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Norouzinia R, Aghabarary M, Rahmatpour P. Psychometric evaluation of the Persian version of Emergency Medical Services- Safety Attitudes Questionnaire (EMS-SAQ). BMC Emerg Med 2024; 24:24. [PMID: 38355405 PMCID: PMC10865542 DOI: 10.1186/s12873-024-00941-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
AIM This study aimed to conduct a psychometric evaluation of the Persian adaptation of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ). METHODS In this cross-sectional study, the validity and reliability of the EMS-SAQ were assessed among 484 Iranian pre-hospital emergency department employees between February and June 2023. RESULTS Five factors were extracted namely safety climate, teamwork, job satisfaction, stress management, and working conditions with explained 38.75% of the total variance. The goodness of fit indexes confirmed the model (χ2 = 409.031, DF = 196, χ2 /df = 2.087, CFI = 0.900, IFI = 0.901, PCFI = 0.763 and PNFI = 0.701, and RMSEA = 0.069 [CI90% 0.059-0.078]). CONCLUSION The Persian version of the SAQ-EMS, comprising 22 items across five factors, demonstrated good validity and reliability. It is recommended to undertake qualitative studies focusing on the concept of patient safety in pre-hospital settings, considering diverse contexts and cultural nuances to develop more robust assessment tools.
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Affiliation(s)
- Roohangiz Norouzinia
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Maryam Aghabarary
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Pardis Rahmatpour
- School of Nursing, Alborz University of Medical Sciences, Karaj, Iran.
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Olesen AE, Juhl MH, Deilkås ET, Kristensen S. Review: application of the Safety Attitudes Questionnaire (SAQ) in primary care - a systematic synthesis on validity, descriptive and comparative results, and variance across organisational units. BMC PRIMARY CARE 2024; 25:37. [PMID: 38273241 PMCID: PMC10809511 DOI: 10.1186/s12875-024-02273-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
Patient safety research has focused mostly on the hospital and acute care setting whereas assessments of patient safety climate in primary health care settings are warranted. Valid questionnaires as e.g., the Safety Attitudes Questionnaire (SAQ) may capture staff perceptions of patient safety climate but until now, an overview of the use of SAQ in primary care has not been systematically presented. Thus, the aim of this systematic review is to present an overview of SAQ used in primary care.Methods The electronic databases: PubMed, Embase, Cinahl, PsycInfo and Web of Science were used to find studies that used any version of SAQ in primary care. Studies were excluded if only abstract or poster was available, as the information in abstract and posters was deemed insufficient. Commentaries and nonempirical studies (e.g., study protocols) were excluded. Only English manuscripts were included.Results A total of 43 studies were included and 40 of them fell into four categories: 1) validation analysis, 2) descriptive analysis, 3) variance assessment and 4) intervention evaluation and were included in further analyses. Some studies fell into more than one of the four categories. Seventeen studies aimed to validate different versions of SAQ in a variety of settings and providers. Twenty-five studies from fourteen different countries reported descriptive findings of different versions of SAQ in a variety of settings. Most studies were conducted in primary health care centres, out-of-hours clinics, nursing homes and general practice focusing on greatly varying populations. One study was conducted in home care. Three studies investigated variance of SAQ scores. Only five studies used SAQ to assess the effects of interventions/events. These studies evaluated the effect of electronic medical record implementation, a comprehensive Unit-based Safety Program or COVID-19.Conclusion The synthesis demonstrated that SAQ is valid for use in primary care, but it is important to adapt and validate the questionnaire to the specific setting and participants under investigation. Moreover, differences in SAQ factor scores were related to a variety of descriptive factors, that should be considered in future studies More studies, especially variance and intervention studies, are warranted in primary care.Trial registration This systematic review was not registered in any register.
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Affiliation(s)
- Anne Estrup Olesen
- Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8a, 9000, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark.
| | - Marie Haase Juhl
- Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8a, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark
| | - Ellen Tveter Deilkås
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, Oslo, Norway
| | - Solvejg Kristensen
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000, Aalborg, Denmark
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DİNÇER M, KARATAŞ OKYAY E, KARATAŞ YE, GÖRAL E. Developing patient safety scale for hospitals. Turk J Med Sci 2024; 54:449-458. [PMID: 39050396 PMCID: PMC11265919 DOI: 10.55730/1300-0144.5810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/04/2024] [Accepted: 01/05/2024] [Indexed: 07/27/2024] Open
Abstract
Background/aim The study aimed to contribute to the literature with a reliable and valid scale for hospitals to be used in determining the current patient safety culture and following up on its development. Materials and methods The study was conducted with the participation of 1137 healthcare professionals selected using the convenience sampling method in 3 secondary-care state hospitals and three research and training hospitals, one of which was affiliated with a medical faculty, and two were affiliated with the Health Sciences University. To begin with, to discover the latent structure of the items on the scale, an Exploratory Factor Analysis (EFA) was performed. Additionally, to determine the factor structure of the scale, the Confirmatory Factor Analysis (CFA) method was used. The Cronbach's alpha coefficient was calculated to check the reliability of the responses. Results According to Kaiser-Meyer-Olkin (KMO = 0.924) coefficient and the result of Bartlett's test of sphericity (χ 2 = 9748.777, df = 770), it was determined that the data structure was suitable for factor analysis. The Cronbach's alpha coefficient of the total scale was found to be 0.921. According to the EFA results, the scale was determined to have seven subscales, which were 1. Organizational Learning, Development, and Communication, 2. Management Support and Leadership, 3. Reporting Patient Safety Events, 4. Number of Personnel and Working Hours, 5. Response to Error, 6. Teamwork, and 7. Working Environment. The goodness-of-fit index results of the scale showed a good model fit (χ 2 / df = 3.04, RMSEA = 0.06, CFI = 0.97, NFI = 0.95, IFI = 0.97, SRMR = 0.06). The Cronbach's alpha coefficients of the subscales varied between 0.66 and 0.91. Conclusion The results showed that the Patient Safety Scale for Hospitals is a valid and reliable measurement instrument for healthcare professionals.
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Affiliation(s)
- Metin DİNÇER
- Health Management Department, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara,
Turkiye
| | - Esra KARATAŞ OKYAY
- Department of Midwifery, Faculty of Health Sciences, Kahramanmaraş Sütçü İmam University, Kahramanmaraş,
Turkiye
| | - Yunus Emre KARATAŞ
- Doctorate Program in Health Management, Social Science Institute, Hacettepe University, Ankara,
Turkiye
| | - Erol GÖRAL
- Master Program in Health Management, Health Science Institute, Ankara Yıldırım Beyazıt University, Ankara,
Turkiye
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Rogers L, Hughes Spence S, Aivalli P, De Brún A, McAuliffe E. A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings. J Interprof Care 2024; 38:156-171. [PMID: 36708308 DOI: 10.1080/13561820.2023.2168632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Shannon Hughes Spence
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
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Sarhadi A, Farahani AS, Rassouli M, Nasiri M, Babaie M, Khademi F. Determining the psychometric properties of safety attitudes questionnaire in NICUs. BMC Psychol 2023; 11:211. [PMID: 37474960 PMCID: PMC10360351 DOI: 10.1186/s40359-023-01229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/21/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION This study aimed to translate and assess the psychometric properties of the Persian version of the "Safety Attitude Questionnaire" in the NICUs. METHODS In this psychometric study, the "Safety Attitude Questionnaire" was translated into Persian. Then this version was used for psychometric evaluation. For this purpose, the qualitative face, content validity and construct validity were performed by confirmatory factor analysis. Internal consistency and stability reliability were calculated. Data were analyzed using SPSS and AMOS software. RESULTS Face validity was also performed with a slight change in four items. The factor structure of the tool was determined by confirmatory factor analysis. Fit indices were appropriate. Internal consistency reliability in the whole questionnaire was 0.65 and the stability reliability was calculated to be 0.64. DISCUSSION AND CONCLUSION "Safety Attitude Questionnaire" has appropriate psychometric properties and can be used in NICUs.
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Affiliation(s)
- Arezo Sarhadi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Shirinabadi Farahani
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Rassouli
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Biostatistics, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadese Babaie
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Khademi
- Department of Nursing, Faculty of Nursing, Arak University of Medical Sciences, Arak, Iran
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Ahmed FA, Asif F, Munir T, Halim MS, Feroze Ali Z, Belgaumi A, Zafar H, Latif A. Measuring the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMJ Open Qual 2023; 12:bmjoq-2022-002029. [PMID: 36931633 PMCID: PMC10030877 DOI: 10.1136/bmjoq-2022-002029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
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.
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Affiliation(s)
- Fasih Ali Ahmed
- Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Center for Patient Safety, Aga Khan University Medical College, Karachi, Pakistan
| | - Fozia Asif
- Center for Patient Safety, Aga Khan University Medical College, Karachi, Pakistan
| | - Tahir Munir
- Department of Anaesthesiology, Aga Khan University Medical College, Karachi, Pakistan
| | - Muhammad Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Zehra Feroze Ali
- Quality and Patient Safety Department, Aga Khan University Hospital, Karachi, Pakistan
| | - Asim Belgaumi
- Quality and Patient Safety Department, Aga Khan University Hospital, Karachi, Pakistan
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Hasnain Zafar
- Department of Surgery, Aga Khan University Medical College, Karachi, Pakistan
| | - Asad Latif
- Department of Anaesthesiology, Aga Khan University Medical College, Karachi, Pakistan
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Atukwatse J, Niyonzima V, Asher Aliga C, Nakandi Serwadda J, Nankunda R, Nakiganda C, Komugabe P, Nantongo H. Validation of the Safety Attitudes Questionnaire for Assessing Patient Safety Culture in Critical Care Settings of Three Selected Ugandan Hospitals. Drug Healthc Patient Saf 2023; 15:13-23. [PMID: 36727107 PMCID: PMC9885870 DOI: 10.2147/dhps.s389978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
Background The safety attitudes questionnaire (SAQ) short form (2006) is important for assessing patient safety culture in clinical environments. However, little is known about its validity and applicability in Uganda. This study validated the SAQ short form (2006) for use in assessing patient safety culture in critical care settings of hospitals in the Ugandan context. Methods Using a sequential exploratory mixed-methods research design, the face, content and construct validity for the SAQ short form (2006) was assessed in a multi-phased approach. A panel of eight (8) purposively selected experts assessed the face and content validity in rounds 1 and 2, respectively, while construct validity was assessed in round 3 using data from a cross-sectional survey of 256 frontline health workers in critical care settings of the selected hospitals. Analysis of survey data followed confirmatory factor analysis. Cronbach's alpha examined internal reliability. Results Of the 36 items in the tool's original version, 33 were rated clear, with a score of 100% on face validity. The use of contextual vocabulary and formatting issues arose as concerns. The S-CVI/Ave was 100%, and S-CVI/UA was 86.1%. Four new items added on effective communication as another dimension of patient safety culture. The survey had KMO=0.8605, the a priori-based model had a scale Cronbach's alpha=0.8881, with unsatisfactory goodness of fit (RMSEA=0.051, 90% CI: 0.044-0.057, pclose=0.427; chi-square=694.28, p <0.001; CFI=0.884, TLI=0.871). The modified final model had a scale Cronbach's alpha =0.8967 and satisfactory goodness of fit (RMSEA=0.030, 90% CI: 0.019-0.039, pclose=1.000; chi-square=424.98, p=0.002; CFI=0.966, TLI=0.960). Conclusion In the tool's original form, the face validity was lacking despite satisfactory scores on item clarity. Content validity was adequate, while construct validity required modifications in construct specifications. Reliability was adequate before and after specification modifications. The modified version has adequate psychometric properties for Uganda.
