A National Study of Patient Safety Culture in Hospitals in Sweden

Assessment of patient safety culture among healthcare providers in tertiary hospitals in Malaysia-A cross-sectional study

Background and Aim

Patient safety culture is crucial for every health care institution, as a lack of it may harm patients seeking treatment. The current study aimed to identify the level of safety culture and assess the knowledge, attitude, and perception of patient safety culture among healthcare providers (HCPs') in tertiary hospital settings.

Methods

A cross-sectional study was conducted among HCPs from two private tertiary hospitals in Johor and Selangor. A structured validated questionnaire, including the Hospital Survey on Patient Safety Culture, was used to assess the level of patient safety culture in these hospitals.

Results

In this study, the calculated sample size was 320, and all 550 eligible participants from both hospitals were approached to participate. However, only 158 responded, resulting in a response rate of 49.38%. The majority of the HCPs (n = 110; 69%) rated their hospital as very good or excellent in maintaining an overall patient safety culture. The study revealed that communication about the errors (PRR = 80) and organizational learning and continuous improvement (PRR = 74) were good in their hospital settings. However, staffing and work pace (PRR = 28), response to errors (PRR = 40), reporting patient safety events (PRR = 48), and handoffs and information exchange (PRR = 39) were inadequate. These findings indicate the negative attitudes among HCPs and the need for further improvement to maintain a culture of patient safety.

Conclusion

HCPs in the study settings had optimal knowledge but negative attitudes towards the culture of patient safety in their organization. Inadequate staffing, work pace, and a lack of response to mistakes were commonly observed, which may increase the chances of errors and pose health threats to patients that need to be addressed immediately. Every healthcare organization is urged to address the issue of patient safety culture as a matter of urgency.

Nurses' burnout and patient safety culture: The moderating effect of structural empowerment

AIMS

To identify correlations among job burnout, structural empowerment, and patient safety culture (PSC), and to explore the potential moderating effect of structural empowerment on the associations between burnout and PSC.

DESIGN

The study used a cross-sectional survey design.

METHODS

Convenient sampling was employed. We conducted an anonymous online survey in January 2024 among nurses employed at hospitals in three regions of China. Job burnout, structural empowerment, and perceptions of PSC were assessed. A total of 1026 useable surveys were included in the analyses. Descriptive statistics were performed using SPSS software. A latent structural equation modeling approach using Mplus software was used to analyze the moderating effect.

RESULTS

The proposed hypothetical model was supported. Job burnout had a strong direct negative effect on structural empowerment and PSC. Structural empowerment had a significant moderating effect on the relationship between job burnout and PSC.

CONCLUSION

The empirically validated moderation model and study results suggest that managers of healthcare organisations can improve patient safety and care quality by fostering empowerment and providing sufficient support to clinical nurses.

IMPLICATION

The findings of this study suggest that providing more support, resources, and information is likely to be effective in weakening the detrimental impact of job burnout on PSC. This study provides insights into the possible approaches that may improve patient safety. To control the impact of nurses' burnout on care quality, nurse managers should increase empowerment as well as staff nurse engagement.

REPORTING METHOD

We have adhered to relevant EQUATOR guidelines and conducted an observational study, following the STROBE checklist.

PUBLIC CONTRIBUTION

During the data collection phase of this study, clinical caregivers participated in completing the online survey.

Developing patient safety scale for hospitals

Background/aim

The study aimed to contribute to the literature with a reliable and valid scale for hospitals to be used in determining the current patient safety culture and following up on its development.

Materials and methods

The study was conducted with the participation of 1137 healthcare professionals selected using the convenience sampling method in 3 secondary-care state hospitals and three research and training hospitals, one of which was affiliated with a medical faculty, and two were affiliated with the Health Sciences University. To begin with, to discover the latent structure of the items on the scale, an Exploratory Factor Analysis (EFA) was performed. Additionally, to determine the factor structure of the scale, the Confirmatory Factor Analysis (CFA) method was used. The Cronbach's alpha coefficient was calculated to check the reliability of the responses.

Results

According to Kaiser-Meyer-Olkin (KMO = 0.924) coefficient and the result of Bartlett's test of sphericity (χ 2 = 9748.777, df = 770), it was determined that the data structure was suitable for factor analysis. The Cronbach's alpha coefficient of the total scale was found to be 0.921. According to the EFA results, the scale was determined to have seven subscales, which were 1. Organizational Learning, Development, and Communication, 2. Management Support and Leadership, 3. Reporting Patient Safety Events, 4. Number of Personnel and Working Hours, 5. Response to Error, 6. Teamwork, and 7. Working Environment. The goodness-of-fit index results of the scale showed a good model fit (χ 2 / df = 3.04, RMSEA = 0.06, CFI = 0.97, NFI = 0.95, IFI = 0.97, SRMR = 0.06). The Cronbach's alpha coefficients of the subscales varied between 0.66 and 0.91.

Conclusion

The results showed that the Patient Safety Scale for Hospitals is a valid and reliable measurement instrument for healthcare professionals.

[Evolution of the perception of the safety culture of healthcare professionals in a pediatric emergency department]

BACKGROUND AND AIM

Safety culture (SC) is a fundamental tool for minimizing adverse events and improving safety and quality of care. Our objective, therefore was to analyze the evolution of the SC of healthcare professionals in a pediatric emergency department (PED) after the implementation of a risk management system for patient safety based on the UNE:EN:ISO 179003 Standard and the execution of new safe practices for Joint Commission International accreditation. At the same time describe the current strengths and weaknesses.

METHODS

Quasi-experimental, single-center study. All PED professionals participated in the study. An initial measurement of SC was performed through the Hospital Survey on Patient Safety Culture (HSOPS) questionnaire of the Agency for Healthcare Research and Quality adapted to Spanish in 2014. Pro-patient safety strategies were implemented between 2015 and 2022. A subsequent measurement was performed in 2022.

RESULTS

The response rate in 2014 was 55% and 78% in 2022. On both occasions the group with the highest participation was nurses with 35.1% and 34.8%, respectively. Five dimensions improved after the interventions: frequency of adverse events (25.2%, p<0.001), organizational learning (25%, p<0.001), feedback and communication about errors (22.3%, p<0.001), non-punitive response to errors (6.5%, p = 0.176), and management support (4%, p = 0.333).

CONCLUSIONS

The actions carried out had a positive influence on organizational learning and the frequency of adverse events reported and communication within the team. In contrast, the perception of SC did not increase.

Work Climate, Improved Communication, and Cohesive Work Linked with Patient Safety Culture: Findings from a Sports Medicine Hospital

BACKGROUND

This study aims to investigate the patient safety culture at a sports medicine hospital and explore the quality of healthcare and associated factors.

METHODS

In a cross-sectional study design, the Hospital Survey on Patient Safety Culture (HSOPC) tool was administered online among staff at a sports medicine hospital in Doha, Qatar. Out of 898 staff who received an email invitation, 504 participated (56.1%).

RESULTS

The results showed that 48.0% of the staff rated the patient safety grade as excellent and 37.5% as very good, totaling 85.5%. Factors associated with excellent or very good patient safety grades were management support OR 4.7 95% CI (1.8 to 12.3); team communication OR 3.0 95% CI (1.4 to 6.3), supervisor action supporting patient safety OR 3.5 95% CI (1.7 to 7.0) and other items related to work area such as working together: OR 3.0 95% CI (1.2 to 7.6), helping out busy areas OR 2.5 95% CI (1.1 to 5.5) and having good procedures and systems: OR 2.8 95% CI (1.4 to 5.8).

