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Shourideh M, Yasseri S, Bahai H. Safety culture influence on safety performance of a post-combustion carbon capture facility. Heliyon 2024; 10:e34640. [PMID: 39130412 PMCID: PMC11315172 DOI: 10.1016/j.heliyon.2024.e34640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/25/2024] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
This article explores the influence of safety culture (as a subset of organizational culture) on the safety performance of a post-combustion carbon capture facility. After determining the controlling variables of safety culture, a system dynamics model was built to assess how those variables contribute to the safety performance of the facility. The focus on safety culture arises for avoiding major disasters that could significantly impact a company's ability to continue, as well as minor but disruptive incidents occurring during routine operations (i.e. when there is no system upset). This paper describes the complex relationship between cultural norms, leadership practices, communication patterns, and safety conduct with an emphasis on management and personnel commitment to safety, open communication, safety investments, and productivity pressure. Insights from this study contribute to the development of strategies for enhancing the safety performance of carbon capture operations, thereby promoting the integrity and reliability of these essential elements of energy networks. This paper focuses on the visible aspect of safety culture as manifested in organismal practices. We proposed a system dynamics model to devise strategies to reconcile the profitability while preventing accidents.
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Affiliation(s)
- Maryam Shourideh
- Mechanical Engineering, Brunel University London, United Kingdom
| | - Sirous Yasseri
- Mechanical Engineering, Brunel University London, United Kingdom
| | - Hamid Bahai
- Institute Director Materials & Manufacturing, Brunel University London, United Kingdom
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Ein-Gal Y, Sela R, Arad D, Szyper Kravitz M, Hanhart S, Goldschmidt N, Kedmi-Shahar E, Bitan Y. Translation and Comprehensive Validation of the Hebrew Survey on Patient Safety Culture (HSOPS 2.0). J Patient Saf 2024:01209203-990000000-00243. [PMID: 39051766 DOI: 10.1097/pts.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVES The study aim was to create an updated valid translation into Hebrew of the AHRQ's survey on patient safety culture for hospitals, version 2.0. It also suggested a supplementary section about workers' safety. Comparable and valid measurement tools are important for national and international benchmarking of patient safety culture in hospitals. METHODS The process was carried out by a designated committee according to AHRQ translation guidelines. Methodology included several translation cycles, 6 semistructured cognitive interviews with health workers, and a web-based pilot survey at 6 general hospitals. Main analyses included an exploratory factor analysis, a comparison of the differences in results between versions 1 and 2 of the survey to the differences reported by AHRQ, and content analysis of open-ended questions. RESULTS A total of 483 returned questionnaires met the inclusion criterion of at least 70% completion of the questionnaire. The demographic distributions suggested this sample to be satisfactory representative. Cronbach's alpha for the translated questionnaire was 0.95, meaning a high internal consistency between the survey items. An exploratory factor analysis revealed 8 underlying factors, and a secondary analysis further divided the first factor into 2 components. The factors structure generally resembled HSOPS 2.0 composite measures. Analyses of the new section about health workers' safety showed high involvement and possible common themes. CONCLUSIONS The study demonstrated good psychometric properties-high reliability and validity of the new translated version of the questionnaire. This paper may serve other countries who wish to translate and adapt the safety culture survey to different languages.
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Affiliation(s)
- Yaffa Ein-Gal
- From the Survey and Quality Assurance Department, Quality and Safety Executive Division, Israel Ministry of Health, Jerusalem
| | - Roni Sela
- Patient Safety and Risk Management Unit, Assuta Medical Centers, Tel Aviv
| | | | | | - Shuli Hanhart
- Statistics, Quality and Safety Executive Division, Israel Ministry of Health, Jerusalem
| | - Nethanel Goldschmidt
- Statistics, Quality and Safety Executive Division, Israel Ministry of Health, Jerusalem
| | | | - Yuval Bitan
- Department of Health Policy and Management, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Tsamasiotis C, Fiard G, Bouzat P, François P, Fond G, Boyer L, Boussat B. From Reporting to Improving: How Root Cause Analysis in Teams Shape Patient Safety Culture. Risk Manag Healthc Policy 2024; 17:1847-1858. [PMID: 39072187 PMCID: PMC11277907 DOI: 10.2147/rmhp.s466852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024] Open
Abstract
Background Given the increasing focus on patient safety in healthcare systems worldwide, understanding the impact of Continuous Quality Improvement Programs (QIPs) is crucial. QIPs, including Morbidity and Mortality Conferences (MMCs) and Experience Feedback Committees (EFCs), have been identified as effective strategies for enhancing patient safety culture. These programs engage healthcare professionals in the identification and analysis of adverse events to foster a culture of safety (ie the product of individual and group value, attitudes, and perceptions about quality and safety). This study aimed to determine whether patient safety culture differed regarding care provider participation in MMCs and EFCs activities. Methods A cross-sectional web-only survey was conducted in 2022 using the Hospital Survey on Patient Safety Culture (HSOPS) among 4780 employees at an 1836-bed, university-affiliated hospital in France. We quantified the mean differences in the 12 HSOPS dimension scores according to MMCs and EFCs participation, using Cohen d effect size. We performed a multivariate analysis of variance to examine differences in dimension scores after adjusting for background characteristics. Results Of 4780 eligible employees, 1457 (30.5%) participated in the study. Among the respondents, 571 (39.2%) participated in MMCs or EFCs activities. Participants engaged in MMCs or EFCs reported significantly higher scores in six out of twelve HSOPS dimensions, particularly in "Nonpunitive response to error", "Feedback and communication about error", and "Organizational learning" (Overall effect size = 0.14, 95% confidence interval = 0.11 to 0.17, P<0.001). Notably, involvement in both MMCs and EFCs was associated with higher improvements in patient safety culture compared to non-participation or singular involvement in either program. However, certain dimensions such as "Staffing", "Hospital management support", and "Hospital handoffs and transition" showed no significant association with MMCs or EFCs participation, highlighting broader systemic challenges. Conclusion The study confirms the positive association between participation in MMCs or EFCs and an enhanced culture of patient safety, emphasizing the importance of such programs in fostering an environment conducive to learning, communication, and nonpunitive responses to errors. While MMCs or EFCs are effective in promoting certain aspects of patient safety culture, addressing broader systemic challenges remains crucial for comprehensive improvements in patient safety.
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Affiliation(s)
- Christos Tsamasiotis
- Department of Clinical Epidemiology, Grenoble-Alps University Hospital; Laboratory TIMC-IMAG, UMR 5525 Joint Research Unit, National Center for Scientific Research, Faculty of Medicine, Grenoble Alps University, Grenoble, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, CNRS, Grenoble INP, TIMC, Université Grenoble Alpes, Grenoble, France
| | - Pierre Bouzat
- Department of Anaesthesia and Intensive Care, Centre Hospitalier Universitaire Grenoble, University Grenoble Alpes; INSERM U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Patrice François
- Department of Clinical Epidemiology, Grenoble-Alps University Hospital; Laboratory TIMC-IMAG, UMR 5525 Joint Research Unit, National Center for Scientific Research, Faculty of Medicine, Grenoble Alps University, Grenoble, France
| | - Guillaume Fond
- AP-HM, Aix-Marseille University, School of Medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Marseille, France
| | - Laurent Boyer
- AP-HM, Aix-Marseille University, School of Medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Marseille, France
| | - Bastien Boussat
- Department of Clinical Epidemiology, Grenoble-Alps University Hospital; Laboratory TIMC-IMAG, UMR 5525 Joint Research Unit, National Center for Scientific Research, Faculty of Medicine, Grenoble Alps University, Grenoble, France
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Spanos S, Leask E, Patel R, Datyner M, Loh E, Braithwaite J. Healthcare leaders navigating complexity: a scoping review of key trends in future roles and competencies. BMC MEDICAL EDUCATION 2024; 24:720. [PMID: 38961343 PMCID: PMC11223336 DOI: 10.1186/s12909-024-05689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND As healthcare systems rapidly become more complex, healthcare leaders are navigating expanding role scopes and increasingly varied tasks to ensure the provision of high-quality patient care. Despite a range of leadership theories, models, and training curricula to guide leadership development, the roles and competencies required by leaders in the context of emerging healthcare challenges (e.g., disruptive technologies, ageing populations, and burnt-out workforces) have not been sufficiently well conceptualized. This scoping review aimed to examine these roles and competencies through a deep dive into the contemporary academic and targeted gray literature on future trends in healthcare leadership roles and competencies. METHODS Three electronic databases (Business Source Premier, Medline, and Embase) were searched from January 2018 to February 2023 for peer-reviewed literature on key future trends in leadership roles and competencies. Websites of reputable healthcare- and leadership-focused organizations were also searched. Data were analyzed using descriptive statistics and thematic analysis to explore both the range and depth of literature and the key concepts underlying leadership roles and competencies. RESULTS From an initial 348 articles identified in the literature and screened for relevance, 39 articles were included in data synthesis. Future leadership roles and competencies were related to four key themes: innovation and adaptation (e.g., flexibility and vision setting), collaboration and communication (e.g., relationship and trust building), self-development and self-awareness (e.g., experiential learning and self-examination), and consumer and community focus (e.g., public health messaging). In each of these areas, a broad range of strategies and approaches contributed to effective leadership under conditions of growing complexity, and a diverse array of contexts and situations for which these roles and competencies are applicable. CONCLUSIONS This research highlights the inherent interdependence of leadership requirements and health system complexity. Rather than as sets of roles and competencies, effective healthcare leadership might be better conceptualized as a set of broad goals to pursue that include fostering collaboration amongst stakeholders, building cultures of capacity, and continuously innovating for improved quality of care.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia.
