A Systematic Review of Patient-Report Safety Climate Measures in Health Care

Setting new priorities for nursing research: The updated Swiss Nursing Research Agenda-a systematic, participative approach

AIM

To identify current key areas for nursing research in Switzerland, we revised the Swiss Research Agenda for Nursing (SRAN) initially published in 2008.

BACKGROUND

By developing a research agenda, nursing researchers internationally prioritize and cluster relevant topics within the research community. The process should be collaborative and systematic to provide credible information for decisionmakers in health care research, policy, and practice.

SOURCES OF EVIDENCE

After a participative, systematic, and critical evaluation within and outside of the Swiss Association for Nursing Science, the updated SRAN 2019-2029 defines four research priorities (new models of care, nursing care interventions, work and care environment, and quality of care and patient safety) and four transversal themes (organization of research, research methodologies, research in health care policy and public health perspectives).

CONCLUSION

Adding to other national nursing research agendas, the categories are organized in a framework of key research priorities and transversal themes. They relate to the importance of global and local foci of research as well as challenges in health care services and policy systems. The agenda is an important prerequisite for enhancing the influence of nursing research in Switzerland and provides guidance for the next decade.

IMPLICATIONS FOR NURSING PRACTICE

The revised agenda ensures that research projects target key knowledge gaps and the discipline's core questions in respective countries.

IMPLICATIONS FOR HEALTH POLICY

Nursing research should inform and influence health policy on all institutional and political levels. Therefore, the integration of public health perspectives in research is one of the most important new aspects of SRAN 2019-2029.

Patients' perception of safety climate in Irish general practice: a cross-sectional study

BACKGROUND

Although patients have the potential to provide important information on patient safety, considerably fewer patient-report measures of safety climate (SC) have been applied in the primary care setting as compared to secondary care. Our aim was to examine the application of a patient-report measure of safety climate in an Irish population to understand patient perceptions of safety in general practice and identify potential areas for improvement. Specifically, our research questions were: 1. What are patients' perceptions of SC in Irish general practice? 2. Do patient risk factors impact perceptions of SC? 3. Do patient responses to an open-ended question about safety enhance our understanding of patient safety beyond that obtained from a quantitative measure of SC?

METHODS

The Patient Perspective of Safety in General Practice (PPS-GP) survey was distributed to primary care patients in Ireland. The survey consisted of both Likert-response items, and free-text entry questions in relation to the safety of care. A series of five separate hierarchical regressions were used to examine the relationship between a range of patient-related variables and each of the survey subscales. A deductive content analysis approach was used to code the free-text responses.

RESULTS

A total of 584 completed online and paper surveys were received. Respondents generally had positive perceptions of safety across all five SC subscales of the PPS-GP. Regarding patient risk factors, younger age and being of non-Irish nationality were consistently associated with more negative SC perceptions. Analysis of the free-text responses revealed considerably poorer patient perceptions (n = 85, 65.4%) of the safety experience in primary care.

CONCLUSION

Our findings indicate that despite being under-utilised, patients' perceptions are a valuable source of information for measuring SC, with promising implications for safety improvement in general practice. Further consideration should be given to how best to utilise this data in order to improve safety in primary care.

The adaptation of the 'Healthcare Complaints Analysis Tool' for general practice

BACKGROUND

Patient complaints about care in general practice are underutilized as a source of safety improvement data.

OBJECTIVE

This study aimed to adapt a secondary care complaints analysis tool for use in general practice contexts and assess the validity, reliability and usability of the adapted tool.

METHODS

The study was conducted in two phases. Phase A: The Healthcare Complaints Analysis Tool (HCAT) designed for use in secondary care was adapted for use in general practice using an iterative six-stage process. Phase B: Participants from key stakeholder groups [General practitioners (n = 5), complaints managers (n = 9), health service researchers (n = 4)]. Participants completed an online survey and analysed 20 fictionalized patient complaints using the adapted tool. Inter-rater reliability and agreement with a referent standard were analysed using Gwet's AC1 statistic.

