: 34698837 DOI: 10.1093/jbcr/irab208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Maryam Moghimian
- Nursing@ Midwifery Sciences Development Research Center, Najafabad Branch, Islamic Azad university, Najafabad, Iran
| | - Sedigheh Farzi
- Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kolsoum Farzi
- MSc of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Javad Tarrahi
- Epidemiology, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Ghasemi
- MSc Student of Nursing, Student Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Jafari
- BSc of Nursing, Emam Musakazem(AS) Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safoura Bighamian
- BSc of Nursing, Emam Musakazem(AS) Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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8
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Kakemam E, Gharaee H, Rajabi MR, Nadernejad M, Khakdel Z, Raeissi P, Kalhor R. Nurses' perception of patient safety culture and its relationship with adverse events: a national questionnaire survey in Iran. BMC Nurs 2021; 20:60. [PMID: 33845822 PMCID: PMC8042945 DOI: 10.1186/s12912-021-00571-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/16/2021] [Indexed: 01/02/2023] Open
Abstract
Background Patient safety culture is an important factor in determining hospitals’ ability to address and reduce the occurrence of adverse events (AEs). However, few studies have reported on the impact of nurses’ perceptions of patient safety culture on the occurrence of AEs. Our study aimed to assess the association between nurses’ perception of patient safety culture and their perceived proportion of adverse events. Methods A cross-sectional survey was carried out among 2295 nurses employed in thirty-two teaching hospitals in Iran. Nurses completed the Persian version of the hospital survey of patients’ safety culture between October 2018 and September 2019. Results Positive Response Rates of overall patient safety culture was 34.1% and dimensions of patient safety culture varied from 20.9 to 43.8%. Also, nurses estimated that the occurrence of six adverse events varied from 51.2–63.0% in the past year. The higher nurses’ perceptions of “Staffing”, “Hospital handoffs and transitions”, “Frequency of event reporting”, “Non-punitive response to error”, “Supervisor expectation and actions promoting safety”, “Communication openness”, “Organizational learning continuous improvement”, “Teamwork within units”, and “Hospital management support patient safety” were significantly related to lower the perceived occurrence at least two out of six AEs (OR = 0.69 to 1.46). Conclusions Our findings demonstrated that nurses’ perception regarding patient safety culture was low and the perceived occurrence of adverse events was high. The research has also shown that the higher level of nurses’ perception of patient safety culture was associated with lowered occurrence of AEs. Hence, managers could provide prerequisites to improve patient safety culture and reduce adverse events through different strategies, such as encouraging adverse events’ reporting and holding training courses for nurses. However, further research is needed to assess how interventions addressing patient safety culture might reduce the occurrence of adverse events. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00571-w.
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Affiliation(s)
- Edris Kakemam
- Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hojatolah Gharaee
- District Health Center of Hamadan City, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Milad Nadernejad
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khakdel
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.,Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran. .,Health Services Management Department, School of Public Health, Qazvin University of Medical Sciences, Shahid Bahonar Blv, Qazvin, Iran.
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9
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Perception of Patient Safety Culture among Hospital Staff. Zdr Varst 2021; 60:97-104. [PMID: 33822831 PMCID: PMC8015657 DOI: 10.2478/sjph-2021-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
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.
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Kang S, Ho TTT, Lee NJ. Comparative Studies on Patient Safety Culture to Strengthen Health Systems Among Southeast Asian Countries. Front Public Health 2021; 8:600216. [PMID: 33511097 PMCID: PMC7835724 DOI: 10.3389/fpubh.2020.600216] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
Patient safety is an important issue in health systems worldwide. A systematic review of previous studies on patient safety culture in Southeast Asian countries is necessary for South Korea's partnership with these countries, especially given South Korea's assistance in strengthening the health systems of these developing countries. Studies on patient safety culture in Southeast Asian countries, published in English and Thai languages, were retrieved from computerized databases using keywords through a manual search. Data extraction, quality assessment, and analyses were performed using several tools. The review included 21 studies conducted in Indonesia (n = 8), Thailand (n = 5), Malaysia (n = 3), Vietnam (n = 2), Singapore (n = 1), and the Philippines (n = 1). They were analyzed and categorized into 12 dimensions of safety culture, and differences in response rate or scores were identified compared to the mean of the dimensions. The heterogeneous of safety culture's situation among Southeast Asian countries, both in practice and in research, can be explained since patient safety policy and its application are not prioritized as much as they are in developed countries in the priority compared to the developed countries. However, Vietnam, Cambodia, Myanmar, and Laos are the priority countries for South Korea's official healthcare development assistance in the Southeast Asia region. Vietnam, for instance, is an economically transitioning country; therefore, consolidated patient safety improvement by inducing patient safety culture in the provincial and central health system as well as strengthening project formulation to contribute to health policy formation are needed for sustainable development of the partner countries' health systems. It is recommended that more evidence-based proactive project planning and implementation be conducted to integrate patient safety culture into the health systems of developing countries, toward health policy on patient safety and quality service for the attainment of sustainable development goals in South Korea's development cooperation.