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Affiliation(s)
- Joseph Atukwatse
- School of Nursing and Midwifery, Aga Khan University Uganda, Kampala, Uganda
| | - Vallence Niyonzima
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda,Correspondence: Vallence Niyonzima, Tel +256777842830, Email
| | - Cliff Asher Aliga
- School of Nursing and Midwifery, Aga Khan University Uganda, Kampala, Uganda
| | - Jalia Nakandi Serwadda
- Department of Surgery and Specialized Areas, Mulago National Referral Hospital, Kampala, Uganda
| | - Rosemary Nankunda
- School of Nursing and Midwifery, Aga Khan University Uganda, Kampala, Uganda
| | - Catherine Nakiganda
- Department of Surgery and Specialized Areas, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Hanifah Nantongo
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
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Ali Ali HM, Abdul-Aziz AM, Darwish EAF, Swelem MS, Sultan EA. Assessment of patient safety culture among the staff of the University Hospital for Gynecology and Obstetrics in Alexandria, Egypt. J Egypt Public Health Assoc 2022; 97:20. [PMID: 36220933 PMCID: PMC9554056 DOI: 10.1186/s42506-022-00110-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Hend Mostafa Ali Ali
- Community Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | | | | | - Manal Shfik Swelem
- Gynecology and Obstetrics Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman Anwar Sultan
- Community Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Bernalte-Martí V. The Spanish and Italian Healthcare Professionals' Contribution to the Safety Attitudes Questionnaire Short Form in the Operating Room: Construct Validity and Reliability. J Patient Saf 2022; 18:e953-e961. [PMID: 35985046 DOI: 10.1097/pts.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study are to determine the construct validity and reliability of the Spanish and Italian versions of the Safety Attitudes Questionnaire Short Form and to study the capability of this scale of distinguishing between different countries, types of healthcare professionals, and attitudes around patient safety. METHOD This was a cross-sectional study of the scale among registered nurses, surgeons, and anesthetists providing direct patient care at surgical inpatient units within public health services in Spain (Sistema Nacional de Salud) and Italy (Servizio Sanitario Nazionale). Construct validity, in both countries, was firstly assessed by exploratory factor analysis. Then, a confirmatory factor analysis was conducted, and finally an assessment was performed by means of hypothesis testing. The reliability of the scale was calculated using Cronbach α coefficient. RESULTS A total of 499 healthcare professionals completed the questionnaire (Spain, n = 183; Italy, n = 316). The questionnaire showed excellent internal consistency (α = 0.85). An exploratory factor analysis identified a new factor model of the scale. The confirmatory factor analysis performed on this new model reflected the fair dimensionality of the construct (χ2 = 1193.63, root mean square error of approximation < 0.05, standardized root mean square residual < 0.08; nonnormed fit index, comparative fit index, incremental fit index, and goodness of fit index values = 0.90, indicating a good fit). CONCLUSIONS This study provides scientific evidence of the construct validity and reliability of the Safety Attitudes Questionnaire Short Form in both Spain and Italy, showing the capability of this scale of distinguishing between different countries, types of healthcare professionals, and attitudes around patient safety.
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The influence of physician-nurse collaboration on patient safety culture. Heliyon 2022; 8:e10649. [PMID: 36164521 PMCID: PMC9508511 DOI: 10.1016/j.heliyon.2022.e10649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 12/20/2021] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Many factors in health care organizations affect patients' safety, such as; multi-professional teamwork and collaboration. Physician-Nurse collaboration is the most crucial inter-professional collaboration in the health care system. Because these professionals are the closest to the patient and make most decisions related to patients' conditions, Physician-Nurse collaboration affects patients' health condition consequences, length of stay in health care facilities, patients' mortality, and the existence of medical errors. Aim of the study This study explores the relationship between physician-nurse collaboration and patient safety culture and compares patient safety culture levels between Jordanian hospitals from different sectors. In addition, examine differences in patient safety culture levels according to the position of health care providers (i.e., nurse managers, RN, and physicians). Methods A descriptive, cross-sectional design using a self-administered questionnaire was used for the current study. Data were collected between February and May of 2019. Four different hospital settings in Jordan (University, not-for-profit, private and governmental hospitals) were selected. In addition, we recruited a convenience sample representing registered nurses, nurse managers, and physicians at the selected hospitals. Measurements Three self-administered questionnaires were used to collect data for the current study: Demographic Data, Collaboration and Satisfaction About Care Decisions (CSACD), and Hospital Survey on Patient Safety Culture version 1.0 (HSOPS). Data analysis Data were screened for errors in data entry, outliers, or missing values. Data were normally distributed without extreme outliers. This study used descriptive statistics, the Pearson product-moment correlation, one-way ANOVA, and the Chi-square tests were used in this study. The level of significance (alpha value) is set at 0.05. Results showed that physician-nurse collaboration had a significant positive relationship with all patient safety culture levels (P < 0.01). In addition, the Pearson's product-moment correlation coefficient results indicated that all patient safety culture scores and subscales were positively and significantly correlated with physician-nurse collaboration (P < 0.01). Furthermore, the results of one-way ANOVA showed a statistically significant difference in the overall perception of patient safety culture according to the position of participants (P < 0.01). Moreover, Participants in Not-for-Profit Hospitals were more likely to report an 'excellent/very good' patient safety grade (P < 0.001) than in other hospitals. Conclusion Physician-nurse collaboration positively impacts overall patient safety culture grades. Health care organization in Jordan has the potential to increase levels of patient safety cultures; however, to achieve this aim, there should be a stronger focus on building effective inter-professional collaboration and building a blame-free culture among healthcare providers, and these organizations should receive the needed support from health care leaders in the country. To help strengthen the health care system, raise patient safety culture levels, and improve quality.
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Bernalte-Martí V. Cross-cultural Adaptation of the Safety Attitudes Questionnaire Short Form in Spanish and Italian Operating Rooms: Psychometric Properties. J Patient Saf 2022; 18:e687-e696. [PMID: 35026793 DOI: 10.1097/pts.0000000000000902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to translate the Safety Attitudes Questionnaire Short Form (SAQ-SF) in Spanish and Italian surgical settings and to assess its psychometric properties. METHOD The cross-cultural adaptation process was performed following the internationally recognized guidelines. A panel of 30 experts evaluated the content validity. Test-retest reliability and internal consistency were evaluated using a cross-sectional design. RESULTS The translation process was carried out without relevant difficulties. In Spain, 29 of the 36 SAQ-SF items showed excellent content validity index. In Italy, there were 33 items with an excellent rating. The SAQ-SF's overall Cronbach α was 0.8 for both countries. Test-retest reliability showed good to very good stability in both in countries. CONCLUSIONS Italian and Spanish researchers rate differently the same scale, demonstrating the diversity of relevance of the same questions in different countries. A validated questionnaire is now accessible to the Spanish and Italian hospital managements of the National Health Service to measure the safety climate in day-to-day practice in the operating rooms.
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Wu HH, Lee YC, Huang CH, Li L. Healthcare professional's perception of patient safety assessed by the hospital survey on patient safety culture in Taiwan: a systematic review. TQM JOURNAL 2022. [DOI: 10.1108/tqm-11-2021-0317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeSafety activities have been initiated in healthcare organizations in Taiwan, but little is known about the performance and trends of safety culture on a timely basis. This study aims to comprehensively review the articles that have conducted two worldwide patient safety culture instruments (HSPSC and SAQ) in Taiwan to provide the extent of existing knowledge about healthcare professionals' perception related to patient safety.Design/methodology/approachThe Web of Science, Medline (Pubmed) and Embas were used as the database to search papers related to the patient safety culture in Taiwan from 2008 to June 30, 2019.FindingsTwenty-four relative articles in total were found and further investigations confirmed that the regular assessment of patient safety culture among hospital staff is essentially important for healthcare organizations to reduce the rates of medical errors and malpractice. Moreover, the elements influencing patient safety culture may vary due to the difference in job positions, age, experience in organization and cultural settings.Research limitations/implicationsThe summary of findings enables healthcare administrators and practitioners to understand key components of patient safety culture for continuous improvement in medical quality.Originality/valueAssessing the safety culture in healthcare organizations is a foundation to achieve excellent medical quality and service. The implications of this study could be useful for hospitals to establish a safer environment for patients.
