Hospital survey on patient safety culture in China

Face Validity, Content Validity, and Psychometric Testing of the Hospital Survey on Patient Safety Culture Among Undergraduate Nursing Students

Background and Purpose: Nursing students have an essential role in patient safety. The purpose of this study was to evaluate the face validity, content validity, and psychometric properties of the Hospital Survey on Patient Safety Culture for Nursing Students (HSOPS-NS). Methods: The cross-sectional study was carried out between January and October 2021. The participants were undergraduate nursing students (N = 482) from 16 Czech nursing faculties. Results: Exploratory factor analysis revealed an 8-factor structure, which was verified by confirmatory factor analysis using the optimization process that results in adequate goodness-of-fit indices (root mean squared error approximation = .037; standardized root mean squared residuals = .056; comparative fit index = .935; Tucker-Lewis index = .926; incremental fit index = .936). The internal consistency of a new model was excellent (α = .914). Conclusion: The results indicate that the HSOPS-NS shows evidence of reliability and validity and is a valuable measure of safety culture as perceived by nursing students.

Practices Used to Improve Patient Safety Culture Among Healthcare Professionals in a Tertiary Care Hospital

Introduction

A patient safety culture primarily refers to the values, beliefs, attitudes, and behaviors within a healthcare setup in a community that assists in prioritizing patient safety and encouraging the reporting of errors and near-misses in that facility. There is a direct impact of patient safety culture on how well patient safety and quality improvement programs work. The aim of this cross-sectional descriptive study was to investigate the practices to improve patient safety culture and adverse event reporting practices among healthcare professionals in a tertiary care hospital located in Mirpur Azad Jammu and Kashmir.

Methods

In the non-probability convenience sampling of this cross-sectional study, Divisional Headquarters Teaching Hospital in Mirpur, Azad Kashmir used the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture Hospital Survey to collect data about the perceptions of healthcare professionals regarding patient safety culture within their hospital to assess the trends of patient safety culture by obtaining longitudinal data. A pre-validated questionnaire that has undergone a rigorous trial of testing to maximize the reliability and accuracy of the outcomes was distributed among clinical staff (healthcare professionals who interact with patients on a daily basis, such as nurses, doctors, pharmacists, and laboratory technicians) and administrative staff (medical superintendent, deputy medical superintendent, assistant medical superintendent, heads of departments).

Results

A total of 312 questionnaires were returned (response rate, 76%). The study found that the dimension "supervisor/manager expectation and action promoting safety" had the highest positive response rate (65.16%), and "nonpunitive response" had the lowest (27.4%). Higher scores in "nonpunitive response to error" were associated with lower rates of medication errors, pressure ulcers, and surgical site infections, and higher scores in "frequency of event reporting" were associated with lower rates of medication errors, pressure ulcers, falls, hospital-acquired infections, and urinary tract infections.

Conclusion

We suggest that in order for hospital staff to continue providing excellent, clinically safe treatment, a well-structured hospital culture promoting patient safety is necessary. Moreover, further study is needed to determine strategies to improve patient safety expertise and awareness, and lower the frequency of adverse occurrences.

Work Climate, Improved Communication, and Cohesive Work Linked with Patient Safety Culture: Findings from a Sports Medicine Hospital

BACKGROUND

This study aims to investigate the patient safety culture at a sports medicine hospital and explore the quality of healthcare and associated factors.

METHODS

In a cross-sectional study design, the Hospital Survey on Patient Safety Culture (HSOPC) tool was administered online among staff at a sports medicine hospital in Doha, Qatar. Out of 898 staff who received an email invitation, 504 participated (56.1%).

RESULTS

The results showed that 48.0% of the staff rated the patient safety grade as excellent and 37.5% as very good, totaling 85.5%. Factors associated with excellent or very good patient safety grades were management support OR 4.7 95% CI (1.8 to 12.3); team communication OR 3.0 95% CI (1.4 to 6.3), supervisor action supporting patient safety OR 3.5 95% CI (1.7 to 7.0) and other items related to work area such as working together: OR 3.0 95% CI (1.2 to 7.6), helping out busy areas OR 2.5 95% CI (1.1 to 5.5) and having good procedures and systems: OR 2.8 95% CI (1.4 to 5.8).

CONCLUSIONS

Addressing management support, enhancing communication, and cohesive work within the work area facilitates a culture of trust that improves patient safety grades.

When Illegitimate Tasks Threaten Patient Safety Culture: A Cross-Sectional Survey in a Tertiary Hospital

Objectives: The current study investigates the prevalence of illegitimate tasks in a hospital setting and their association with patient safety culture outcomes, which has not been previously investigated. Methods: We conducted a cross-sectional survey in a tertiary referral hospital. Patient safety culture outcomes were measured using the Hospital Survey on Patient Safety Culture questionnaire; the primary outcome measures were a low safety rating for the respondent's unit and whether the respondent had completed one or more safety event reports in the last 12 months. Analyses were adjusted for hospital department and staff member characteristics relating to work and health. Results: A total of 2,276 respondents answered the survey (participation rate: 35.0%). Overall, 26.2% of respondents perceived illegitimate tasks to occur frequently, 8.1% reported a low level of safety in their unit, and 60.3% reported having completed one or more safety event reports. In multivariable analyses, perception of a higher frequency of illegitimate tasks was associated with a higher risk of reporting a low safety rating and with a higher chance of having completed event reports. Conclusion: The prevalence of perceived illegitimate tasks was rather high. A programme aiming to reduce illegitimate tasks could provide support for a causal effect of these tasks on safety culture outcomes.

Level of patient safety culture among public healthcare professionals in Pretoria

BACKGROUND

 Patient safety culture (PSC) norms set within an organisation prevent harm during medical care. This study assessed the level of PSC among public healthcare professionals (HCPs) in Pretoria, South Africa.

METHODS

 A multi-centre cross-sectional study conducted in three hospitals and 25 clinics in regions 1 and 2 of Pretoria, using a self-administered questionnaire adapted from the Hospital Survey on Patient Safety Culture. Using the Raosoft online sample size formula, from 1238 public HCPs identified, the sample size was calculated at 294; this expanded to 319 as a result of respondents' willingness to participate in the study.

RESULTS

 Of the 319 respondents with a mean age of 39.9 years, the minimum and maximum ages were 22 and 66 years, respectively. The age group of 30-39 years had the highest participation rate (17.6%). Most respondents (41.1%) came from the Odi district hospital and there were more women (78.1%) and nurses (49.2%). Positive attitudes were found for all PSC components, with staff education and training scoring highest (98.7%). Patient safety culture received a satisfactory rating from HCPs from the targeted facilities.

CONCLUSION

 This study showed that public HCPs in Pretoria's regions 1 and 2 have a good PSC, particularly among nurses, professionals with more experience, and at primary care level.Contribution: To maintain or increase awareness of this concept among HCPs, the study advocates a PSC programme as well as ongoing education that can be supported by district and facility managers.

Patient safety culture at the unit level of a tertiary hospital in South Africa: a survey study

Background

Patient safety research is scarce in developing countries. Estimates of patient harm due to healthcare processes in resource-poor settings are thought to be greater than those in developed countries. Ideally, errors in healthcare should be seen as opportunities to improve the future quality of care.

Objective

This study aimed to investigate patient safety culture within high-risk units of a tertiary hospital in South Africa.

Methods

A quantitative, descriptive, cross-sectional methodology, using a survey questionnaire that measured 10 safety dimensions and one outcome measure among clinical and nursing staff, was employed.

Results

Two hundred participants completed the survey questionnaire. Areas of strength identified by the participants included organizational learning (91.09%), staff attitudes (88.83%), and perceptions of patient safety (76.65%). Dimensions that have potential for improvement included awareness and training (74.04%), litigation (73.53%), feedback and communication about errors (70.77%), non-punitive response to error reporting (51.01%), size and tertiary level of the hospital (53.76%), and infrastructure and resources (58.07%). The only dimension identified as weak was teamwork and staffing (43.72%). In terms of the patient safety grade, respondents graded their own units highly but graded the hospital as a whole as having a poor patient safety grade.

Conclusion

There are still significant gaps in the quality of care provided at this tertiary hospital. The current patient safety culture is perceived as punitive in nature with regard to reporting adverse events. It is advised that targeted patient safety improvements be made, followed by further investigation.

