The perception of hospital safety culture and selected outcomes among nurses: An exploratory study

Exploring the perception of safety culture among nurses in Saudi Arabia

BACKGROUND

Medical errors and adverse events pose a serious challenge to the global healthcare industry. Nurses are at the frontline in implementing safety measures and protecting patients. This study aimed to investigate nurses' perceptions of the patient safety culture in Saudi Arabia.

METHODS

This cross-sectional descriptive study used convenience sampling to survey 402 nurses from various hospitals in Jazan, Saudi Arabia. The Hospital Survey on Patient Safety Culture was used for the data collection.

RESULTS

Nurses reported a moderate perception of safety culture, with 60% positive responses. Teamwork had the highest safety culture rating at 77.8%, while responses to error and staffing were the lowest at 39.75% and 46.17%, respectively. Qualifications significantly predicts nurses' safety culture rating (B = -0442, t = -4.279, p < 0.01). Positive correlations were found between event reporting frequency and communication openness (r = 0.142, p < 0.01), and patient safety grades with communication about errors (r = 0.424, p < 0.01) and hospital management support (r = 0.231, p < 0.01).

CONCLUSIONS

Nurses in Saudi Arabia demonstrated a strong sense of teamwork and commitment to organizational learning. However, critical areas such as staffing and error response require attention to improve patient safety.

Patient-Safety Culture among Emergency and Critical Care Nurses in a Maternal and Child Department

INTRODUCTION

The quality of healthcare has multiple dimensions, but the issue of patient safety stands out due to the impact it has on health outcomes, particularly on the achievement of the Sustainable Development Goals (SDGs), expressly SDG3. In the services that we propose to study, the patient-safety culture had never been evaluated.

AIM

To evaluate nurses' perceptions of the patient-safety culture in the Emergency and Critical Care Services of the Maternal and Child Department of a University Hospital and to identify strengths, vulnerabilities, and opportunities for improvement.

METHODS

This an exploratory, cross-sectional study with a quantitative approach, using the Hospital Survey on Patient Safety Culture as an instrument for data collection. The population were all nurses working in the emergency and critical care services of the maternal and child-health department, constituted, at the time of writing, by 184 nurses, with a response rate of 45.7%.

RESULTS

Applying the guidelines from the Agency for Healthcare Research and Quality (AHRQ), only teamwork within units had a score greater than 75%. For this reason, it is considered the strength (fortress) in the study. The lowest-rated were non-punitive responses to errors and open communication.

CONCLUSION

The overall average percentage score is below the benchmark of the AHRQ, indicating that issue of patient safety is not considered a high priority, or that the best strategies to make it visible have not yet been found. One of the important implications of this study is the opportunity to carry out a deep reflection, within the organization, that allows the development of a non-punitive work environment that is open to dialogue, and that allows the provision of safe nursing care.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Perceived Relationship Between Horizontal Violence and Patient Safety Culture Among Nurses

Objective

Despite the value of undertaking patient safety culture, its association with horizontal violence in nursing workplace is still understudied. This study aimed to investigate the association between the perceived patient safety culture and its relationship with horizontal violence among nurses working in Jordan.

Methods

A cross-sectional correlational design was used. Nurses working in major governmental hospitals in Jordan were conveniently recruited to complete an online self-administered questionnaire, which included the following tools: Hospital Survey on Patient Safety Culture and Negative Behaviours in Healthcare (NBHC) Survey. The survey was designed to measure attitudes and perceptions on patient safety culture at multiple levels of a healthcare organization with ten dimensions. The Negative Behaviours in Healthcare (NBHC) survey was developed as an adaptation of the Lateral Violence in Nursing Survey (LVNS) with 25 items and two open-ended questions.

Results

A total of 330 nurses responded to the questionnaire. Nurses moderately perceived patient safety culture (HSOPS mean = 3.5, SD = 1.1). Low incidence of horizontal violence was claimed (mean = 2.1, SD = 1.1). However, it was associated with moderate negative correlation with patient safety culture (r = -0.53, p < 0.001). Regression model revealed that patient safety culture explained an additional 53% of the variance of horizontal violence after controlling the effects of age and length of clinical experience (R-square change: 0.560, SE: 19.7, P: 0.001, CI: 1.21-1.57).