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Brubakk K, Svendsen MV, Deilkås ET, Hofoss D, Barach P, Tjomsland O. Hospital work environments affect the patient safety climate: A longitudinal follow-up using a logistic regression analysis model. PLoS One 2021; 16:e0258471. [PMID: 34653217 PMCID: PMC8519418 DOI: 10.1371/journal.pone.0258471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/28/2021] [Indexed: 01/21/2023] Open
Abstract
Background Occupational worker wellness and safety climate are key determinants of healthcare organizations’ ability to reduce medical harm to patients while supporting their employees. We designed a longitudinal study to evaluate the association between work environment characteristics and the patient safety climate in hospital units. Methods Primary data were collected from Norwegian hospital staff from 970 clinical units in all 21 hospitals of the South-Eastern Norway Health Region using the validated Norwegian Work Environment Survey and the Norwegian version of the Safety Attitudes Questionnaire. Responses from 91,225 surveys were collected over a three year period. We calculated the factor mean score and a binary outcome to measure study outcomes. The relationship between the hospital unit characteristics and the observed changes in the safety climate was analyzed by linear and logistic regression models. Results A work environment conducive to safe incident reporting, innovation, and teamwork was found to be significant for positive changes in the safety climate. In addition, a work environment supportive of patient needs and staff commitment to their workplace was significant for maintaining a mature safety climate over time. Conclusions A supportive work environment is essential for patient safety. The characteristics of the hospital units were significantly associated with the unit’s safety climate scores, hence improvements in working conditions are needed for enhancing patient safety.
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Affiliation(s)
- Kirsten Brubakk
- Department of Human Resources, South Eastern Norway Regional Health Authority, Hamar, Norway
- Institute for Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Martin Veel Svendsen
- Department of Occupational and Environmental Medicine, Telemark Hospital Trust, Skien, Norway
| | - Ellen Tveter Deilkås
- Department of Quality Improvement and Patient Safety, Norwegian Directorate of Health, Oslo, Norway
- Unit for Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Dag Hofoss
- Department of Health and Inequality, National Institute of Public Health, Oslo, Norway
| | - Paul Barach
- Department of Pediatrics, Wayne State University, Detroit, Michigan, United States of America
- Jefferson College of Population Health, Philadelphia, Pennsylvania, United States of America
- Sigmund Freud University, Vienna, Austria
| | - Ole Tjomsland
- Department of Health, South Eastern Norway Regional Health Authority, Hamar, Norway
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Wong SY, Fu ACL, Han J, Lin J, Lau MC. Effectiveness of customised safety intervention programmes to increase the safety culture of hospital staff. BMJ Open Qual 2021; 10:bmjoq-2020-000962. [PMID: 34625426 PMCID: PMC8504354 DOI: 10.1136/bmjoq-2020-000962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/22/2021] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to investigate the effectiveness of customised safety interventions in improving the safety cultures of both clinical and non-clinical hospital staff. This was assessed using the Safety Attitude Questionnaire-Chinese at baseline, 2 years and 4 years after the implementation of safety interventions with a high response rate ranging from 80.5% to 87.2% and excellent internal consistency (Cronbach’s alpha=0.93). The baseline survey revealed a relatively low positive attitude response in the Safety Climate (SC) domain. Both SC and Working Conditions (WC) domains were shown to have increased positive attitude responses in the second survey, while only the Management Perception domain had gained 3.8% in the last survey. In addition, safety dimensions related to collaboration with doctors and service delays due to communication breakdown were significantly improved after customised intervention was applied. Safety dimensions related to safety training, reporting and safety awareness had a high positive response in the initial survey; however, the effect was difficult to sustain subsequently. Multilevel analysis further illustrated that non-clinical staff were shown to have a more positive attitude than clinical staff, while female staff had a higher positive attitude percentage in job satisfaction than male staff. The results showed some improvements in various safety domains and dimensions, but also revealed inconsistent changes in subsequent surveys. The change in positive safety culture over the years and its sustainability need to be further explored. It is suggested that hospital management should continuously monitor and evaluate their strategies while delivering multifaceted interventions to be more specifically focused and to motivate staff to be enthusiastic in sustaining patient safety culture.
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Affiliation(s)
- Shiu Yee Wong
- Physiotherapy Department, Shatin Hospital, Hospital Authority, Hong Kong
| | - Allan Chak Lun Fu
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jia Han
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Jianhua Lin
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Rehabilitation Therapy, Tongji University School of Medicine, Shanghai, China
| | - Mun Cheung Lau
- Sports Medicine and Rehabilitation Centre, Chinese University of Hong Kong, New Territories, Hong Kong.,School of Health Sciences, Caritas Institute of Higher Education, Kowloon, Hong Kong
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Bohmann FO, Guenther J, Gruber K, Manser T, Steinmetz H, Pfeilschifter W. Measuring Patient Safety Climate in Acute Stroke Therapy. Front Neurol 2021; 12:686649. [PMID: 34659080 PMCID: PMC8517443 DOI: 10.3389/fneur.2021.686649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Treatment of acute stroke is highly time-dependent and performed by a multiprofessional, interdisciplinary team. Interface problems are expectable and issues relevant to patient safety are omnipresent. The Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure patient safety climate. The objective of this study was to evaluate the SAQ for the first time in the context of acute stroke care. Methods: A survey was carried out during the STREAM trial (NCT00032282) at seven university hospitals in Germany from October 2017 to October 2018. The anonymous survey included 33 questions (5-point Likert scale, 1 = disagree to 5 = agree) and addressed the entire multiprofessional stroke team. Statistical analyses were used to examine psychometric properties as well as descriptive findings. Results: 164 questionnaires were completed yielding a response rate of 66.4%. 67.7% of respondents were physicians and 25.0% were nurses. Confirmatory Factor Analysis revealed that the original 6-factor structure fits the data adequately. The SAQ for acute stroke care showed strong internal consistency (α = 0.88). Exploratory analysis revealed differences in scores on the SAQ dimensions when comparing physicians to nurses and when comparing physicians according to their duration of professional experience. Conclusion: The SAQ is a helpful and well-applicable tool to measure patient safety in acute stroke care. In comparison to other high-risk fields in medicine, patient safety climate in acute stroke care seems to be on a similar level with the potential for further improvements. Trial registration: www.ClinicalTrials.gov Identifier: NCT032282.
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Affiliation(s)
- Ferdinand O. Bohmann
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Joachim Guenther
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Katharina Gruber
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), Olten, Switzerland
| | - Helmuth Steinmetz
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- Klinikum Lüneburg, Klinik für Neurologie und Klinische Neurophysiologie, Lüneburg, Germany
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Alshyyab MA, FitzGerald G, Albsoul RA, Ting J, Kinnear FB, Borkoles E. Strategies and interventions for improving safety culture in Australian Emergency Departments: A modified Delphi study. Int J Health Plann Manage 2021; 36:2392-2410. [PMID: 34476834 DOI: 10.1002/hpm.3314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient safety and safety culture are critical for quality healthcare delivery in general and in Emergency Departments (EDs) in particular. The aim of this study is to identify strategies that may contribute to the improvement and maintenance of patient safety culture and which are considered most feasible in the ED environment. METHODS A two-step modified Delphi method with 11 experts' panel was performed to establish consensus. A list of potential expert participants with a background in patient safety culture in EDs was compiled through the professional networks of the supervisory team. Snowball sampling was used to identify additional possible participants. The expert panel included key leaders in the emergency medicine community in Queensland, Australia: patient safety experts and researchers, patient safety directors, and healthcare providers in an Australian ED The study ran from September 2018 to December 2018. The tool used in Round 1 in this study was developed through triangulating the outcomes of a review of literature, results from a survey of ED staff and findings from semi-structured interviews with key stakeholders in ED. The results from Round 1 informed the development of the Round 2 tool. The responses from the Delphi Round 1 tool were analysed as both qualitative data and quantitative data. The responses from the Delphi Round 2 tool were treated as quantitative data and analysed with the SPSS software. Consensus was calculated based on more than 80% agreement in collapsed categories 1 and 2 (or 4 and 5) of the five-point Likert scale. RESULTS Only six strategies out of 17 (35%) achieved consensus for both importance and feasibility. These strategies may therefore be considered the most important and feasible key strategies for improving safety culture in EDs. Seven strategies (41.1%) achieved consensus for importance, but not for feasibility and four strategies (23.55%) did not achieve consensus for either importance or feasibility. CONCLUSIONS This study offers practical solutions for safety culture improvement in the ED context. Six key strategies were seen as both important and feasible and these grouped into three main themes; leadership through agenda setting, operational management approaches to reinforce the agenda and commitment, and systems and structures to reinforce the agenda and monitor progress.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- Department of Public Health, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Gerard FitzGerald
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia
| | - Rania Ali Albsoul
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Joseph Ting
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Mater Health Services, Brisbane, Queensland, Australia
| | - Frances B Kinnear
- Emergency Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Erika Borkoles
- Department of Public Health, School of Medicine, Public Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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Bohmann FO, Guenther J, Gruber K, Manser T, Steinmetz H, Pfeilschifter W. Simulation-based training improves patient safety climate in acute stroke care (STREAM). Neurol Res Pract 2021; 3:37. [PMID: 34247651 PMCID: PMC8273945 DOI: 10.1186/s42466-021-00132-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Treatment of acute stroke performed by a multiprofessional, interdisciplinary team is highly time dependent. Interface problems are preprogrammed and pitfalls relevant to patient safety are omnipresent. The Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure patient safety. The objective of this study was to evaluate the influence of Simulation-based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM) on patient safety measured by SAQ in the context of acute stroke care. Methods During the STREAM trial at seven university hospitals in Germany from October 2017 to October 2018, an anonymous survey was conducted before and after the STREAM intervention centering around interdisciplinary simulation training. The questionnaire, based on the SAQ, included 33 items (5-point Likert scale, 1 = disagree to 5 = agree) and was addressed at the whole multiprofessional stroke team. Statistical analyses were used to examine psychometric properties as well as descriptive findings. Results In total 167 questionnaires were completed representing an overall response rate of 55.2%, including especially physicians (65.2%) and nurses (26.3%). Safety climate was significantly improved (pre-interventional: 3.34 ± .63 vs. post-interventional: 3.56 ± .69, p = .028). The same applies for teamwork climate among stroke teams (pre-interventional: 3.76 ± .59 vs. post-interventional: 3.84 ± .57, p = .001). The perceived benefit was most relevant among nurses. Conclusions The STREAM intervention centering around interdisciplinary simulation training increases perceived patient safety climate assessed by the SAQ in acute stroke therapy. These results have the potential to be a basis for future quality improvement programs. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00132-1.