| | - Elle Leask
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Romika Patel
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Michael Datyner
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Erwin Loh
- Royal Australasian College of Medical Administrators, Melbourne, VIC, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
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Alkahf D, Alonazi W. Exploring the safety reporting culture among healthcare practitioners in Saudi hospitals: a comprehensive 2022 national study. BMC Health Serv Res 2024; 24:769. [PMID: 38943125 PMCID: PMC11214220 DOI: 10.1186/s12913-024-11160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/31/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND With the rise in medical errors, establishing a strong safety culture and an effective incident reporting system is crucial. As part of the Saudi National Health Transformation Vision of 2030, multiple projects have been initiated to periodically assess healthcare quality measures and ensure a commitment to continuous improvement. Among these is the Hospital Survey on Patient Safety Culture National Project (HSPSC), conducted regularly by the Saudi Patient Safety Center (SPSC). However, comprehensive tools for assessing reporting culture are lacking. Addressing this gap can enhance reporting, efficiency, and health safety. OBJECTIVE This paper aims to investigate the reporting practices among healthcare professionals (HCPs) in Saudi Arabian hospitals and examine the relationship between reporting culture domains and other variables such as hospital bed capabilities and HCPs' work positions. METHODS The study focuses on measuring the reporting culture-related items measures and employs secondary data analysis using information from the Hospital Survey on Patient Safety Culture conducted by the Saudi Center for Patient Safety in 2022, encompassing hospitals throughout Saudi Arabia. Data incorporated seven items in total: four items related to the Response to Error Domain, two related to the Reporting Patient Safety Events Domain, and one associated with the number of events reported in the past 12 months. RESULTS The sample for the analyzed data included 145,657 HCPs from 392 hospitals. The results showed that the average positive response rates for reporting culture-related items were between 50% and 70%. In addition, the research indicated that favorable response rates were relatively higher among managerial and quality/patient safety/risk management staff. In contrast, almost half had not reported any events in the preceding year, and a quarter reported only 1 or 2 events. Pearson correlation analysis demonstrates a strong negative correlation between bed capacity and reporting safety events, response to error, and number of events reported (r = -0.935, -0.920, and - 0.911, respectively; p < 0.05), while a strong positive correlation is observed between reporting safety events and response to error (r = 0.980; p < 0.01). CONCLUSIONS Almost 75% of the HCPs reported fewer safety events over the last 12 months, indicating an unexpectedly minimal recorded occurrence variance ranging from 0 to 2 incidents.
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Affiliation(s)
- Dyma Alkahf
- Health Administration Department, College of Business Administration, King Saud University , PO Box 71115, Riyadh, 11587, Saudi Arabia.
| | - Wadi Alonazi
- Health Administration Department, College of Business Administration, King Saud University , PO Box 71115, Riyadh, 11587, Saudi Arabia
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Boyer L, Wu AW, Fernandes S, Tran B, Brousse Y, Nguyen TT, Yon DK, Auquier P, Lucas G, Boussat B, Fond G. Exploring the fear of clinical errors: associations with socio-demographic, professional, burnout, and mental health factors in healthcare workers - A nationwide cross-sectional study. Front Public Health 2024; 12:1423905. [PMID: 38989124 PMCID: PMC11233687 DOI: 10.3389/fpubh.2024.1423905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
Background The fear of clinical errors among healthcare workers (HCW) is an understudied aspect of patient safety. This study aims to describe this phenomenon among HCW and identify associated socio-demographic, professional, burnout and mental health factors. Methods We conducted a nationwide, online, cross-sectional study targeting HCW in France from May to June 2021. Recruitment was through social networks, professional networks, and email invitations. To assess the fear of making clinical errors, HCW were asked: "During your daily activities, how often are you afraid of making a professional error that could jeopardize patient safety?" Responses were collected on a 7-point Likert-type scale. HCW were categorized into "High Fear" for those who reported experiencing fear frequently ("once a week," "a few times a week," or "every day"), vs. "Low Fear" for less often. We used multivariate logistic regression to analyze associations between fear of clinical errors and various factors, including sociodemographic, professional, burnout, and mental health. Structural equation modeling was used to explore how this fear fits into a comprehensive theoretical framework. Results We recruited a total of 10,325 HCW, of whom 25.9% reported "High Fear" (95% CI: 25.0-26.7%). Multivariate analysis revealed higher odds of "High Fear" among males, younger individuals, and those with less professional experience. High fear was more notable among physicians and nurses, and those working in critical care and surgery, on night shifts or with irregular schedules. Significant associations were found between "High Fear" and burnout, low professional support, major depressive disorder, and sleep disorders. Conclusions Fear of clinical errors is associated with factors that also influence patient safety, highlighting the importance of this experience. Incorporating this dimension into patient safety culture assessment could provide valuable insights and could inform ways to proactively enhance patient safety.
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Affiliation(s)
- Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Albert W Wu
- Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sara Fernandes
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Bach Tran
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Yann Brousse
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
| | - Tham Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Pascal Auquier
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Guillaume Lucas
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
| | - Bastien Boussat
- TIMC-IMAG, UMR 5525 Joint Research Unit, Centre National de Recherche Scientifique, National Center for Scientific Research, Université Grenoble-Alpes, Grenoble, France
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Department of Public Health, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Finn M, Walsh A, Rafter N, Mellon L, Chong HY, Naji A, O'Brien N, Williams DJ, McCarthy SE. Effect of interventions to improve safety culture on healthcare workers in hospital settings: a systematic review of the international literature. BMJ Open Qual 2024; 13:e002506. [PMID: 38719514 PMCID: PMC11086522 DOI: 10.1136/bmjoq-2023-002506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND In an era of safety systems, hospital interventions to build a culture of safety deliver organisational learning methodologies for staff. Their benefits to hospital staff are unknown. We examined the literature for evidence of staff outcomes. Research questions were: (1) how is safety culture defined in studies with interventions that aim to enhance it?; (2) what effects do interventions to improve safety culture have on hospital staff?; (3) what intervention features explain these effects? and (4) what staff outcomes and experiences are identified? METHODS AND ANALYSIS We conducted a mixed-methods systematic review of published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in MEDLINE, EMBASE, CINAHL, Health Business Elite and Scopus. We adopted a convergent approach to synthesis and integration. Identified intervention and staff outcomes were categorised thematically and combined with available data on measures and effects. RESULTS We identified 42 articles for inclusion. Safety culture outcomes were most prominent under the themes of leadership and teamwork. Specific benefits for staff included increased stress recognition and job satisfaction, reduced emotional exhaustion, burnout and turnover, and improvements to working conditions. Effects were documented for interventions with longer time scales, strong institutional support and comprehensive theory-informed designs situated within specific units. DISCUSSION This review contributes to international evidence on how interventions to improve safety culture may benefit hospital staff and how they can be designed and implemented. A focus on staff outcomes includes staff perceptions and behaviours as part of a safety culture and staff experiences resulting from a safety culture. The results generated by a small number of articles varied in quality and effect, and the review focused only on hospital staff. There is merit in using the concept of safety culture as a lens to understand staff experience in a complex healthcare system.
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Affiliation(s)
- Mairead Finn
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Natasha Rafter
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lisa Mellon
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hui Yi Chong
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Abdullah Naji
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niall O'Brien
- Library Services, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Siobhan Eithne McCarthy
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
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Dirik HF, Seren Intepeler S. An authentic leadership training programme to increase nurse empowerment and patient safety: A quasi-experimental study. J Adv Nurs 2024; 80:1417-1428. [PMID: 37921089 DOI: 10.1111/jan.15926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/20/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Authentic leadership and empowered nurses are necessary if a healthy work environment is to be created and patient safety maintained; however, few studies have examined the impact of authentic leadership, on nurse empowerment and the patient safety climate. PURPOSE The aim of the study was to investigate the impact of an educational intervention delivered through a multi-faceted training programme on nurses' perceptions of authentic leadership, nurse empowerment (both structural and psychological) and the patient safety climate. DESIGN A quasi-experimental study using a one-group pretest-posttest design consistent with TREND guidelines. METHODS The study was conducted in a university hospital between December 2018 and January 2020. Participants were followed for 6 months. The programme involved 36 head nurses (leaders) and 153 nurses (followers). The effectiveness of the programme was evaluated using repeated measures of analysis of variance, dependent sample t-tests and hierarchical regression analysis. RESULTS Following the intervention, safety climate and authentic leadership scores increased among both leaders and followers. Structural and psychological empowerment scores also increased among followers. We found that authentic leadership and structural empowerment were predictors of safety climate. CONCLUSION The implementation of the education programme resulted in positive changes in participants' perceptions of authentic leadership and empowerment, which can enhance patient safety. IMPLICATIONS Healthcare organizations can implement similar multi-faceted training programmes focused on authentic leadership, and nurse empowerment to increase patient safety. Achieving effective results in such programmes can be facilitated by motivating participants with the support of the top management. PATIENT OR PUBLIC CONTRIBUTION The study included nurses in the intervention and the data collection processes. IMPACT Patient safety is a global concern, and improving patient safety culture/climate is a key strategy in preventing harm. Authentic leadership and nurse empowerment are essential in creating healthy work environments and delivering safe, high-quality care. Training programmes addressing these issues can help bring about improvements in healthcare organizations.
