Implications of resource constraints and high workload on speaking up about threats to patient safety: a qualitative study of surgical teams in Ghana

Patient Safety Culture: Nurses' Perspective in the Hospital Setting

(1) Background: Patient safety culture (PSC) encompasses the values, attitudes, norms, beliefs, practices, perceptions, competencies, policies, and behaviours of professionals that determine organisational commitment to quality and patient safety. Few studies use mixed methods to analyse patient safety culture, and none offer the richness of using a mixed methodology to develop their theoretical model. This study aims to identify the factors nurses believe contextualise and influence PSC in relation to existing theoretical frameworks. (2) Methods: This study employed a sequential explanatory mixed-methods design combined with the Pillar Integration Process for data integration. (3) Results: In the final data integration process, 26 factors affecting nurses' PSC were identified. Factors nurses related to PSC not being assessed with the tool used in phase 1 were notification system, flow of patients, patient involvement, resources and infrastructure, and service characteristics. (4) Conclusions: This mixed-methods study provides an opportunity to identify the weaknesses and strengths of currently developed theoretical frameworks related to PSC and offers content for its improvement. Even though multiple studies aim to assess PSC using existing quantitative method tools, the development of this study offers a glimpse of some aspects relevant to nurses' PSC not included in the theoretical framework of the said tools, such as patient involvement, the flow of patients, and service infrastructure.

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

Background

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

Objective

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

Methodology

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

Findings

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

Conclusion

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

How Can Servant Leadership Promote Employees' Voice Behavior? A Moderated Chain Mediation Model

Purpose

Based on Social Exchange Theory, this paper constructs and evaluates the mediation model of servant leadership on employees' voice behavior through psychological security and error learning ability and discusses the moderation role of work autonomy in the model.

Design

This research used 424 employees and their direct superiors as the research objects and then conducted a paired survey at three points. Mplus7.4 software analyzed the empirical data.

Findings

The results are shown servant leadership is positively correlated with employees' voice behavior, but psychological security and error learning ability play a partial mediation role in the positive impact of servant leadership on employees' voice behavior. while psychological security and error learning ability play a chain mediation role in the positive impact of servant leadership on employees' voice behavior. Besides, work autonomy moderates the chain mediation path by enhancing the positive impact of servant leadership on psychological security. the higher the employees' work autonomy is, the stronger the positive impact of servant leadership on psychological security will be, and the stronger the chain mediation effect of psychological security and error learning ability between servant leadership and employees' voice behavior.

Practical Implications

Managers should abandon the traditional "command and control" management mode, focus on the servant leadership style and improve employees' psychological security through a comfortable and independent working environment. Besides, managers should set up a suitable error learning atmosphere mechanism, appropriately allow employees to work, give them a specific work autonomy, increase employees' work flexibility, and encourage employees to provide a cheerful voice for the development and progress of the organization.

Origin/value

From the perspective of Social Exchange, this study more comprehensively discusses the internal action path of the impact of servant leadership on employees' voice behavior, enriches the antecedent variables of employees' voice behavior, expands the existing research on the mediation mechanism of servant leadership, deepens the understanding of the efficiency mechanism of servant leadership, and has enlightenment significance for managers to stimulate employees' voice better.

How Does Strategic Human Resource Management Impact on Employee Voice Behavior and Innovation Behavior With Mediating Effect of Psychological Mechanism

Employees' voice and innovation behaviors are an important source of organizational competitiveness. Scholars in the field of organizational behaviors have discussed how to increase the willingness of employees to engage in voice and innovation behaviors from a diversity of perspectives. Innovation has always been a strategic goal of organizations. To motivate employees to offer valuable advice and innovative ideas, organizations have to provide various incentive, feedback and supportive programs. Combined with the social exchange and social cognitive theories, this study presents an argument that the effective strategic human resource management can gradually improve the self-efficacy, psychological contract, voice behaviors and innovation behaviors of employees, and further verifies the relationship among them. A sample of 553 employees was used and analyzed via structure equation modeling. This study adopted PLS-SEM to verify structural model and examine the mediating effect of psychological mechanism. The results showed that strategic human resource management has a significant and positive impact on self-efficacy, psychological contract, voice behavior and innovation behavior; self-efficacy has a significant and positive impact on psychological contract, voice behavior and innovation behavior; psychological contract only has a significant and positive impact on innovation behavior, but not on voice behavior. Given the above research findings, this study gives some practical implications in the end.