CONCLUSIONS

Addressing management support, enhancing communication, and cohesive work within the work area facilitates a culture of trust that improves patient safety grades.

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.

Perceived patient safety culture and its associated factors among clinical managers of tertiary hospitals: a cross-sectional survey

BACKGROUND

Patient safety is a global challenge influenced by perceived patient safety culture. However, limited knowledge exists regarding the patient safety culture perceived by hospital clinical managers and its associated factors. This study aims to investigate the perceptions of patient safety culture and associated factors among clinical managers of tertiary hospitals in China.

METHODS

A cross-sectional survey was conducted from June 19 to July 16, 2021, involving 539 clinical managers from four tertiary hospitals in Changsha City of Hunan Province. The Hospital Survey on Patient Safety Culture (HSOPSC) was utilized to assess perceived patient safety culture. Bivariate, multivariable linear regression, and logistic regression analyses were performed.

RESULTS

The mean score for the total HSOPSC was 72.5 ± 7.6, with dimensional scores ranging from 62.1 (14.9) to 86.6 (11.7). Three dimensions exhibited positive response rates (PRRs) < 50%, indicating areas that need to be improved: "nonpunitive response to errors" (40.5%), "staffing" (41.9%), and "frequency of events reported" (47.4%). Specialized hospitals (β = 1.744, P = 0.037), female gender (β = 2.496, P = 0.003), higher professional title (β = 1.413, P = 0.049), a higher education level (β = 1.316, P = 0.001), and shorter time delays per shift (β=-1.13, P < 0.001) were correlated with higher perceived patient safety culture. Education level, work department, "teamwork within a unit", "management support for patient safety", "communication openness", and "staffing" dimensions were associated with patient safety grades (all P < 0.05). Years worked in hospitals, occupation, education level, work department, hospital nature, professional title, "communication openness", and "handoffs & transitions" were associated with the number of adverse events reported (all P < 0.05).

CONCLUSIONS

Our study revealed a generally low level of patient safety culture perceived by clinical managers and identified priority areas requiring urgent improvement. The associated factors of patient safety culture provide important guidance for the development of targeted interventions in the future. Promoting patient safety by optimizing the patient safety culture perceived by clinical managers should be prioritized.

Patient safety culture in home care settings in Sweden: a cross-sectional survey among home care professionals

BACKGROUND

The connection between a weak patient safety culture and adverse patient events is well known, but although most long-term care is provided outside of hospitals, the focus of patient safety culture is most commonly on inpatient care. In Sweden, more than a third of people who receive care at home have been affected by adverse events, with the majority judged to be preventable. The aim of this study was to investigate the patient safety culture among care professionals working in care at home with older people.

METHODS

This cross-sectional study used a purposive sample of 66 municipal care workers, health care professionals, and rehabilitation staff from five municipal care units in two districts in western Sweden who provided care at home for older people and had been employed for at least six months. The participants completed the Hospital Survey on Patient Safety Culture (HSOPSC) self-report questionnaire, which assessed aspects of patient safety culture-norms, beliefs, and attitudes. Logistic regression analysis was used to test how the global ratings of Patient safety grade in the care units and Reporting of patient safety events were related to the dimensions of safety culture according to the staff's professions and years of work experience.

RESULTS

The most positively rated safety culture dimension was Teamwork within care units (82%), which indicates good cooperation with the closest co-workers. The least positively rated dimensions were Handoffs and transitions among care units (37%) and Management support (37%), which indicate weaknesses in the exchange of patient information across care units and limited support from top-level managers. The global rating of Patient safety grade was associated with Communication openness and Management support (p < 0.01 and p = 0.03, respectively). Staff with less work experience evaluated the Patient safety grade higher than those with more work experience.

CONCLUSIONS

This study suggests that improvements are needed in care transitions and in support from top-level managers and that awareness of patient safety should be improved in staff with less work experience. The results also highlight that an open communication climate within the care unit is important for patient safety.

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.

The relationship between patient safety culture and adverse events in Iranian hospitals: a survey among 360 nurses

BACKGROUND

Adverse events have become a global problem and are an important indicator of patient safety. Patient safety culture is essential in efforts to reduce adverse events in the hospital. This study aimed to investigate the status of the patient safety culture, the frequency of adverse events, and the relationship between them in Qazvin's hospitals in Iran.

METHODS

The present study is a descriptive-analytical study conducted in six hospitals in Qazvin, Iran, in 2020. The study population was nurses working in Qazvin hospitals. We collected data via a patient safety culture questionnaire and an adverse event checklist. Three hundred sixty nurses completed questionnaires. Multiple logistic regression was used to investigate the relationship between variables.

RESULTS

The highest mean of patient safety culture was related to the organizational learning dimension (3.5, SD = .074) and feedback and communication about errors (3.4, SD = 0.82). The participants gave the lowest score to dimensions of exchanges and transfer of information (2.45,=0.86) and management support for patient safety (2.62,Sd = 0.65). Management's support for patient safety, general understanding of patient safety culture, teamwork within organizational units, communication and feedback on errors, staff issues, and information exchange and transfer were significant predictors of adverse events.

CONCLUSION

This study confirms patient safety culture as a predictor of adverse events. Healthcare managers should provide the basis for improving the patient safety culture and reducing adverse events through methods such as encouraging the reporting of adverse events and also holding training courses for nurses.

Patient safety culture and associated factors among nurses working at public hospitals in Gamo Zone, Southern Ethiopia

BACKGROUND

Patient safety culture is the prevention of errors and adverse effects to patients associated with health care delivery. It is a vital component in the provision of quality care. In healthcare settings where there is a safety culture, the people (providers, staff, administrators, and patients/families) are engaged, encouraged, and supported to make care safer. Though it is an essential component in the provision of quality care, little is known about its level, contributory, and hindering factors from the nurses' perspectives. This study aimed to assess patient safety culture and associated factors among nurses working at public Hospitals in Gamo Zone, Southern Ethiopia.

METHODS

This institution-based cross-sectional study was conducted among 398 nurses working at public hospitals in Gamo Zone. Data were collected by pretested, well-structured self-administered questionnaire from June 1 to 30, 2022. The collected data were checked, coded, and entered into Epi-data version 4.6.0.2 and were exported to SPSS version 25 for analyses. Bivariable and multivariable logistic regression was done to identify independent factors associated with patients' safety culture.

RESULTS

This study revealed that 202(50.8%), 95% CI: (46%-56%) of the participants had indicated good patient safety culture. From factors analysis, having an educational status of a bachelor's degree and above [AOR = 2.26, 95%CI: (1.13-4.52)], working in a surgical ward [AOR = 5.48, 95%CI: (1.96-15.34)], not being blamed when medical errors happened [AOR = 3.60, 95%CI: (1.82 - 7.14)], and working 40 up to 49 h per week [AOR = 0.30, 95%CI: (0.13 - 0.74)] were identified to be significantly associated with good patient safety culture.

CONCLUSION

Based on the study findings, it could be observed that good patient safety culture was indicated only by half of the study participants. Implementing actions that support dimensions of patient safety culture, and creating opportunities for continuous educational advancement is recommended. Moreover, Hospital administrators, nurses' directors, and healthcare policy-makers should work in collaboration to improve the patient safety culture, and also it would be better to create a blame-free environment to promote event reporting practices.

Radiographers' perception of patient safety culture in radiology

INTRODUCTION

Radiographers play a central role in patient safety because of their knowledge of and responsibilities in relation to the imaging process. To maintain safe care, the workplace must create a safety culture that enables sustainable safety work.