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Vikan M, Deilkås EC, Valeberg BT, Bjørnnes AK, Husby VS, Haugen AS, Danielsen SO. The anatomy of safe surgical teams: an interview-based qualitative study among members of surgical teams at tertiary referral hospitals in Norway. Patient Saf Surg 2024; 18:7. [PMID: 38374077 PMCID: PMC10877820 DOI: 10.1186/s13037-024-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams' perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department. METHODS This qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke's method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes. RESULTS The analysis process resulted in three themes describing the participants' perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning. CONCLUSIONS This study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals' competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.
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Affiliation(s)
- Magnhild Vikan
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway.
| | - Ellen Ct Deilkås
- Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Berit T Valeberg
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Ann K Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Vigdis S Husby
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Orthopedic Surgery, Trondheim University Hospital, Trondheim, Norway
- Department of Health Sciences Aalesund, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Aalesund, Norway
| | - Arvid S Haugen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Stein O Danielsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
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Cañadas-Aragón CP. The importance of the patient safety culture in the clinical field. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:75-76. [PMID: 38215883 DOI: 10.1016/j.enfcle.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Claudia Patricia Cañadas-Aragón
- Enfermería, Coordinación de Estudios Clínicos, Clínica Sebastián de Belalcázar, Clínica Colsanitas, Grupo Keralty, Cali, Colombia.
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Mistri IU, Badge A, Shahu S. Enhancing Patient Safety Culture in Hospitals. Cureus 2023; 15:e51159. [PMID: 38283419 PMCID: PMC10811440 DOI: 10.7759/cureus.51159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Patient safety has become a top priority for healthcare organizations. A better patient safety environment is associated with a lower probability of significant complications. Training programmers is critical to promoting patient safety and minimizing misunderstandings. The quality, performance, and productivity of the healthcare industry can be dramatically improved by changing the patient safety atmosphere operating within the hospital sector. Hospitals can significantly reduce medical errors and adverse events by implementing the program and training programmers to prioritize patient safety. This will improve patient outcomes and increase efficiency and effectiveness. Creating a patient safety culture within hospitals will contribute to a higher standard of care and improved overall performance in the healthcare industry. Hospitals can identify systemic problems and implement proactive measures to prevent future incidents by creating an environment in which healthcare professionals feel comfortable reporting errors. A patient safety culture encourages collaboration and open communication among healthcare teams leading to more effective and coordinated care.
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Affiliation(s)
- Isha U Mistri
- Hospital Administration, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| | - Ankit Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| | - Shivani Shahu
- Hospital Administration, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
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Brás CPDC, Ferreira MMC, Figueiredo MDCABD, Duarte JC. Cultura de segurança do doente na prática clínica dos enfermeiros. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6231.3838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Resumo Objetivo: avaliar as caraterísticas psicométricas do Hospital Survey on Patient Safety Culture, caracterizar a cultura de segurança do doente e avaliar a influência das variáveis sociodemográficas e profissionais nas dimensões da cultura de segurança. Método: estudo metodológico, observacional, analítico, transversal, realizado com 360 enfermeiros, utilizando o questionário Hospital Survey on Patient Safety Culture. Os dados foram submetidos à análise descritiva, inferencial e estudos de fiabilidade e validade. Resultados: os enfermeiros possuem em média 42 anos de idade, 19 anos de experiência profissional e são maioritariamente do sexo feminino. Obteve-se boa consistência interna (alfa de Cronbach - 0,83) e índices aceitáveis de qualidade de ajustamento do modelo. O trabalho em equipa dentro das unidades, expetativas do supervisor, feedback e comunicação sobre o erro, foram dimensões que apresentaram scores acima dos 60%. A resposta ao erro não punitiva, frequência da notificação, apoio à segurança pela gestão, dotação de profissionais, apresentaram scores abaixo dos 40%. Estas dimensões são influenciadas pela idade, escolaridade e experiência profissional. Conclusão: as propriedades psicométricas do questionário certificam a sua qualidade. O trabalho em equipa pode ser considerado um fator potenciador da cultura de segurança. Avaliar a cultura de segurança permitiu identificar dimensões problemáticas, possibilitando o planeamento de intervenções futuras.
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Brás CPDC, Ferreira MMC, Figueiredo MDCABD, Duarte JC. Cultura de seguridad del paciente en la práctica clínica de enfermería. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6231.3836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Resumen Objetivo: evaluar las características psicométricas de la Hospital Survey on Patient Safety Culture, caracterizar la cultura de seguridad del paciente y evaluar la influencia de variables sociodemográficas y profesionales en las dimensiones de la cultura de seguridad. Método: estudio metodológico, observacional, analítico, transversal, realizado con 360 enfermeros, utilizando el cuestionario Hospital Survey on Patient Safety Culture. Los datos fueron sometidos a análisis descriptivo e inferencial y estudios de confiabilidad y validez. Resultados: los enfermeros tienen en promedio 42 años de edad, 19 años de experiencia profesional y la mayoría es de sexo femenino. Se obtuvo buena consistencia interna (alfa de Cronbach - 0,83) e índices aceptables de bondad de ajuste del modelo. El trabajo en equipo dentro de las unidades, las expectativas del supervisor, el feedback y la comunicación del error fueron las dimensiones que presentaron puntajes superiores al 60%. La respuesta al error no punitiva, la frecuencia de notificación, el apoyo a la seguridad por parte de los gestores, la dotación de personal, presentaron puntajes por debajo del 40%. Estas dimensiones son influenciadas por la edad, la educación y la experiencia profesional. Conclusión: las propiedades psicométricas del cuestionario certifican su calidad. El trabajo en equipo puede considerarse un factor que potencia la cultura de seguridad. La evaluación de la cultura de seguridad permitió identificar las dimensiones que tenían problemas y poder planificar futuras intervenciones.
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Garzón González G, Parra Ramírez LM. [Validation of a questionnaire to assess patient safety culture in healthcare managers: Psychometric properties and usability]. J Healthc Qual Res 2023; 38:354-365. [PMID: 37891095 DOI: 10.1016/j.jhqr.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 10/29/2023]
Abstract
AIM To validate a reduced and applicable to distinct location version of the only validated questionnaire of patient safety culture in managers in Spanish language. METHOD Questionnaire validation study. Community of Madrid 2022. Reduction/adaptation of the original questionnaire: Giménez-Aibar-Gutiérrez, 2013 Questionnaire was reduced from 85 items to 25; those local or not applicable were removed. Pre-test: Semi-structured survey on comprehension and response scale. There was no need to modify the questionnaire. VALIDATION It was tested in 39 primary care managers without care activity. Internal consistency (α Cronbach), content validity (experts) and construct validity (factor analysis) were analysed. Usability analysis: Survey on time spent and non-response rate. RESULTS α Cronbach=0.894. Content validity: Experts deemed questionnaire was complete. Factor analysis: five factors explain 68% of variance. The factors corresponded to the dimensions of the theoretical construct. Factors, internal consistency of each and correlation with global score were: commitment with patient safety: α Cronbach=0.793, r=0.778; P<.001; procedures/reporting: α Cronbach=0.83, r=0.806; P<.001; attitudes with patient safety: α Cronbach=0.766, r=0.596; P<.001; clinicians involving: α Cronbach=0.773, r=0.798; P<.001; patient safety communication: α Cronbach=0.615, r=0.518; P=.001; usability survey: 95% thought spent time was adequate. Non-response rate was 0%, except one item. CONCLUSION In this work, a reduced and adapted version of questionnaire of Giménez-Aibar-Gutiérrez was validated at distinct location (Madrid region). Psychometric properties and usability, which were found, suggest that the reduced questionnaire is a reliable, valid and usable instrument to assess patient safety culture in managers of any place.
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Affiliation(s)
- G Garzón González
- Unidad de Calidad y Seguridad del Paciente, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España.
| | - L M Parra Ramírez
- Unidad de Calidad y Seguridad del Paciente, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
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Carvalho REFLD, Bates DW, Syrowatka A, Almeida I, Sousa L, Goncalves J, Oliveira N, Gama M, Alencar AP. Factors determining safety culture in hospitals: a scoping review. BMJ Open Qual 2023; 12:e002310. [PMID: 37816540 PMCID: PMC10565149 DOI: 10.1136/bmjoq-2023-002310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE To evaluate and synthesise the factors determining patient safety culture in hospitals. METHODS The scoping review protocol was based on the criteria of the Joanna Briggs Institute. Eligibility criteria were as follows: (1) empirical study published in a peer-reviewed journal; (2) used methods or tools to assess, study or measure safety culture or climate; (3) data collected in the hospital setting and (4) studies published in English. Relevant literature was located using PubMed, CINAHL, Web of Science and PsycINFO databases. Quantitative and qualitative analyses were performed using RStudio and the R interface for multidimensional analysis of texts and questionnaires (IRaMuTeQ). RESULTS A total of 248 primary studies were included. The most used instruments for assessing safety culture were the Hospital Survey on Patient Safety Culture (n=104) and the Safety Attitudes Questionnaire (n=63). The Maslach Burnout Inventory (n=13) and Culture Assessment Scales based on patient perception (n=9) were used in association with cultural instruments. Sixty-six articles were included in the qualitative analysis. In word cloud and similarity analyses, the words 'communication' and 'leadership' were most prominent. Regarding the descending hierarchical classification analysis, the content was categorised into two main classes, one of which was subdivided into five subclasses: class 1a: job satisfaction and leadership (15.56%), class 1b: error response (22.22%), class 1c: psychological and empowerment nurses (20.00%), class 1d: trust culture (22.22%) and class 2: innovation worker (20.00%). CONCLUSION The instruments presented elements that remained indispensable for assessing the safety culture, such as leadership commitment, open communication and learning from mistakes. There was also a tendency for research to assess patient and family engagement, psychological safety, nurses' engagement in decision-making and innovation.
