Assessing Patients' Perceptions of Safety Culture in the Hospital Setting: Development and Initial Evaluation of the Patients' Perceptions of Safety Culture Scale

Relationship between patient safety culture and patient experience in hospital settings: a scoping review

BACKGROUND

Measures of patient safety culture and patient experience are both commonly utilised to evaluate the quality of healthcare services, including hospitals, but the relationship between these two domains remains uncertain. In this study, we aimed to explore and synthesise published literature regarding the relationships between these topics in hospital settings.

METHODS

This study was performed using the five stages of Arksey and O'Malley's Framework, refined by the Joanna Briggs Institute. Searches were conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, SciELO and Scopus databases. Further online search on the websites of pertinent organisations in Australia and globally was conducted. Data were extracted against predetermined criteria.

RESULTS

4512 studies were initially identified; 15 studies met the inclusion criteria. Several positive statistical relationships between patient safety culture and patient experience domains were identified. Communication and teamwork were the most influential factors in the relationship between patient safety culture and patient experience. Managers and clinicians had a positive view of safety and a positive relationship with patient experience, but this was not the case when managers alone held such views. Qualitative methods offered further insights into patient safety culture from patients' and families' perspectives.

CONCLUSION

The findings indicate that the patient can recognise safety-related issues that the hospital team may miss. However, studies mostly measured staff perspectives on patient safety culture and did not always include patient experiences of patient safety culture. Further, the relationship between patient safety culture and patient experience is generally identified as a statistical relationship, using quantitative methods. Further research assessing patient safety culture alongside patient experience is essential for providing a more comprehensive picture of safety. This will help to uncover issues and other factors that may have an indirect effect on patient safety culture and patient experience.

Development and Preliminary Evaluation of Patient Perceptions on Safety Culture in a Hospital Setting Scale

Objectives

Majority of the existing patient safety culture tools are designed for healthcare workers. Despite the claims that this patient safety tools are patient-centered, limited attention was given to the patients' perspectives and cultural considerations in the development. Local studies are not available in extant literature that capture patient perspectives on being safe during hospitalization. The goal of the study was to develop and provide preliminary psychometric analysis on a tool that measures patients' perception of safety culture in a hospital setting.

Methods

The study was a quantitative methodological study. The instrument was developed in three phases, conceptualization and item generation through literature review, clinical observation, and focus group discussion, two rounds of expert panel review, and pilot testing. The tool was tested on 122 eligible patients admitted in a tertiary hospital. Factor analysis of the items was done to determine the underlying factor under each item. Cronbach's alpha was used to test the degree of internal consistency of the scale.

Results

The Patient Perceptions on Safety Culture in Hospital Setting Scale consists of 25 items. The analysis yielded four factors explaining a total of 69.23% of the variance in the data. Items were grouped in four dimensions: Hospital workforce (4 items), Hospital Environment (5 items), Heath Management and Care Delivery (7 items), and Information Exchange (9 items). Each factor registered a Cronbach's alpha of 0.81, 0.78, 0.91, 0.94, respectively. The overall Cronbach's alpha of the scale is 0.95.

Conclusion

The study offers preliminary evidence on the psychometric properties of a newly developed tool that measures patient perceptions on hospital safety culture. Subsequent studies on larger samples need to be conducted to determine the reliability and validity of the tool when applied to different population and contexts as well as determining valid cut-off points in scoring and interpretation.

Research on the Characteristics of Safety Culture and Obstacle Factors among Residents under the Influence of COVID-19 in China

This study established a comprehensive evaluation indicator model for the safety culture among residents during COVID-19 and an obstacle degree model for the identification of the major factors affecting the residents' safety culture. The results show that the overall level of the safety culture among residents was 0.6059. Safety education, channels for learning knowledge regarding safety, and implementation of safety management systems are currently the major obstacles affecting safety culture among residents, but there is still space for improvement in the future. Furthermore, the level of safety culture was strongly related to the distance from the infected, because this changes the risk of viral infection. There are also differences in obstacle factors in different regions. Therefore, it is necessary to implement measures targeting the improvement of safety culture in accordance with the risk of viral infection. Strategies for strengthening the safety culture are also given in this study for consideration in strategic decision making with the aim of promoting the improvement of safety culture among residents, which may help to reduce the risk of infection with COVID-19 for residents.

Awareness and understanding among patients about patient safety in India: A cross-sectional questionnaire-based study

Background

There is a dearth of studies from India evaluating the awareness of patient safety. This study was performed to gain insight into the Indian patients’ awareness about patient safety and evaluate their willingness in promoting the same.

Methods

In this cross-sectional study, online interactive sessions pertaining to patient safety and patient safety culture were arranged by clinical pharmacologists for 800 urban patients post-discharge from a tertiary care hospital in India. A validated questionnaire was used, and the responses were analysed using descriptive statistics.

Results

A total of 635 patients [mean age, 43.2  ±  10.3 years; 385 (60.6%) males] responded. A total of 93.4% of the patients were aware of the term “patient safety” and 35.3% faced situations where they felt that patient safety was compromised. Of these patients, 64.3% reported to higher authorities when faced with such situations, while the remaining either ignored the issue or had no idea about how to deal with the same. A total of 99.2% of the patients never participated in any patient safety program; nevertheless, 94.5% of them were willing to participate in the same. Accessibility to information about patient care was deemed essential by 58.3% of the patients.

Conclusions

Although the overall awareness about patient safety among urban Indian patients is high, there is a lack of awareness about ways of dealing with patient safety issues. Given the high level of interest in participating in patient safety programs, such programs should routinely include patients for optimizing the chances for safer provision of health care.

Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals

BACKGROUND

The study of safety culture and its relationship to patient care have been challenged by variation in definition, dimensionality and methods of assessment. This systematic review aimed to map methods to assess safety culture in hospitals, analyse the prevalence of these methods in the published research literature and examine the dimensions of safety culture captured through these processes.

METHODS

We included studies reporting on quantitative, qualitative and mixed methods to assess safety culture in hospitals. The review was conducted using four academic databases (PubMed, CINAHL, Scopus and Web of Science) with studies from January 2008 to May 2020. A formal quality appraisal was not conducted. Study purpose, type of method and safety culture dimensions were extracted from all studies, coded thematically, and summarised narratively and using descriptive statistics where appropriate.

RESULTS

A total of 694 studies were included. A third (n=244, 35.2%) had a descriptive or exploratory purpose, 225 (32.4%) tested relationships among variables, 129 (18.6%) evaluated an intervention, while 13.8% (n=96) had a methodological focus. Most studies exclusively used surveys (n=663; 95.5%), with 88 different surveys identified. Only 31 studies (4.5%) used qualitative or mixed methods. Thematic analysis identified 11 themes related to safety culture dimensions across the methods, with 'Leadership' being the most common. Qualitative and mixed methods approaches were more likely to identify additional dimensions of safety culture not covered by the 11 themes, including improvisation and contextual pressures.

DISCUSSION

We assessed the extent to which safety culture dimensions mapped to specific quantitative and qualitative tools and methods of assessing safety culture. No single method or tool appeared to measure all 11 themes of safety culture. Risk of publication bias was high in this review. Future attempts to assess safety culture in hospitals should consider incorporating qualitative methods into survey studies to evaluate this multi-faceted construct.

Evaluation of Patients' Perception of Safety in an Italian Hospital Using the PMOS-30 Questionnaire

Background: In our study, an Italian version of the PMOS-30 questionnaire was used to evaluate its feasibility and to improve health care quality in an Italian hospital. Methods: A cross-sectional study was conducted with 435 inpatients at a hospital in the Campania Region of Southern Italy using the PMOS-30 questionnaire and two other questions to assess patient feedback about the overall perception of safety. Results: The item “I was always treated with dignity and respect” showed the greatest percentage of agreement (agree/strongly agree = 89.2%; mean = 4.24). The least agreement was associated with the four “Staff Roles and Responsibilities” items (agree/strongly agree ranged from 31.5 to 40.0%; weighted mean = 2.84). All other 25 items had over 55.0% agreement, with 19 items over 70%. Moreover, 94.5% of the patients considered the safety of the ward sufficient/good/very good, and 92.8% did not notice situations that could cause harm to patients. Conclusion: Patient perception of safety was found to be satisfactory. The results were presented to the hospital decision makers for suggesting appropriate interventions. Our experience showed that the use of the PMOS-30 questionnaire may improve safety and health care quality in hospital settings through patient feedback.

Variations in Patient Satisfaction Scores Between HCAHPS and a Novel Orthopedic Practice-Specific Survey

Performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey can affect up to 33% of a physician's reimbursement from the Centers for Medicare & Medicaid Services. At this pseudo-private orthopedic practice, the authors characterized how physicians often achieve drastically different scores between HCAHPS and an Internal Patient Satisfaction Questionnaire (IPSQ). Eighteen physicians were ranked separately according to percentage of top-box scores on HCAHPS and IPSQ. There was an inverse relationship between physician rank for the 2 surveys according to Spearman correlation coefficient (ρ = -0.36, P = .15). Qualitative subanalysis indicated that although "physician interaction" was the most common reason for negative comments on HCAHPS, "ancillary staff" and "workflow" concerns were common on IPSQ. The outpatient setting remains a critical component in achieving high-quality orthopedic care. Consequently, HCAHPS alone may not be a sufficient indicator of patient satisfaction for orthopedic and other subspecialty practices.

Adapting and validating the Hospital Survey on Patient Safety Culture (HSOPS) for nursing students (HSOPS-NS): A new measure of Patient Safety Climate

BACKGROUND

Patient Safety Culture and Patient Safety Climate (PSC) are different factors. PSC is the shared perception that is held within a hospital's area or unit at a specific moment in time. This measure is necessary for designing activities for promoting and improving safety. It must include the perception of all the agents involved, including future nurses throughout their patient safety education.

OBJECTIVES

The aim was to adapt and validate a new version of the Hospital Survey on Patient Safety Culture (HSOPS), targeted specifically at nursing students. It provides a new comprehensive and more complete measure of PSC that contributes to improving patient safety.

METHODS

Data were obtained from 654 undergraduate and postgraduate nursing students. PSC was tested using factor analyses and structural equation modeling. In order to facilitate the improvement of PSC, we examined differences in climate strength across different academic groups using the Rwg(j) and ICC measures of inter-rater agreement.

RESULTS

Factor analyses confirmed a five-factor solution that explained between 52.45% and 54.75% of the variance. The model was found to have adequate fit χ² (5) = 14.333, p = .014; CFI = 0.99; RMSEA = 0.05. Cronbach's alphas for PSC were between 0.74 and 0.77. "Teamwork within units" was the highest rated dimension, and "Staffing" the lowest rated. Medium-to-high scores were obtained for PSC. The median of Rwg (j) was high in the five dimensions of the PSC survey, supporting the idea of shared climate perceptions (0.81-0.96) among undergraduate and postgraduate nursing students.

CONCLUSIONS

HSOPS-NS is a useful and versatile tool for measuring the level and strength of PSC. It screens knowledge regarding patient safety in clinical practice placements and compares nursing students' perceptions of the strength of PSC. Weaknesses perceived in relation to PSC help implement changes in patient safety learning.