AIM

This study aims to describe radiographers' perceptions of the patient safety culture in radiology units in Sweden.

METHODS

The Swedish Hospital Survey of Patients' Safety Culture (S-HSOPSC) was used to gather descriptive data from 171 Swedish registered radiographers working in five radiology clinics distributed across 15 units. Fifty-one questionnaire items and one open-ended question were analysed, comprising perceptions of the overall safety grade, the frequency of number of reported risks and events, and 14 composites regarding patient safety dimensions.

RESULTS

The radiographers' concerns surrounding the patient safety culture in their workplaces related to weaknesses regarding the safety dimensions "Staffing", "Frequency of error reporting", "Organizational learning - continuous improvement" and "Executive management support for patient safety". They perceived "Teamwork within the unit" to be a strength.

CONCLUSION

Despite some weaknesses in the patient safety culture, the radiographers perceived that the overall patient safety level was good, in part because of their ability to spot risks in time. The executive management, however, needed to improve their feedback on safety measures; and another reason for some weaknesses in the patient safety culture could be staffing issues such as lack of time for meetings for continuous improvement. Managers and leaders have a great responsibility to establish a patient safety culture through support and good leadership.

IMPLICATIONS FOR PRACTICE

An understanding of what creates a safety culture is important to prevent patient safety incidents.

A Brief Assessment of Patient Safety Culture in Anesthesia and Intensive Care Departments

Due to the nature of their activity, anesthesia and critical care have generally well-developed patient safety cultures, which are linked to a greater level of incident awareness and reporting during clinical activity. In order to determine the status quo and identify and adopt, where appropriate, techniques and instruments for further improving patient safety, it is necessary to evaluate the culture and barriers in these departments. The main objective of our study was to assess patient safety culture in Romanian anesthesia and intensive care departments (AICDs), to pinpoint the areas that may need improvement, and to examine the correlation between the prevalence of adverse event reporting, as well as the level of self-reported patient safety culture. To determine how anesthesia and intensive care department staff perceived patient safety, the Hospital Survey on Patient Safety Culture (HSOPSC) was used in a translated Romanian version. In total, 1200 employees from 36 anesthesiology and intensive care departments across 32 hospitals in Romania received the questionnaire, representing 42.66% of all anesthesia and intensive care departments in the country. In 7 of the 12 examined dimensions, significant differences between tertiary and secondary hospitals were observed. Among all dimensions, the highest positive score was for "organizational learning and continuous development". In general, our study revealed a positive view on patient safety in anesthesia and intensive care departments. Further studies are required to determine a threshold of the level of culture development.

Patient Safety Culture and Speaking Up Among Health Care Workers

PURPOSE

Although previous research showed the importance of safety culture on health care workers' speaking up behaviors, it is not clear how particular safety culture domains are associated with the speaking up behaviors of hospital staff. Also, researchers have suggested that health care workers' speaking up behaviors vary by profession, but there has been limited research into such differences. Thus, this study examined differences in perceptions of patient safety culture and the promotive and prohibitive speaking up behaviors of health care workers by profession and investigated the relationships between patient safety culture and the two types of speaking up behaviors.

METHODS

A descriptive correlational study was conducted using secondary data collected through an online survey of health care workers at a private, nonprofit, tertiary-level teaching hospital in South Korea. The sample (N = 831) consisted of nurses (54.0%), physicians (13.0%), and other licensed and unlicensed hospital personnel (33.0%). Analyses of variance were conducted to examine differences in study variables by profession. Hierarchical regression analyses were conducted to evaluate the effects of the seven patient safety culture factors on promotive and prohibitive voice after controlling for tenure and profession.

RESULTS

Perceptions of safety culture and promotive voice behaviors were higher for physicians compared with nurses. Communication openness, reporting patient adverse events, and unit supervisors' and hospital managements' support for patient safety were significant predictors of both types of voice behaviors.

CONCLUSION

Hospital administrators and unit managers should create a supportive environment where staff feel free to voice their concerns and suggestions. They should also pay attention to the varying perspectives held by different groups of hospital workers and their different voice behaviors. Knowing which dimensions of patient safety culture are most strongly related to health care workers' voice behaviors can guide patient safety improvement activities in health care organizations.

The relationship among safety leadership, risk perception, safety culture, and safety performance: Military volunteer soldiers as a case study

Safety is fundamental to any organization; if not based on safety, organizational decision-making and management would be meaningless. For a country, soldiers are responsible for national security; they serve as a barrier that defends a country against external invasive forces, thus assuming great missions and responsibilities on their shoulders. To ensure soldiers fulfill their duties of protecting the country and the people, they should gain clear risk perception, which should be instilled into them during their daily combat readiness training. Only when their performances meet safety criteria can they become a strong fighting force. This study recruited military volunteer soldiers as its research participants and employed convenience sampling to distribute questionnaires. In total, this research collected 725 valid copies, of which the data were used to explore the relationship among safety leadership, risk perception, safety culture, and safety performance. To achieve this goal, this study proposed some research hypotheses based on literature review. The hypotheses were all verified via latent variable modeling and multiple hierarchical regression analysis after the reliability and validity of each construct had been tested via confirmatory factor analysis. The research results showed that the more deeply military volunteer soldiers sense safety leadership, the clearer their risk perception will be and the more helpful it would be in achieving safety performance. It is worth mentioning that risk perception can serve as a mediator while safety culture can mediate the relationship between safety leadership and safety performance. Lastly, the research proposes suggestions in the section of conclusions, which provides reference to the combat readiness training and daily tasks of soldiers.

Nurses' Perceptions of Patient Safety Culture During the Pandemic in Covid-19 Referral Hospitals

Patient safety culture is essential in creating a safe and healthy hospital environment. This study aims to portray nurses' perceptions of patient safety culture during the Pandemic in COVID-19 Referral Hospitals. This paper was a descriptive study. The population was nurses working in inpatient, Covid-19 isolation, intensive, and emergency rooms. In addition, the sample was 268 nurses with a stratified random sampling. Data collection used a questionnaire using Google Forms. It consisted of the demographic characteristics of respondents (name, gender, age, marital status, working time, education, nurse position, levels of nursing, and patient safety training) also nurses' perception of patient safety culture. The Hospital Survey on Patient Safety Culture (HSOPC) was an instrument to assess patient safety culture. Data analysis used IBM SPSS Statistics version 22.0 to describe the mean, median, minimum, and maximum values and presentation. Results showed that the mean patient safety culture among nurses in COVID-19 referral hospitals was 147.09 (62.55%). In addition, the lowest dimension of patient safety culture was feedback and communication (31.75%), while the highest was an organizational improvement (73.16%). Thus, the patient safety culture in the COVID-19 referral hospital still needed improvement. A good patient safety culture can increase patient safety and the quality of health services. Therefore, hospital management should optimize all dimensions of patient safety culture to ensure patient safety. Future research could explore predisposing factors of patient safety culture

A National Study of Patient Safety Culture and Patient Safety Goal in Chinese Hospitals

OBJECTIVES

This study aimed to measure the patient safety culture and the current practice of patient safety goals in China.

METHODS

This cross-sectional survey was conducted between November 2020 and November 2021. The 12-dimensions Hospital Survey on Patient Safety Culture questionnaire and the 14-items Survey on the Current Practice of Patient Safety Goal questionnaire were electronically distributed to 8164 healthcare providers across 26 provinces in China. Data were analyzed using descriptive statistics, correlation analysis, and multivariate linear regression.