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Affiliation(s)
- Sunjoo Kang
- College of Nursing, Seoul National University, Seoul, South Korea.,Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Trang Thi Thuy Ho
- Department of Nursing, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Nam-Ju Lee
- College of Nursing, Seoul National University, Seoul, South Korea.,The Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
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11
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Khosravizadeh O, Mohseni M, Baghian N, Maleki A, Hashtroodi A, Yari S. Front-line staff's perspective on patient safety culture in Iranian medical centers: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 31:193-207. [PMID: 32568116 DOI: 10.3233/jrs-191021] [Citation(s) in RCA: 2] [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 The prerequisite for promoting safety culture is to assess the existing safety culture level of institutes, because safety precautions without appropriate evaluation increase costs and unforeseen risks. OBJECTIVE This study aimed to systematically review the status of patient safety culture from the perspective of clinical personnel at Iranian hospitals through a meta-analysis of studies using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. METHODS The present systematic review and meta-analysis was conducted in 2018. Data were gathered by searching Google Scholar, Scopus, PubMed, and Web of Science databases up to November 2018. Search keywords were "patient", "safety", "culture", "healthcare", "hospital", "medical center", "HSOPSC tool", and "Iran". The search protocol was limited to 10 years. To estimate the PSC score, computer software CMA:2 (Comprehensive Meta-Analysis) was used. The presence of heterogeneity across the studies was assessed with the I2 statistic. A forest plot was used to report the results. Publication bias was assessed through a funnel plot. RESULTS The meta-analysis of studies showed that the PSC score based on the random effect model was 52.7% (95% CI: 50.2%-55.2%), (Q = 522.3, df = 54, P < 0.05, I2 = 89.6). A mean of 12 dimensions of HSOPSC showed that the "Teamwork within units" dimension had the highest PSC score (67.2%) and "Non-punitive response to error" had the lowest score (40.4%). CONCLUSIONS Managers and policymakers should be directed towards non-punitive responses to errors and persuade staff to report errors and execute the approach to learn from mistakes. Also, a periodic government evaluation of the patient safety culture will help further its sustainable development.
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Affiliation(s)
- Omid Khosravizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Mohseni
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Najmeh Baghian
- Research Development Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Aisa Maleki
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ailar Hashtroodi
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Saeed Yari
- Student Research Committee, Department of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Occupational Health Engineering, Faculty of Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
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12
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Chegini Z, Kakemam E, Asghari Jafarabadi M, Janati A. The impact of patient safety culture and the leader coaching behaviour of nurses on the intention to report errors: a cross-sectional survey. BMC Nurs 2020; 19:89. [PMID: 32973398 PMCID: PMC7504664 DOI: 10.1186/s12912-020-00472-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 08/18/2020] [Indexed: 11/11/2022] Open
Abstract
Background There is growing interest in examining the factors affecting the reporting of errors by nurses. However, little research has been conducted into the effects of perceived patient safety culture and leader coaching of nurses on the intention to report errors. Methods This cross-sectional study was conducted amongst 256 nurses in the emergency departments of 18 public and private hospitals in Tabriz, northwest Iran. Participants completed the Hospital Survey on Patient Safety Culture (HSOPSC), Coaching Behavior Scale and Intention to Report Errors’ questionnaires and the data was analyzed using multiple linear regression analysis. Results Overall, 43% of nurses had an intention to report errors; 50% of respondents reported that their nursing managers demonstrated high levels of coaching. With regard to patient safety culture, areas of strength and weakness were “teamwork within units” (PRR = 66.8%) and “non-punitive response errors” (PRR = 19.7%). Regression analysis findings highlighted a significant association between an intention to report errors and patient safety culture (B = 0.2, CI 95%: 0.1 to 0.3, P < 0.05), leader coaching behavior (B = 0.2, CI 95%: 0.1 to 0.3, P < 0.01) and nurses’ educational status (B = 0.8, 95% CI: − 0.1 to 1.6, P < 0.05). Conclusions Further research is needed to assess how interventions addressing patient safety culture and leader coaching behaviours might increase the intention to report errors.