Conclusion

Despite its low incidence, patient safety culture was found influential to the horizontal violence based on the perspectives of nurses in Jordan. Patient safety culture can be incorporated with other factors that contribute to the development of horizontal violence in nursing workplace.

Nurses' Perceptions of Patient Safety on Patient Safety Climate

PURPOSE

The purpose of this study was to determine the relationship between nurses' perception of patient safety and the safety climate.

DESIGN

Descriptive study.

METHODS

The sample consisted of 262 surgical nurses. Data were collected with an online questionnaire system using the Leiden Operating Theatre and Intensive Care Safety (LOTICS) Scale and Patient Safety Climate (PSC) Scale.

FINDINGS

Intensive care unit (ICU) nurses were found to have higher perceptions of patient safety (106.0 ± 15.2 vs 102.6 ± 17.0) and safety climate (59.2 ± 20.9 vs 50.9 ± 24.3) than Operating Room (OR) nurses. According to ICU nurses, OR nurses stated that teamwork was weak, they did not feel like a part of the team, and teamwork was incompatible. They stated that there was no preliminary information about the operation, that they could not get enough information during the operation, that sufficient materials were not available in the OR in case of need, and that the worn-out materials were not replaced and repaired in a timely manner.

CONCLUSION

As nurses' perception of patient safety increases; patient safety climate perceptions also increased. Providing both professional and in-service trainings to raise awareness of patient safety, developing strategies that prevent team conflicts, providing preliminary information about the surgery, and eliminating material deficiencies can increase nurses' perception of PSC.

Evaluation of COVID-19 Patient Safety Compared to Non-COVID-19 Patients and Predisposing Factors of Nursing Errors

Objectives: The present study aims to determine Patient Safety in hospitalized patients with COVID-19 compared to non-COVID-19 ones and find predisposing factors of nursing errors according to nurses’ perceptions. Methods: This descriptive-comparative research employed data from 800 nurses in eight Iranian hospitals in 2021 using three researcher-made questionnaires of sociodemographic, patient safety indicators, and predisposing factors of nursing errors, with high reliability and validity. The collected data were analyzed using ANOVA, independent t-test, and the SPSS22 software. Results: The mean patient safety scores in patients with and without COVID-19 were 3.42 ± 0.17 and 3.74 ± 0.06, respectively. The highest differences in patient safety were attributed to infection control (0.66) and patient fall (0.56) dimensions. The most common causes of nursing errors were related to management (2.67 ± 1.39), and the most common predisposing factors of nursing errors were high workload, low ratio of nurses to patients, and fatigue. Conclusions: COVID-19 patients have lower safety than non-COVID ones. Also, improper management and high workload lead to nursing errors. Therefore, the authorities must devise appropriate strategies to reduce the nurses’ workload and improve patient safety, especially in COVID-19 patients.

Patient safety culture in Palestine: university hospital nurses' perspectives

Background

Understanding the perspectives of healthcare workers toward patient safety-related activities is critical in maintaining a healthy safety climate. The objectives of this research are 1) to examine the perception of Patient Safety Culture (PSC) at a university hospital in Palestine, and to highlight areas in need of improvement, and 2) to assess the relationship between the outcome dimensions (frequency of events reported, and overall perceptions of safety) and the other dimensions of PSC, and 3) to determine the relationship among selected demographic variables (gender, age, hospital tenure, work tenure, profession tenure, and hours worked per week) and nurses’ perceptions of PSC.

Methods

A cross-sectional study design was used with a convenience sample of 107 nurses. Nurses were asked by email to complete the Arabic version of the Hospital Survey of Patients’ Safety Culture (HSOPSC) using the SurveyMonkey® online account form within two weeks. The survey data were analyzed using descriptive and inferential statistics. Univariate and multiple regression were used to examine the relationships.