Measuring the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC)

BACKGROUND

Patient safety is a top priority for many healthcare organisations worldwide. However, most of the initiatives aimed at the measurement and improvement of patient safety culture have been undertaken in developed countries. The purpose of this study was to measure the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC).

METHODS

The HSOPSC was used to measure the patient safety culture across 12 dimensions at Aga Khan University Hospital, Karachi. 2,959 individuals, who had been working at the hospital, were administered the HSOPSC in paper form between June and September 2019.

RESULTS

The response rate of the survey was 50%. In the past 12 months, 979 respondents (33.1%) had submitted at least one event report. Results showed that the personnel viewed the patient safety culture at their hospital favourably. Overall, respondents scored highest in the following dimensions: 'feedback and communication on error' (91%), 'organisational learning and continuous improvement' (85%), 'teamwork within units' (83%), 'teamwork across units' (76%). The dimensions with the lowest positive per cent scores included 'staffing' (40%) and 'non-punitive response to error' (41%). Only the reliability of the 'handoffs and transitions', 'frequency of events reported', 'organisational learning' and 'teamwork within units' was higher than Cronbach's alpha of 0.7. Upon regression analysis of positive responses, physicians and nurses were found to have responded less favourably than the remaining professional groups for most dimensions.

CONCLUSION

The measurement of safety culture is both feasible and informative in developing countries and could be broadly implemented to inform patient safety efforts. Current data suggest that it compares favourably with benchmarks from hospitals in the USA. Like the USA, high staff workload is a significant safety concern among staff. This study lays the foundation for further context-specific research on patient safety culture in developing countries.

Patient Safety Culture Perception among Moroccan Healthcare professionals: Cross-Sectional Study in Public Hospitals

Background

There is a growing recognition of the need to establish a culture that focuses on patient safety in order to reduce the number of adverse events associated with care and improve health-care quality in Morocco. The aim of this research is to analyze results of the perception of health professionals working in two university hospitals concerning the concept of patient safety culture in Morocco.

Methods

This study evaluated the healthcare professional's perceptions of patient safety culture in two selected university hospitals centers in Morocco by using the validated French version of the Hospital Survey on Patient Safety Culture questionnaire (HSOPSC). A cross-sectional descriptive study was conducted in 2021. We randomly selected 10 health units of each hospital, to include up to 10 health professionals from each unit, regardless of length of experience. This self-administered questionnaire was distributed to a population of 204 Moroccan healthcare professionals who consisted predominately of available physicians and nurses across ten different health units.

Result

The overall grade of patient safety was deemed "good" for 52 % of the staff, "very good" for 17%, against "failing" for 2%. Out of the 10 dimensions explored. The "Teamwork within units" dimension had the highest score with 80%. The dimensions with the lowest positive response rates were "Staffing (23%)", "non-punitive response to error" (31%) and "Teamwork across units' (47%). Seven dimensions were considered underdeveloped and three were undeveloped.

Conclusion

This work provides a better understanding of healthcare professional perception towards patient safety.

Level of Patient Safety Culture Awareness Among Healthcare Workers

Background

Patient safety is a major concern at all levels of the healthcare system, with the primary objective of reducing patient hazards when providing care. The Kingdom of Saudi Arabia has made great progress in improving the health of its citizens over the last few decades, particularly in terms of patient safety. Currently, many health-care institutions throughout the world are interested in implementing a safety culture to lower the risk of harm and the number of accidents associated with routine treatment.

Purpose

This study aims to assess the level of awareness concerning patient safety culture among health-care providers in hospitals in Riyadh, Saudi Arabia.

Methods

This is a descriptive cross-sectional quantitative study that used the Agency for Healthcare Research and Quality's patient safety culture questionnaire. The survey was conducted online and was completed by 204 health-care employees from three distinct hospital settings in Riyadh, Saudi Arabia: government, quasi-government, and private hospitals.

Results

The results showed a low level of patient safety culture awareness among health-care workers in the 10 dimensions of patient safety. The mean score was 2.24 out of 5 and the standard deviation was 0.50. Participants assigned the highest mean scores to Organisational Learning and Continuous Improvement (Mean: 2.48, Standard deviation: 0.66), Communication About Error (Mean: 2.44, Standard deviation: 0.70), and Teamwork (Mean: 2.40, Standard deviation: 0.64). Interestingly, the scores for hospital supervisor and managerial positions are significant compared to other clinical positions (p-value = 0.047). Moreover, the patient safety rating and the number of reported events were significantly related to the overall level of awareness (p-value <0.001), (p-value = 0.042), respectively.

Conclusion

In Riyadh hospitals, overall patient safety awareness is low, necessitating adequate attention and effective solutions such as encouraging reporting errors, implementing safety huddles and leadership walkarounds, and establishing a patient safety culture. Health-care executives and managers are encouraged to develop safety cultures that promote trust and justice, allowing employees to be candid about their mistakes and failings without retaliation. Moreover, this safety culture should be defined by the following qualities: a just culture, a learning culture, and a reporting culture.

Cross-cultural adaptation and validation of the Chinese version of the revised surveys on patient safety culture™ (SOPS®) hospital survey 2.0

BACKGROUND

Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey (HSOPS 1.0), developed by the U.S. Agency for Healthcare Research and Quality in 2004, has been widely adopted in the United States and internationally. An updated version, the SOPS Hospital Survey 2.0 (HSOPS 2.0), released in 2019, has not yet been applied in China. The aim of the present study was to translate HSOPS 2.0 into Chinese version with cross-cultural adaptations and test its psychometric properties.

METHODS

A convenience sample was used. Hospital nurses (N = 1013) and a sub-set (n = 200) was invited for the re-test. A three-stage study was conducted. Firstly, the HSOPS 2.0 was translated by a panel. Secondly, the content validity was tested using the two-round Delphi method and cognitive interview. Next, the construct validity was tested by the confirmatory factor analysis and further demonstrated by the convergent validity, discriminant validity, and correlations with the outcome of patient safety. Thirdly, the reliability was tested by internal consistency reliability and re-test reliability.

RESULTS

The "float or PRN" and "manager" words were deleted as considered unfitted for the Chinese health care system. The content validity index provided evidence of strong content validity (I-CVI = 0.84 ~ 1.00, S-CVI = 0.98). Confirmatory factor analysis revealed a good model fit (χ²/df = 4.05, RMSEA = 0.06, CFI = 0.94) and acceptable factor loadings (0.41 ~ 0.97). Convergent validity, and discriminant validity supported the factorial structure of the Chinese version of HSOPS 2.0. Further evidence for the construct validity was derived from correlations with the outcome of patient safety (r = 0.10 ~ 0.41). A good internal consistency (Cronbach's α = 0.68 ~ 0.93, McDonald's omega = 0.84 ~ 0.96) and test-retest reliability (ICC = 0.78 ~ 0.95) showed acceptable reliability. Additionally, Chinese nurses reported markedly lower scores for three dimensions, including "Response to Error", "Communication Openness", and "Reporting Patient Safety Events", when comparing the findings of this study with those from U.S. research utilizing the HSOPS 2.0.

CONCLUSION

The Chinese version of HSOPS 2.0 demonstrated good validity and reliability in a Chinese sample of hospital nurses, which suggests that it can be used to measure nurse-perceived patient safety culture in future research and practice. Psychometric properties of the Chinese version of HSOPS 2.0 among other Chinese healthcare professionals remain to be confirmed.

Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis

INTRODUCTION

Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America.

PURPOSE

Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC).

METHODS

This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated.

RESULTS

In total, 30 studies from five countries-Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)-were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were "organizational learning: continuous improvement" and "teamwork within units", while the least positive were "nonpunitive response to error" and "staffing". Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53-51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02-63.66).

CONCLUSIONS

Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives.

The relationship between patient safety culture and patient safety competency with adverse events: a multicenter cross-sectional study

Background

Patient safety culture and patient safety competency could be associated with adverse events (AEs). This study aimed to investigate the associations between nurses’ perceptions of patient safety culture, patient safety competency, and AEs.

Methods

A cross-sectional study was carried out among 338 nurses employed in three university hospitals in Qom, Iran between 17 August 2021 and 12 November 2021. Data were collected using three questionnaires: patient safety culture, patient safety competency, and AEs. Data were analyzed using SPSS-21 software. A multiple logistic regression model was used to analyze the data.