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Affiliation(s)
- Ferdinand O Bohmann
- University Hospital Frankfurt, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
| | - Joachim Guenther
- University Hospital Frankfurt, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Katharina Gruber
- University Hospital Frankfurt, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), Olten, Switzerland
| | - Helmuth Steinmetz
- University Hospital Frankfurt, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Waltraud Pfeilschifter
- University Hospital Frankfurt, Department of Neurology, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.,Klinik für Neurologie und Klinische Neurophysiologie, Klinikum Lüneburg, Lüneburg, Germany
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Variation in Perception of Safety Culture in Out-of-hours Family Medicine Service in Croatia. Zdr Varst 2021; 60:152-157. [PMID: 34249161 PMCID: PMC8256768 DOI: 10.2478/sjph-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The Safety Attitudes Questionnaire (SAQ) is among the most frequently cited tools for measuring safety culture in healthcare settings. Its ambulatory version was used in this study. The aim was to assess safety culture in out-of-hours (OOH) family medicine service and its variation across job positions, regions, and respondents’ demographic characteristic. Methods A cross-sectional observational study was carried out targeting 358 health professionals working in the 29 largest Croatian healthcare centres providing out-of-hours family medicine service. The response rate was 51.7% (185 questionnaires). The questionnaire comprised 62 Likert items with 5 responses (fully disagree to fully agree). Scores of negatively worded items were reversed before analysis. Scores on the total scale and subscales were calculated as additive scores. The study included demographic data on gender, age, working experience, and job position. Repeated measurement analysis of variance was used to assess variation of Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV) sub-scales. Results Nurses assessed safety culture higher than did physicians and residents. Teamwork climate had higher scores than Ambulatory process of care and Organizational climate. Stress recognition and Perceptions of workload had the lowest overall scores. Variation across gender, age, working experience, and region was not statistically significant. Conclusions SAQ-AV can be used to identify areas for improvement in patient safety at OOH GPs. There is a need to improve staffing and support for OOH GP residents. Further research is needed in order to gain better understanding of factors influencing observed variations among job positions.
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Li Y, Cheng Y, Hu X, Zhang L. 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. BMJ Open 2021; 11:e043994. [PMID: 34158294 PMCID: PMC8220463 DOI: 10.1136/bmjopen-2020-043994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Yaqin Li
- School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yufei Cheng
- Core Facilities, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, School of Medicine/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Longhao Zhang
- 'Double First-Class' Construction Office, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Denning M, Goh ET, Tan B, Kanneganti A, Almonte M, Scott A, Martin G, Clarke J, Sounderajah V, Markar S, Przybylowicz J, Chan YH, Sia CH, Chua YX, Sim K, Lim L, Tan L, Tan M, Sharma V, Ooi S, Winter Beatty J, Flott K, Mason S, Chidambaram S, Yalamanchili S, Zbikowska G, Fedorowski J, Dykowska G, Wells M, Purkayastha S, Kinross J. Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study. PLoS One 2021; 16:e0238666. [PMID: 33861739 PMCID: PMC8051812 DOI: 10.1371/journal.pone.0238666] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/21/2021] [Indexed: 01/09/2023] Open
Abstract
The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and 'other clinical' (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Significant factors inversely correlated with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.
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Affiliation(s)
- Max Denning
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ee Teng Goh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Benjamin Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Melanie Almonte
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alasdair Scott
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Guy Martin
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jonathan Clarke
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sheraz Markar
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jan Przybylowicz
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ying Xian Chua
- Pioneer Polyclinic, National University Polyclinic, National University Health System, Singapore, Singapore
| | - Kang Sim
- Institute of Mental Health, Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lucas Lim
- Department of Forensic Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Lifeng Tan
- Division of Healthy Ageing, Alexandra Hospital, Singapore, Singapore
| | - Melanie Tan
- Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Vijay Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shirley Ooi
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | | | - Kelsey Flott
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sam Mason
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Seema Yalamanchili
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Gabriela Zbikowska
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Grazyna Dykowska
- Department of Economics of Health and Medical Law, Medical University of Warsaw, Poland
| | - Mary Wells
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - James Kinross
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Malinowska-Lipień I, Brzyski P, Gabryś T, Gniadek A, Kózka M, Kawalec P, Brzostek T, Squires A. Cultural adaptation of the Safety Attitudes Questionnaire - Short Form (SAQ-SF) in Poland. PLoS One 2021; 16:e0246340. [PMID: 33544732 PMCID: PMC7864443 DOI: 10.1371/journal.pone.0246340] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background It is essential to provide safe healthcare in complex, difficult, and quickly changing conditions. The quality of healthcare services directly influences the safety of both the patients and staff. Understanding healthcare staff attitudes toward safety in the healthcare delivery context is foundational for building a culture of safety. Aim of the work To adapt, via a structured translation methodology, the Safety Attitudes Questionnaire–Short Form (SAQ-SF), which assesses how employees of the health care sector perceive the safety climate in their workplace, to the Polish context. Methods Using a content validation approach to structure the translation process, we tested and psychometrically analysed the translated SAQ-SF. The sample comprised 322 employees of a district hospital (second referral level, which ensures 24/7 emergency care services) in Poland. Results The reliability of the sub-scales of the Polish version of the SAQ-SF ranged from 0.66 to 0.95. The discriminatory power of particular SAQ items ranged between 0.02 and 0.90. For 6 out of the 8 scale dimensions, the questions with the highest factor loadings were those measuring the same dimensions of the safety climate, according to the original scale. Conclusions The Polish version of the SAQ-SF (SAQ-SF-PL) meets the criteria of psychometric and functional validation as well as demonstrates good reliability as a measure of patient safety culture in the Polish context. The SAQ-SF-PL is an instrument that enable a valid and reliable assessment of patient safety climate in the Polish healthcare facilities and identify opportunities for improvement. International comparisons will also become easier.
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Affiliation(s)
- Iwona Malinowska-Lipień
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
- * E-mail:
| | | | - Teresa Gabryś
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Agnieszka Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Maria Kózka
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Paweł Kawalec
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Tomasz Brzostek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
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Huang CH, Lai CT, Wu CF, Lee YC, Yu CH, Hsueh HW, Wu HH. Gender difference in the perceptions of the patient safety culture: a case from a medical center in Taiwan. TQM JOURNAL 2021. [DOI: 10.1108/tqm-09-2020-0216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeGender difference exists in the perception of the patient safety culture in healthcare organizations. A case from a medical center in Taiwan is presented to examine how different genders perceive the patient safety culture in practice from 2014 to 2017.Design/methodology/approachA longitudinal study using the data from 2014 to 2017 is conducted quantitatively. Mann–Whitney U test and one-way analysis of variance are employed for analyses.FindingsThe results showed that female nurses had significantly higher emotional exhaustion than male nurses in 2015 and 2016 indicating male nurses had better fatigue recovery than their female counterparts. In addition, male nurses felt a higher degree of fatigue in 2016 and 2017 than those in 2015 statistically. In contrast, female nurses felt more stressful in 2016 and 2017 than those in 2014 statistically. Female nurses had higher emotional exhaustion in 2016 and 2017 than those in 2014 and 2015 statistically.Practical implicationsTo sum up, female nurses were more stressful than before, and their recovery was also relatively poor particularly in 2016 and 2017. There is a need to reduce the degree of fatigue for female nurses in this medical center through employee assistance programs, mindfulness-based stress reduction programs, building up female nurses' positive currency and setting up their appreciative inquiry. In contrast to female nurses, male nurses recovered better from fatigue. This might encourage hospital management to deploy male nurses more effectively in this medical center.Originality/valueThe results enable the hospital management to know there is a gender difference in this case hospital. More attention on female nurses is required.
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Tollefsen S, Førland O, Deilkås ECT, Baste V, Bondevik GT. Patient Safety Culture in Norwegian Home Health Care – a study protocol. TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mesarić J, Šimić D, Katić M, Tveter Deilkås EC, Hofoss D, Bondevik GT. The safety attitudes questionnaire for out-of-hours service in primary healthcare-Psychometric properties of the Croatian version. PLoS One 2020; 15:e0242065. [PMID: 33186353 PMCID: PMC7665828 DOI: 10.1371/journal.pone.0242065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/27/2020] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to assess the reliability and construct validity of the Croatian translation of the Safety Attitudes Questionnaire—Ambulatory version (SAQ-AV) in the out-of-hours (OOH) primary care setting. A cross-sectional observational study using anonymous web-survey was carried out targeting a convenience sample of 358 health professionals working in the Croatian OOH primary care service. The final sample consisted of 185 questionnaires (response rate 51.7%). Psychometric properties were assessed using exploratory hierarchical factor analysis with Schmid-Leiman rotation to bifactor solution, McDonald’s ω, and Cronbach’s α. Five group factors were identified: Organization climate, Teamwork climate, Stress recognition, Ambulatory process of care, and Perceptions of workload. Items loading on the Stress recognition and Perceptions of workload factor had low loadings on the general factor. Cronbach’s α ranged between 0.79 and 0.93. All items had corrected item-total correlation above 0.5. McDonalds’ ω total for group factors ranged between 0.76 and 0.91. Values of ω general for factors Organization climate, Teamwork climate, and Ambulatory process of care ranged between 0.41 and 0.56. McDonalds’ ω general for Stress recognition and Perceptions of workload were 0.13 and 0.16, respectively. Even though SAQ-AV may not be a reliable tool for international comparisons, subsets of items may be reliable tools in several national settings, including Croatia. Results confirmed that Stress recognition is not a dimension of patient safety culture, while Ambulatory process of care might be. Future studies should investigate the relationship of patient safety culture to treatment outcome.