Results

The dimensions of patient safety with the highest positive response were organizational learning and continuous improvement (87%) and teamwork within units (86%). The dimension with the lowest positive score was the nonpunitive response to error (22%). Multiple regression revealed that the dimension of communication openness was a predictor of the overall perceptions of safety (β = 0.257, p = 0.019). In addition, the dimension of feedback and communication about error was a predictor of the frequency of the reported events (β = 0.334, p = 0.005). Furthermore, age was found to be a predictor of PSC (p < 0.05).

Conclusions

This study provides a general assessment of perceived safety among nurses in a hospital. However, we found that nurses negatively perceive a nonpunitive response to error. Therefore, strenuous efforts are required by hospital management to improve the culture of incident reporting.

Safety climate in hospitals: A cross-sectional study on the perspectives of nurses and midwives

Aims

To explore nurses' and midwives' perspectives of safety climate in Austrian hospitals as measurable elements of safety culture and to identify areas of quality improvement.

Background

Due to close contact with patients, nurses and midwives play a vital role in ensuring patient safety.

Method

An online survey among 713 nurses and midwives was conducted, using the 19‐item Safety Climate Survey (SCS). To answer the survey, a 5‐point Likert scale was provided with higher ratings indicating a more positive safety climate.

Results

Results demonstrate a positive safety culture (MD 4.09, SD 0.53). Significant group differences in overall safety climate score could be found regarding nurses and midwives in managerial positions, between gender and participants age with low effect size. High item missing rates focus aspects on management/leadership, institutional concerns, leadership by physicians, and handling of adverse events. In addition, these items present the lowest ratings in safety climate.

Conclusion

Results indicate potentials for optimization in the areas of leadership communication and feedback, the handling of safety concerns, and visibility or improvement of patient safety strategies.

Implications for Nursing Management

A regular, standardized safety climate measurement can be a valuable tool for nurse managers and (political) decision‐makers to manage patient safety initiatives.

Predictors of Nurse-Reported Quality of Care in Neonatal Intensive Care Units in Korea

PURPOSE

This study aimed to investigate predictors of nurse-reported quality of care (NQoC) in neonatal intensive care units (NICU) in Korea.

DESIGN AND METHODS

The study participants were 217 NICU nurses working in four tertiary general hospitals and three general hospitals across South Korea. Data were collected in February 2019, when a survey was performed to measure nurse-related characteristics, intent to leave, job satisfaction, and NQoC. Collected data were analyzed using t-test, chi-square test, and hierarchical logistic regression on the SPSS WIN 26.0 program.

RESULTS

Approximately 53% of NICU nurses perceived good quality of care. NICU work experience of less than 2 years and 2 to 4 years were associated with increased odds of good NQoC in all regression models. Perceived adequacy of nurse staffing level was significantly associated with increased odds of good NQoC in model 2 (OR 4.90, 95% CI: 1.75-13.70), model 3 (OR 5.01, 95% CI: 1.73-14.50), and model 4 (OR 3.96, 95% CI: 1.29-12.12). Moreover, in model 3, intent to leave was associated with decreased odds of good NQoC (OR 0.83, 95% CI: 0.21-0.71), and job satisfaction was associated with increased odds of good NQoC (OR 5.41, 95% CI: 2.74-10.67) in model 4.

CONCLUSIONS

Nurses' NICU work experience, adequate nurse staffing level, no intent to leave, and job satisfaction were predictors of good NQoC among NICU nurses.

PRACTICE IMPLICATION

Improvement of nurse staffing levels and job satisfaction is a promising strategy to achieve good quality of care in NICUs.

Using Dominance Analysis to Identify the Most Important Dimensions of Safety Culture for Predicting Patient Safety

Studies have demonstrated associations between safety culture and patient safety based on the perceptions of healthcare professionals, but limited attention has been given to the perceptions of nurses. Moreover, most studies have used regression modeling, an approach that limits researchers’ ability to identify the most important predictors of patient safety due to intercorrelations among predictors in the model. Therefore, the purpose of this study was to examine the effects of seven dimensions of safety culture on nurse-rated patient safety and identify the relative importance of these dimensions for predicting patient safety. This correlational study used data from the Agency for Healthcare Research and Quality’s 2018 Hospital Survey on Patient Safety Culture. Data from 13,031 nurses working in surgical areas of 443 hospitals in the United States were examined using logistic regression and dominance analysis. Staffing adequacy was the strongest predictor of patient safety, followed by hospital management support for patient safety and organizational learning/continuous improvement. However, dominance analysis showed that hospital management support for patient safety was the most important predictor rather than staffing adequacy. Nurse managers and hospital administrators should role model a culture of safety and demonstrate their valuing of patient safety by providing sufficient resources, listening to and valuing staff suggestions regarding patient safety, and providing feedback about organizational changes to improve patient safety.