RESULTS

Phase A: The HCAT was adapted to the Healthcare Complaints Analysis Tool (General Practice) [HCAT(GP)]. The HCAT(GP) tool consists of three domains (clinical, management and relationship problems), and seven categories. The HCAT(GP) had both content and face validity. Phase B: Inter-rater reliability was substantial for the HCAT(GP) categories (Gwet's AC1 = 0.65). Within-group agreement on the seven HCAT(GP) categories was substantial to perfect (AC1 0.61-0.85). Participants had substantial to perfect agreement with the referent standard across the survey with a mean AC1 of 0.899 (Range 0.76-0.97).

CONCLUSIONS

This study reports the adaptation of the HCAT(GP) and has established that the tool has sufficient validity, reliability and usability. This adapted tool can be applied to general practice complaints to identify areas for improvement.

Development and validation of a patient-report measure of safety climate for general practice

BACKGROUND

Patients remain an under-utilized source of information on patient safety, as reflected by the dearth of patient-report measures of safety climate, particularly for use in general practice settings. Extant measures are marked by poor coverage of safety climate domains, inadequate psychometric properties and/or lack of consideration of usability.

OBJECTIVE

To develop a novel patient-report measure of safety climate specifically for completion by general practice patients, and to establish the validity, reliability and usability of this measure.

METHODS

An iterative process was used to develop the safety climate measure, with patient and general practitioner input. A cross-sectional design was employed to examine the validity (content, construct and convergent), reliability (internal consistency), and usability (readability and burden) of the measure.

RESULTS

A total of 584 general practice patients completed the measure. The exploratory factor analysis identified five factors pertaining to safety climate in general practice: Feeling of Safety with GP; Practice Staff Efficiency and Teamwork; Staff Stress and Workload; Patient Knowledge and Accountability, and; Safety Systems and Behaviours. These factors strongly correlated with two global safety measures, demonstrating convergent validity. The measure showed strong internal consistency, and was considered usable for patients as indicated by readability and duration of completion.

CONCLUSION

Our novel measure of safety climate for use in general practice demonstrates favourable markers of validity, reliability and usability. This measure will provide a mechanism for the patient voice to be heard in patient safety measurement, and to be used to improve patient safety in general practice.

Measuring and monitoring patient safety in hospitals in Saudi Arabia

Background

There is much variability in the measurement and monitoring of patient safety across healthcare organizations. With no recognized standardized approach, this study examines how the key components outlined in Vincent et al’s Measuring and Monitoring Safety (MMS) framework can be utilized to critically appraise a healthcare safety surveillance system. The aim of this study is to use the MMS framework to evaluate the Saudi Arabian healthcare safety surveillance system for hospital care.

Methods

This qualitative study consisted of two distinct phases. The first phase used document analysis to review national-level guidance relevant to measuring and monitoring safety in Saudi Arabia. The second phase consisted of semi-structured interviews with key stakeholders between May and August 2020 via a video conference call and focused on exploring their knowledge of how patient safety is measured and monitored in hospitals. The MMS framework was used to support data analysis.

Results

Three documents were included for analysis and 21 semi-structured interviews were conducted with key stakeholders working in the Saudi Arabian healthcare system. A total of 39 unique methods of MMS were identified, with one method of MMS addressing two dimensions. Of these MMS methods: 10 (25 %) were concerned with past harm; 14 (35 %) were concerned with the reliability of safety critical processes, 3 (7.5 %) were concerned with sensitivity to operations, 2 (5 %) were concerned with anticipation and preparedness, and 11 (27.5 %) were concerned with integration and learning.

Conclusions

The document analysis and interviews show an extensive system of MMS is in place in Saudi Arabian hospitals. The assessment of MMS offers a useful framework to help healthcare organizations and researchers to think critically about MMS, and how the data from different methods of MMS can be integrated in individual countries or health systems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07228-z.