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Affiliation(s)
| | - David W Bates
- General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ania Syrowatka
- General Internal Medicine and Primary Care, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Italo Almeida
- Health Sciences Centre, Universidade Estadual do Ceara, Fortaleza, Ceará, Brazil
| | - Luana Sousa
- Health Sciences Centre, Universidade Estadual do Ceara - Campus do Itaperi, Fortaleza, Ceará, Brazil
| | - Jaira Goncalves
- Health Sciences Centre, Universidade Estadual do Ceara - Campus do Itaperi, Fortaleza, Ceará, Brazil
| | - Natalia Oliveira
- Health Sciences Centre, Universidade Estadual do Ceara - Campus do Itaperi, Fortaleza, Ceará, Brazil
| | - Milena Gama
- Health Sciences Centre, Universidade Estadual do Ceara - Campus do Itaperi, Fortaleza, Ceará, Brazil
| | - Ana Paula Alencar
- Health Sciences Centre, Universidade Estadual do Ceara - Campus do Itaperi, Fortaleza, Ceará, Brazil
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Alanazi FK, Lapkin S, Molloy L, Sim J. Healthcare-associated infections in adult intensive care units: A multisource study examining nurses' safety attitudes, quality of care, missed care, and nurse staffing. Intensive Crit Care Nurs 2023; 78:103480. [PMID: 37379679 DOI: 10.1016/j.iccn.2023.103480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES This study examined the association between safety attitudes, quality of care, missed care, nurse staffing levels, and the rate of healthcare-associated infection (HAI) in adult intensive care units (ICUs). METHODS A cross-sectional study was conducted in five hospitals. Nurses completed a validated survey on safety attitudes, quality of care, missed care, nurse staffing levels, and the frequency of HAIs. Secondary data were collected on the incidence of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) in participating units. Descriptive analysis and generalized linear models were performed. RESULTS A total of 314 nurses from eight ICUs participated in this study. The mean safety culture score was 60.85 (SD = 3.53). ICUs with strong job satisfaction had lower incidence and nurse-reported frequency of CLABSI, CAUTI, and VAP. Missed care was common, with 73.11% of nurses reporting missing at least one required care activity on their last shift. The mean patient-to-nurse ratio was 1.95. Increased missed care and higher workload were associated with higher HAIs. Nurses' perceptions of CLABSI and VAP frequency were positively associated with the actual occurrence of CLABSI and VAP in participating units. CONCLUSION Positive safety culture and better nurse staffing levels can lower the rates of HAIs in ICUs. Improvements to nurse staffing will reduce nursing workloads, which may reduce missed care, increase job satisfaction, and, ultimately, reduce HAIs. IMPLICATIONS FOR CLINICAL PRACTICE Higher levels of job satisfaction among ICU nurses, lower proportions of missed nursing care and higher nurse staffing are associated with lower rates of HAIs. Nurse-reported HAI frequency was positively associated with the incidence of HAIs; therefore, nurses provide reliable data on infection control outcomes in ICU settings.
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Affiliation(s)
| | - Samuel Lapkin
- School of Nursing, University of Wollongong, Wollongong, NSW 2500 Australia; Discipline of Nursing, Faculty of Health, Southern Cross University, Gold Coast, QLD 4225, Australia
| | - Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, NSW 2500 Australia
| | - Jenny Sim
- School of Nursing, University of Wollongong, Wollongong, NSW 2500 Australia; School of Nursing & Midwifery, University of Newcastle, Callaghan, NSW Australia; World Health Organization Collaborating Centre for Nursing, Midwifery & Health Development, University of Technology Sydney, Ultimo, New South Wales, Australia.
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Pulzi Júnior SA, Araujo CAS, Ferreira da Silva M. Leadership to promote patient safety culture in public hospitals managed by social health organizations. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print. [PMID: 37728239 DOI: 10.1108/lhs-03-2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
PURPOSE This paper aims to identify the kind of internal climate leaders should offer health-care professionals to promote a patient safety culture in public hospitals managed by social health organizations in Brazil. DESIGN/METHODOLOGY/APPROACH Two surveys were applied to health-care professionals working at three Brazilian public hospitals. The internal climate survey reached 1,013 respondents, and the patient safety culture survey reached 1,302 participants. Both factor and regression analyses were used to analyze the study model and determine how internal climate influences patient safety culture. FINDINGS Results indicate that to promote a patient safety culture among health-care professionals, leaders should generate an internal climate based on trust to foster pride in working in the hospital. Possibly, the trust dimension is the most important one and must be developed to achieve job satisfaction and provide better services to patients. RESEARCH LIMITATIONS/IMPLICATIONS All the hospitals studied were managed by the same Organização Social de Saúde. Due to the limited responses concerning the respondents' profiles, demographic variables were not analyzed. PRACTICAL IMPLICATIONS This research reveals that the trust and pride dimensions can most strongly influence a positive patient safety culture, helping hospital leaders face this huge managerial challenge of consistently delivering high standards of patient safety. ORIGINALITY/VALUE This research studies the promotion of a patient safety culture in public hospitals managed by social health organizations, characterized by greater flexibility and autonomy in health-care management and by a greater need for accountability.
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Affiliation(s)
| | | | - Mônica Ferreira da Silva
- Programa de Pós-graduação em Informática, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Churruca K, Falkland E, Saba M, Ellis LA, Braithwaite J. An integrative review of research evaluating organisational culture in residential aged care facilities. BMC Health Serv Res 2023; 23:857. [PMID: 37580765 PMCID: PMC10424376 DOI: 10.1186/s12913-023-09857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Evidence suggests that the culture of healthcare organisations, including residential aged care facilities (RACFs), is linked to the quality of care offered. The number of people living in RACFs has increased globally, and in turn, attention has been placed on care quality. This review aimed to identify how organisational culture is studied, sought to elucidate the results of previous studies, and aimed to establish what interventions are being used to improve organisational culture in RACFs. METHODS We employed an integrative review design to provide a comprehensive understanding of organisational culture. Five academic data bases were searched (Ovid Medline, Scopus, PsycInfo, CINAHL, Embase). Articles were included if they were empirical studies, published in peer reviewed journals in English, conducted in a RACF setting, and were focused on organisational culture/climate. RESULTS Ninety-two articles were included. Fifty-nine studies (64.1%) utilised a quantitative approach, while 24 (26.0%) were qualitative, and nine used mixed methods (9.8%). Twenty-two (23.9%) aimed to describe the culture within RACFs, while 65 (70.7%) attempted to understand the relationship between culture and other variables, demonstrating mixed and indeterminate associations. Only five (5.4%) evaluated an intervention. CONCLUSIONS This review highlights the heterogenous nature of this research area, whereby differences in how culture is demarcated, conceptualised, and operationalised, has likely contributed to mixed findings. Future research which is underpinned by a sound theoretical basis is needed to increase the availability of empirical evidence on which culture change interventions can be based.
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Affiliation(s)
- Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW Australia
| | - Emma Falkland
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW Australia
| | - Maree Saba
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW Australia
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Ellis LA, Falkland E, Hibbert P, Wiig S, Ree E, Schultz TJ, Pirone C, Braithwaite J. Issues and complexities in safety culture assessment in healthcare. Front Public Health 2023; 11:1217542. [PMID: 37397763 PMCID: PMC10309647 DOI: 10.3389/fpubh.2023.1217542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
The concept of safety culture in healthcare-a culture that enables staff and patients to be free from harm-is characterized by complexity, multifacetedness, and indefinability. Over the years, disparate and unclear definitions have resulted in a proliferation of measurement tools, with lack of consensus on how safety culture can be best measured and improved. A growing challenge is also achieving sufficient response rates, due to "survey fatigue," with the need for survey optimisation never being more acute. In this paper, we discuss key challenges and complexities in safety culture assessment relating to definition, tools, dimensionality and response rates. The aim is to prompt critical reflection on these issues and point to possible solutions and areas for future research.