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Affiliation(s)
- Jasna Mesarić
- Faculty of Health Sciences, Libertas International University, Zagreb, Croatia
- Croatian Society for Quality Improvement in Healthcare, Croatian Medical Association, Zagreb, Croatia
- * E-mail: (JM); (DS)
| | - Diana Šimić
- Faculty of Organization and Informatics, University of Zagreb, Varaždin, Croatia
- * E-mail: (JM); (DS)
| | - Milica Katić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ellen Catharina Tveter Deilkås
- The Norwegian Directorate of Health, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Dag Hofoss
- Lovisenberg Diaconal College, Oslo, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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Al Nadabi W, Faisal M, Mohammed MA. Patient safety culture in Oman: A national study. J Eval Clin Pract 2020; 26:1406-1415. [PMID: 31749203 DOI: 10.1111/jep.13322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/03/2019] [Accepted: 11/06/2019] [Indexed: 12/01/2022]
Abstract
RATIONAL, AIM, AND OBJECTIVES A positive patient safety culture in maternity units is linked to higher quality of care and better outcomes for mothers. However, safety culture varies across maternity units. Analyses of variation in safety culture using statistical process control (SPC) methods may help provider units to learn from each other's performance. This study aims to measure patient safety culture across maternity units in Oman using SPC methods. METHODS The 36-item Safety Attitude Questionnaire (SAQ) was distributed to all doctors, nurses, and midwifes working in ten maternity care units in Oman's hospitals and analysed using SPC methods. The SAQ considers six domains: job satisfaction, perception of management, safety climate, stress recognition, teamwork, and work condition. RESULTS Of the 892 targeted participants, 735 (82%) questionnaires were returned. The overall percentage of positive safety responses in all hospitals ranged from 53% to 66%, but no hospital had the targeted response of above 75%. Job satisfaction had the highest safety score (4.10) while stress recognition was the lowest (3.17). SPC charts showed that the overall percentage of positive responses in three maternity units (H1, H7, and H10) was above and one (H4) was below the control limits that represent special cause variation that merits further investigation. CONCLUSION Generally, the safety culture in maternity units in Oman is below target and suggests that considerable work is required to enhance safety culture. Several maternity units showed evidence of high/low special cause variation that may offer a useful starting point for understanding and enhancing safety culture.
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Affiliation(s)
- Waleed Al Nadabi
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, BD7 1DP, UK
| | - Muhammad Faisal
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, BD7 1DP, UK
| | - Mohammed Amin Mohammed
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, BD7 1DP, UK
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Santomauro CM, Hill A, McCurdie T, McGlashan HL. Improving the Quality of Evaluation Data in Simulation-Based Healthcare Improvement Projects: A Practitioner's Guide to Choosing and Using Published Measurement Tools. Simul Healthc 2020; 15:341-355. [PMID: 32520766 PMCID: PMC7531509 DOI: 10.1097/sih.0000000000000442] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STATEMENT Simulation is increasingly being used in healthcare improvement projects. The aims of such projects can be extremely diverse. Accordingly, the outcomes or participant attributes that need to be measured can vary dramatically from project-to-project and may include a wide range of nontechnical skills, technical skills, and psychological constructs. Consequently, there is a growing need for simulation practitioners to be able to identify suitable measurement tools and incorporate them into their work. This article provides a practical introduction and guide to the key considerations for practitioners when selecting and using such tools. It also offers a substantial selection of example tools, both to illustrate the key considerations in relation to choosing a measure (including reliability and validity) and to serve as a convenient resource for those planning a study. By making well-informed choices, practitioners can improve the quality of the data they collect, and the likelihood that their projects will succeed.
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Affiliation(s)
- Chiara M Santomauro
- From the Clinical Skills Development Service (C.M.S., A.H., T.M., H.L.M.), Metro North Hospital and Health Service; and School of Psychology (C.M.S., A.H., T.M.), The University of Queensland, Brisbane, Queensland, Australia
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Deilkås ECT, Bondevik GT. Pasientsikkerhetskultur og koronapandemien –nye muligheter for trygghet og samarbeid i norsk helse- og omsorgstjeneste. TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-01-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Gunnar Tschudi Bondevik
- Gruppe for helsetjenesteforskning, Institutt for global helse og samfunnsmedisin, Universitetet i Bergen / Nasjonalt kompetansesenter for legevaktmedisin, NORCE Norwegian Research Centre, Bergen
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Chi CY, Huang CH, Lee YC, Wu CF, Wu HH. Understanding critical demographic variables affecting patient safety culture from nurses' viewpoints. TQM JOURNAL 2020. [DOI: 10.1108/tqm-05-2019-0128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study is to identify critical demographic variables that would significant influence each dimension of patient safety culture. Understanding nurses' attitudes toward patient safety is important for healthcare organizations to relentlessly improve medical quality and services for patients.Design/methodology/approachThe internal survey data sets in 2015 and 2016 from nurses' viewpoints are used. Linear regression with forward selection is applied where nine demographic variables are the input variables, while each dimension of the Chinese version of safety attitudes questionnaire (SAQ) is the dependent variable.FindingsSupervisor/manager is the most essential demographic variable that has significant impacts on six dimensions. Experience in organization is the other critical demographic variable.Practical implicationsNurses who are in charge of supervisors/managers are more satisfied in six of eight dimensions. Nurses who have much experience in an organization tend to have less satisfaction in three dimensions. Therefore, hospital management should enhance the leader's effectiveness in engaging their subordinates' commitment.Originality/valueThe results enable the hospital management to pay much attention to two major demographic variables, namely supervisor/manager and experience in organization, in order to improve the patient safety culture based on the Chinese version of SAQ in this hospital. Moreover, supervisor/manager is a more critical demographic variable for nurses due to larger absolute values of standardized coefficients by linear regression with forward selection.
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Gambashidze N, Hammer A, Ernstmann N, Manser T. Psychometric properties of the Georgian version of the Safety Attitudes Questionnaire: a cross-sectional study. BMJ Open 2020; 10:e034863. [PMID: 32060162 PMCID: PMC7045008 DOI: 10.1136/bmjopen-2019-034863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To study the psychometric properties of the Georgian version of the Safety Attitudes Questionnaire short version. DESIGN Cross-sectional study. SETTING Three Georgian hospitals. PARTICIPANTS Personnel of participating hospitals (n=305 responses, estimated response rate 30%). INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES Psychometric properties (model fit, internal consistency, construct validity, convergent and discriminant validity) of the instrument, factor structure derived from the data. RESULTS The Georgian version of Safety Attitudes Questionnaire demonstrated acceptable construct validity and internal consistency (Cronbach's alpha 0.61-0.91). Three factors, Teamwork Climate, Safety Climate and Working Conditions, had limited convergent and discriminant validity. Confirmatory factor analysis with the original six-factor model resulted in limited model fit (χ2/df=2.14, root mean square error of approximation (RMSEA)=0.06, goodness of fit index (GFI)=0.83, CFI=0.88, TLI=0.86). Exploratory factor analysis resulted in a modified four-factor model with satisfactory model fit (χ2/df=2.09, RMSEA=0.06, GFI=0.88, CFI=0.93, TLI=0.91). CONCLUSIONS The Georgian version of the Safety Attitudes Questionnaire (short version) demonstrated acceptable psychometric properties, with acceptable to good internal consistency and construct validity. While the whole model had limited fit to the data, a modified factor model resulted in good model fit. Our findings suggest the dimension Working Conditions has questionable psychometric properties and should be interpreted with caution. Other two correlated dimensions Teamwork Climate and Safety Climate share considerable variance and may be merged. Overall, the instrument can provide valuable information relevant for advancement of patient safety culture in Georgian hospitals.
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Affiliation(s)
- Nikoloz Gambashidze
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- School of Health Sciences and Public Health, University of Georgia, Tbilisi, Georgia
| | - Antje Hammer
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Nicole Ernstmann
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Tanja Manser
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Ibrahim MAM, Osman OB, Ahmed WAM. Assessment of patient safety measures in governmental hospitals in Al-Baha, Saudi Arabia. AIMS Public Health 2020; 6:396-404. [PMID: 31909062 PMCID: PMC6940565 DOI: 10.3934/publichealth.2019.4.396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background/objective There is a need for patient safety in healthcare settings, WHO recommended an intergradation of patient safety in the curriculum of health specialties. This study aimed to assess the application patient safety measures at governmental hospitals in Al-Baha region. Methods This is a descriptive cross-sectional study. It was conducted at Al-Baha governmental hospitals, 2017-2018. The data was collected using a pretested, modified and validated questionnaire, a convenience sampling technique was used among 115 health care providers (doctors and nurses). The collected data was analyzed using SPSS version 22. Results The study showed that most of participants have previous training on patient safety and about 81.7% of them had heard about global aims of patient safety. The level of application of patient safety at Al-Baha governmental hospitals was 106 (92.2%) as very often. The findings showed that there are no significant influencing factors on application of patient safety. Conclusion The application of patient safety in Al-Baha governmental hospitals was very high. There are no significant influencing factors for the application status of patient safety measures in Al-Baha governmental hospitals.
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Affiliation(s)
| | - Osman Babiker Osman
- Public Health Department, Faculty of Applied Medical Sciences, Albaha University, Saudi Arabia
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Brubakk K, Svendsen MV, Hofoss D, Hansen TM, Barach P, Tjomsland O. Associations between work satisfaction, engagement and 7-day patient mortality: a cross-sectional survey. BMJ Open 2019; 9:e031704. [PMID: 31843830 PMCID: PMC6924769 DOI: 10.1136/bmjopen-2019-031704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study examines the association between profession-specific work environments and the 7-day mortality of patients admitted to these units with acute myocardial infarction (AMI), stroke and hip fracture. DESIGN A cross-sectional study combining patient mortality data extracted from the South-Eastern Norway Health Region, and the work environment scores at the hospital ward levels. A case-mix adjustment model was developed for the comparison between hospital wards. SETTING Fifty-six patient wards in 20 hospitals administered by the South-Eastern Norway Regional Health Authority. PARTICIPANTS In total, 46 026 patients admitted to hospitals with AMI, stroke and hip fracture, and supported by 8800 survey responses from physicians, nurses and managers over a 3-year period (2010-2012). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were the associations between the relative mortality rate for patients admitted with AMI, stroke and hip fractures and the profession-specific (ie, nurses, physicians, middle managers) mean scores on the 19 organisational factors in a validated cross sectional, staff survey conducted annually in Norway. The secondary outcome measures were the mean scores with SD on the organisational factors in the staff survey reported by each profession. RESULTS The Nurse workload (beta 0.019 (95% CI0.009-0.028)) and middle manager engagement (beta 0.024 (95% CI0.010-0.037)) levels were associated with a case-mix adjusted 7-day patient mortality rates. There was no significant association between physician work environment scores and patient mortality rates. CONCLUSION 7-day mortality rates in hospital wards were negatively correlated with the nurse workload and manager engagement levels. A deeper understanding of the relationships between patient outcomes, organisational structure and their underlying cultural barriers is needed because they may provide a better understanding of the harm and death risks for patients due to organisational characteristics.