Results

The results of this study showed that medication errors were significantly associated with “frequency of events reported” (OR = 0.706, P = 0.012), “supervisor/manager expectations and actions promoting patient safety” (OR = 0.733, P = 0.048), and “management support for patient safety” (OR = 0.755, P = 0.012). Pressure ulcers were significantly associated with “supervisor/manager expectations and actions promoting patient safety” (OR = 0.729, P = 0.039), “handoffs and transition” (OR = 0.707, P = 0.034), and “comfort speaking up about patient safety” (OR = 0.614, P = 0.016). Falls were significantly associated with “teamwork within units” (OR = 0.735, P = 0.031), “feedback and communication about error” (OR = 0.756, P = 0.046), and “handoffs and transition” (OR = 0.660, P = 0.012). The use of restraints for ≥8 hr. was significantly associated with “management support for patient safety” (OR = 0.701, P = 0.021).

Conclusions

According to the results of this study, AEs are associated with some dimensions of patient safety culture and patient safety competency. Further research is needed to confirm these findings and identify interventions to reduce the occurrence of AEs.

Assessment of patient safety culture among the staff of the University Hospital for Gynecology and Obstetrics in Alexandria, Egypt

Background

Patient safety (PS) is a fundamental component of healthcare quality. Patient Safety Culture (PSC) assessment provides an organization with insight of perceptions and attitudes of its staff related to patient safety. In addition, it is meant to improve performance rather than blaming individuals. This study aimed to assess patient safety culture from the health care staff perspective in El-Shatby University Hospital for Gynecology and Obstetrics.

Methods

A descriptive cross-sectional study was conducted. The study was conducted at El-Shatby University Hospital for Gynecology and Obstetrics from November 2020 to January 2021. The target participants were assistant lecturers, residents, and head nurses in charge during the field study period. The number of potential participants who fulfilled the inclusion criteria (in charge during the period of data collection and working in the hospital for more than 3 months) was 83; the twelve participants who participated in the pilot study were excluded. The total number of participants who agreed to participate in the study was 66 participants (38 residents, 18 assistant lecturers, and 10 head nurses) out of 71 potential participants representing a 92.9% response rate. A structured self-administered questionnaire format adapted from Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was distributed anonymously to the participants. The questionnaire has 42 items measuring twelve patient safety culture dimensions: teamwork within the unit, supervisors’ expectations and actions to promote patient safety, feedback and communication about error, organizational learning, communication openness, overall perception of patient safety, hands-off and transitions, teamwork across units, frequency of events reported, management support for patient safety, staffing, and management support for patient safety. Except for two items that are responded on a five-point frequency scale (never, rarely, sometimes, most of the time, and always) the majority of patient safety culture questions are answered on a five-point agreement scale (strongly disagree, disagree, neutral, agree, and strongly agree), with a higher score indicating a more favorable attitude toward patient safety.

Results

The overall average positive percent score was 45.4%. Average positive response percentages to individual items ranged from 28.8 to 81.8%. No domain had an average positive percent score of more than 75%. Out of the twelve dimensions of patient safety culture included in the HSOPSC questionnaire, “the teamwork within unit” domain had the highest average positive percent score (62.1%) among all participants. On the other hand, the “Non-punitive response to error” domain had the lowest score (18.9%). More than half (57.6%) of the participants rated patient’s safety at the hospital as acceptable.

Conclusion

Investing in practices that strengthen patient safety is crucial if the hospital is to improve overall performance and quality of services. The present study displays a frail patient safety culture (PSC) in the majority of the domains. All the domains should be considered of high priority focused areas for remark and reformative tasks. Continuous training programs of the staff on patient safety to improve their perception of safety culture are necessary. All PSC composites need improvement starting with regular assessment of PSC along with continuous monitoring and increasing the healthcare providers’ awareness of demanded PSC.

Concern for Patient Safety Culture of ECMO Team in Emergency Department: A Cross-Sectional Survey

To evaluate the patient safety culture status of the ECMO team in the emergency department of a tertiary care hospital. A cross-sectional survey was conducted in the emergency department of Xiangya Hospital from September 1st to 30th, 2021. The Chinese version of HSOPSC electronic questionnaire was administered to all staff involved in ECMO management and initiation. A total of 152 ECMO team members completed the survey. Among the 12 dimensions of patient safety culture, 4 dimensions recorded relatively high positive response rates (&gt;50%): organizational learning-continuous improvement (87.1%), teamwork within units (86.8%), feedback and communication about errors (58.5%), and supervisor/manager expectations and actions promoting patient safety (55.6%). 8 dimensions recorded relatively low positive response rates (&lt;50%): nonpunitive responses to errors (24.1%), hospital handoffs and transitions (27.1%), staffing (28.6%), the frequency of event reporting (32.4%), teamwork across units (33.2%), communication openness (39.7%), management support for patient safety (48.7%), and overall perceptions of patient safety (49.3%). The overall level of patient safety culture was measured at 47.6%. The ECMO team should immediately address issues of nonpunitive responses to errors, hospital handoffs and transitions, and staffing to improve the safety of ECMO. Going forward, the head of the ECMO team should regard patient safety culture as a top priority, improve staff satisfaction, standardize the transfer and handover process, and create a blame-free environment to facilitate event reporting.

Comparison of Perceptions About Patient Safety Culture Between Physicians and Nurses in Public Hospitals in Vietnam

Introduction

Patient safety culture (PSC) is a vital component in ensuring high-quality and safe patient care. Assessment of physicians' and nurses' perceptions of existing hospital PSC is the first step to promoting PSC. This paper is aimed to assess physicians' and nurses' perceptions of PSC in 5 public general hospitals in Hanoi, Vietnam.

Methods

This cross-sectional study surveyed 410 physicians and 824 nurses utilizing the validated Hospital Survey on Patient Safety Culture in an online format.

Results

The composite positive physician's perception of PSC varied from 47.8 to 89.6% with the lowest composite score of patient safety for "staffing" (47.8%) and the highest composite score for "teamwork within units" (89.6%). The composite positive responses for perception among nurses varied from 51.3 to 94.2% with the lowest composite score of patient safety for "staffing" (51.3%) and the highest composite score for "teamwork within units" (94.2%).

Conclusion

The mean scores for "supervisor/manager expectations"; "staffing", "management support for patient safety", "teamwork across units", "handoffs and transitions" among nurses were significantly higher than that among physicians (p<0.05). About two-thirds of physicians and nurses reported no event in the past 12 months (62.8 and 71.7%, respectively). The nurses reported significantly higher patient grades (every good and excellent) than physicians (75% vs 67.1%, p <0.001). Hospitals could develop and implement intervention programs to improve patient safety, including providing interventions on teamwork and communication, encouraging staff to notify incidents, and avoiding punitive responses.

Psychometric Properties of the Hospital Survey of Patient Safety Culture in Type A Hospitals in Kingston and St. Andrew, Jamaica

This study sought to examine the internal consistency reliability and underlying factor structure of the Agency of Health Research on Quality Hospital Survey on Patient Safety Culture (AHRQ HSOPSC) in two large acute care hospitals in a developing country setting (Jamaica). A cross-sectional study was done among 328 doctors and nurses. Reliability (internal consistency) analysis was done for each of the 12 composites and the Cronbach’s Alpha coefficients were reported. Principal axis factor analysis (PA) using Varimax rotation was done to identify the underlying factor structure. The Cronbach’s Alpha coefficient was ≥ 0.60 in ten composites. ‘Overall perception of patient safety’ and ‘staffing’ had Cronbach’s Alpha values of 0.585 and 0.553 respectively. A ten-factor solution (34 items) with factor loading of ≥ 0.40 is the best model fit, and composites are now named ‘handoff and transitions/information exchange,’ ‘communication/feedback,’ ‘frequency of events reported,’ ‘management support for patient safety,’ ‘teamwork in unit,’ ‘non-punitive response to errors,’ ‘overall perception of patient safety,’ ‘supervision/management expectations and actions promoting patient safety,’ ‘organizational learning - continuous improvement’ and ‘staffing’. The AHRQ HSOPSC is generally reliable in this developing country setting and the ten-factor structure is consistent with suggested modifications for the emergent AHRQ HSOPSC Version 2 tool.