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Affiliation(s)
- Louise A. Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Emma Falkland
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Siri Wiig
- SHARE—Centre for Resilience in Healthcare, Department of Quality and Health Technology, Universitetet i Stavanger, Stavanger, Norway
| | - Eline Ree
- SHARE—Centre for Resilience in Healthcare, Department of Quality and Health Technology, Universitetet i Stavanger, Stavanger, Norway
| | - Timothy J. Schultz
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Christy Pirone
- Southern Adelaide Department of Health, Adelaide, SA, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
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Pevec T, Albreht T, Turk E. Safety culture in the operating room: translation, validation of the safety attitudes questionnaire - operating room version. BMC Health Serv Res 2023; 23:491. [PMID: 37193963 DOI: 10.1186/s12913-023-09539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Measuring the safety culture in Healthcare is an important step in improving patient safety. One of the most commonly used instruments to measure the safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the current study was to establish the validity and reliability of the Slovenian version of the SAQ for the operating room SAQ-OR. METHODS The SAQ, consisting of six dimensions, was translated and adapted to the Slovenian context and applied in operating rooms from seven out of ten Slovenian regional hospitals. Cronbach's alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument. RESULTS The sample consisted of 243 health care professionals who hold positions in the OR, divided into 4 distinct professional classes, namely, 76 surgeons (31%), 15 anesthesiologists (6%), 140 nurses (58%) and 12 auxiliary persons (5%). It was observed a very good Cronbach's alpha (0.77 to 0.88). The CFA and its goodness-of-fit indices (CFI 0.912, TLI 0.900, RMSE 0.056, SRMR 0.056) showed an acceptable model fit. There are 28 items in the final model. CONCLUSIONS The Slovenian version of the SAQ-OR revealed good psychometric properties for studying the organisational safety culture.
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Affiliation(s)
- Teodor Pevec
- General Hospital Dr. Jožeta Potrča Ptuj, Ptuj, Slovenia.
- Medical Faculty, University of Maribor, Maribor, Slovenia.
| | - Tit Albreht
- Medical Faculty, University of Maribor, Maribor, Slovenia
- National Institute of Public Health, Ljubljana, Slovenia
| | - Eva Turk
- Medical Faculty, University of Maribor, Maribor, Slovenia
- Centre for Digital Health and Social Innovation, University of Applied Sciences St. Pölten, St. Pölten, Austria
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White VanGompel E, Carlock F, Singh L, Keer E, Brown J, Kane Low L. Attitudes of Clinicians and Patient Safety Culture Before and After the ARRIVE Trial. J Obstet Gynecol Neonatal Nurs 2023; 52:211-222. [PMID: 36720433 PMCID: PMC10544748 DOI: 10.1016/j.jogn.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To assess the attitudes of intrapartum clinicians about elective induction of labor before and after A Randomized Trial of Induction Versus Expectant Management (ARRIVE) and to assess the effect of different attitudes on patient safety culture. DESIGN Repeated cross-sectional design. SETTING Online surveys. PARTICIPANTS Clinicians (883 nurses and 201 physicians in the before-ARRIVE group and 1,741 nurses and 574 physicians in the after-ARRIVE group) who provided intrapartum care at 35 hospitals in California in 2017 and 57 hospitals in Michigan in 2020 and participated in statewide quality improvement efforts to reduce use of cesarean. METHODS We used annual nulliparous, term, singleton, vertex cesarean rates to stratify hospitals into performance quartiles. We used cumulative proportional odds logistic regression to examine induction attitudes before and after ARRIVE by role and hospital performance quartile as well as induction attitudes and patient safety culture among clinicians. We used content analysis to examine qualitative data. RESULTS After ARRIVE, physicians' attitudes shifted in favor of induction at hospitals within the top three performance categories (top quartile: M = 3.48 vs. 2.81, p < .0001), whereas nurses' attitudes did not change (p = .388). After ARRIVE, attitudes among clinicians were more aligned at hospitals with stronger patient safety cultures. Qualitative themes included The Timing of Induction is Important, Who Should Have Inductions, Need for Clear Protocols and More Staff, and Ideas to Improve the Induction of Labor Process. CONCLUSION Physician attitudes about induction were significantly different before versus after ARRIVE, whereas nurse attitudes were not. Differences in attitudes may erode the quality of team-based care; intentional interdisciplinary engagement is essential when implementing ARRIVE findings.
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Pfeiffer Y, Atkinson A, Maag J, Lane MA, Schwappach D, Marschall J. Are cross-sectional safety climate survey results in operating room staff associated with the surgical site infection rates in Swiss hospitals? BMJ Open 2023; 13:e066514. [PMID: 37076144 PMCID: PMC10124250 DOI: 10.1136/bmjopen-2022-066514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the association between surgical site infections (SSIs), a major source of patient harm, and safety and teamwork climate. Prior research has been unclear regarding this relationship. DESIGN Based on the Swiss national SSI surveillance and a survey study assessing (a) safety climate and (b) teamwork climate, associations were analysed for three kinds of surgical procedures. SETTING AND PARTICIPANTS SSI surveillance data from 20 434 surgeries for hip and knee arthroplasty from 41 hospitals, 8321 for colorectal procedures from 28 hospitals and 4346 caesarean sections from 11 hospitals and survey responses from Swiss operating room personnel (N=2769) in 54 acute care hospitals. PRIMARY AND SECONDARY OUTCOMES The primary endpoint of the study was the 30-day (all types) or 1-year (knee/hip with implants) National Healthcare Safety Network-adjusted SSI rate. Its association with climate level and strength was investigated in regression analyses, accounting for respondents' professional background, managerial role and hospital size as confounding factors. RESULTS Plotting climate levels against infection rates revealed a general trend with SSI rate decreasing as the safety climate increased, but none of the associations were significant (5% level). Linear models for hip and knee arthroplasties showed a negative association between SSI rate and climate perception (p=0.02). For climate strength, there were no consistent patterns, indicating that alignment of perceptions was not associated with lower infection rates. Being in a managerial role and being a physician (vs a nurse) had a positive effect on climate levels regarding SSI in hip and knee arthroplasties, whereas larger hospital size had a negative effect. CONCLUSIONS This study suggests a possible negative correlation between climate level and SSI rate, while for climate strength, no associations were found. Future research should study safety climate more specifically related to infection prevention measures to establish clearer links.
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Affiliation(s)
- Yvonne Pfeiffer
- Research department, Stiftung fur Patientensicherheit, Zurich, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Inselspital University Hospital Bern, Bern, Switzerland
| | - Judith Maag
- Department of Infectious Diseases, Inselspital University Hospital Bern, Bern, Switzerland
- Swissnoso, National Center for Infection Control, Bern, Switzerland
| | - Michael A Lane
- Quality & Safety Operations, Parkland Health, Dallas, Texas, USA
| | - David Schwappach
- Institute of Social and Preventive Medicine, Universität Bern, Bern, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Inselspital University Hospital Bern, Bern, Switzerland
- Swissnoso, National Center for Infection Control, Bern, Switzerland
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
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Vikan M, Haugen AS, Bjørnnes AK, Valeberg BT, Deilkås ECT, Danielsen SO. The association between patient safety culture and adverse events - a scoping review. BMC Health Serv Res 2023; 23:300. [PMID: 36991426 DOI: 10.1186/s12913-023-09332-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Adverse events (AEs) affect 10% of in-hospital patients, causing increased costs, injuries, disability and mortality. Patient safety culture (PSC) is an indicator of quality in healthcare services and is thus perceived as a proxy for the quality of care. Previous studies show variation in the association between PSC scores and AE rates. The main objective of this scoping review is to summarise the evidence on the association between PSC scores and AE rates in healthcare services. In addition, map the characteristics and the applied research methodology in the included studies, and study the strengths and limitations of the evidence. METHODS We applied a scoping review methodology to answer the broad research questions of this study, following the PRISMA-ScR checklist. A systematic search in seven databases was conducted in January 2022. The records were screened independently against eligibility criteria using Rayyan software, and the extracted data were collated in a charting form. Descriptive representations and tables display the systematic mapping of the literature. RESULTS We included 34 out of 1,743 screened articles. The mapping demonstrated a statistical association in 76% of the studies, where increased PSC scores were associated with reduced AE rates. Most of the studies had a multicentre design and were conducted in-hospital in high-income countries. The methodological approaches to measuring the association varied, including missing reports on the tools` validation and participants, different medical specialties, and work unit level of measurements. In addition, the review identified a lack of eligible studies for meta-analysis and synthesis and demonstrated a need for an in-depth understanding of the association, including context complexity. CONCLUSIONS We found that the vast majority of studies report reduced AE rates when PSC scores increase. This review demonstrates a lack of studies from primary care and low- and- middle-income countries. There is a discrepancy in utilised concepts and methodology, hence there is a need for a broader understanding of the concepts and the contextual factors, and more uniform methodology. Longitudinal prospective studies with higher quality can enhance efforts to improve patient safety.