RESULTS

A total of 8164 surveys were received, of which 7765 were valid and analyzed. The average positive response rate for the Hospital Survey on Patient Safety Culture survey was 69.68% (43.41%-91.54%). The percentage of positive responses in 5 dimensions (organizational learning, teamwork within units, feedback about error, management support for safety, and teamwork across units) was above the control limits, and 3 (nonpunitive response to error, staffing, and frequency of event reporting) were below the control limits. The average positive response rate for the Survey on the Current Practice of Patient Safety Goal survey was 96.11%. Patient safety culture was positively related to the current practice of patient safety goals ( r = 0.34, P < 0.001).

CONCLUSIONS

Our study concludes that although healthcare providers in China feel positively toward patient safety culture and practicably toward patient safety goals, considerable work is still needed to promote a patient safety movement.

Overview of Patient Safety Culture in Bosnia and Herzegovina With Improvement Recommendations for Hospitals

OBJECTIVES

This study investigates the patient safety culture (PSC) in Bosnia and Herzegovina (BiH). We identify factors that contribute to higher patient safety and improved reporting of adverse events, thereby developing recommendations to improve PSC.

METHODS

The study used a correlation design based on cross-sectional surveys in the healthcare sector of BiH (N = 2617). We analyzed the correlation between 9 PSC factors, 4 background characteristics (explanatory variables), and 2 outcome variables (patient safety grade and number of events reported). We also analyzed the variance to determine perceived differences in PSC across the various staff roles in hospitals.

RESULTS

The highest rated PSC factors were Hospital handoffs and transitions and Hospital management support for patient safety and the lowest rated factor was Nonpunitive response to error. Each of the 9 factors showed considerable potential to improve from a hospital, department, and outcome perspective. A comparison of the various employee positions shows significant differences in the PSC perceptions of managers versus nurses and doctors as well as nurses versus doctors.

CONCLUSIONS

We found average scores for most PSC factors, leaving the considerable potential for improvement. Compared with the number of events reported and background characteristics, it is evident that PSC factors contribute significantly to patient safety. These factors are essential for the targeted development of PSC. We propose evidence-based practices as recommendations for improving patients' safety factors.

Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis

INTRODUCTION

Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America.

PURPOSE

Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC).

METHODS

This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated.

RESULTS

In total, 30 studies from five countries-Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)-were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were "organizational learning: continuous improvement" and "teamwork within units", while the least positive were "nonpunitive response to error" and "staffing". Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53-51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02-63.66).

CONCLUSIONS

Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives.

Hospital managers’ views on the state of patient safety culture across three regions in Ghana

Background

Improving patient safety culture in healthcare organisations contributes positively to the quality of care and patients’ attitudes toward care. While hospital managers undoubtedly play critical roles in creating a patient safety culture, in Ghana, qualitative studies focussing on hospital managers’ views on the state of patient safety culture in their hospitals remain scanty.

Objective

This study aimed to explore the views of hospital managers regarding compliance to patient safety culture dimensions in the selected hospitals in the Bono, Greater Accra, and Upper East regions of Ghana.

Methodology

This was a qualitative exploratory study. A purposive sampling of all hospital managers involved in patient safety practices was conducted. The sampled managers were then invited to a focus group discussion. Twelve focus group discussions with each consisting of a maximum of twelve participants were conducted. The ten patient safety culture dimensions adapted from the Agency for Healthcare Research and Quality’s patient safety culture composite measures framed the interview guide. Deductive thematic content analysis was done. Lincoln and Guba’s methods of trustworthiness were applied to ensure that the findings are valid and reliable.

Findings

Positive patient safety culture behaviours such as open communication, organisational learning, and strong teamwork within units, were an established practice in the selected facilities across Ghana. Lack of teamwork across units, fear of reporting adverse events, the existence of a blame culture, inconsistent response to errors, extreme shortage of staff, sub-standard handover, lack of management support with resources constrained the patient safety culture. The lack of standardised policies on reporting adverse events and response to errors encouraged managers to use various approaches, some resulting in a blame culture. Staff shortage contributed to poor quality of safety practices including poor handover which was also influenced by lateness to duty.

Conclusion

Prompt and appropriate responses by managers to medical errors require improvements in staffing and material resources as well as the enactment of standard policies across health facilities in the country. By so doing, hospital managers would contribute significantly to patient safety, and help build a patient safety culture in the selected hospitals.

Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety

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.

Patient safety culture in Austria and recommendations of evidence-based instruments for improving patient safety

This study aimed to investigate the patient safety culture in Austria. We identified factors that contributed to a higher degree of patient safety and subsequently developed evidence-based suggestions on how to improve patient safety culture in hospitals. Moreover, we examined differences in the perception of patient safety culture among different professional groups. This study used a cross-sectional design in ten Austrian hospitals (N = 1,525). We analyzed the correlation between ten patient safety culture factors, three background characteristics (descriptive variables), and three outcome variables (patient safety grade, number of adverse events reported, and influence on patient safety). We also conducted an analysis of variance to determine the differences in patient safety culture factors among the various professional groups in hospitals. The findings revealed that all ten factors have considerable potential for improvement. The most highly rated patient safety culture factors were communication openness and supervisor/manager’s expectations and actions promoting safety; whereas, the lowest rated factor was non-punitive response to error. A comparison of the various professional groups showed significant differences in the perception of patient safety culture between nurses, doctors, and other groups. Patient safety culture in Austria seems to have considerable potential for improvement, and patient safety culture factors significantly contribute to patient safety. We determined evidence-based practices as recommendations for improving each of the patient safety factors.

Nurses' Perception of Patient Safety Culture in a Referral Hospital: A Cross-Sectional Study

Healthcare systems are becoming increasingly complex which is helping to promote a ‘culture of safety’ within them based on the best scientific evidence available. Indeed, creating a positive institutional culture of patient safety is reflected in health outcomes. The aim of this present study was to describe the perception of culture of safety by nurses in adult inpatient units in a tertiary hospital and to analyze adverse events reporting. It was a cross-sectional study in which 202 nurses from adult hospitalization units of the Hospital Universitario y Politécnico La Fe in Valencia (Spain) participated. The perception of safety culture was measured using the Hospital Survey on Patient Safety questionnaire version 1.0, which consists of 42 items distributed in 12 dimensions that are considered strengths or weaknesses. In addition, adverse events related to nursing care during the study period and those reported in the official hospital registry were collected. Finally, the association between safety culture and sociodemographic and labor variables was explored. A total of 148 responses to the questionnaire were analyzed (Cronbach’s alpha = 0.94), where seven dimensions and 25 items were identified as weaknesses. Two hundred and fourteen events were identified and none were reported in the official registry. Years of experience were significantly (p < 0.05) associated with safety culture. It is necessary to establish strategies to improve the perception of the safety culture of nurses, as well as to make nurses aware of the importance of notifying adverse events derived from health care.

Factors influencing patient safety culture in operating room in a teaching hospital in Jordan: a qualitative descriptive study

Purpose

To explore the perceptions of surgical team members in a tertiary hospital in Jordan toward the factors influencing patient safety culture (PSC).

Design/methodology/approach

This was a qualitative descriptive study intended to characterize the factors that influence PSC. Interviews were conducted with health-care providers in the operation room (OR) in a tertiary Jordanian hospital. Participants included surgeons, anesthetists, nurses and senior surgical residents who had worked for three years minimum in the OR. Thematic analysis was used to analyze the data.