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Affiliation(s)
- Zahra Chegini
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahonar Blvd, Zip code, Qazvin, 1531534199 Iran.,National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Edris Kakemam
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Janati
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Chegini Z, Janati A, Afkhami M, Behjat M, Shariful Islam SM. A comparative study on patient safety culture among emergency nurses in the public and private hospitals of Tabriz, Iran. Nurs Open 2020; 7:768-775. [PMID: 32257264 PMCID: PMC7113497 DOI: 10.1002/nop2.449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022] Open
Abstract
Aim To appraise patient safety culture in emergency departments of Iranian public and private hospitals. Design A comparative cross-sectional survey design was used. Methods This cross-sectional study was conducted from January-March 2019. For data collection, the Hospital Patient Safety Culture (HSOPSC) questionnaire was employed. The study sample comprised 256 participants. Independent t test and analysis of variance were performed to report the mean differences in total patient safety culture perception according to the participants' characteristics and according to hospital ownership. Results There was no significant difference in overall perceptions of patient safety culture in public and private sectors (2.94 vs. 2.84, p > .05). There are no solid areas regarding patient safety found neither in public nor in private sectors. Out of 12 dimensions of patient safety culture, different perceptions of nurses working in public and private hospitals belonged to "Organizational learning" (t = 2.13, p = .034) and "Handoffs and transitions" (t = 2.91, p = .004). Regarding the participants' characteristics, no significant difference was observed as to the perspectives of nurses on patient safety culture. However, there was a meaningful difference in the attitudes of nurses working in public hospitals according to their employment status (t = 2.07, p = .039).
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Affiliation(s)
- Zahra Chegini
- Iranian Center of Excellence in Health ManagementSchool of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
- Social Determinants of Health Research CenterQazvin University of Medical SciencesQazvinIran
| | - Ali Janati
- Iranian Center of Excellence in Health ManagementSchool of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
- Health Services Management Research CenterTabriz University of Medical SciencesTabrizIran
| | - Maryam Afkhami
- Iranian Center of Excellence in Health ManagementSchool of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Maryam Behjat
- Iranian Center of Excellence in Health ManagementSchool of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
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14
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Palmieri PA, Leyva-Moral JM, Camacho-Rodriguez DE, Granel-Gimenez N, Ford EW, Mathieson KM, Leafman JS. Hospital survey on patient safety culture (HSOPSC): a multi-method approach for target-language instrument translation, adaptation, and validation to improve the equivalence of meaning for cross-cultural research. BMC Nurs 2020; 19:23. [PMID: 32308560 PMCID: PMC7153229 DOI: 10.1186/s12912-020-00419-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/31/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument. METHODS This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation. RESULTS The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate). CONCLUSIONS The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.
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Affiliation(s)
- Patrick A. Palmieri
- Office of the Vice Chancellor for Research, Universidad Norbert Wiener, Av. Arequipa 444, 15046 Lima, Peru
- College of Graduate Health Studies, A. T. Still University, 800 West Jefferson Street, Kirksville, MO 63501 USA
- School of Nursing, Walden University, 100 S Washington Ave, Suite 900, Minneapolis, MN 55401 USA
- EBHC South America: A Joanna Briggs Institute Affiliated Group, Universidad Norbert Wiener, Av. Arequipa 444, Lima, 15046 Lima, Peru
| | - Juan M. Leyva-Moral
- Departament d’Infermeria, Facultat de Medicina, Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
- Center for Health Sciences Research, Universidad María Auxiliadora, Av. Canto Bello 431, 15408 Lima, Peru
- EBHC South America: A Joanna Briggs Institute Affiliated Group, Universidad Norbert Wiener, Av. Arequipa 444, 15046 Lima, Peru
| | - Doriam E. Camacho-Rodriguez
- EBHC South America: A Joanna Briggs Institute Affiliated Group, Universidad Norbert Wiener, Av. Arequipa 444, 15046 Lima, Peru
- School of Nursing, Universidad Cooperativa de Colombia, Calle 30, Santa Marta, Magdalena Colombia
| | - Nina Granel-Gimenez
- Departament d’Infermeria, Facultat de Medicina, Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Eric W. Ford
- School of Public Health, University of Alabama at Birmingham, Ryals Public Health Building, 1665 University Blvd., Ryals 310E, Birmingham, AL 35233 USA
| | - Kathleen M. Mathieson
- College of Graduate Health Studies, A. T. Still University, 800 West Jefferson Street, Kirksville, MO 63501 USA
| | - Joan S. Leafman
- College of Graduate Health Studies, A. T. Still University, 800 West Jefferson Street, Kirksville, MO 63501 USA
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15