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Affiliation(s)
- Magnhild Vikan
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Arvid Steinar Haugen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Berit Taraldsen Valeberg
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- University of South-Eastern Norway, Drammen, Norway
| | | | - Stein Ove Danielsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Alanazi FK, Lapkin S, Molloy L, Sim J. Safety culture, quality of care, missed care, nurse staffing and their impact on pressure injuries: A cross-sectional multi-source study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023. [DOI: 10.1016/j.ijnsa.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Curtis SJ, Trewin A, McCormack LM, Were K, McDermott K, Walsh N. Building a safety culture for infection prevention and control adherence at Howard Springs: A workplace survey. Infect Dis Health 2023; 28:47-53. [PMID: 36127286 DOI: 10.1016/j.idh.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Building a safety culture is essential to facilitate infection prevention and control (IPC) adherence in workplaces. We aimed to explore perceptions, barriers and facilitators to IPC procedures by the Australian Medical Assistance Team (AUSMAT) at Howard Springs International Quarantine Facility (HSIQF). METHODS We performed a descriptive analysis of a cross-sectional survey administered to the AUSMAT employed at HSQIF from October 2020 to April 2021. We described motivation, training and compliance to IPC adherence and Likert scales described the level of agreement to the success of IPC procedures across the domains of communication, risk, trust, safety and environment, from the individual, team and organisational perspective. RESULTS There were 101 participants (response rate 59%, 101/170) and 70% (71/101) were clinical. There was strong agreement to the success of IPC procedures, with a median 4 (agree) or 5 (strongly agree) across each domain and perspective of the 67 Likert items. Clinical staff reported slightly higher agreement than non-clinical staff across Likert items. To improve IPC compliance, most reported that daily training should be provided (77/97, 79%) and daily training was very or extremely effective (91/97, 93%). Participants were motivated by protecting self, friends, family and the community rather than workplace pressures. Barriers to IPC compliance were the ambient environment and fatigue. CONCLUSIONS A safety culture was successfully built at HSQIF to optimise IPC adherence whilst managing multiple hazards including prevention of COVID-19 transmission. Strategies implemented by AUSMAT at the quarantine facility may inform the development of safety culture in other settings.
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Affiliation(s)
- Stephanie J Curtis
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, 0810, Australia.
| | - Abigail Trewin
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, 0810, Australia
| | - Luke M McCormack
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, 0810, Australia; Response Psychological Services, Melbourne, Victoria, 3004, Australia
| | - Karen Were
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, 0810, Australia
| | - Kathleen McDermott
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, 0810, Australia
| | - Nick Walsh
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, 0810, Australia
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Lee SE, Hyunjie L, Sang S. Nurse Managers' Leadership, Patient Safety, and Quality of Care: A Systematic Review. West J Nurs Res 2023; 45:176-185. [PMID: 35876005 DOI: 10.1177/01939459221114079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This review examined relationships between nurse unit managers' leadership and patient safety and quality of care outcomes in hospital settings. Employing four databases (CINAHL, Embase, PubMed, and Web of Science) and ancestry searches, we identified 14 English-language, peer-reviewed, primary studies that examined such relationships using quantitative analyses. The studies were published between 2012 and 2021, and most used a cross-sectional design. Each study's quality was assessed using the Mixed-Method Appraisal Tool. In synthesizing results by categorizing outcomes, we found a positive trend in associations between effective nurse unit manager leadership and better outcomes, including fewer patient adverse events, increased nurse error reporting, and higher patient satisfaction and care quality. However, the heterogeneity of leadership measurement approaches and outcomes limited integration of study findings. Future researchers should clearly define study concepts to support interpretation of their findings and should use a suitable theoretical framework to help determine appropriate units of analysis.
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Affiliation(s)
- Seung Eun Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Lee Hyunjie
- Severance Hospital, College of Nursing, Graduate School, Yonsei University, Seoul, South Korea
| | - Somin Sang
- College of Nursing, Graduate School, Yonsei University, Seoul, South Korea
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De Miguel MS, de Elguea JO, Gómez-Gastiasoro A, Urcola F, Cid-Expósito MG, Torres-Enamorado D, Orkaizagirre-Gomara A. Patient safety and its relationship with specific self-efficacy, competence, and resilience among nursing students: A quantitative study. NURSE EDUCATION TODAY 2023; 121:105701. [PMID: 36563588 DOI: 10.1016/j.nedt.2022.105701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/01/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Patient safety is a relevant subject in the nursing curriculum. Each university programs patient safety teaching and practical training differently. However, few studies have sought to explore the relationship between patient safety as perceived by nursing students and other important psychosocial competencies in the nursing curriculum, such as self-efficacy, competence, and resilience. OBJECTIVES To analyze differential patient safety integration into three nursing education programs, and to assess agreement levels regarding patient safety climate, students' knowledge of patient safety and correlations with specific self-efficacy, competence and resilience. METHODS Participants were 647 undergraduate students from three universities. Patient safety climate and knowledge of patient safety (good praxis) were measured using the Hospital Survey on Patient Safety Culture for nursing students, and other psychosocial variables were also analyzed using other instruments: specific self-efficacy, perceived competence and resilience. Nursing education programs and patient safety climate were analyzed using the Rwg(j) and ICC measures of inter-rater agreement across different academic levels. RESULTS The ICC and Rwg indexes revealed high inter-rate agreement in all three universities. Differences were observed between Univ-2 and Univ-3 in patient safety climate scores and agreement values between academic levels. Differences in good praxis were found when academic levels were compared in Univ1-and Univ-2. Patient safety climate was found to correlate significantly with the psychosocial variables studied, but only in Univ-1. CONCLUSIONS Perceived patient safety climate differs between universities and academic levels. This competency is related to self-efficacy, competence and resilience, which endorses the assessment of patient safety integration from a broader perspective.
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Affiliation(s)
- Manuel Sánchez De Miguel
- Faculty of Psychology, University of the Basque Country UPV/EHU, San Sebastián, Gipuzkoa, Spain; Biodonostia Health Research Institute, San Sebastián, Gipuzkoa, Spain.
| | - Javier Ortiz de Elguea
- Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, San Sebastián, Gipuzkoa, Spain; Donostia University Hospital (Osakidetza, Basque Health Service), San Sebastián, Gipuzkoa, Spain
| | | | - Fernando Urcola
- Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
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Babaie M, Nourian M, Atashzadeh-Shoorideh F, Manoochehri H, Nasiri M. Patient safety culture in neonatal intensive care units: A qualitative content analysis. Front Public Health 2023; 11:1065522. [PMID: 36741949 PMCID: PMC9895384 DOI: 10.3389/fpubh.2023.1065522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
Background Safety culture, as an important and influential component of neonatal safety, can lay the ground for the provision of professional and quality care by creating a positive insight among workers. The present study aimed to explain the concept of safety culture and its dimensions from the perspective of the nurses and the physicians working in neonatal intensive care units (NICUs). Methods This qualitative directed content analysis study was carried out with 24 NICU physicians and nurses working in Tehran, Iran. These multicenter participants were selected through purposive sampling with maximum diversity in terms of demographic characteristics. The data was collected through in-depth semi-structured interviews and was analyzed using the deductive approach. The COREQ checklist was used for the comprehensive report of this study. Results The concept of patient safety culture in NICUs included achieving professional development, constructive interactions, organizational supportive climate, management's commitment to neonatal safety, planning and implementation of neonatal developmental care, which are extracted from 5 main categories, 10 generic categories and 21 sub-categories. Conclusion The dimensions of safety culture include procedures that, if promoted, could improve neonatal safety, reducing harm to neonates' health while expending less financial and human resources. Gaining knowledge of the status of these dimensions in wards and hospitals can give a purposeful direction to promote neonate health and policymaking.
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Affiliation(s)
- Mohadese Babaie
- Student Research Committee, Department of Pediatric and Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Manijeh Nourian
- Department of Pediatric and Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Manijeh Nourian ✉
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Houman Manoochehri
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Biostatistics, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Vifladt A, Ballangrud R, Myhr K, Grusd E, Porthun J, Mæhlum PA, Aase K, Sollid SJM, Odberg KR. Team training program's impact on medication administration, teamwork and patient safety culture in an ambulance service (TEAM-AMB): a longitudinal multimethod study protocol. BMJ Open 2023; 13:e067006. [PMID: 36669839 PMCID: PMC9872483 DOI: 10.1136/bmjopen-2022-067006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Medication administration errors (MAEs) have the potential for significant patient harm, and the frequency of MAEs in the ambulance services is not well known. Effective teamwork is paramount for providing safe and effective patient care, especially in a time-sensitive, high-risk environment such as the ambulance services. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based team training programme that, to our knowledge, has not been studied in the ambulance services previously. TeamSTEPPS is based on the five principles: team structure, communication, leadership, situation monitoring and mutual support. This study aims to advance the knowledge of the medication administration process in the ambulance services and study the impact of a team training programme on the frequency of MAEs, and the perception of teamwork, and patient safety culture. METHODS AND ANALYSIS This study uses a longitudinal multimethod design to evaluate medication administration and the implementation of the team training programme TeamSTEPPS in an ambulance service. A review of electronic patient journals 6 months prior to the intervention, and 12 months after the intervention will provide data on the frequency of MAEs. Focus group interviews and questionnaires will be carried out before and after the intervention to describe the perception of teamwork and patient safety culture among ambulance professionals. Observations, individual interviews and a review of guidelines will be conducted in the first and second quarters of 2022 to study the medication administration process in ambulance services. ETHICS AND DISSEMINATION The study protocol was reviewed by the Regional Committees for Medical and Health Research Ethics Central Norway and approved by the Hospital Trust data protection officer, and the head of the Prehospital Division at the Hospital Trust. The data material will be managed confidentially and stored according to regulations. The results will be disseminated through scientific papers, reports, conference presentations, popular press, and social media. TRIAL REGISTRATION NUMBER NCT05244928.