Findings

A total of 33 interviews were conducted. Thematic analysis of the content yielded four major themes: (1) operational factors, (2) organizational factors, (3) health-care professionals factors and (4) patient factors. The respondents emphasized the role of the physical layout of the OR, implementing new techniques and new equipment, and management support to establish a safety culture in the operating room setting.

Originality/value

The present research study will have implications for hospitals and health-care providers in Jordan for developing organizational strategies to eliminate or decrease the occurrence of adverse events and improve patient safety in the OR.

Key drivers of promoting patient safety culture from the perspective of medical staff at a tertiary hospital in China

Purpose

Understanding the antecedents of patient safety culture among medical staff is essential if hospital managers are to promote explicit patient safety policies and strategies. The factors that influence patient safety culture have received little attention. The authors aim to investigate the antecedents of patient safety culture (safety climate) in relation to medical staff to develop a comprehensive approach to improve patient safety and the quality of medical care in China.

Design/methodology/approach

The Chinese version of the Safety Attitudes Questionnaire (CSAQ) was used to examine the attitudes toward patient safety among physicians and nurses. This medical staff was asked to submit the intra-organizational online survey via email. A total of 1780 questionnaires were issued. The final useable questionnaires were 256, yielding a response rate of 14.38%. One-way analysis of variance (ANOVA) was employed to test if different sex, supervisor/manager, age, working experience, and education result in different perceptions. Confirmatory factor analysis (CFA) was used to verify the structure of the data. Then linear regression with forward selection was performed to obtain the essential dimension(s) that affect the safety culture (safety climate).

Findings

The CFA results showed that 26 CSAQ items measured 6 safety-related dimensions. The linear regression results indicated that working conditions, teamwork climate, and job satisfaction had significant positive effects on safety culture (safety climate).

Practical implications

Hospital managers should put increased effort into essential elements of patient-oriented safety culture, such as working conditions, teamwork climate, and job satisfaction to develop appropriate avenues to improve the quality of delivered medical services as well as the safety of patients.

Originality/value

This study focused on the contribution that the antecedents of patient safety culture (safety climate) make with reference to the perspective of medical staff in a tertiary hospital in China.

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.

Healthcare professionals' perceptions of patient safety culture and teamwork in intrapartum care: a cross-sectional study

Background

In complex healthcare organizations, such as intrapartum care, both patient safety culture and teamwork are important aspects of patient safety. Patient safety culture is important for the values and norms shared by interprofessional teams in an organization, and such values are principles that guide team members’ behavior. The aim of this study was 1) to investigate differences in perceptions of patient safety culture and teamwork between professions (midwives, physicians, nursing assistants) and between labor wards in intrapartum care and 2) to explore the potential associations between teamwork and overall perceptions of patient safety and frequency of events reported. 

Methods

The design was cross-sectional, using the Swedish version of the Hospital Survey on Patient Safety Culture (14 dimensions) and the TeamSTEPPS® Teamwork Perceptions Questionnaire (5 dimensions). Midwives, physicians, and nursing assistants in three labor wards in Sweden in 2018 were included. Descriptive statistics, the Kruskal–Wallis H test, two-way ANOVA, and standard multiple regression analysis were used.

Results

The questionnaires were completed by 184 of the 365 healthcare professionals, giving a response rate of 50.4%. Two-way ANOVA showed a significant main effect of profession on two patient safety culture dimensions and one teamwork dimension and a significant main effect of labor ward on four patient safety culture dimensions and four teamwork dimensions. A significant interaction effect of profession and labor ward was found on four patient safety culture dimensions and four teamwork dimensions. The regression analysis revealed that four out of the five teamwork dimensions explained 40% of the variance in the outcome dimension ´Overall perceptions of patient safety´.

Conclusions

The results of the study indicate that profession and labor ward are important for healthcare professionals' perceptions of patient safety culture and teamwork in intrapartum care. Teamwork perceptions are significant for overall patient safety.

Hospital management priorities and key factors affecting overall perception of patient safety: a cross-sectional study

Objective

Evaluating a staff's perception of safety culture is a critical factor in hospital management, and the knowledge of value and efficiency in hospitals is still inadequate. This study aimed to investigate the perceptions of safety culture among medical staffs and determine priorities for clear and better management.

Methods

A cross-sectional survey of 595 medical staff members was conducted at 2 tertiary hospitals in Western China using a hospital survey on patient safety culture (HSOPSC) and its value and efficiency in the hospital.

Results

The dimensions with a disadvantaged positive response were nonpunitive response to error (44.6%) and staffing (42.0%). Five dimensions can explain 37.7% of the variation in the overall perception of patient safety, and handoffs and transitions are the most important dimensions (standardized coefficients 0.295).

Conclusions

Hospital managers should pay more attention to nonpunitive management and staffing. Handoffs and transitions are the most important areas of potential improvement in patient safety in hospitals.

[Patient safety culture in neonatal intensive care units as seen by nurses]

Neonatal intensive care units (NICUs) are critical environments in terms of safety of care, with a high risk of adverse events. Measuring the patient safety culture of the professionals working there should help to improve the care offered. A descriptive cross-sectional study, conducted among 141 nurses and childcare workers in 2020 in 5 Tunisian hospitals, examined this question.

Patient safety culture improvements depend on basic healthcare education: a longitudinal simulation-based intervention study at two Danish hospitals

Background

A growing body of evidence supports the existence of an association between patient safety culture (PSC) and patient outcomes. PSC refers to shared perceptions and attitudes towards norms, policies and procedures related to patient safety. Existing literature shows that PSC varies among health professionals depending on their specific profession and specialty. However, these studies did not investigate whether PSC can be improved. This study investigates whether length of education is associated with improvements in PCS following a simulation intervention.

Methods

From April 2017 to November 2018, a cross-sectional intervention study was conducted at two regional hospitals in Denmark. Two groups with altogether 1230 health professionals were invited to participate. One group included nurses, midwives and radiographers; the other group included doctors. A train-the-trainer intervention approach was applied consisting of a 4-day simulation instructor course that emphasised team training, communication and leadership. Fifty-three healthcare professionals were trained as instructors. After the course, instructors performed in situ simulation in their own hospital environment.

Outcomes

The Safety Attitude Questionnaire (SAQ), which has 6 dimensions and 32 items, was used to collect main outcome variables. All employees from both groups were surveyed before the intervention and again four and nine months after the intervention.

Results

Mean baseline scores were higher among doctors than among nurses, midwives and radiographers for all SAQ dimensions. At the second follow-up, four of six dimensions improved significantly (p ≤ 0.05) among nurses, midwives and radiographers, whereas no dimensions improved significantly among doctors.

Conclusion

Over time, nurses, midwives and radiographers improved more in PSC attitudes than doctors did.

The Effects of Safety Climate on Psychosocial Factors: An Empirical Study in Healthcare Workplaces

ABSTRACT

How to develop a better patient safety culture has been an important goal for healthcare organizations, but the effects of safety culture on psychosocial factors, such as emotional exhaustion and stress, have not been fully addressed. This study aimed to reconfigure important dimensions affecting safety culture and examine the associations between safety culture and psychosocial factors (emotional exhaustion and work-life balance). The partial least squaring technique was used to analyze the data, showing that job satisfaction (β = 0.320, P < 0.001), working conditions (β = 0.307, P < 0.001), and perception of management (β = 0.282, P < 0.001) positively affected the safety climate. The safety climate and work-life balance could reduce the occurrence of emotional exhaustion, whereas a high-stress environment would cause a higher level of emotional exhaustion. Given these findings, hospitals should endeavor to help employees feel safe and not threatened, reduce stress, and advise them to maintain a good work-life balance.