Nurses' Perception of Patient Safety Culture in a Referral Hospital: A Cross-Sectional Study

Healthcare systems are becoming increasingly complex which is helping to promote a ‘culture of safety’ within them based on the best scientific evidence available. Indeed, creating a positive institutional culture of patient safety is reflected in health outcomes. The aim of this present study was to describe the perception of culture of safety by nurses in adult inpatient units in a tertiary hospital and to analyze adverse events reporting. It was a cross-sectional study in which 202 nurses from adult hospitalization units of the Hospital Universitario y Politécnico La Fe in Valencia (Spain) participated. The perception of safety culture was measured using the Hospital Survey on Patient Safety questionnaire version 1.0, which consists of 42 items distributed in 12 dimensions that are considered strengths or weaknesses. In addition, adverse events related to nursing care during the study period and those reported in the official hospital registry were collected. Finally, the association between safety culture and sociodemographic and labor variables was explored. A total of 148 responses to the questionnaire were analyzed (Cronbach’s alpha = 0.94), where seven dimensions and 25 items were identified as weaknesses. Two hundred and fourteen events were identified and none were reported in the official registry. Years of experience were significantly (p < 0.05) associated with safety culture. It is necessary to establish strategies to improve the perception of the safety culture of nurses, as well as to make nurses aware of the importance of notifying adverse events derived from health care.

Patient Safety Culture in 2 Public Hospitals in Vietnam: A Mixed Method Study

BACKGROUND

Patient safety culture is an important measure in assessing the quality of care. There is a growing need to establish a patient safety culture in hospitals. This study explored the perception of health professionals on patient safety culture in 2 public hospitals in Hanoi, Vietnam.

METHOD

A mixed-methods study with an online Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative data collection was conducted in Hanoi. The HSOPSC was validated in Vietnam before using it.

RESULTS

A total of 626 health professionals, including physicians and nurses, were involved in the survey, and 49 of them participated in in-depth interviews and focus group discussions. The average positive response of patient safety culture composites was high at 85.2% and varied from 49.4% to 97.9%. The strongest areas were teamwork within units (91.3%) and organizational learning/continuous improvement (88.4%), and the areas that needed improvement were staffing (49.4%) and nonpunitive response to error (53.1%).

CONCLUSION

The centralized incident reporting, management with peer involvement on event reporting, and continuous quality improvement should be routinely embedded by hospital leaders down to unit managers and all staff.

Improving Knowledge and Attitudes in Pregnant, Postpartum, and Lactating Women toward Preventing COVID-19 Transmission and Self-Care with Health Education Packages using Android Applications

Background: The Covid-19 outbreak is rapidly increasing as evidenced by the number of cases, deaths and countries affected. However, limited data is available on pregnant women with Covid-19 on which to base recommendations for pregnancy and post-partum care. This study aims to identify the effectiveness of nursing intervention with health education via an android application about self-care and prevention of Covid-19 transmission toward the knowledge and attitudes of pregnant, post-partum and lactating women. Method: This study was done with a research and development design that consisted of three stages. Stage one was identifying the existing nursing intervention for respondents with Covid-19, stage two involved the health education formulation and built it in to an android application, stage three measured the differences in knowledge attitude of respondents before and after health education by using the android application. 152 respondents pregnant, post-partum and lactating with Covid-19 women participated in this study.  Samples were collected by quota sampling from hospitals where they were being treated. Result: Stage one results showed that nursing intervention has been done comprehensively, (bio including nutrition, exercise, psychosocial, spiritual etc). Stage two established the health education and built it in to an android application. Stage three found that there were differences between pre and post health education via an android application in the knowledge and attitudes during pregnancy, post-partum and lactating women in self-care and prevention of Covid-19 transmission. Significancy was found among post-partum and lactating women (p=0.018*). Conclusion: There was a difference in knowledge and attitudes among pregnant, post-partum and lactating women in self-care and prevention regarding the spread of Covid-19 before and after health education via an android application. This study recommends that health care providers use this health education method in their intervention to improve health status and prevent further spread of Covid-19. Further research to explore more health indicators is needed.  

Adoption of a Data-Driven Bayesian Belief Network Investigating Organizational Factors that Influence Patient Safety

Medical errors pose high risks to patients. Several organizational factors may impact the high rate of medical errors in complex and dynamic healthcare systems. However, limited research is available regarding probabilistic interdependencies between the organizational factors and patient safety errors. To explore this, we adopt a data-driven Bayesian Belief Network (BBN) model to represent a class of probabilistic models, using the hospital-level aggregate survey data from U.K. hospitals. Leveraging the use of probabilistic dependence models and visual features in the BBN model, the results shed new light on relationships existing among eight organizational factors and patient safety errors. With the high prediction capability, the data-driven approach results suggest that "health and well-being" and "bullying and harassment in the work environment" are the two leading factors influencing the number of reported errors and near misses affecting patient safety. This study provides significant insights to understand organizational factors' role and their relative importance in supporting decision-making and safety improvements.

Cross-culture adaptation and validation of the Indonesian version of the Hospital Survey on Patient Safety Culture (HSOPSC 2.0)

Background

Hospital Survey on Patient Safety Culture (HSOPSC) is considered one of the most scientifically rigorous tools available with excellent psychometric properties. However, it is not yet available in an Indonesian version.

Objective

This study aimed to determine the validity of the content and psychometric properties of HSOPSC 2.0 for use in Indonesian hospitals.

Methods

The study was divided into three stages: translation, adaptation, and validation. Culture-adaptation was assessed using cognitive interviews with ten direct care nurses who worked in the hospital to evaluate their perceptions and the coherence of the translated items, response categories, and questionnaire directions. Content validity was also done by ten experts from academic and clinical settings. Finally, Confirmatory Factor Analysis (CFA) and reliability testing were conducted among 220 nurses from two Indonesian hospitals.

Results

The cognitive test results indicated that the language clarity was 87.8 % and 84.5% for cultural relevance. The Content Validity Index (CVI) ranged between 0.73 to 1.00, while the construct validity results indicated that each factor had factor loadings above 0.4, from 0.47 to 0.65. The fit indices showed an acceptable fit for the data provided by the 10-factor model, with RMSEA = 0.052, SRMR = 0.089, and CFI = 0.87. The Pearson correlation coefficients between the ten subscales ranged from 0.276 to 0.579 (p < 0.05). The Cronbach's alpha for all sub-scales was more than 0.70, except for organizational learning - continuous improvement, response to error, and communication openness.

Conclusion

This study offers initial evidence of the psychometric properties of the Indonesian-HSOPSC 2.0. Future studies are needed to examine its psychometric features to improve generalizability. However, nurses and other healthcare professionals could use the tool to measure hospital patient safety culture in Indonesia.

Effects of Mindfulness Meditation on Doctors' Mindfulness, Patient Safety Culture, Patient Safety Competency and Adverse Event

Objective: This study investigated the effects of mindfulness meditation on doctors’ mindfulness, patient safety culture, patient safety competency, and adverse events. Methods: We recruited 91 doctors from a hospital in China and randomized them to mindfulness meditation group (n = 46) and a waiting control group (n = 45). The mindfulness meditation group underwent an 8-week mindfulness meditation intervention, while the control group underwent no intervention. We measured four main variables (mindfulness, patient safety culture, patient safety competency, and adverse event) before and after the mindfulness meditation intervention. Results: In the experimental group, mindfulness, patient safety culture and patient safety competency were significantly higher compared with those of the control group. In the control group, there were no significant differences in any of the three variables between the pre-test and post-test. Adverse events in the experimental group were significantly lower than in the control group. Conclusions: The intervention of mindfulness meditation significantly improved the level of mindfulness, patient safety culture and patient safety competency. During the mindfulness meditation intervention, the rate of adverse events in the meditation group was also significantly lower than in the control group. As a simple and effective intervention, mindfulness meditation plays a positive role in improving patient safety and has certain promotional value.

Patient safety attitude among healthcare workers at different levels of healthcare in Sharqia Governorate, Egypt

Background

Patient safety (PS) has been identified as a significant healthcare challenge. A good safety attitude helps healthcare workers (HCWs) to decrease medical errors.

Aim

This study aimed to assess the PS attitude and identify its determinants among HCWs.

Setting

This study was conducted in Sharqia Governorate at different levels of health care.

Methods

This was a comparative cross-sectional study that involved240 HCWs selected after using a multistage cluster sampling technique from Sharqia Governorate.In ordertto assess the respondents’ attitudes towards PS, the modified Chinese Safety Attitudes Questionnaire (CSAQ) was used.