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Affiliation(s)
- Anne Vifladt
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Randi Ballangrud
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Kjetil Myhr
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Acute Care Medicine, Innlandet Hospital Trust, Brumunddal, Norway
| | - Eystein Grusd
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Prehospital Care, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jan Porthun
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Pål Anders Mæhlum
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
- Department of Prehospital Care, Innlandet Hospital Trust, Brumunddal, Norway
| | - Karina Aase
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
- Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Stephen J M Sollid
- Department of Prehospital Care, Innlandet Hospital Trust, Brumunddal, Norway
- Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kristian Ringsby Odberg
- Department of Health Sciences Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
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Wang Q, Zhao Y, Wang J, Liu H, Zhang H. Research on the Characteristics of Safety Culture and Obstacle Factors among Residents under the Influence of COVID-19 in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1676. [PMID: 36767054 PMCID: PMC9914590 DOI: 10.3390/ijerph20031676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Qifei Wang
- School of Mechanical-Electronic and Vehicle Engineering, Beijing University of Civil Engineering and Architecture, Beijing 102616, China
| | - Yihan Zhao
- School of Mechanical-Electronic and Vehicle Engineering, Beijing University of Civil Engineering and Architecture, Beijing 102616, China
| | - Jian Wang
- Institute of Urban Systems Engineering, Beijing Academy of Science and Technology, Beijing 100089, China
| | - Haolin Liu
- School of Mechanical-Electronic and Vehicle Engineering, Beijing University of Civil Engineering and Architecture, Beijing 102616, China
| | - Hui Zhang
- Research Center of Urban Operation Safety, Beijing Academy of Emergency Management Science and Technology, Beijing 101101, China
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Brás CPDC, Ferreira MMC, de Figueiredo MDCAB, Duarte JC. Patient safety culture in nurses' clinical practice. Rev Lat Am Enfermagem 2023; 31:e3837. [PMID: 36995849 PMCID: PMC10077844 DOI: 10.1590/1518-8345.6231.3837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/07/2022] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE to assess the psychometric characteristics of the Hospital Survey on Patient Safety Culture, to characterize the patient safety culture, and to assess the influence of the sociodemographic and professional variables on the safety culture dimensions. METHOD a methodological, observational, analytical and cross-sectional study conducted with 360 nurses in which the Hospital Survey on Patient Safety Culture questionnaire was used. The data were submitted to descriptive and inferential analysis, as well as to feasibility and validity studies. RESULTS the nurses' mean age is 42 years old, their mean time of professional experience is 19 years, and they are mostly female. Good internal consistency was obtained (Cronbach's alpha: 0.83), as well as acceptable model fit quality indices. Teamwork within units, Supervisor expectations and Feedback and communication about errors were the dimensions that obtained scores above 60%. Non-punitive response to error, Frequency of events reported, Support for patient safety and Staffing presented scores below 40%. These dimensions are influenced by age, schooling level and professional experience. CONCLUSION the psychometric properties of the questionnaire certify its good quality. Teamwork can be considered as an enhancing factor for the safety culture. Assessing the safety culture allowed identifying problematic dimensions, thus enabling planning of future interventions.
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Affiliation(s)
- Cláudia Patrícia da Costa Brás
- Escola Superior de Enfermagem de Coimbra, Unidade de Investigação em Ciências da Saúde (UICISA: E), Coimbra, PT, Portugal
| | - Manuela Maria Conceição Ferreira
- Escola Superior de Saúde de Viseu - Instituto Politécnico de Viseu, Unidade de Investigação em Ciências da Saúde (UICISA: E/ESEnfC - ESSV/IPV), Viseu, PT, Portugal
| | | | - João Carvalho Duarte
- Escola Superior de Saúde de Viseu - Instituto Politécnico de Viseu, Unidade de Investigação em Ciências da Saúde (UICISA: E/ESEnfC - ESSV/IPV), Viseu, PT, Portugal
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Krishnamoorthy Y, Samuel G, Elangovan V, Kanth K, Krishnan M, Sinha I. Development and validation of questionnaire assessing the perception of hospital patient safety practices in public health facilities of India. Int J Qual Health Care 2022; 34:mzac087. [PMID: 36281952 DOI: 10.1093/intqhc/mzac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/06/2022] [Accepted: 10/24/2022] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND In 'To Err is Human' released by the Institute of Medicine Committee on Quality of Health Care, it was emphasized that it is important to establish a safety culture in the hospitals and ensure that patients are not inadvertently harmed by errors. OBJECTIVE Hence, we developed and validated a questionnaire for assessing the perception of patient safety practices across secondary and tertiary care facilities in India. METHOD The scale was developed based on the literature review and expert opinion. It consisted of 10 questions, and the responses to these items were based on a five-point Likert scale ranging from 'strongly agree' to 'strongly disagree'. All analysis was performed using STATA version 14.2 software. Exploratory factor analysis (EFA) was run using principal component analysis with oblique promax rotation and confirmatory factor analysis (CFA) using structural equation modelling with maximum likelihood estimation. RESULTS The entire dataset was split into testing set to run EFA (with 692 participants) and validation set to run CFA (with 645 participants). In EFA, two factors were retained as they had eigenvalue more than one (4.76, 1.09) and the scree plot also showed that the slope flattens off after two factors. Factor loadings were generated using oblique promax rotation. Factor 1 consisted of seven items (Item 1, Item 2, Item 3, Item 4, Item 5, Item 6 and Item 7-questions related to patient-doctor communication, hospital environment and procedures) accounting for 47.6% of variance, and Factor 2 had three items (Item 8, Item 9 and Item 10-infection prevention and control practices in hospital) explaining 10.9% of the variance. Thus, together, the two factors explained 58.5% of the variance. CFA revealed good confirmatory fit indices of 0.85, standardized root mean square residual of 0.07 and acceptable Tucker-Lewis Index of 0.80. The reliability coefficient was 0.88 indicating very good internal consistency. CONCLUSION This study develops and validates a scale that can be used universally for assessing the patients' perception on hospital safety practices across secondary and tertiary care facilities in India.
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Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai 600078, India
| | - Gerald Samuel
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai 600078, India
| | - Venmathi Elangovan
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai 600078, India
| | - Krishna Kanth
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai 600078, India
| | - Murali Krishnan
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai 600078, India
| | - Isha Sinha
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai 600078, India
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Finn M, Mellon L, Walsh A, O'Brien N, Williams DJ, Rafter N, McCarthy SE. 'What effect do safety culture interventions have on health care workers in hospital settings?' A systematic review of the international literature. HRB Open Res 2022; 5:48. [PMID: 37485071 PMCID: PMC10357077 DOI: 10.12688/hrbopenres.13576.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 07/25/2023] Open
Abstract
Introduction: Interventions designed to improve safety culture in hospitals foster organisational environments that prevent patient safety events and support organisational and staff learning when events do occur. A safety culture supports the required health workforce behaviours and norms that enable safe patient care, and the well-being of patients and staff. The impact of safety culture interventions on staff perceptions of safety culture and patient outcomes has been established. To-date, however, there is no common understanding of what staff outcomes are associated with interventions to improve safety culture and what staff outcomes should be measured. Objectives: The study seeks to examine the effect of safety culture interventions on staff in hospital settings, globally. Methods and Analysis: A mixed methods systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches will be conducted using the electronic databases of MEDLINE, EMBASE, CINAHL, Health Business Elite, and Scopus. Returns will be screened in Covidence according to inclusion and exclusion criteria. The mixed-methods appraisal tool (MMAT) will be used as a quality assessment tool. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials and non-randomised studies of interventions will be employed to verify bias. Synthesis will follow the Joanna Briggs Institute methodological guidance for mixed methods reviews, which recommends a convergent approach to synthesis and integration. Discussion: This systematic review will contribute to the international evidence on how interventions to improve safety culture may support staff outcomes and how such interventions may be appropriately designed and implemented.
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Affiliation(s)
- Mairéad Finn
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lisa Mellon
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Niall O'Brien
- Library Services, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - David J. Williams
- Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Natasha Rafter
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Siobhán E. McCarthy
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Tenza IS, Attafuah PYA, Abor P, Nketiah-Amponsah E, Abuosi AA. Hospital managers’ views on the state of patient safety culture across three regions in Ghana. BMC Health Serv Res 2022; 22:1300. [DOI: 10.1186/s12913-022-08701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
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.