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Affiliation(s)
- Kirsten Brubakk
- Department of Human Resources, Helse Sør-Øst RHF, Hamar, Norway
| | - Martin Veel Svendsen
- Department of Occupational and Environmental Medicine, Sykehuset Telemark HF, Skien, Norway
| | - Dag Hofoss
- Department of Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Tonya Moen Hansen
- Department of Health Services Research, Folkehelseinstituttet, Oslo, Norway
| | - Paul Barach
- Pediatrics, Wayne State University, Detroit, Michigan, USA
| | - Ole Tjomsland
- Department of Health, Helse Sør-Øst RHF, Hamar, Norway
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Dickens GL, Salamonson Y, Ramjan L, Steel K, Everett B. Safety attitudes, perceived organizational culture and knowledge of the physiologically deteriorating patient among mental health nurses: Cross-sectional, correlational study. Int J Ment Health Nurs 2019; 28:1347-1362. [PMID: 31498959 DOI: 10.1111/inm.12649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 11/29/2022]
Abstract
Mental health nurses have traditionally lagged in terms of physical healthcare skills and have been found to have poorer cultural safety-related attitudes relative to other nurses. Organizational culture, including safety-related culture, is associated with important aspects of care quality. The aim of the current study was to examine the relationships between safety-related attitudes, physical healthcare-related knowledge and organizational culture among mental health nurses. By doing so, the intention was to inform decisions about interventions to improve attitudes and care related to severe physiological deterioration among mental health nurses. The study design was cross-sectional and correlational. The safety-related attitudes of N = 133 nurses from the inpatient mental health services of one Local Health District in New South Wales, Australia, were examined in terms of a range of potential predictor variables of safety attitudes (Safety Attitudes Questionnaire) including individual organizational-perceiver type (Organisational Climate Assessment Inventory), knowledge of emergency medical healthcare (Lambeth In situ Training Questionnaire), use and perception of medical emergency teams (purpose-designed questionnaire) and a range of demographic variables. Regression analyses revealed that those who perceived the organization to have a primarily market-oriented culture had poorer safety-related attitudes than those who perceived a more clan-type culture. Number of years qualified was negatively associated with safety attitudes. To our knowledge, this is the first study in mental health which demonstrates a link between organizational culture-perception and safety attitudes related to physical healthcare. Results suggest that, among nurses, individuals have quite different perceptions of the organizational culture. In turn, this suggests that the 'one-size fits all' approach to changing organizational culture may be inappropriate.
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Affiliation(s)
- Geoffrey L Dickens
- Centre for Applied Nursing Research, Ingham Institute for Medical Research, Liverpool, New South Wales, Australia.,School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.,South West Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Yenna Salamonson
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Lucie Ramjan
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Kelly Steel
- South West Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Bronwyn Everett
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
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Zhao C, Chang Q, Zhang X, Wu Q, Wu N, He J, Zhao Y. Evaluation of safety attitudes of hospitals and the effects of demographic factors on safety attitudes: a psychometric validation of the safety attitudes and safety climate questionnaire. BMC Health Serv Res 2019; 19:836. [PMID: 31727062 PMCID: PMC6854737 DOI: 10.1186/s12913-019-4682-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objectives of this study are to test the psychometric properties of the safety attitudes and safety climate questionnaire Chinese simplified version (SAQ-CS), to test the safety attitudes of health professionals in tertiary hospitals in the Liaoning province and to explore the effects of demographic factors on safety attitudes. METHODS The SAQ-CS was used to conduct a cross-sectional survey in nine tertiary hospitals in Liaoning province. RESULTS Cronbach's alpha of each subscale of SAQ-CS were > 0.7, the values of GFI, TLI, and CFI were > 0.8, and RMSEA values ranged from 0.048-0.199. The mean of the safety attitudes of 2157 health professionals was 4.00, indicating a good safety attitude, with a positive response rate (% of items that scored ≥4) of 51.1%. The stress recognition subscale had the lowest score, with a mean of 2.73 and a positive response rate of 17.8%. A multiple linear regression equation revealed that demographic factors like gender, age, and training participation significantly affected the scores (βgender > 0.06, βage < - 0.08, βtraining < - 0.07, p < 0.05). CONCLUSIONS The psychometric properties of SAQ-CS are good and stable. Health professionals rate teamwork climate, safety climate, perception of management, and work conditions in Liaoning province are perceived as good; however, the stress of the health professionals is poor. To improve safety attitudes, it is necessary to not only reduce the stress of health professionals, but also to pay more attention to men, older health professionals, and health professionals who have not participated in safety training.
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Affiliation(s)
| | - Qing Chang
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Xi Zhang
- Liaoning Province Medical Doctor Association, Shenyang, China
| | - Qijun Wu
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Wu
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jiao He
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Jeong HJ, Lee WC, Liao HH, Chu FY, Chen TJ, Wang PC. The Hospital Patient Safety Culture Survey: Reform of Analysis and Visualization Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193624. [PMID: 31569628 PMCID: PMC6801378 DOI: 10.3390/ijerph16193624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/09/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022]
Abstract
Understanding the topography of hospital safety culture is vital for developing, implementing, and monitoring the effectiveness of tailored safety programs. Since 2009, the Chinese version of the Safety Attitudes Questionnaire (SAQ-C) has been introduced and administered to providers in many Taiwanese hospitals. The mean percentage of SAQ survey respondents who demonstrate attitudinal agreement within each of the SAQ domains, the percent agreement (PA) score, is used worldwide as the main parameter of safety culture surveys. However, several limitations within PA scoring have been identified. Our study sought to improve scoring methodology and develop a new graph layout for cultural topography presentation. A total of 37,163 responses to a national SAQ-C administration involving 200 Taiwan hospitals were retrospectively analyzed. To understand the central tendency and spread of safety culture scores across all participating hospitals, the median and interquartile range (IQR) of PA scores to the SAQ's teamwork domain were calculated, plotted, and named "safety culture grid." Study results denote limitations in the current PA scoring scheme, suggest SAQ analysis modification, and introduce a visualization graph layout that can provide richer information about safety culture dissemination than that available from currently utilized tools.
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Affiliation(s)
- Heon-Jae Jeong
- Joint Commission of Taiwan, No. 31, Sec. 2, Sanmin Rd., Banqiao Dist., New Taipei City 220, Taiwan.
- The Care Quality Research Group, 174 Toegye, Chuncheon, Gangwon 24450, Korea.
| | - Wui-Chiang Lee
- Department of Medical Affairs and Planning, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City 112, Taiwan.
- Institute of Hospital and Healthcare Administration, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112, Taiwan.
| | - Hsun-Hsiang Liao
- Joint Commission of Taiwan, No. 31, Sec. 2, Sanmin Rd., Banqiao Dist., New Taipei City 220, Taiwan.
| | - Feng-Yuan Chu
- Department of Family Medicine, Taipei Veterans General Hospital, Yuanshan & Su-Ao Branch, No. 386, Rongguang Rd., Yuanshan Township, Yilan County 264, Taiwan.
| | - Tzeng-Ji Chen
- Institute of Hospital and Healthcare Administration, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112, Taiwan.
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd., Beitou Dist., Taipei 112, Taiwan.
| | - Pa-Chun Wang
- Joint Commission of Taiwan, No. 31, Sec. 2, Sanmin Rd., Banqiao Dist., New Taipei City 220, Taiwan.
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Bondevik GT, Hofoss D, Husebø BS, Deilkås ECT. The safety attitudes questionnaire - ambulatory version: psychometric properties of the Norwegian version for nursing homes. BMC Health Serv Res 2019; 19:423. [PMID: 31238991 PMCID: PMC6593577 DOI: 10.1186/s12913-019-4244-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 06/11/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patient safety culture involves leader and staff interaction, routines, attitudes, practices and awareness that influence risks of adverse events in patient care. The Safety Attitudes Questionnaire (SAQ) is an instrument to measure safety attitudes among health care providers. The instrument aims to identify possible weaknesses in clinical settings and motivate quality improvement interventions leading to reductions in medical errors. The Ambulatory Version of the SAQ (SAQ-A) was developed to measure safety climate in the primary care setting. The original version of the SAQ includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition. Patients in nursing homes are particularly vulnerable to adverse events. We present the psychometric properties of the Norwegian translation of the SAQ-A for the nursing home setting. METHODS The study was conducted in five nursing homes in Tønsberg, Norway, in February 2016. A total of 463 employees working more than 20% received a paper version of the translated SAQ-A adapted to the Norwegian nursing home setting and responded anonymously. Filled-in questionnaires were scanned and transferred to an SPSS file. SPSS was used to estimate Cronbach alphas, corrected item-total correlations, item-to-own and item-to-other correlations, and item-descriptive statistics. The confirmatory factor analysis was done by AMOS. RESULTS Of the 463 health care providers, 288 (62.2%) responded to the questionnaire. The confirmatory factor analysis showed that the total model of the six factors Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition had acceptable goodness-of-fit values in the nursing home setting. CONCLUSIONS The results of our study indicate that the Norwegian translated version of the SAQ-A, with the confirmed six factor model, is an appropriate tool for measuring patient safety climate in the nursing home setting. Future research should study whether there is an association between patient safety climate in nursing homes and occurrence of adverse events among the patients.