Results

The scale with the highest percentage of positive responses, on average, was safety climate (49.59%). The study found a statistically significant association between the level of health care and mean scores of ‘teamwork climate, perception of management, job satisfaction, working conditions, and stress recognition’ and the overall CSAQ score. In regression analysis, the highest degree of education and job type were significant predictors of PS attitude among the HCWs under study (p = 0.031 and 0.011, respectively).

Conclusion

According to the study’s findings, PS is low among HCWs in both healthcare units and hospitals, with a significantly higher score among hospital workers than among primary care workers. All PS composites need improvement starting with regular assessment of PS culture along with continuous monitoring.

Professional performance in the administration of medicines in pediatrics: a study cross-sectional observational

ABSTRACT Objectives: to evaluate Patient Safety actions carried out by nurses in the Administration of Medicines in Pediatrics. Methods: observational, cross-sectional, quantitative study carried out in 2018, with 25 nurses from a Hospital in Peru. 183 observations were made; the instrument Safety of the patient was used in the administration of medicines in Pediatrics Spanish version. The performance of the professionals was evaluated by the Positivity Index. Results: of 22 itens observed, five were adequate, five were safe, two were classified as borderline and ten as endurable among those who stand out; Bring to bed only medications prescribed for a single child and maintains an adequate record of prepared medications that will be stored. Conclusions: weaknesses were observed in the medication administration process, since only 10 itens were classified as safe or adequate, reinforcing the need for permanent education activities by the institution for nursing training.

The relationship between patient safety culture with patient satisfaction and hospital performance in Shafa Hospital of Kerman in 2020

BACKGROUND

Hospitals are a significant part of the health system, so their performance is always measured based on some factors such as patient satisfaction and their safety level.

AIM

The present study was aimed to examine the relationship between patient safety culture with patient satisfaction and hospital performance.

MATERIALS AND METHODS

This descriptive-analytical, cross-sectional study was performed on 240 patients, 240 staff and 20 hospital managers in Shafa hospital of Kerman, Iran, in 2020. To collect data, the patient safety culture, the patient satisfaction, and the hospital performance questionnaires were used. The data were analyzed by SPSS and PLS software; to measure the research model, structural equation models and confirmatory factor analysis were used.

RESULTS

The variable "patient satisfaction" and its components had a high mean, with the component "the treating physician" having the highest mean. The variables "patient safety culture and hospital performance" had a medium mean. There was a significant positive relationship between patient safety culture-hospital performance, patient safety culture-patient satisfaction, and patient satisfaction-hospital performance.

CONCLUSION

The patient satisfaction level was appropriate in the studied center, and a positive and significant relationship was found between patient safety culture and patient satisfaction and hospital performance.

What Do We Know About Teamwork in Chinese Hospitals? A Systematic Review

Background and Objective: Improving quality of care is one of the primary goals in current Chinese hospital reforms. Teamwork can play an essential role. Characteristics of teamwork and interventions for improving teamwork in hospitals have been widely studied. However, most of these studies are from a Western context; evidence from China is scarce. Because of the contextual differences between China and Western countries, empirical evidence on teamwork from Western hospitals may have limited validity in China. This systematic review aims to advance the evidence base and understanding of teamwork in Chinese hospitals. Methods: Both English (i.e., Embase, Medline, and Web of Science) and Chinese databases (i.e., CNKI, CQVIP, and Wanfang) were searched for relevant articles until February 6, 2020. We included the studies that empirically researched teamwork in Chinese hospitals. Studies were excluded if they (1) were not conducted in hospitals in Mainland China, (2) did not research teamwork on team interventions, (3) were not empirical, (4) were not written in English or Chinese, (5) were not published in peer-reviewed journals, and (6) were not conducted in teams that provide direct patient care. Both deductive and inductive approaches were used to analyze data. The Mixed Methods Appraisal Tool (MMAT) was used to assess their methodological quality. Results: A total of 70 articles (i.e., 39 English articles and 31 Chinese articles) were included. The results are presented in two main categories: Teamwork components and Team interventions. The evidence regarding the relationships among inputs, processes, and outcomes is scarce and mostly inconclusive. The only conclusive evidence shows that females perceive better team processes than males. Similar types of training and tools were introduced as can be found in Western literature, all showing positive effects. In line with the Chinese health reforms, many of the intervention studies regard the introduction of multidisciplinary teams (MDTs). The evidence on the implementation of MDTs reveals that they have led to lower complication rates, shorter hospital stays, higher diagnosis accuracy, efficiency improvement, and a variety of better disease-specific clinical outcomes. Evidence on the effect on patient survival is inconclusive. Conclusion: The Chinese studies on teamwork components mainly focus on the input-process relationship. The evidence provided on this relationship is, however, mostly inconclusive. The intervention studies in Chinese hospitals predominantly focus on patient outcomes rather than organizational and employee outcomes. The introduction of training, tools, and MDTs generally shows promising results. The evidence from primary hospitals and rural areas, which are prioritized in the health reforms, is especially scarce. Advancing the evidence base on teamwork, especially in primary hospitals and rural areas, is needed and can inform policy and management to promote the health reform implementation. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175069, identifier CRD42020175069.

Inconsistencies Between Two Cross-Cultural Adaptations of the Hospital Survey on Patient Safety Culture Into French

OBJECTIVES

Two cross-cultural adaptations of the 12-dimension Hospital Survey on Patient Safety Culture (HSOPSC) into French coexist: the Occelli and Vlayen versions. The objective of this study was to assess the psychometric properties of the Occelli version in comparison with those reported for the Vlayen and the original US versions of this instrument.

METHODS

Using the original data from a cross-sectional study of 5,064 employees at a single university hospital in France, we examined the acceptability, internal consistency, factorial structure, and construct validity of the Occelli version of the HSOPSC.

RESULTS

The response rate was 76.8% (n = 3888). Our study yielded lower missing value rates (median, 0.4% [range, 0.0%-2.4%] versus 0.8% [range, 0.2%-11.4%]) and lower dimension scores (median, 3.19 [range, 2.67-3.54] versus 3.42 [range, 2.92-3.96]) than those reported for the Vlayen version. Cronbach alphas (median, 0.64; range, 0.56-0.84) compared unfavorably with those reported for the Vlayen (median, 0.73; range, 0.57-0.86) and original US (median, 0.78; range, 0.63-0.84) versions. The results of the confirmatory factor analysis were consistent between the Vlayen and Occelli versions, making it possible to conduct surveys from the 12-dimensional structure with both versions.

CONCLUSIONS

The inconsistencies observed between the Occelli and Vlayen versions of the HSOPSC may reflect either differences between the translations or heterogeneity in the study population and context. Current evidence does not clearly support the use of one version over the other. The two cross-cultural adaptations of the HSOPSC can be used interchangeably in French-speaking countries.

Patient safety culture in burn care units from the perspectives of healthcare providers: across-sectional study

Creating a positive patient safety culture is a key step in the improvement of patient safety in healthcare settings. PSC is a set of shared attitudes, beliefs, and perceptions about PS among healthcare providers. This study aimed to assess PSC in burn care units from the perspectives of healthcare providers. This cross-sectional descriptive study was conducted in 2020 in the units of a specialty burn center. Participants were 213 healthcare providers recruited to the study through a census. A demographic questionnaire and the Hospital Survey on Patient Safety Culture were used for data collection. Data were managed using the SPSS16 software and were summarized using the measures of descriptive statistics. The mean of positive responses to PSC items was 51.22%, denoting a moderate-level PSC. The lowest and the highest dimensional mean scores were related to the no punitive response to error dimension (mean: 12.36%) and the teamwork within departments dimension (mean: 73.25%), respectively. Almost half of the participants (49.3%) reported acceptable PS level in their workplace and 69.5% of them had not reported any error during the past twelve months before the study. Given the great vulnerability of patients with burn injuries in clinical settings, improving PSC, particularly in the no punitive response to error dimension, is essential to encourage healthcare providers for reporting their errors and thereby, to enhance PS. For quality care delivery, healthcare providers in burn care units need a safe workplace, adequate managerial support, a blame-free PSC, and an incentive error reporting system to readily report their errors.

Patient Safety Climate in General Public Hospitals in China: A Multiregion Study

OBJECTIVE

This study aimed to analyze the potential difference in patient safety climate by region (Shanghai vs Hubei Province vs Gansu Province) and general public hospital level (tertiary vs secondary) in China.