Development of the German version of the patient safety climate inventory to the Austrian context

OBJECTIVES

In recent years, patient safety culture (PSC) in hospitals, including its development and measurement, has increasingly received attention in Europe. Even though several instruments have been developed for PSC measurement in European countries, there is, to date, no validated measure to assess PSC in Austria. The study at hand addresses this gap in the evidence base by psychometrically assessing the German 'Patient Safety Climate Inventory' (PaSKI) in terms of its potential suitability for the Austrian healthcare system. The goal is to theoretically develop and empirically verify a separate instrument for PSC measurement in Austria.

SETTING

Ten hospitals.

PARTICIPANTS

Healthcare professionals (n=1202); doctors (n=142), nurse (n=645), other health workers (n=51), medical technology professions (n=170), management/administration (n=76), other (n=20), no response (n=98).

PRIMARY AND SECONDARY OUTCOME MEASURES

The pretest was conducted with 101 health professionals. Psychometric evaluations, including exploratory factor analysis and confirmatory factor analysis, were performed with both an original version of the PaSKI and an adapted one. The original PaSKI and the newly adapted 'Austrian Patient Safety Climate Inventory' (A-PaSKI) were then compared.

RESULTS

The A-PaSKI's factor structure developed in our study differs from the original 14-factor structure (49 items) of the PaSKI. The new instrument consists of 10 factors (30 items), comprising seven departmental factors, two hospital factors, and one outcome factor. The new instrument A-PaSKI revealed satisfactory results on the model-level and internal consistency. The confirmatory factor analysis for the A-PaSKI (χ2 (360)=1408.245, p=0.0001) showed a good model fit, and the absolute and relative fit indices showed an excellent model adjustment. The construct validity was acceptable for nine and unacceptable for one factor.

CONCLUSIONS

This is the first validation study of a standardised safety culture measure in Austrian hospitals. The Austrian version of PaSKI demonstrated good psychometric properties, with acceptable to good internal consistency and construct validity for use in Austrian hospitals.

Patient Safety Culture in European Hospitals: A Comparative Mixed Methods Study

BACKGROUND

Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries.

PURPOSE

This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden.

DESIGN

A comparative mixed methods study with a convergent parallel design.

METHODS

Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data.

RESULTS

The overall perception of safety culture for most dimensions was 'adequate' in Sweden and 'adequate' to 'poor' in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia.

CONCLUSIONS

Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy.

Evaluation of the Green Cross Method Regarding Patient Safety Culture and Incidence Reporting

OBJECTIVES

The Green Cross (GC) method is a visual method for health service staff to recognize risks and preventable adverse events (PAEs) on a daily basis. The aim was to compare patient safety culture and the number of reported PAEs in units using the GC method with units that do not.

METHODS

This study has a retrospective cross-sectional design in the setting of psychiatric and somatic care departments in a Swedish hospital. In total, 1476 staff members from 62 different units participate in the study.

RESULTS

Units who had implemented the GC method scored higher than non-GC units in overall quality. The dimensions Feedback and communication about error, Nonpunitive response to errors, Organizational learning-continuous improvement, Handoffs and transitions between units and shifts, and Teamwork within units scored significantly higher in GC units. More risks were reported in the incident reporting system in GC units than in non-GC units, but the number of PAEs was similar. Units with nursing staff who used the GC method scored higher on patient safety culture than those who did not use the method. This difference was not seen in physician units.

CONCLUSIONS

The implementation of the GC method has a positive impact on patient safety culture and PAE reporting. However, the method does not seem to have the same impact in physician units as in units with nursing staff, which calls for further investigation.

Evaluating Polish nurses' working conditions and patient safety during the COVID-19 pandemic

Aim

To study the relationship between Polish nurses' working conditions and their attitudes towards patient safety during the COVID‐19 pandemic.

Background

Facing the COVID‐19 pandemic, caused by the SARS‐CoV‐2 virus, healthcare worldwide has been reorganised. How these changes affected patient safety for hospitalised persons is not well understood.

Introduction

Difficult working conditions related to the outbreak of the COVID‐19 pandemic may affect the provision of safe and effective care by healthcare staff.

Methods

This observational research was performed on the group of 577 nurses working during the COVID‐19 pandemic in isolation infection wards (n = 201) and non‐infectious diseases wards (n = 376) in Polish hospitals. The evaluation of working conditions was performed with an author's questionnaire, while the evaluation of factors influencing attitudes towards safety of the hospitalised patients was performed using Safety Attitudes Questionnaire. The STROBE checklist was used to report this study.

Results

The procedures developed by management in advance for COVID‐19 patient treatment had a statistically significant influence on nurses' ‘evaluation of teamwork climate, safety climate, job satisfaction, perception of management and work conditions’. Providing management with the ability to perform a swab polymerase chain reaction SARS‐CoV‐2 test for hospital staff in the workplace, and psychological support from professionals and employers were statistically significant for higher ratings of ‘teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and work conditions’ by the Polish nurses. Hospital workload during the COVID‐19 pandemic was significantly correlated with lower evaluation of work conditions.

Discussion

Our study reinforces the existing literature on many fronts and demonstrates how even when operating under the COVID‐19 pandemic conditions, some factors remain critical for fostering a culture of patient safety. Reinforcing patient safety practices is a imperative under these conditions.

Conclusions and implications for nursing

Working conditions influence nurses' attitudes towards safety of the hospitalised patients. These are largely modifiable factors related to the workplace and include prior preparation of procedures, restrictions to extending daily work hours and psychological counselling for the staff.

Differences between professionals' views on patient safety culture in long-term and acute care? A cross-sectional study

Purpose

This paper aims to assess how patient safety culture and incident reporting differs across different professional groups and between long-term and acute care. The Hospital Survey On Patient Safety Culture (HSPOSC) questionnaire was used to assess patient safety culture. Data from the organizations’ incident reporting system was also used to determine the number of reported patient safety incidents.

Design/methodology/approach

Patient safety culture is part of the organizational culture and is associated for example to rate of pressure ulcers, hospital-acquired infections and falls. Managers in health-care organizations have the important and challenging responsibility of promoting patient safety culture. Managers generally think that patient safety culture is better than it is.

Findings

Based on statistical analysis, acute care professionals’ views were significantly positive in 8 out of 12 composites. Managers assessed patient safety culture at a higher level than other professional groups. There were statistically significant differences (p = 0.021) in frequency of events reported between professional groups and between long-term and acute care (p = 0.050). Staff felt they did not get enough feedback about reported incidents.

Originality/value

The study reveals differences in safety culture between acute care and long-term care settings, and between professionals and managers. The staff felt that they did not get enough feedback about reported incidents. In the future, education should take these factors into consideration.

Patient safety culture among nursing professionals in the intensive care environment

OBJECTIVE

To analyze the patient safety culture among intensive care nursing professionals.

METHOD

This is a cross-sectional study carried out in Intensive Care Units of a public hospital. Data collection was carried out from September to October 2017 with nursing professionals, using the Hospital Survey on Patient Safety Culture questionnaire. Cronbach's Alpha, Pearson's Chi-Square or Fischer's Exact tests (5% significance level) were performed.