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.

An exploration of health workers risks of contracting tuberculosis in the workplace: a qualitative study

BACKGROUND

To explore the perceptions of health workers on the risks of contracting tuberculosis at Namwala District Hospital. Tuberculosis literature indicates that health workers are at risk of contracting tuberculosis while conducting their daily duties in the workplace. This is mainly attributed to low tuberculosis awareness. It is with this empirical evidence that this study was conducted to further explore health workers risky behavior, attitude and practices that expose them to tuberculosis infection when on duty and eventually generate effective health promotion and public health interventions.

METHODS

Semi-structured interviews lasting between 35 to 45 min were conducted to all the participants. A purposive sampling technique was used to recruit ten participants for this study. All the ten interviews were audio recorded in order to enhance consistency during data analysis process. Interview materials were transcribed verbatim, coded and themes generated to form thematic networks. Data analysis was conducted using thematic analysis strategy.

RESULTS

Four themes were identified; 1. Health workers personal safety: participants reported wearing uniforms and gloves but they were not putting-on face masks hence, exposing themselves to tuberculosis infection. 2. Tuberculosis infection prevention practices: hand washing was described by many participants as a universal method of protecting health staff from the risks of contracting tuberculosis at the hospital however, few health workers frequently washed their hands after attending to tuberculosis patients. 3. Health workers working environment: the working environment at the hospital was not conducive for both health workers and patients due to poor ventilation, unhygienic conditions, overcrowding and the lack of an isolation ward. 4. Health promotion: awareness on tuberculosis was reported to be low with no refresher training being conducted for health workers at the hospital.

CONCLUSION

The risks of contracting tuberculosis by health workers at Namwala District Hospital did exist hence, a need of advocating for tuberculosis awareness for health workers through appropriate health promotion interventions. Health policy should focus on continuous health promotion activities on prevention and control of tuberculosis in health facilities and communities.

Interface between accreditation and patient safety: nursing team perspectives

OBJECTIVE

To understand the relationship between accreditation and patient safety from the perspective of the nursing team.

METHOD

A descriptive-exploratory study implementing a qualitative approach. It was developed with nursing workers from two Intensive Care Units in a hospital certified in excellence by Brazilian accreditation. The participants responded to individual semi-structured interviews guided by the question: "Tell me about the relationship between accreditation and patient safety in this hospital and unit". The corpus was transcribed in full, and the thematic content analysis technique was used.

RESULTS

There were 14 professionals interviewed. There are several specific improvements in patient safety mediated by accreditation between the two emerging categories. The workers reported that at times the advances in safe care are transversally visible to the certification/maintenance of accreditation visit, and at times they point to safety as something independent of the quality seal.

CONCLUSION

It was concluded that the investigated relationship was shown to be both dependent, as accreditation is a bridge for specific improvements, as well as independent, since patient safety goes beyond the certification process itself. In this context, criticality was revealed among nursing workers.

Factors associated with patient safety in neonatal intensive care units: A multicenter study using ordinal logistic regression

AIM

This study aimed to identify nurses' staffing levels, neonatal infection experience, infection control knowledge, and infection control performance, as well as levels of patient safety, and to verify the factors influencing patient safety related to infection control in multi-centered neonatal intensive care units (NICUs).

METHODS

A self-administered questionnaire was completed by 251 NICU nurses working in seven hospitals throughout South Korea. The data were collected in February 2019 and analyzed using generalized ordinal logistic regression.