METHODS

Using a stratified sampling method, employees from 54 public general hospitals in Shanghai, Hubei Province, and Gansu Province in China were surveyed in 2015. The Patient Safety Climate in Health Care Organizations tool and the percentage of "problematic responses" (PPRs) were used to measure and analyze the patient safety climate. A χ2 test and hierarchical linear modeling were applied for the analysis.

RESULTS

In the study, 4121 valid questionnaires were collected. The psychometric analysis supported the validity and reliability of our Chinese version of the Patient Safety Climate in Health Care Organizations. The overall patient safety climate was relatively good and exhibited no significant differences among the surveyed hospitals by various regions (Shanghai vs Hubei Province vs Gansu Province) and diverse hospital levels (tertiary vs secondary) using hierarchical linear models. "Fear of blame and punishment" and "fear of shame" had the highest PPRs and were prevalent in various types of hospitals. "Provision of safe care" and "organizational resources for safety" also had notably high PPRs. There were 4 dimensions varied by region and hospital level in this survey.

CONCLUSIONS

Fear of shame and fear of blame are the most important barriers to the improvement of patient safety in the hospitals of China. Facility characteristics contributed somewhat to hospital patient safety climate in some dimensions. The initiatives to improve hospital patient safety climate are necessary and its implementation strategies needs to be shared.

An Evaluation of Patient Satisfaction with Nursing Care: A Qualitative Study in an Indonesian Hospital

Background

Patients experience first-hand quality services from nurses who are directly responsible for their welbeing. However, patient dissatisfaction with nursing services remains a problem in most developing countries. Therefore, this study aims to explore patient satisfaction with nursing care services in an Indonesian hospital.

Method

A qualitative study with a descriptive phenomenology method was employed. Also, in-depth interviews were conducted with 15 informants, and thematic analysis was adopted to analyze the data.

Results

The results of this study are described in the following themes and sub-themes: (1) hospital existence in public eyes: a) service commitment b) accessibility; (2) patients' background: a) religious aspect, b) cultural influence on perceiving health and sickness.

Conclusion

Hospital management needs to enhance the quality of nursing services through sustainable education programs and continuous training. These are important to improve nurses' cognition and skills, and further to ensure patient satisfaction and hospital quality.

Assessment of Patient Safety Culture in Public General Hospital in Capital City of Vietnam

Patient safety culture is a vital component in ensuring high quality and safe patient care. Assessment of staff perception on existing hospital patient safety culture (PSC) is the first step to promote PSC. This paper is aimed to assess the patient safety culture in 1 big public autonomous general hospital in Hanoi, Vietnam. This cross-sectional study surveyed 638 healthcare professional utilizing the validated (Hospital Survey on Patient Safety Culture [HSOPSC]) in an online format. This study adhered to STROBE guidelines. The positive response rate was high, with a percentage of 74.2. The strongest areas are teamwork within units (91.3%) and organizational learning/continuous improvement (88.4%). The areas for improvement are staffing (49.4%) and non-punitive response to error (53.1%). Hospital administrators should strengthen the culture of patient safety by formulating strategies and implementing interventions with emphasis on adequate staffing and promoting blame-free working environment.

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

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

Team Strategies and Tools to Enhance Performance and Patient Safety at primary healthcare units: Effect on patients' outcomes

The purpose of this study was to examine the effect of application of team strategies and tools to enhance performance and patient safety at primary healthcare units on patients' safety and outcomes. Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS) are specially intended to enhance patient safety through effective communication and teamwork skills. To examine, a quasi-experimental (pre-posttest) design was utilized. Six primary healthcare centers in Egypt were selected. The subjects included composed of two groups: (1) All-available healthcare providers (114) and (2) convenience sample of 108 clients. Four questionnaires were used, namely; the Hospital Survey on Patient Safety Culture (HSPSC), Perception of Teamwork Questionnaire, the Short Assessment of Patient Satisfaction Scale, and Patient's Adverse Events Questionnaire. Results showed that there was a highly significant decrease in the level of weakness and the need for potential improvement of all 11 domains of the HSPSC survey except the staffing domain (p < 0.001). The teamwork perceptions scores showed significant improvement post intervention (p < 0.001). In addition, a highly significant decrease in the frequency of patient-reported adverse events compared to a significant increase in patient satisfaction level was proved (p < 0.001). It may, hence, be concluded that Team STEPPS implementation had improved patient safety culture among healthcare providers and significantly improved patient outcomes.

Transcultural adaptation and psychometric evaluation of the mainland China version of Nursing Home Survey on Patient Safety Culture Questionnaire: a cross-sectional survey based on 50 nursing homes in China

OBJECTIVE

To provide a validated Chinese-language measurement of the Nursing Home Survey on Patient Safety Culture (NHSOPS) in mainland China. The primary goal is to carry out a transcultural adaptation of the NHSOPS Questionnaire into Chinese and evaluate its psychometric properties.

DESIGN

A psychometric evaluation study is constructed. First, the 'translation-back-translation-cultural adaptation' and the pretesting procedure were followed to introduce the NHSOPS. Second, a cross-sectional survey was used to assess the psychometric properties for the mainland China version of the NHSOPS (M-NHSOPS), and a test-retest survey was then applied.

SETTING AND PARTICIPANTS

The survey was carried out among 1397 nursing home staff from 50 nursing homes in Southwest China.

OUTCOME MEASURES

Exploratory factor analysis (EFA) was used to assess the potential structure, and confirmatory factor analysis (CFA) was then applied. Reliability was assessed by the content validity index, Cronbach's α and the test-retest value.

RESULTS

Among the 1397 respondents, 1211 were included (86.7%). EFA was used, and a nine-factor structure was explored. Five factors (Cronbach's α ＞0.6) were selected into the new structure for the M-NHSOPS. Moreover, data showed that it was suitable for CFA, and convergent validity and discriminant validity were satisfactory. On the other hand, M-NHSOPS contains five dimensions and 22 items. The overall Cronbach's α value was 0.883; the values of each dimension ranged from 0.648 to 0.913. Additionally, content validity showed significant performance. Eventually, test-retest reliability was 0.892, and each dimension was 0.713, 0.809, 0.924, 0.795 and 0.859, respectively (p<0.001).

CONCLUSIONS

M-NHSOPS has acceptable reliability and satisfactory validity among staff of nursing homes in Southwest China, and further verification among samples in other regions of mainland China is required.

Assessment of Patient Safety Culture in a Pediatric Department

Background An assessment of the prevalent culture needs to be the first step when building patient safety programs in healthcare organizations to achieve high-quality health care. Objective To conduct a baseline assessment of patient safety culture, to provide insight into the factors that contribute to patient safety, and to use the information to make improvements.  Methods The Hospital Survey on Patient Safety Culture (PSC) questionnaire was conducted from October through December 2020 at the Brookdale Hospital Medical Center (BHMC) Pediatric departments (Pediatric Inpatient Unit, Neonatal Intensive Care Unit [NICU], Pediatric Intensive Care Unit [PICU], and Pediatric Emergency Department) and four community-based ambulatory pediatric practices (Brookdale Family Care Centers [BFCC]). The percentages of positive responses on the 12 patient-safety dimensions and the summation of PSC and two outcomes (overall patient safety grade and adverse events reported in the past year) were assessed. Factors associated with PSC aggregate score were analyzed. Results From the 385 emails that were sent, 136 surveys were considered for analysis. This gives us a response rate of 35.3%. Most of the participants were nurses (58%) with direct contact with patients (94.2%). Most respondents did not report any events (60.7%), whereas 30.3% reported 1-2 events in the past year. The patient safety composites with the highest positive scores were teamwork within units (78%), supervisor/manager expectations and actions promoting patient safety (71.2%), and organizational learning--continuous improvement (66.8%). The composites with the lowest scores were non-punitive response to error (35.9%) and staffing (38%). Conclusions All of our composite measures, with the exception of teamwork within units, appear to be low, which means that all the other composite measures require interventions for improvement of overall safety culture. In order for healthcare leaders and policymakers to establish a culture of safety and improvement, they must create a climate of open communication, continuous learning, and eliminate the fear of blame and punitive feedback.

Variations in Patient Safety Climate in Chinese Hospitals

OBJECTIVES

Patient safety climate is associated with patient outcomes in hospitals around the world. A better understanding of how safety climate varies within and across hospitals will help identify improvement opportunities. We examined variations in safety climate by work area and job category in Chinese hospitals.