RESULTS

The final sample consisted of a total of 163 nursing professionals. No strong areas were observed for patient safety. The dimensions "teamwork in the unit", "expectations and actions of the supervisor/manager for the promotion of patient safety" and "organizational learning and continuous improvement" had the highest rates of positive responses, whereas the dimensions "opening for communication" and "feedback and communication about the error" had the lowest percentages. The general degree of patient safety was considered very good 72 (47%) and underreporting of the events was observed, most of them were carried out by nurses.

CONCLUSION

No dimension assessed was considered to be a strong area. However, most were shown to be potential areas for patient safety culture.

Patient Safety Culture and Associated Factors Among Health-Care Providers in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Introduction

Patient safety is an issue of global concern; however, health-care organizations have lately observed to pay more attention to the importance of establishing a culture of safety. The study aimed to assess the level of patient safety culture and associated factors among health-care providers at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia, 2020.

Methods

A cross-sectional study design supported by the qualitative approach was conducted from March 15 to May 15/2020. A stratified simple sampling technique was used to select 575 study participants. The standardized tool, which measures 12 safety culture dimensions, was used for data collection. Bivariate and multivariable linear regression analyses performed using SPSS version 23. The significance level was obtained at 95% CI and p-value <0.05. For the qualitative part, a semi-structured interview guide with probing was used. Data were analyzed thematically using open code software version 4.02.

Results

The overall level of positive patient safety culture was 45.3% (95% CI: 44.7, 45.9) with a response rate of 92.2%. Factor analysis indicated that female, masters, participation in patient safety program, adverse event report, hospital management encourage reporting event and resource were positively associated with the patient safety culture. Whereas divorced/widowed, midwives, anesthetist, medicine, pediatrics, emergency, outpatient, pharmacy, direct contact with patients, and hospital management blame when medical errors happened were negatively associated. The in-depth interview revealed that teamwork, health-care professionals’ attitude toward patient safety and patient involvement as important factors that influence patient safety culture.

Conclusions and Recommendations

The overall level of positive patient safety culture was low. All variables except age, training, working hour, and working experience were factors significantly associated with the patient safety culture. Health-care policy-makers and managers should consider patient safety culture a top priority, and also create a blame-free environment that promotes event reporting.

Results of survey on perception of patient safety culture among emergency nurses in Jordan: Influence of burnout, job satisfaction, turnover intention, and workload

BACKGROUND

Patient safety culture is an essential factor in the decreasing of medical errors and development of the institutions. This study was conducted to determine to what extent the selected variables, including age, weekly working hours, years of experience, burnout, turnover intention, workload, and job satisfaction, predict perceived patient safety culture among emergency nurses in Jordanian hospitals.

METHODS

A cross-sectional design with convenience sampling approach was used. A total of 157 emergency nurses from governmental and public hospitals were participated in the study and completed the study's survey: Hospital Survey on Patient Safety Culture (PSC), Copenhagen Burnout Inventory-Student Survey (CBI-SS), NASA Task Load Index (NASA-TLX), Nursing Workplace Satisfaction Questionnaire (NWSQ) and turnover intention scale (TIS).

RESULTS

The results showed that there was a negative relationship found between nurses' age and PSC perception (r=-.166, P=.039), personal burnout and PSC (r=-.160, P=.048), and there was also a negative relationship between turnover intentions and perceived PSC (r=-.334, P=.000). The results from the regression model indicated that turnover intentions, reporting patient safety events, and the number of events reported predicted PSC. The results showed that R²=.29, adjusted R²=.287, F(6,141)=9.45, P<0.01.

CONCLUSION

Our results suggests that nurses' managers may pay attention to decreasing burnout and analyze turnover intention among nurses in order to improve the culture of patient safety.

Evaluation of patient safety culture in a private general hospital: a case study in Brazil

PURPOSE

The purpose is to assess the patient safety culture perceived by healthcare and administrative staff in a Brazilian hospital and examine whether education and experience are related to positive perceptions.

DESIGN/METHODOLOGY/APPROACH

A descriptive-analytical case study was carried out at Ernesto Dornelles Hospital, a private Brazilian institution. The Brazilian version of the Hospital Survey on Patient Safety Culture was used to assess the perceptions of 618 participants, of whom 315 worked in healthcare assistance and 303 in administrative services. The main outcome was the percentage of positive responses, and the independent variables included the type of work, schooling and length of experience.

FINDINGS

None of the twelve dimensions was strengthened. The percentage of positive responses was the highest for "Hospital management support for patient safety" (67.5%), and the lowest was for "Nonpunitive response to error" (29%). The healthcare staff had a slightly higher average than the administrative staff. The percentage of positive responses from professionals with undergraduate or graduate degrees was higher for the eight dimensions of safety culture. The length of hospital experience was not associated with any dimensions.

ORIGINALITY/VALUE

This study explored the influence of education and professional experience on the perception of patient safety in healthcare and administrative staff from a private institution. These approaches allow to know with greater depth and clarity factors that are related to the patient safety culture and, thus, have more consistent evidence to support interventions in specific needs.

Incident Report: Between the Shadows of Obligation and Formality

BACKGROUND: Incident reports are the primary data source for monitoring patient safety in the hospital. Monitoring of these reports determines the success of managing safety-related incidents as an effort to improve patient care. Hospital staff plays an essential role in the management of incident reports. Each staff member has a role in managing incident reports. AIM: This article aimed to explore the role of hospital staff in the incident reporting process. METHODS: This qualitative research used an exploratory approach. The research informants were three doctors, 21 nurses, one pharmacist, and two computer administrators. Data were collected using interviews and observations of incident reporting implementation. The research data were analyzed with the qualitative analysis software Atlas.ti. RESULTS: Report management is not done solely for the formality of achieving the target. Implementation of regulations for report management is also done by all hospital staff to prioritize discipline, honesty, and responsibility according to their roles. Staff is expected to report adverse or dangerous events (incidents) that could affect patient safety. The reporting coordinator is responsible for the report’s completeness. Heads of participation room are expected to validate reports. The patient safety team is in charge of analyzing and providing feedback. Supportive attitudes from the board of directors are needed to create a reporting culture. There are several barriers to reporting management, including management support factors, facilities, and an effective feedback system. CONCLUSION: Leaders need to develop staff who focus on discipline, honesty, and responsibility in providing services to patients by prioritizing patient safety. All staff is involved in managing incident reports by playing an active role in following their duties.

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.

Enabling patient safety awareness using the Green Cross method: A qualitative description of users' experience

AIM

The Green Cross method was developed to support healthcare staff in daily patient safety work. The aim of this study was to describe users' experiences of the method when working with patient safety and their views on the core elements.

BACKGROUND

Patient safety systems need to be user-friendly to facilitate learning from adverse events. The Green Cross method is described as a simple visual method to recognise risks and preventable adverse events (PAEs) in real time. There are no previous studies describing users' experiences of the Green Cross method.

DESIGN

A qualitative descriptive design.

METHODS

32 healthcare workers and managers from different specialties in a Swedish hospital were interviewed, from May-September 2018 about their experiences of the Green Cross method; either individually or as part of a group. The interviews were analysed using thematic analysis. The study follows the COREQ guidelines for qualitative data.

RESULTS

Participants associated the Green Cross method with patient safety, but no core elements of the method were identified. Instead, the opportunity to be engaged in patient safety work in a systematic way was underlined by all study participants. Highlighted key areas were the simplicity and the systematic framework of the method along with a need of distinct leadership. The daily meetings promoted trust and dialogue and developed the patient safety mindset. Daily meetings, together with the visualisation of the cross, were emphasised as important by users who otherwise had limited knowledge of the entire method.