RESULTS

The distribution of patient safety was as follows: level 1 (very poor) 0%, level 2 (poor) 6.8%, level 3 (fair) 29.7%, level 4 (good) 35.0%, level 5 (very good) 21.5%, and level 6 (excellent) 7.2%. The factors influencing patient safety differed across the different levels of patient safety. Comparing patient safety level 2 with the other levels (3, 4, 5, 6), the nurse staffing level (b = 1.12) was a significant influencing factor. Comparing patient safety levels 2, 3, 4 and 5 with level 6, the influencing factors were neonatal infection experience (b = -1.18) and infection control performance (b = 5.77).

CONCLUSION

The nurse staffing level was a factor when patient safety levels were low, and nurses' neonatal infection experience and infection control performance were factors when patient safety levels were high. Institutional policy efforts are required to identify patient safety levels in NICUs to develop comprehensive strategies to ensure appropriate nurse staffing and enhance neonatal infection control performance to prevent infections.

The Enabling, Enacting, and Elaborating Factors of Safety Culture Associated With Patient Safety: A Multilevel Analysis

PURPOSE

Worldwide, 1 in 10 hospital patients is harmed while receiving care. Despite evidence that a culture of safety is associated with greater patient safety, these effects and the processes by which safety culture impacts patient safety are not yet clearly understood. Therefore, the purpose of this study was to examine the effects of various safety culture factors on nurses' perceptions of patient safety using an innovative theoretical model.

DESIGN

This descriptive, correlational study drew on deidentified, publicly available data from the 2018 Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. The study sample included 34,514 nurses who provided direct care to patients in medical and surgical units in 535 hospitals in the United States.

METHODS

Multilevel linear regression was used to examine the effects of 11 safety culture factors on nurses' overall perceptions of patient safety. The 11 safety culture factors were grouped as enabling, enacting, and elaborating processes, and entered in separate blocks.

FINDINGS

All 11 safety culture factors were associated with nurse-perceived patient safety, and all but two of the 11 factors uniquely predicted nurse-perceived patient safety. Staffing adequacy was the strongest predictor of nurse-perceived patient safety, followed by hospital management support for patient safety (both enabling processes), and continuous organizational learning and improvement (an elaborating process).

CONCLUSIONS

Hospital administrators and managers play a key role in promoting a safety culture and patient safety in healthcare organizations through enabling and elaborating processes.

CLINICAL RELEVANCE

Organizational efforts should be made to provide sufficient staffing and hospital-wide support for patient safety. However, all staff, administrators, and managers have a role to play in patient safety.

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

INTRODUCTION

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

METHODS

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

FINDINGS

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

CONCLUSION

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

Psychometric testing of the Turkish version of the Health Professional Education in Patient Safety Survey: H-PEPSSTR

Nursing students are trained in patient safety issues in clinical settings during their undergraduate nursing education both theoretically and practically. This study aims to test the psychometric properties of the Turkish version of the "Health Professional Education in Patient Safety Survey" which was developed to measure healthcare professional candidates' patient safety knowledge and competence both in the classroom and clinical settings during their education. The data for this methodological study were collected from 305 nursing students in 2017. The tool consisted of 23 items, two main dimensions as classroom and clinical settings and six subscales. Content validity ratings of the scale items were over 0.80. Five modifications were made during the Confirmatory Factor Analyses. Three of the modifications were among classroom items and two of them were from clinical settings items. After modifications, fit indices were calculated as: χ2/df = 2.58, RMSEA = 0.072 and CFI = 0.95 for the classroom. They were χ2/df = 2.23, RMSEA = 0.063 and CFI = 0.96 for the clinical settings. Cronbach's alpha coefficient was 0.97 for both classroom and clinical settings. In conclusion, The Turkish version of the scale is valid and reliable in assessment of patient safety knowledge and competence of nursing students.

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

OBJECTIVE

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

DESIGN

Literature review and an analysis framework to review studies.

SETTING

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

DATA SOURCES

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

PRIMARY AND SECONDARY OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Changes in patient safety culture: A patient safety intervention for Finnish forensic psychiatric hospital staff

AIM

To evaluate how a 3-year patient safety intervention, more specifically, the implementation of a patient safety incident reporting system, influences patient safety culture.