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Razzani B, Atashzadeh-Shoorideh F, Jamshidi T, Barkhordari-Sharifabad M, Lotfi Z, Skerrett V. The effect of education around ethical principles on nurses' perception to patient safety culture in an Iranian mental health inpatient unit: a pilot study. BMC Nurs 2020; 19:10. [PMID: 32042265 PMCID: PMC7003320 DOI: 10.1186/s12912-020-0402-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/29/2020] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Behzad Razzani
- 1Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- 2Department of Psychiatric Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Vali-Asr Avenue, Cross of Vali-Asr and Hashemi Rafsanjani Highway, Opposite to Rajaee Heart Hospital, Tehran, 1996835119 Iran
| | - Tayebeh Jamshidi
- 2Department of Psychiatric Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Vali-Asr Avenue, Cross of Vali-Asr and Hashemi Rafsanjani Highway, Opposite to Rajaee Heart Hospital, Tehran, 1996835119 Iran
| | | | - Zahra Lotfi
- 4Department of Nursing, Royal Free Hospital, London, UK
| | - Victoria Skerrett
- 5Mental Health Nursing, School of Nursing and Midwifery, Birmingham City University, Birmingham, UK
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Kusumawati AS, Handiyani H, Rachmi SF. Patient safety culture and nurses’ attitude on incident reporting in Indonesia. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Okuyama JHH, Galvão TF, Crozatti MTL, Silva MT. 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. SAO PAULO MED J 2019; 137:216-222. [PMID: 31340252 PMCID: PMC9743998 DOI: 10.1590/1516-3180.2018.0430140319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/14/2019] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Julia Hiromi Hori Okuyama
- MSc. Pharmacist at Hospital São Paulo, Hospital Universitário, Universidade Federal de São Paulo (HU-UNIFESP), and Doctoral Student, Postgraduate Program on Pharmaceutical Sciences, Universidade de Sorocaba (UNISO), Sorocaba (SP), Brazil.
| | - Taís Freire Galvão
- MSc, PhD. Pharmacist and Professor, Faculdade de Ciências Farmacêuticas (FCF), Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | | | - Marcus Tolentino Silva
- MSc, PhD. Pharmacist and Professor, School of Medicine, Universidade Federal do Amazonas (UFAM), Manaus (AM), and Professor, Postgraduate Program on Pharmaceutical Sciences, Universidade de Sorocaba (UNISO), Sorocaba (SP), Brazil.
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Healthcare Professional's Perception of Patient Safety Measured by the Hospital Survey on Patient Safety Culture: A Systematic Review and Meta-Analysis. ScientificWorldJournal 2018; 2018:9156301. [PMID: 30104917 PMCID: PMC6076892 DOI: 10.1155/2018/9156301] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/27/2018] [Accepted: 06/12/2018] [Indexed: 12/20/2022] Open
Abstract
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.
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Ali H, Ibrahem SZ, Al Mudaf B, Al Fadalah T, Jamal D, El-Jardali F. Baseline assessment of patient safety culture in public hospitals in Kuwait. BMC Health Serv Res 2018; 18:158. [PMID: 29510705 PMCID: PMC5840785 DOI: 10.1186/s12913-018-2960-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 02/21/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Samaa Zenhom Ibrahem
- Ministry of Health, Kuwait City, Kuwait.,Department of Health Management, Planning and Policy, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | | | | | - Diana Jamal
- Department of Health Management and Policy, Faculty of Heath Sciences, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Heath Sciences, American University of Beirut, Beirut, Lebanon.
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Ng GWY, Pun JKH, So EHK, Chiu WWH, Leung ASH, Stone YH, Lam CL, Lai SPW, Leung RPW, Luk HW, Leung AKH, Au Yeung KW, Lai KY, Slade D, Chan EA. Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses. BMJ Open 2017; 7:e015721. [PMID: 28801406 PMCID: PMC5724079 DOI: 10.1136/bmjopen-2016-015721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. DESIGN A mixed-methods design with quantitative and sequential qualitative components was used. SETTING AND PARTICIPANTS Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. RESULTS The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. CONCLUSIONS Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.
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Affiliation(s)
- George Wing Yiu Ng
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Jack Kwok Hung Pun
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
- Department of Education, St Antony’s College, University of Oxford, Oxfordshire, Oxford, UK
| | - Eric Hang Kwong So
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Wendy Wai Hang Chiu
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Avis Siu Ha Leung
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Yuk Han Stone
- Multi-disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Chung Ling Lam
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Sarah Pui Wa Lai
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Rowlina Pui Wah Leung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Hing Wah Luk
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Anne Kit Hung Leung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Kin Wah Au Yeung
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Kang Yiu Lai
- Intensive Care Unit, Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR, China
| | - Diana Slade
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
- School of Literature, Languages and Linguistics, Australian National University, Canberra, Australia
| | - Engle Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Institute for Communication in Healthcare, ANU, Canberra, Australia
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