CONCLUSION

This study offers valuable information that can help deepen the understanding of how the method specifically supports patient safety work.

RELEVANCE TO CLINICAL PRACTICE

Healthcare workers are expected to report patient safety issues. This study presents user-friendly aspects of the method as well as limitations, relevant for present and future users.

Patient safety culture and associated factors among health care professionals at public hospitals in Dessie town, north east Ethiopia, 2019

Introduction

Patient safety culture is defined as the attitudes, perceptions, and values that staffs share within an organization related to patient safety. The safety of health care is now a major global concern. It is likely that millions of people suffer disabling injuries or death directly related to medical care. Particularly in developing and transitional countries, patient harm is a global public health problem. The objective of the study is to assess patient safety culture and associated factors among health care professionals working in public hospitals in Dessie town, North East Ethiopia, 2019.

Methods

Facility based quantitative study was employed from March 15 –April 30, 2019 in public hospitals in Dessie town. Four hundred and twenty two health care professionals were recruited to complete a structured pretested self-administered questionnaire. The data was cleaned, coded and entered in to Epi Info-7 and exported to SPSS version 20. Data was further analyzed using bivariate and multivariate logistic regression analyses. Variables with P value of less than 0.05 in multivariate analysis were declared as statistically significant at 95% CI.

Results

Of the 422 recruited a total of 411 participants completed the survey with a response rate of 97.4%. Close to half (184(44.8%)) of the participants indicated good patient safety culture. Good patient safety culture was positively associated with working in primary hospital (AOR = 2.56, 95% CI = 1.56, 4.21). On the other hand, good patient safety culture was negatively associated with health professional’s age between 25–34 year (AOR = 0.25, 95% CI = 0.08–0.74) and working in Pediatrics ward (AOR = 0.39, 95% CI = 0.17–0.9) and in emergency ward (AOR = O.25, 95%CI = 0.09–0.67).

Conclusion

The overall level of patient safety culture was under 50%. Good patient safety culture had positive association with working in primary hospital and negative association with professionals’ age between 25–29 year, 30–34 year and working in pediatrics and emergency ward. Implementing actions that support all dimensions of safety culture should be promoted at all levels of hospitals.

A baseline assessment of patient safety culture and its associated factors from the perspective of critical care nurses: Results from 10 hospitals

INTRODUCTION

Critical care nurses are considered the key to patient safety improvement and play a vital role in enhancing quality of care in intensive care units (ICUs) where adverse events are frequent and have severe consequences. Moreover, there is recognition of the importance of the assessment and the development of patient safety culture (PSC) as a strategic focus for the improvement of patient safety and healthcare quality, notably in critical care settings.

OBJECTIVES

This study aimed to assess critical care nurses' perception of PSC and to determine its associated factors.

METHODS

This cross-sectional study was conducted among nurses working in the ICUs of the Tunisian centre (six Tunisian governorates). The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture questionnaire, comprising 10 dimensions and a total of 50 items.

RESULTS

A total of 249 nurses from 18 ICUs participated in the study, with a participation rate of 87.36%. The dimensions scores ranged between 17.2% for the dimension "frequency of events reported" and 50.1% for the dimension "teamwork within units". Multivariable logistic regression indicated that respondents who worked in private hospitals were five times more likely to have a developed PSC (adjusted odds ratio [AOR]: 5.34; 95% confidence interval [CI], [2.28, 12.51]; p < 10^-3). Similarly, participants who worked in a certified hospital were two times more likely to have a more developed PSC than respondents who work in noncertified hospitals (AOR: 2.51; 95% CI, [.92-6.82]; p = 0.041). In addition, an increased nurse-per-patient ratio (i.e., reduced workload) increased PSC (AOR: 1.10; 95% CI, [1.02-1.12]; p = 0.018).

CONCLUSION

This study has shown that the state of critical care nurses' PSC is critically low and these baseline results can help to form a plan of actions for improvements.

Assessment and Comparison of Patient Safety Culture Among Health-Care Providers in Shenzhen Hospitals

Purpose

To investigate the health-care providers’ perceptions of patient safety culture in Shenzhen hospitals and to compare 2019 with 2015 data.

Methods

This cross-sectional study adopted a questionnaire survey and targeted hospital staff fitting the sampling criteria (physicians, nurses, technicians, and managers). A total of 5490 staff from 13 Shenzhen hospitals were surveyed using the Hospital Survey on Patient Safety Culture (HSOPSC).

Results

The average positive response rates of this study were generally higher than the data from the 2018 Agency for Healthcare Research and Quality (AHRQ) survey and the 2015 HSOPSC Shenzhen survey. Bivariate and multivariate regression showed that respondents who had direct contact with patients were less likely to report high overall patient safety grade. The probability of high overall patient safety grade was rated higher by men than by women. Compared with nurses, the probability of high overall patient safety grade was higher for both physicians and technicians.

Conclusion

The overall results of the patient safety culture in Shenzhen hospitals were relatively good and have improved significantly in recent years, but some areas of weakness still need improvement. Our recommendations are to develop training programs for various positions, recruit more employees, provide management support, and establish a just culture to promote a strong patient safety culture. Regular assessment is also needed to provide valuable information to hospital leaders on areas requiring improvement and to evaluate the quality improvement plan that has been implemented.

Assessment of patient safety climate by nurses in Slovak Public and private hospitals

AIM

To examine variations in the safety climate reported by nurses in Slovak hospitals and to analyse the association between dimensions of the patient safety climate and demographic and organisational factors.

BACKGROUND

A deeper understanding of how safety climate varies across hospitals can be useful in determining areas with a potential for improvement. Staffing and non-punitive response to errors were identified in recent research syntheses as the weakest dimensions of safety climate that require strengthening.

METHODS

The sample consisted of 1,429 nurses working in public and private hospitals in Slovakia. The Hospital Survey on Patient Safety Culture questionnaire was used for data collection, and descriptive analysis was carried out to examine relationships between variables.

RESULTS

Nurses working in general private hospitals with a bed capacity of less than 500 beds were more positive about their hospital safety climate than other nurses working in differently organised hospitals. The lowest number of positive responses was scored in the domain of 'Non-Punitive Response to Error'. This result came from a blame-free error-reporting atmosphere.

CONCLUSIONS

Nurses perceived a higher level of patient safety when they had experienced better sharing of information on event reporting and had better learning opportunities.

IMPLICATIONS FOR NURSING MANAGEMENT

The results revealed strengths and weaknesses of the patient safety climate in the network of Slovak hospitals from the perspective of nurses working in these hospitals. This knowledge can enable nurse managers to instigate supportive strategies for just reporting, and learning from events, within an enhanced safety culture.

Nurses' perceptions of patient safety culture: a mixed-methods study

BACKGROUND

There are relatively few qualitative studies concerning patient safety culture.

METHODS

We aimed to explore patient safety culture as perceived by the nursing staff in two public hospitals in Catalonia, Spain. A mixed-methods design was employed using a questionnaire, in-depth interviews, and non-participant observations.

RESULTS

Sixty-two percent of the nursing staff rated patient safety as "Acceptable" but was not higher because of work pressure and lack of resources as perceived by staff. "Teamwork within units" had the highest rate of positive responses, and "Staffing" had the lowest rate. Emergency units showed more negative results than the other two units.

CONCLUSIONS

Safety incidents are not always reported due to fear of punishment, reflecting a lack of positive safety culture. It is necessary to design and implement strategies that promote a positive culture to avoid punitive responses and apply and evaluate these changes.