BACKGROUND

Positive patient safety culture improves both the quality of health care and patient safety. Nevertheless, nursing managers need tools that can help them develop and evaluate patient safety culture.

METHODS

The Hospital Survey on Patient Safety Culture was used to evaluate patient safety culture at two Finnish forensic psychiatric hospitals (study and control) over two periods, baseline and follow-up. Data were analysed using Z-score and T test statistics.

RESULTS

The follow-up results from the study hospital showed that five patient safety culture dimensions exhibited a significantly (p < 0.05) positive change in positive response rates over the 3-year period. Furthermore, nine out of twelve patient safety culture dimensions at the study hospital showed a significant improvement in mean score. At the control hospital, only the dimension of frequency of reporting events showed a significantly positive change (p < 0.05) in mean score.

CONCLUSION

This research shows that the studied patient safety intervention (implementation of the patient safety incident reporting system) significantly influences patient safety culture.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers should utilize a variety of patient safety interventions to improve patient safety and focus on leveraging information from patient safety incidents to advance patient safety culture.

Healthcare Professional's Perception of Patient Safety Measured by the Hospital Survey on Patient Safety Culture: A Systematic Review and Meta-Analysis

Objective

To assess the culture of patient safety in studies that employed the hospital survey on patient safety culture (HSOPS) in hospitals around the world.

Method

We searched MEDLINE, EMBASE, SCOPUS, CINAHL, and SciELO. Two researchers selected studies and extracted the following data: year of publication, country, percentage of physicians and nurses, sample size, and results for the 12 HSOPS dimensions. For each dimension, a random effects meta-analysis with double-arcsine transformation was performed, as well as meta-regressions to investigate heterogeneity, and tests for publication bias.

Results

59 studies with 755,415 practitioners surveyed were included in the review. 29 studies were conducted in the Asian continent and 11 in the United States. On average studies scored 9 out of 10 methodological quality score. Of the 12 HSOPS dimensions, six scored under 50% of positivity, with “nonpunitive response to errors” the lowest one. In the meta-regression, three dimensions were shown to be influenced by the proportion of physicians and five by the continent where survey was held.

Conclusions

The HSOPS is widely used in several countries to assess the culture of patient safety in hospital settings. The culture of culpability is the main weakness across studies. Encouraging event reporting and learning from errors should be priorities in hospitals worldwide.

Safety Culture, Patient Safety, and Quality of Care Outcomes: A Literature Review

This integrative literature review was conducted to examine the relationships between safety culture and patient safety and quality of care outcomes in hospital settings and to identify directions for future research. Using a search of six electronic databases, 17 studies that met the study criteria were selected for review. This review revealed semantic inconsistencies, infrequent use of a theory or theoretical framework, limited discussions of validity of instruments used, and significant methodological variations. Most notably, this review identified a large array of nonsignificant and inconsistent relationships between safety culture and patient safety and quality of care outcomes. To improve understanding of the relationships, investigators should consider using a theoretical framework and valid measures of the key concepts. Researchers should also give more attention to selecting appropriate sampling and data collection methods, units of analysis, levels of data measurement and aggregation, and statistical analyses.

Improving patient safety culture in Saudi Arabia (2012-2015): trending, improvement and benchmarking

Background

Measuring patient safety culture can provide insight into areas for improvement and help monitor changes over time. This study details the findings of a re-assessment of patient safety culture in a multi-site Medical City in Riyadh, Kingdom of Saudi Arabia (KSA). Results were compared to an earlier assessment conducted in 2012 and benchmarked with regional and international studies. Such assessments can provide hospital leadership with insight on how their hospital is performing on patient safety culture composites as a result of quality improvement plans. This paper also explored the association between patient safety culture predictors and patient safety grade, perception of patient safety, frequency of events reported and number of events reported.