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Ellis LA, Pomare C, Churruca K, Carrigan A, Meulenbroeks I, Saba M, Braithwaite J. Predictors of response rates of safety culture questionnaires in healthcare: a systematic review and analysis. BMJ Open 2022; 12:e065320. [PMID: 36113948 PMCID: PMC9486325 DOI: 10.1136/bmjopen-2022-065320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Safety culture questionnaires are widely used in healthcare to understand how staff feel at work, their attitudes and views, and the influence this has on safe and high-quality patient care. A known challenge of safety culture questionnaires is achieving high response rates to enhance reliability and validity. This review examines predictors of response rates, explores reasons provided for low response rates and identifies strategies to improve those rates. METHODS Four bibliometric databases were searched for studies assessing safety culture in hospitals from January 2008 to May 2022. Data were extracted from 893 studies that included a safety culture questionnaire conducted in the hospital setting. Regression was used to predict response rate based on recruitment and data collection methods (incentives, reminders, method of survey administration) and country income classification. Reasons for low response were thematically analysed and used to identify strategies to improve response rates. RESULTS Of the 893 studies that used a questionnaire to assess safety culture in hospitals, 75.6% reported a response rate. Response rates varied from 4.2% to 100%, with a mean response rate of 66.5% (SD=21.0). Regression analyses showed that safety culture questionnaires conducted in low-income and middle-income countries were significantly more likely to yield a higher response rate compared with high-income countries. Mode of administration, questionnaire length and timing of administration were identified as key factors. Remote methods of questionnaire data collection (electronic and by post) were significantly less likely to result in a higher response rate. Reasons provided for low response included: survey fatigue, time constraints, and lack of resources. CONCLUSION This review presents strategies for researchers and hospital staff to implement when conducting safety culture questionnaires: principally, distribute questionnaires in-person, during meetings or team training sessions; use a local champion; and consider the appropriate time of distribution to manage survey fatigue.
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Affiliation(s)
- Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Maree Saba
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Harton L, Skemp L. Medical-surgical nurse leaders' experiences with safety culture: An inductive qualitative descriptive study. J Nurs Manag 2022; 30:2781-2790. [PMID: 36048854 PMCID: PMC10087417 DOI: 10.1111/jonm.13775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/10/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
AIM To describe safety culture as experienced by medical-surgical nurse leaders. BACKGROUND Safety culture remains a barrier in safer patient care. Nurse leaders play an important role in creating and supporting a safety culture. METHODS An inductive qualitative descriptive study using semi-structured interviews, document review, and observations in a Midwestern community hospital in the United States. RESULTS Making sure nurses are keeping patients safe, making sure nurses have nursing interventions in place, expecting nurses to stop unsafe acts or escalate when they feel uncomfortable, making sure nurses have what they need to provide safe care, organization prioritizes patient safety, and making sure nurses are learning and growing emerged as themes describing safety culture. CONCLUSIONS Nurse leaders made sure patients were safe by making sure everyone was doing their best to provide safe care. Insufficient time, too many priorities, insufficient resources, poor physician behaviors, and lack of respect for their role emerged as barriers to leading a safety culture. IMPLICATIONS FOR NURSING MANAGEMENT Organizations must remove barriers for nurse leaders to develop and lead a safety culture. Nurse leaders must learn to advocate successfully for safe nursing care and professional work environments.
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Finn M, Mellon L, Walsh A, O'Brien N, Williams DJ, Rafter N, McCarthy SE. ‘What effect do safety culture interventions have on health care workers in hospital settings?’ A systematic review of the international literature. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13576.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Interventions designed to improve safety culture in hospitals foster organisational environments that prevent patient safety events and support organisational and staff learning when events do occur. A safety culture supports the required health workforce behaviours and norms that enable safe patient care, and the well-being of patients and staff. The impact of safety culture interventions on staff perceptions of safety culture and patient outcomes has been established. To-date, however, there is no common understanding of what staff outcomes are associated with interventions to improve safety culture and what staff outcomes should be measured. Objectives: The study seeks to examine the effect of safety culture interventions on staff in hospital settings, globally. The research questions are: 1) what effects do interventions to improve safety culture have on staff? 2) What intervention features, safety culture domains or other factors explain these effects? 3) What staff outcomes and experiences are identified? Methods and Analysis: A mixed methods systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches will be conducted using the electronic databases of MEDLINE, EMBASE, CINAHL, Health Business Elite, and Scopus. Returns will be screened in Covidence according to inclusion and exclusion criteria. The mixed-methods appraisal tool (MMAT) will be used as a quality assessment tool. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials and non-randomised studies of interventions will be employed to verify bias. Synthesis will follow the Joanna Briggs Institute methodological guidance for mixed methods reviews, which recommends a convergent approach to synthesis and integration. Discussion: This systematic review will contribute to the international evidence on how interventions to improve safety culture may support staff outcomes and how such interventions may be appropriately designed and implemented.
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Aouicha W, Tlili MA, Sahli J, Mtiraoui A, Ajmi T, Said Latiri H, Chelbi S, Ben Rejeb M, Mallouli M. Patient safety culture as perceived by operating room professionals: a mixed-methods study. BMC Health Serv Res 2022; 22:799. [PMID: 35725613 PMCID: PMC9210674 DOI: 10.1186/s12913-022-08175-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Routine assessments of patient safety culture within hospitals have been widely recommended to improve patient safety. Experts suggested that mixed-methods studies can help gain a deeper understanding of the concept. However, studies combining quantitative and qualitative approaches exploring patient safety culture are still lacking. This study aimed to explore patient safety culture as perceived by operating room professionals of two university hospitals in Sousse, Tunisia. Methods Based on a mixed-methods approach, a cross-sectional survey followed by semi-structured interviews were conducted over a period of two months (December 2019 to January 2020). This study took place in all the operating rooms of two public university hospitals in the district of Sousse, Tunisia. To collect data for this survey, the French version of the Hospital Survey On Patient Safety Culture was used. For interviews, 13 participants were selected purposively using a critical case sampling approach and a topic guide was prepared. Anonymity and confidentiality were respected. Results Overall, twelve operating rooms, with different surgical specialties, were included in the study. Survey feedback was provided by 297 professionals representing a response rate of 85.6%. Concerning patient safety culture, the 10 dimensions had low scores (below 50%) and were considered “to be improved”. The highest score was found in ‘teamwork within units’ (45%). Whereas, the lowest scores were allocated to ‘non-punitive response to error’ (22.9%), followed by “frequency of adverse event reported” (25.6%) and “communication openness” (26.3%). Per qualitative data, participants provided a more detailed picture of patient safety issues such as underreporting, absence of an effective reporting system, lack of freedom of expression, and an existing blame culture in operating rooms. Conclusions The findings of this study showed a concerning perception held by participants about the lack of a patient safety culture in their operating rooms. It seems essential to design, implement and evaluate strategies that promote a positive patient safety culture and obliterate punitive climate in operating rooms. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08175-z.
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Affiliation(s)
- Wiem Aouicha
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia.
| | - Mohamed Ayoub Tlili
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Jihene Sahli
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Ali Mtiraoui
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Thouraya Ajmi
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Houyem Said Latiri
- Department of Prevention and Care Safety, Sahloul University Hospital, Route de ceinture Sahloul city 4054, Sousse, Tunisia
| | - Souad Chelbi
- Faculty of Medicine of Sousse, Faculty of Medicine, University of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care Safety, Sahloul University Hospital, Route de ceinture Sahloul city 4054, Sousse, Tunisia
| | - Manel Mallouli
- Department of Family and Community Health, LR12ES03, University of Sousse, Faculty of Medicine of Sousse, Avenue Mohamed El Karoui, 4002, Sousse, Tunisia
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Brubakk K, Svendsen MV, Deilkås ET, Hofoss D, Barach P, Tjomsland O. Hospital work environments affect the patient safety climate: A longitudinal follow-up using a logistic regression analysis model. PLoS One 2021; 16:e0258471. [PMID: 34653217 PMCID: PMC8519418 DOI: 10.1371/journal.pone.0258471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/28/2021] [Indexed: 01/21/2023] Open
Abstract
Background Occupational worker wellness and safety climate are key determinants of healthcare organizations’ ability to reduce medical harm to patients while supporting their employees. We designed a longitudinal study to evaluate the association between work environment characteristics and the patient safety climate in hospital units. Methods Primary data were collected from Norwegian hospital staff from 970 clinical units in all 21 hospitals of the South-Eastern Norway Health Region using the validated Norwegian Work Environment Survey and the Norwegian version of the Safety Attitudes Questionnaire. Responses from 91,225 surveys were collected over a three year period. We calculated the factor mean score and a binary outcome to measure study outcomes. The relationship between the hospital unit characteristics and the observed changes in the safety climate was analyzed by linear and logistic regression models. Results A work environment conducive to safe incident reporting, innovation, and teamwork was found to be significant for positive changes in the safety climate. In addition, a work environment supportive of patient needs and staff commitment to their workplace was significant for maintaining a mature safety climate over time. Conclusions A supportive work environment is essential for patient safety. The characteristics of the hospital units were significantly associated with the unit’s safety climate scores, hence improvements in working conditions are needed for enhancing patient safety.
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Affiliation(s)
- Kirsten Brubakk
- Department of Human Resources, South Eastern Norway Regional Health Authority, Hamar, Norway
- Institute for Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Martin Veel Svendsen
- Department of Occupational and Environmental Medicine, Telemark Hospital Trust, Skien, Norway
| | - Ellen Tveter Deilkås
- Department of Quality Improvement and Patient Safety, Norwegian Directorate of Health, Oslo, Norway
- Unit for Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Dag Hofoss
- Department of Health and Inequality, National Institute of Public Health, Oslo, Norway
| | - Paul Barach
- Department of Pediatrics, Wayne State University, Detroit, Michigan, United States of America
- Jefferson College of Population Health, Philadelphia, Pennsylvania, United States of America
- Sigmund Freud University, Vienna, Austria
| | - Ole Tjomsland
- Department of Health, South Eastern Norway Regional Health Authority, Hamar, Norway
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