METHODS

We administered the Chinese Hospital Survey on Patient Safety Climate in 2011 to workers in 6 hospitals in China, with completed surveys from 1464 (86% response). We calculated the percent positive response for survey items and dimensions among hospitals and compared this across work areas and job categories using general linear models.

RESULTS

Overall, 68% of responses suggested the presence of a positive safety climate. The percent positive responses were highest for organizational learning (86.1%) and unit management support for safety (84.5%) and lowest for staffing (30.6%) and error reporting (44.5%). Workers in surgical units, intensive care units, operating rooms, and emergency departments were slightly more negative regarding overall safety climate than those in medical and ancillary units. Physicians reported worse perceptions than nurses or other hospital workers on all dimensions except for unit management support for safety and communication and peer support.

CONCLUSIONS

The perceived problem with staffing in Chinese hospitals was consistent with other studies. The lack of positive responses for error reporting may indicate a lack of awareness of the importance of learning from and reporting minor events and near misses. Variations within and across hospitals in safety climate suggest that improvement interventions should be tailored to individual units and professional groups.

Survey of Critical Standards of Patient Safety in Hospitals of Iran: A Systematic Review and Meta-Analysis

BACKGROUND

Patient safety is an important and mandatory component of quality health services. Insecure health services, in addition to inflicting pain and suffering to patients, impose a high financial burden on the health system of every society. The present study was conducted to evaluate the critical standards of patient safety based on the Patient Safety Friendly Hospital Initiative (PSFHI) checklist in Iran.

METHODS

The present systematic review and meta-analysis were performed based on the PRISMA guideline. For this purpose, articles related to the critical standards of patient safety based on the PSFHI checklist were obtained by searching valid Persian and English keywords in SID, Magiran, PubMed, Scopus, Web of Science, and Google scholar data resource through the end of 2019. The studies were analyzed using the STATA (version 14) software.

RESULTS

In the initial search, 533 articles were extracted among which 7 were eligible and entered into the meta-analysis process. Overall, 55 hospitals were surveyed, and the results of the meta-analysis showed that the average critical standards of patient safety were 69.52% (95%, CI = 57.09-81.95, I2 = 69%, P = 0.004).

CONCLUSIONS

The results showed that a moderate level of critical standards of patient safety in hospitals in Iran. Since meta-regression analysis revealed a decreasing trend in compliance rate, hospital managers should implement principals designated by the World Health Organization to achieve the required standards that are the basis and pillar of a patient-friendly hospital. With proper management, hospitals should set goals and take steps based on a strategic plan toward achieving these goals.

Perception of Patient Safety Culture among Hospital Staff

Introduction

A patient safety culture (PSC) is a complex phenomenon, representing an essential part of the organizational culture and refers to the shared values, conceptions and beliefs which contribute to the formation and encouragement of safe behavioural models in a health organization. With this study, the authors wanted to delineate the attitude of hospital staff in Bulgaria regarding PSC and to document to whether attitudes differ between physicians and other healthcare professionals (HCPs).

Methods

A national cross-sectional survey among 384 HCPs was conducted using an online version of the Bulgarian version of Hospital Survey on Patient Safety Culture (B-HSOPSC). The data was analysed with descriptive statistics, non-parametric Mann-Whitney U and x 2 tests.

Results

The physicians represented 37.50% (144) of the sample and other HCPs 62.50% (240). Respondents from governmental/municipal hospitals prevailed (53.6%). The dimensions “Staffing” and “Non-punitive response to error” were most problematic, as their percentage of positive response rates (PRRs) were lowest. However, “Handoffs and transitions” and “Supervisor/manager expectations and actions promoting safety“ showed the highest mean values in both physicians and other HCPs. From all participants, 76.0% have never reported an adverse event or error.

Conclusion

The results of the study show that all respondents demonstrate a positive attitude regarding PSC. A comparison of the mean values and that of PRRs in the dimensions did not show any group differences, according to the type of staff position, i.e. physicians or other HCPs.

Staying ahead of the curve: avigating changes and maintaining gains in patient safety culture - a mixed-methods study

OBJECTIVES

This study examines how the results of the Hospital Survey on Patient Safety Culture changed between 2012 and 2019 and identifies organisational factors affecting these changes.

DESIGN

The study combined the use of quantitative surveys of staff and qualitative interviews with hospital leadership. Secondary data analysis was performed for previous surveys.

SETTING

This study was conducted in a tertiary care teaching multisite hospital in Riyadh, Saudi Arabia.

PARTICIPANTS

One thousand hospital staff participated in the survey. Thirty-one executive board members and directors and four focus groups of frontliners were qualitatively interviewed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Twelve safety culture dimensions were assessed to study the patient safety culture as perceived by the healthcare professionals. An additional semi-structured interview was conducted to identify organisational factors, changes, and barriers affecting the patient safety culture. Furthermore, suggestions to improve patient safety were proposed.

RESULTS

Comparing the results revealed a general positive trend in scores from 2012 to 2019. The areas of strength included teamwork within and across units, organisational learning, managerial support, overall perception of safety and feedback and communication about error. Non-punitive response to error, staffing and communication and openness consistently remain the lowest-scoring composites. Interview results revealed that organisational changes may have influenced the answers of the participants on some survey composites.

CONCLUSIONS

Patient safety is a moving target with areas for improvement that are continuously identified. Effective quality improvement initiatives can lead to visible changes in the patient safety culture in a hospital, and consistent leadership commitment and support can maintain these improvements.

Assessing Patient Safety Culture in Hospital Settings

The current knowledge about patient safety culture (PSC) in the healthcare industry, as well as the research tools that have been used to evaluate PSC in hospitals, is limited. Such a limitation may hamper current efforts to improve patient safety worldwide. This study provides a systematic review of published research on the perception of PSC in hospitals. The research methods used to survey and evaluate PSC in healthcare settings are also explored. A list of academic databases was searched from 2006 to 2020 to form a comprehensive view of PSC's current applications. The following research instruments have been applied in the past to assess PSC: the Hospital Survey on Patient Safety Culture (HSPSC), the Safety Attitudes Questionnaire (SAQ), the Patient Safety Climate in Health Care Organizations (PSCHO), the Modified Stanford Instrument (MSI-2006), and the Scottish Hospital Safety Questionnaire (SHSQ). Some of the most critical factors that impact the PSC are teamwork and organizational and behavioral learning. Reporting errors and safety awareness, gender and demographics, work experience, and staffing levels have also been identified as essential factors. Therefore, these factors will need to be considered in future work to improve PSC. Finally, the results reveal strong evidence of growing interest among individuals in the healthcare industry to assess hospitals' general patient safety culture.

The Patient Safety Culture Scale for Chinese Primary Health Care Institutions: Development, Validity and Reliability

BACKGROUND

Existing patient safety culture assessment tools are mostly developed in western countries and may not be suitable for Chinese primary health care institutions. Primary care plays an important role in China's medical system, and a targeted tool for its patient safety culture is urgently needed.

OBJECTIVE

The aim of the study was to develop a dependable instrument to assess the patient safety culture in Chinese primary health care institutions.

METHODS

Three phases were undertaken to develop the scale. The first phase developed a pilot scale by literature review, focus groups, and 2-round Delphi expert consultation. The second phase conducted a pilot survey. The third phase carried out a formal survey to test reliability and validity, involving 369 participants from 9 primary health care institutions.

RESULTS

The final scale included 32 items under 7 dimensions. For reliability, the Cronbach α coefficients among dimensions varied from 0.754 to 0.926, and the Cronbach α for the scale was 0.940. For content validity, the corrected item-level content validity varied between 0.64 and 1, the scale-level content validity index/universal agreement was 0.625, and the scale-level content validity index/average was 0.93. For construct validity, the Spearman correlations of dimension-total score varied between 0.129 and 0.851, all Spearman correlations of the dimension-total score were greater than that of interdimensions and the Spearman correlations of item-total score ranged from 0.042 to 0.775. The results of the confirmatory factor analysis indicated that the model fitted well.

CONCLUSIONS

The Patient Safety Culture Scale for Chinese primary health care institutions demonstrated good reliability and acceptable validity; thus, it can be used as an assessment instrument for patient safety culture in Chinese primary health care institutions.

Quality control circle: a tool for enhancing perceptions of patient safety culture among hospital staff in Chinese hospitals

OBJECTIVE

To explore whether quality control circle (QCC) is associated with hospital staff's perceptions of patient safety culture (PSC).