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Affiliation(s)
- Gunnar Tschudi Bondevik
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Dag Hofoss
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Bettina Sandgathe Husebø
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Municipality of Bergen, Bergen, Norway
| | - Ellen Catharina Tveter Deilkås
- The Norwegian Directorate of Health, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Abstract
BACKGROUND The first step towards establishing and improving patient safety culture in hospitals is measuring patient safety culture perceptions of staff. Few studies have examined the perception of patient safety culture in general surgery departments. OBJECTIVES The objective of this study was to evaluate patient safety culture and patient safety grade in general surgery departments and to examine the relation between the patient safety culture and the patient safety grade. METHODS This study examined patient safety culture and patient safety grades of 124 staff in seven surgery departments of a hospital in Turkey. The staff completed the hospital survey on patient safety culture and answered questions about their professional characteristics. One-way ANOVA, Independent-samples t test, corrected chi-square test, multiple correspondence analysis and Eta co-efficient were used in statistical analyses. RESULTS The patient safety dimension of "teamwork within units" had the highest mean and percentage of positive responses. The "frequency of events reported" and "non-punitive response to errors" had the lowest means and percentages of positive responses. Participants with resident or nurse positions, < age 31 years, with < 6 years of professional experience, and 60 or more work hours/week, had significantly more negative perceptions of patient safety culture than other participants. Patient safety grades and the dimensions of "management support for patient safety" and "overall perceptions of patient safety" had significantly high Eta coefficients. CONCLUSION Frequency of events reported and non-punitive responses to errors should be improved, and participants' characteristics should be considered at improvement efforts in general surgery departments. The dimesions with low means suggest opportunities for improvement.
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Affiliation(s)
- Mesut Teleş
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University
| | - Sıdıka Kaya
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University
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Validation of the Indonesian version of the Safety Attitudes Questionnaire: A Rasch analysis. PLoS One 2019; 14:e0215128. [PMID: 30970024 PMCID: PMC6457536 DOI: 10.1371/journal.pone.0215128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 03/24/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Safety climate, which provides a snapshot of safety culture, is rarely measured in Indonesian healthcare organisations because there are no validated surveys that can be administered in its native language, Bahasa Indonesia. The objectives of this study were to translate and linguistically adapt the Safety Attitudes Questionnaire into Bahasa Indonesia, and investigate the internal construct validity and reliability of the translated survey. Methods The Safety Attitudes Questionnaire was translated into Indonesian language through forward and backward translation. The internal construct validity and reliability of the translated survey was assessed using Rasch analysis which examines overall model fit, unidimensionality, response format, targeting, internal consistency reliability and item bias. Results A total of 279 nurses (response rate 82%) completed the Indonesian version of the Safety Attitudes Questionnaire. Most respondents were Division 2 registered nurses (n = 209; 75%), female (n = 174; 62%), and aged less than 30 years (n = 187; 67%). All six domains of the Indonesian version of the Safety Attitudes Questionnaire demonstrated unidimensionality (t-test less than 0.05 threshold value). However, suboptimal targeting (ceiling effect) was observed in all domains, and had at least one misfitting item (item fit residual beyond ±2.5) Item bias was also evident in most domains. Conclusion This study has translated and validated an Indonesian version of the Safety Attitudes Questionnaire for the first time. Whilst there was general support to sum items to obtain domain scores, further work is required to refine the response options as well as the wording and number of items in this survey to improve its overall measurement properties.
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Cheng HC, Yen AMF, Lee YH. Factors affecting patient safety culture among dental healthcare workers: A nationwide cross-sectional survey. J Dent Sci 2019; 14:263-268. [PMID: 31528254 PMCID: PMC6739285 DOI: 10.1016/j.jds.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 11/27/2018] [Indexed: 11/26/2022] Open
Abstract
Background/purpose Patient safety is a major healthcare challenge. Due to a lack of safety culture knowledge among dental professionals, our objectives were to measure the level of patient safety culture using the Safety Attitude Questionnaire in Chinese (SAQ-C) and identify factors associated with positive attitudes toward patient safety. Materials and methods A nationwide cross-sectional survey was conducted within dentistry departments of 20 hospitals and in 40 dental clinics, from which were randomly chosen. The survey (SAQ-C) comprised of 32 items and reflects five dimensions of patient safety culture. The second section collects demographic information that supposedly affects attitudes toward patient safety. Logistic regression analyses were used to identify factors that supposedly influenced positive attitudes toward patient safety. Results Mean SAQ-C scores were significantly higher in respondents who were male, older, dentists, supervisors, and working in clinics. Positive attitudes toward patient safety were found in 172 participants (55.7%). Multivariate analyses revealed age and place of work are significantly associated with positive safety attitudes. A limitation of this study is that the association between SAQ-C scores and patient outcomes could not be examined. Conclusion With a lack of research in the dental field, our study provides important information on patient safety attitudes for dental healthcare workers. Results from this study present the current status of patient safety culture and help raise awareness of it. Most notably, the study identified several factors associated with positive attitudes toward patient safety. The information can be used to improve patient safety in the future.
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Affiliation(s)
- Hsin-Chung Cheng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
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Røyset B, Talseth-Palmer BA, Lydersen S, Farup PG. Effects of a fall prevention program in elderly: a pragmatic observational study in two orthopedic departments. Clin Interv Aging 2019; 14:145-154. [PMID: 30697039 PMCID: PMC6339647 DOI: 10.2147/cia.s191832] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Falls are a common adverse event experienced by elderly in hospitals. This study assessed the effects of a fall prevention program on the rate of fallers, the patient safety culture, and patient-perceived safety. Materials and methods Two orthopedic departments in different towns in Norway participated in the study. A comprehensive, multifactorial fall prevention program was implemented in one of the departments, the other one was used for control. The changes in the outcomes in the two departments from before to after the intervention were compared. All patients above 64 years of age admitted to the two departments in a 1-year period before and after the intervention were included. All employees at the two departments were invited to participate in surveys measuring the patient safety culture, and a selection of the patients reported patient-perceived safety. The primary outcome was the rate of fallers. Secondary outcomes were the employees’ perceived patient safety culture (measured with the Safety Attitudes Questionnaire) and patient-perceived safety (measured with Norwegian Patient Experience Questionnaire). Results Falls were registered in 114 out of 3,143 patients (3.6%) with 17,006 days in the hospital. Ten patients had two falls, giving a fall rate of 7.3 falls/1,000 days in the hospital. The number of fallers before and after the intervention in the intervention department were 37/734 (5.04%) and 31/735 (4.22%), P=0.46, and in the control department, 25/811 (3.08%) and 21/863 (2.43%), P=0.46. The difference between the changes in the two departments was not statistically significant; 0.17% (95% CI: −2.49 to 2.84; P=0.90). There were also no significant differences in the changes in patient safety culture and patient-perceived safety. Conclusion The fall prevention program revealed no significant effect on the rate of fallers, the patient safety culture, or patient-perceived safety.
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Affiliation(s)
- Bodil Røyset
- Department for Medicine and Rehabilitation, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Bente A Talseth-Palmer
- Department for Research, Innovation, Education and Competence Development, Møre og Romsdal Hospital Trust, Molde, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per G Farup
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway, .,Unit for Applied Clinical Research, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway,
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Klemenc-Ketis Z, Makivić I, Poplas-Susič A. Safety culture in the primary health care settings based on workers with a leadership role: the psychometric properties of the Slovenian-language version of the safety attitudes questionnaire - short form. BMC Health Serv Res 2018; 18:767. [PMID: 30305161 PMCID: PMC6180368 DOI: 10.1186/s12913-018-3594-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/02/2018] [Indexed: 11/21/2022] Open
Abstract
Background Safety culture describes leader and staff interactions, attitudes, routines, awareness, and practices within an organisation. With this study, we aimed to determine the psychometric properties of the Slovenian-language version of the Safety Attitudes Questionnaire (SAQ) – Short Form in primary health care settings. Methods This was a cross-sectional study in the largest primary health care in Slovenia. We invited all employees with a leadership role to participate in the study (N = 211). We used the Slovenian-language version of the SAQ – Short Form. Results There were 154 participants in the final sample (73.0% response rate), of which 136 (88.3%) were women. The mean age of the sample was 46.2 ± 10.0 years. Exploratory factor analysis put forward six factors: 1) Perceptions of Management; 2) Stress recognition; 3) Teamwork Climate; 4) Communication; 5) Safety Climate; 6) Working Conditions and Satisfaction. This model explained 61.7% of the variance of the safety culture in the primary health care setting. The reliability of the whole scale and of the six factors, assessed using Cronbach’s alpha, was all above 0.78. Conclusion The results of our study suggests that the Slovenian-language version of the SAQ – Short Form with six factors could be a reliable and valid tool for measuring the safety culture in the primary health care workers with leadership role In Slovenia. The Slovenian version differed from the original SAQ – Short Form and the majority of other translated versions. Also, the data was from one health centre only and therefore we cannot draw strong conclusions on its external validity.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia. .,Department of Family Medicine, Faculty of Medicine, University of Maribor, Taborska 8, 2000, Maribor, Slovenia. .,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, 1000, Ljubljana, Slovenia.
| | - Irena Makivić
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia
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Alqattan H, Cleland J, Morrison Z. An evaluation of patient safety culture in a secondary care setting in Kuwait. J Taibah Univ Med Sci 2018; 13:272-280. [PMID: 31435334 PMCID: PMC6694905 DOI: 10.1016/j.jtumed.2018.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/29/2018] [Accepted: 02/11/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To improve patient safety outcomes, it is considered essential to create a positive culture of patient safety. This study carried out an initial evaluation of the patient safety culture in a secondary care setting in Kuwait. METHODS This cross-sectional questionnaire study was conducted in a general hospital medical department in Kuwait, using the Hospital Survey on Patient Safety Culture (HSPSC). Multiple linear regression analyses were used to identify patient safety culture predictors. Both an ANOVA and a Kruskal Wallis test were carried out to assess the differences between participants' total scores and the scores they achieved in each dimension, categorized by nationality. RESULTS A total of 1008 completed questionnaires were received, yielding a response rate of 75.2%. Three dimensions of patient safety culture were found to be priority areas for improvement: non-punitive responses to errors, staffing, and communication openness. Teamwork within units and organizational learning with continuous improvement were identified as areas of strength. Respondents from Kuwait and the Gulf State countries had a less positive perception of the hospital's patient safety culture than did Asian respondents. A regression analysis showed that the respondents' countries of origin, professions, age, and patient safety course/lecture attendance were significantly correlated with their perceptions of the hospital's patient safety culture. CONCLUSION This study demonstrates that patient safety is perceived differently by medical staff members from different countries of origin, professional groups, and age groups. These variables must be acknowledged and addressed when planning or evaluating patient safety initiatives.