Methods

We utilized a customized version of the patient safety culture survey developed by the Agency for Healthcare Research and Quality. The Medical City is a tertiary care teaching facility composed of two sites (total capacity of 904 beds). Data was analyzed using SPSS 24 at a significance level of 0.05. A t-Test was used to compare results from the 2012 survey to that conducted in 2015. Two adopted Generalized Estimating Equations in addition to two linear models were used to assess the association between composites and patient safety culture outcomes. Results were also benchmarked against similar initiatives in Lebanon, Palestine and USA.

Results

Areas of strength in 2015 included Teamwork within units, and Organizational Learning—Continuous Improvement; areas requiring improvement included Non-Punitive Response to Error, and Staffing. Comparing results to the 2012 survey revealed improvement on some areas but non-punitive response to error and Staffing remained the lowest scoring composites in 2015. Regression highlighted significant association between managerial support, organizational learning and feedback and improved survey outcomes. Comparison to international benchmarks revealed that the hospital is performing at or better than benchmark on several composites.

Conclusion

The Medical City has made significant progress on several of the patient safety culture composites despite still having areas requiring additional improvement. Patient safety culture outcomes are evidently linked to better performance on specific composites. While results are comparable with regional and international benchmarks, findings confirm that regular assessment can allow hospitals to better understand and visualize changes in their performance and identify additional areas for improvement.

Status of patient safety culture in Arab countries: a systematic review

OBJECTIVES

To explore the status of patient safety culture in Arab countries based on the findings of the Hospital Survey on Patient Safety Culture (HSPSC).

DESIGN

Systematic review.

METHODS

We performed electronic searches of the MEDLINE, EMBASE, CINAHL, ProQuest and PsychINFO, Google Scholar and PubMed databases, with manual searches of bibliographies of included articles and key journals. We included studies that were conducted in the Arab countries that were focused on patient safety culture. 2 reviewers independently verified that the studies met the inclusion criteria and critically assessed the quality of the studies.

RESULTS

18 studies met our inclusion criteria. The review identified that non-punitive response to error is seen as a serious issue which needs to be improved. Healthcare professionals in the Arab countries tend to think that a 'culture of blame' still exists that prevents them from reporting incidents. We found an overall similarity between the reported composite score for dimension of teamwork within units in all of the reviewed studies. Teamwork within units was found to be better than teamwork across hospital units. All of the reviewed studies reported that organisational learning and continuous improvement was satisfactory as the average score of this dimension for all studies was 73.2%. Moreover, the review found that communication openness seems to be a concerning issue for healthcare professionals in the Arab countries.

CONCLUSIONS

There is a need to promote patient safety culture as a strategy for improving the patient safety in the Arab world. Improving patient safety culture should include all stakeholders, like policymakers, healthcare providers and those responsible for medical education. This review was limited only to English language publications. The varied settings in which the HSPSC was used may have influenced the areas of strengths and weaknesses as healthcare workers' perception of safety culture may differ.

Mental health nurses' perceptions of patient safety culture in psychiatric settings

BACKGROUND

Mental health nurses have a crucial role in preventing medical incidents and in promoting safety culture because they provide and coordinate most of patients' care. Therefore, they are able to enhance patients' outcomes and reduce nurses' injuries.

AIMS

The aims of this study were to assess the perception of mental health nurses about patients' safety culture and to detect the factors which may affect patients' safety culture at psychiatric hospitals.

METHODS

A predictive correlational design was employed to collect data about patient safety culture and safety outcomes from 224 mental health nurses working in psychiatric hospitals using Hospital Survey on Patient Safety Culture.

RESULTS

Positive scores to patients' safety culture dimensions ranged between 13.4% and 81.2%. Two-thirds of mental health nurses perceived safety as excellent/very good, 20.5% perceived it as acceptable and 10.8% perceived it as poor/failing. Overall perception of safety correlated significantly with four dimensions and explained 32.6% of the variance. Frequency of events reported correlated significantly with six dimensions and explained 23.1% of the variance.

CONCLUSION

Of the 12 dimensions of patients' safety culture, only one was strong, six within acceptable range and five were weak and need improvement.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Healthcare managers and policy-makers should encourage educational interventions and help to establish a reporting system that focus on improving systems, not on blaming individuals and encourage open communication among mental healthcare workers.