DESIGN

A cross-sectional survey in 12 public hospitals from October to December 2018 and a longitudinal survey in one public hospital from November 2017 to November 2018.

SETTING

In 12 public hospitals from six provinces located in eastern, central and western of China, and one public hospital in eastern China.

PARTICIPANTS

In total, 811 and 102 hospital staff participated in the cross-sectional survey and the longitudinal survey, respectively. These participants included doctors, nurses, medical technicians and administrative staff.

MAIN OUTCOME MEASURES

Hospital staff's perceptions of PSC were measured by the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. The association between QCC implementation and PSC was identified by univariate analysis and multiple linear regression analysis.

RESULTS

Univariate analysis showed that the staff from hospitals that had implemented QCC received significantly higher HSOPSC scores than those from hospitals where QCC had not been implemented (3.73 ± 0.61 vs. 3.57 ± 0.41, P < 0.05). The QCC implementation was a significant predictor in the established multiple linear regression model. One year after QCC implementation, the hospital involved in the longitudinal survey scored higher in HSOPSC than before (3.75 ± 0.42 vs. 3.60 ± 0.36, P < 0.001).

CONCLUSIONS

QCC implementation was positively associated with PSC and the former could promote the establishment of the latter. It is suggested that QCC can play an active role in enhancing PSC so as to further improve patient safety management.

The Association between the Participation of Quality Control Circle and Patient Safety Culture

Promoting patient safety culture (PSC) is a critical issue for healthcare providers. Quality control circles program (QCCP) can be used as an effective tool to foster long-lasting improvements on the quality of medical institution. The effect of QCCP on PSC is still unknown. This was a retrospective study conducted with matching data. A safety attitudes questionnaire (SAQ) was used for the evaluation of PSC. The association between all scores of six subscales of SAQ and the participation QCCP were analyzed with both the Mann-Whitney and Kruskal-Wallis tests. A total of 2718 valid questionnaires were collected. Most participants of QCCP were females (78.9%), nurses (52.6%), non-supervisors (92.2%), aged <40 years old (64.8%), degree of specialist or university graduates (78%), and with work experience of <10 years (61.6%). Of all participants, the highest scores were in the dimension of safety climate (74.11 ± 17.91) and the lowest scores in the dimension of working conditions (68.90 ± 18.84). The participation of QCCP was associated with higher scores in four dimensions, namely: teamwork climate (p = 0.006), safety climate (p = 0.037), perception of management (p = 0.009), and working conditions (p = 0.015). The participation or not of QCCP had similar results in the dimension of job satisfaction and stress recognition. QCCP was associated with SAQ in subjects with the following characteristics: female, nurse, non-supervisor, aged >50 years old, higher education degrees and with longer working experiences in the hospital. In this first study on the association between each dimension of SAQ and the implementation of QCCP, we found that QCCP interventions were associated with better PSC. QCCP had no benefits in the dimensions of job satisfaction and stress recognition.

Arabic version of pharmacy survey on patient safety culture: Hospital pharmacy settings

Objective:

The objective was to assess the validity and reliability of a translated Arabic language version of the pharmacy survey on patient safety culture released by the United States Agency for Healthcare Research and Quality in 2012 and to utilize this to assess staff attitudes and perceptions of the patient safety culture in hospital pharmacies of Kuwait.

Methods:

This study used a cross-sectional timeframe. Data were gained from three of the largest public hospital pharmacies and three of the largest private hospital pharmacies in Kuwait. The primary and secondary outcome measures were descriptive statistics, internal consistency, construct validity, model fit, and calculation of the positive response rate for all composites and items.

Results:

The results demonstrated that 9 of the 11 composites had a Cronbach’s alpha (α) of >0.7, and all composites had factor loadings above 0.6. The standardized root mean residual score appropriately fitted the data with a value of 0.072. The intercorrelations among the patient safety composites ranged from 0.29 to 0.83. The proportion of pharmacy staff who categorized the grade of patient safety as “Good,” Very good,” or “Excellent” was 93%.

Conclusion:

The Arabic version of the pharmacy survey on patient safety culture questionnaire indicated suitable levels of reliability and validity. Also, the results demonstrated that the pharmacy staff surveyed in Kuwait have a positive perception of patient safety culture in their organizations.

Assessment and Comparison of Patient Safety Culture Among Health-Care Providers in Shenzhen Hospitals

Purpose

To investigate the health-care providers’ perceptions of patient safety culture in Shenzhen hospitals and to compare 2019 with 2015 data.

Methods

This cross-sectional study adopted a questionnaire survey and targeted hospital staff fitting the sampling criteria (physicians, nurses, technicians, and managers). A total of 5490 staff from 13 Shenzhen hospitals were surveyed using the Hospital Survey on Patient Safety Culture (HSOPSC).

Results

The average positive response rates of this study were generally higher than the data from the 2018 Agency for Healthcare Research and Quality (AHRQ) survey and the 2015 HSOPSC Shenzhen survey. Bivariate and multivariate regression showed that respondents who had direct contact with patients were less likely to report high overall patient safety grade. The probability of high overall patient safety grade was rated higher by men than by women. Compared with nurses, the probability of high overall patient safety grade was higher for both physicians and technicians.

Conclusion

The overall results of the patient safety culture in Shenzhen hospitals were relatively good and have improved significantly in recent years, but some areas of weakness still need improvement. Our recommendations are to develop training programs for various positions, recruit more employees, provide management support, and establish a just culture to promote a strong patient safety culture. Regular assessment is also needed to provide valuable information to hospital leaders on areas requiring improvement and to evaluate the quality improvement plan that has been implemented.

Measuring patient safety climate in operating rooms: Validation of the Spanish version of the hospital survey on patient safety

OBJECTIVE

The measurement of patient safety climate within hospitals, and specifically in operating rooms is a basic tool for the development of the patient's safety policy. There are no validated Spanish versions of instruments to measure safety climate. The objective of this research was to validate the Spanish version of the Hospital Survey on Patient Safety (HSOPS®), with the addition of a module for surgical units, to evaluate the patient safety climate in operating rooms.

METHODS

Survey validation study. The Hospital Survey on Patient Safety (HSOPS®) was applied to health workers from 6 acute general hospitals, from Medellín (Colombia), with surgical procedures greater than 300 per month, 18 items were added considered specific for Operating Rooms. For construct validation, an exploratory factor analysis (EFA) was used, utilizing principal components as the extraction method. Reliability was evaluated with Cronbach's α.

RESULTS

A 10 dimensions model was obtained with EFA, most of the dimensions of the original questionnaire were conserved, although the factorial structure was not reproduced. Two new dimensions emerged from the added items. The Cronbach's α ranged between 0.66 and 0.87. Conclusions: We found the HSOPS questionnaire is valid and reliable for measuring patient safety climate in Spanish speaking Latin American countries. Two additional dimensions are proposed for Operating Rooms.

Areas of Potential Improvement for Hospitals' Patient-Safety Culture in Western Ethiopia

Background

Patient-safety culture is an important component of health-care quality and currentlyan issue of high concern globally. In Ethiopia, little is known about patient-safety culture in hospitals. We assessed the patient-safety culture and associated factors among health-care workers in public hospitals of East Wollega Zone, western Ethiopia.

Methods

This institution-based cross-sectional study was conducted among 421 health-care workers selected using simple random sampling from March 4 to March 29, 2019. A standardized measuring 12 patient safety–culture components was used for data collection. Data were cleaned and entered into EpiData version 3.1 and analysis done using SPSS version 25 (IBM). Bivariate and multivariate linear regression analyses were performed. Significance was set at 95% CI and p<0.05, and unstandardized β-coefficients were used to measure extent of association.

Results

This study revealed that the level of patient-safety culture was 49.2% and patient safety culture–component scores ranged from 29.2% for nonpunitive responses to error to 77.9% for teamwork within a hospital unit. Age ≥45 years (β=13.642, CI: 5.324–21.959; p=0.001), 1–5 years’ experience at the current hospital (β=5.559, 95% CI 2.075–9.042; p=0.002), and working in general hospitals (β=11.988, 95% CI 7.233–16.743; p<0.001) and primary hospitals (β=6.408, 95% CI 2.192–10.624; p=0.003) were factors associated with better scores on patient-safety culture.

Conclusion

Overall scores for patient-safety culture were low. Improving the current state of patient safety in public hospitals would require tailored interventions to address low-scoring components, such as nonpunitive responses to error.