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Affiliation(s)
- Hamad Alqattan
- From the Centre for Health Education Research and Innovation, Institute of Education in Medical and Dental Sciences (Alqattan, Cleland), and the Business School (Morrison), University of Aberdeen, Aberdeen, UK
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Alquwez N, Cruz JP, Almoghairi AM, Al-Otaibi RS, Almutairi KO, Alicante JG, Colet PC. Nurses' Perceptions of Patient Safety Culture in Three Hospitals in Saudi Arabia. J Nurs Scholarsh 2018; 50:422-431. [PMID: 29758128 DOI: 10.1111/jnu.12394] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess the present patient safety culture of three general hospitals in Saudi Arabia, as perceived by nurses. DESIGN This study utilized a descriptive, cross-sectional design. METHODS A convenience sample of 351 nurses working in three general hospitals in the central region of Saudi Arabia was surveyed in this study using the Hospital Survey of Patients' Safety Culture (HSOPSC) from October 2016 to April 2017. RESULTS From the 12 composites of the HSOPSC, the nurses perceived only the following two patient safety areas as strengths: teamwork within units and organizational learning-continuous improvement. Six areas of patient safety were identified as weaknesses, namely overall perception of patient safety, handoffs and transitions, communication openness, staffing, frequency of events reported, and nonpunitive response to errors. Nationality, educational attainment, hospital, length of service in the hospital, work area or unit, length of service in the current work area or unit, current position, and direct patient contact or interaction were significant predictors of the nurses' perceived patient safety culture. CONCLUSIONS The findings in this study clarify the current status of patient safety culture in three hospitals in the Kingdom of Saudi Arabia. CLINICAL RELEVANCE The present findings should be considered by policymakers, hospital leaders, and nurse executives in creating interventions aimed at improving the patient safety culture in hospitals. A multidimensional network intervention targeting the different dimensions of patient safety culture and involving different organizational levels should be implemented to improve patient safety.
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Affiliation(s)
- Nahed Alquwez
- Assistant Professor and Vice Dean for Academic Affairs, College of Applied Medical Sciences, Shaqra University, Al Dawadmi, Saudi Arabia
| | - Jonas Preposi Cruz
- Lecturer, Nursing Department, College of Applied Medical Sciences, Shaqra University, Al Dawadmi, Saudi Arabia and Visiting Professor, Graduate School, Union Christian College, San Fernando, La Union, Philippines
| | - Ahmed Mohammed Almoghairi
- Lecturer and Department Head, Nursing Department, College of Applied Medical Sciences, Shaqra University, Al Dawadmi, Saudi Arabia
| | | | - Khalid Obaid Almutairi
- Lecturer, Nursing Department, College of Applied Medical Sciences, Shaqra University, Al Dawadmi, Saudi Arabia
| | - Jerico G Alicante
- Shearwater Health, Training and Development, Taguig City, Manila, Philippines
| | - Paolo C Colet
- Assistant Professor, School of Medicine, Nazarbayev University, Astana, Republic of Kazakhstan
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Patient safety culture as a quality indicator for a safe health system: Experience from Almadinah Almunawwarah, KSA. J Taibah Univ Med Sci 2018; 13:377-383. [PMID: 31435350 PMCID: PMC6695079 DOI: 10.1016/j.jtumed.2018.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives Safety culture assessments allow healthcare organisations to get a clear understanding of those aspects of patient safety requiring urgent attention and highlight safety culture strengths and weaknesses. This study aimed to evaluate the extent to which the culture supports patient safety at a hospital in KSA. Methods A cross-section analytical observational study was conducted at King Fahad Hospital in Almadinah Almunawwarah, KSA. Results After the survey, the staff felt less certain about the patient safety culture inside the institution. The greatest positive scores were obtained for teamwork within units, safety culture composites, feedback, communication about error, management expectations, actions promoting patient safety, organisational learning, and continuous improvement. However, none of these features achieved a positive score of 75% or more as an area of strength. The rest of the aspects were negatively ranked as areas for probable development, with the lowest scores obtained for non-punitive reaction to error, staffing, hospital handoff and transition, communication openness, and hospital management support for patient safety. Conclusion Commitment to quality care as an outcome is certainly correlated with patient safety. There is a strong need to improve and promote applicable policies to improve the culture of patient safety in hospitals. The development of strong management competence to promote an environment of open consultation and administrative wisdom will contribute to improving patient safety culture.
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Li Y, Zhao Y, Hao Y, Jiao M, Ma H, Teng B, Yang K, Sun T, Wu Q, Qiao H. Perceptions of patient safety culture among healthcare employees in tertiary hospitals of Heilongjiang province in northern China: a cross-sectional study. Int J Qual Health Care 2018; 30:618-623. [PMID: 29684158 DOI: 10.1093/intqhc/mzy084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 04/12/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Ying Li
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, China
| | - Yanming Zhao
- Department of CT, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang province, China
| | - Yanhua Hao
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Mingli Jiao
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, China
| | - Hongkun Ma
- Department of Health Management, Harbin Medical University, Harbin, China
| | - Baijun Teng
- Health Development Research Center of Heilongjiang Province, Health and Family Planning Commission of Heilongjiang Province, Harbin, China
| | - Kai Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Tongbo Sun
- Department of Health Management, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Hong Qiao
- Endocrine and Metabolic Diseases, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
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Ali H, Ibrahem SZ, Al Mudaf B, Al Fadalah T, Jamal D, El-Jardali F. Baseline assessment of patient safety culture in public hospitals in Kuwait. BMC Health Serv Res 2018; 18:158. [PMID: 29510705 PMCID: PMC5840785 DOI: 10.1186/s12913-018-2960-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 02/21/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Samaa Zenhom Ibrahem
- Ministry of Health, Kuwait City, Kuwait.,Department of Health Management, Planning and Policy, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | | | | | - Diana Jamal
- Department of Health Management and Policy, Faculty of Heath Sciences, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Heath Sciences, American University of Beirut, Beirut, Lebanon.
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Smits M, Keizer E, Giesen P, Deilkås ECT, Hofoss D, Bondevik GT. Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey. Scand J Prim Health Care 2018; 36:28-35. [PMID: 29334826 PMCID: PMC5901437 DOI: 10.1080/02813432.2018.1426150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness. DESIGN Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience. RESULTS Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N = 470) and triage nurses (N = 189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors. CONCLUSIONS Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents' profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture. Key Points Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that: • healthcare providers in Dutch GP cooperatives perceive patient safety culture positively; • triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals - on several patient safety culture factors; and • within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.
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Affiliation(s)
- Marleen Smits
- Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- CONTACT Marleen Smits NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands
| | - Ellen Keizer
- Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Paul Giesen
- Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Ellen Catharina Tveter Deilkås
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- The Norwegian Directorate of Health, Oslo, Norway
| | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
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Nilsson U, Göras C, Wallentin FY, Ehrenberg A, Unbeck M. The Swedish Safety Attitudes Questionnaire-Operating Room Version: Psychometric Properties in the Surgical Team. J Perianesth Nurs 2018; 33:935-945. [PMID: 30449442 DOI: 10.1016/j.jopan.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/31/2017] [Accepted: 09/22/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE To validate the Swedish Safety Attitudes Questionnaire-operating room (SAQ-OR) version by re-evaluating its psychometric properties for the surgical team. DESIGN Cross-sectional questionnaire study. METHODS 541 surgical team members including perioperative nurses, physicians, and licensed practical nurses at three Swedish hospitals were included. FINDINGS For the total sample, the Cronbach's α for the six factors ranged from 0.51 to 0.76. Goodness-of-fit analyses indicated that the six-factor model was acceptable and the factor loadings were statistically significant. The test of the hypothesized relationships among the factors showed a correlation from 0.936 to 0.042. CONCLUSIONS The refined Swedish version of the SAQ-OR is a reasonably reliable and acceptably valid instrument for the measurement of patient safety climate in the surgical team. However, the results related to the different analyses varied among the different professionals and further research, using larger samples, is needed to explore these differences, especially among the physicians.
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Thojampa S. Psychometric evaluation of the Thai translation of the Self-Efficacy for Diabetes Scale in delaying the progress of diabetic nephropathy in adults with T2DM. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Norman RM, Sjetne IS. Measuring nurses' perception of work environment: a scoping review of questionnaires. BMC Nurs 2017; 16:66. [PMID: 29200962 PMCID: PMC5697362 DOI: 10.1186/s12912-017-0256-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/02/2017] [Indexed: 11/22/2022] Open
Abstract
Background Nurses’ work environment has been shown to be associated with quality of care and organizational outcomes. In order to monitor the work environment, it is useful for all stakeholders to know the questionnaires that assess or evaluate conditions for delivering nursing care. The aim of this article is: to review the literature for assessed survey questionnaires that measure nurses’ perception of their work environment, make a brief assessment, and map the content domains included in a selection of questionnaires. Methods The search included electronic databases of internationally published literature, international websites, and hand searches of reference lists. Eligible papers describing a questionnaire had to be; a) suitable for nurses working in direct care in general hospitals, nursing homes or home healthcare settings; and b) constructed to measure work environment characteristics that are amenable to change and related to patient and organizational outcomes; and c) presented along with an assessment of their measurement properties. Results The search yielded 5077 unique articles. For the final synthesis, 65 articles met inclusion criteria, consisting of 34 questionnaires measuring nursing work environments in different settings. Most of the questionnaires that we found were developed, and tested, for registered nurses in a general hospital setting. Six questionnaires were developed specifically for use in nursing home settings and one for home healthcare. The content domains covered by the questionnaires were both overlapping and unique and the terminology in use was inconsistent. The most common content domains in the work environment questionnaires were supportive managers, collaborative relationships with peers, busyness, professional practice and autonomy. Conclusions The findings from this review enhance the understanding of how “work environment” can be measured by an overview of existing questionnaires and domains. Our results indicate that there are very many work environment questionnaires with varying content. Electronic supplementary material The online version of this article (10.1186/s12912-017-0256-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecka Maria Norman
- Norwegian Institute of Public Health (FHI), PO Box 4404 Nydalen, N-0403 Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Health and Society, Department of Health Management and Health Economics, PO Box 1130 Blindern, N-0318 Oslo, Norway
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Mekonnen AB, McLachlan AJ, Brien JAE, Mekonnen D, Abay Z. Hospital survey on patient safety culture in Ethiopian public hospitals: a cross-sectional study. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40886-017-0062-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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