Patient safety culture in Peking University Cancer Hospital in China: baseline assessment and comparative analysis for quality improvement

Instruments for Patient Safety Assessment: A Scoping Review

BACKGROUND

Patient safety is an important component of healthcare service quality, and there are numerous instruments in the literature that measure patient safety. This scoping reviewaims to map the instruments/scales for assessing patient safety in healthcare services.

METHOD

This scoping review follows the JBI methodology. The protocol was registered on the Open Science Framework. Eligibility criteria were defined based on studies that include instruments or scales for assessing patient safety in healthcare services, in any language, and without temporal restrictions. It adhered to all scoping review checklist items [PRISMA-ScR], with searches in the Embase, Lilacs, MedLine, and Scopus databases, as well as the repository of the Brazilian Digital Library of Theses and Dissertations. Two independent reviewers performed selection and data extraction in July 2023.

RESULTS

Of the 4019 potential titles, 63 studies reported on a total of 47 instruments/scales and 71 dimensions for patient safety assessment. The most-described dimensions were teamwork, professional satisfaction, safety climate, communication, and working conditions.

CONCLUSION

The diversity of instruments and dimensions for patient safety assessment characterizes the multidimensionality and scope of patient safety. However, it hinders benchmarking between institutions and healthcare units.

Assessment of patient safety culture among healthcare providers in tertiary hospitals in Malaysia-A cross-sectional study

Background and Aim

Patient safety culture is crucial for every health care institution, as a lack of it may harm patients seeking treatment. The current study aimed to identify the level of safety culture and assess the knowledge, attitude, and perception of patient safety culture among healthcare providers (HCPs') in tertiary hospital settings.

Methods

A cross-sectional study was conducted among HCPs from two private tertiary hospitals in Johor and Selangor. A structured validated questionnaire, including the Hospital Survey on Patient Safety Culture, was used to assess the level of patient safety culture in these hospitals.

Results

In this study, the calculated sample size was 320, and all 550 eligible participants from both hospitals were approached to participate. However, only 158 responded, resulting in a response rate of 49.38%. The majority of the HCPs (n = 110; 69%) rated their hospital as very good or excellent in maintaining an overall patient safety culture. The study revealed that communication about the errors (PRR = 80) and organizational learning and continuous improvement (PRR = 74) were good in their hospital settings. However, staffing and work pace (PRR = 28), response to errors (PRR = 40), reporting patient safety events (PRR = 48), and handoffs and information exchange (PRR = 39) were inadequate. These findings indicate the negative attitudes among HCPs and the need for further improvement to maintain a culture of patient safety.

Conclusion

HCPs in the study settings had optimal knowledge but negative attitudes towards the culture of patient safety in their organization. Inadequate staffing, work pace, and a lack of response to mistakes were commonly observed, which may increase the chances of errors and pose health threats to patients that need to be addressed immediately. Every healthcare organization is urged to address the issue of patient safety culture as a matter of urgency.

Palliative Care for Cancer Patients in Asia: Challenges and Countermeasures

With the increasing incidence of cancer worldwide, palliative care has become an effective intervention to relieve cancer patients' pain and improve their quality of life, although the present development of palliative medicine and hospice care in many Asian countries remains insufficient. To this end, this review comprehensively discussed the main challenges that influence the promotion of palliative medicine, from the perspective of both healthcare professionals and cancer patients. We further proposed and summarized a series of potentially effective countermeasures and solutions, including the shared decision-making modal, multidisciplinary professional cooperation, application of modern science and technology, standardization training for medical workers, personalized palliative treatment regimens, and others, aiming to improve the clinical quality of palliative care practice for cancer patients and promote the development of palliative medicine in Asian regions.

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

Background

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

Methods

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

Result

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

Conclusion

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Assessing patient safety culture in obstetrics ward: A pilot study using a modified Manchester Patient Safety Framework in China

AIM

The primary objective of this study was to assess the patient safety culture in a general hospital in Shanghai, China, through a modified Manchester Patient Safety Framework (MaPSaF).

DESIGN

This study has a qualitative interview design. Data were collected through group interviews and analyses performed through content analysis.

METHODS

The MaPSaF was translated into Chinese and used to assess the patient safety culture in a large general hospital in Shanghai, China. Group interviews using the MaPSaF were conducted with 15 nurses in the obstetric ward. Participants rated their safety practice individually on each of the nine MaPSaF safety culture dimensions. The dimensions and scores were then collectively discussed and a practice-wide consensus score for each dimension was agreed. Discussions were recorded, transcribed and analysed to assess patient safety in the obstetric ward.

RESULTS

It took about 2 hr to complete the discussion focusing on patients' safety employing the MaPSaF. Most participants recognized the process as acceptable and useful. The MaPSaF directed team discussion about patient safety issues and facilitated communication, prompting some practice changes. All participants responded positively to the discussion and perceived MaPSaF as a good safety culture assessment tool, with clear, comprehensive and understandable entries. The process demonstrated that the department of obstetrics in the hospital already had a positive patient safety culture, but certain areas were highlighted as still needing improvement. Based on participants' positive experience and perception of the MaPSaF, it can be concluded that there is potential benefit in its adaptation and use in obstetrics wards of Chinese hospitals. The MaPSaF has the potential to strengthen existing safety cultures and improve general safety through collaborative measures.

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

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

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

OBJECTIVE

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

DESIGN

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

SETTING AND PARTICIPANTS

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

OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Evaluation of patient safety culture in a private general hospital: a case study in Brazil

PURPOSE

The purpose is to assess the patient safety culture perceived by healthcare and administrative staff in a Brazilian hospital and examine whether education and experience are related to positive perceptions.

DESIGN/METHODOLOGY/APPROACH

A descriptive-analytical case study was carried out at Ernesto Dornelles Hospital, a private Brazilian institution. The Brazilian version of the Hospital Survey on Patient Safety Culture was used to assess the perceptions of 618 participants, of whom 315 worked in healthcare assistance and 303 in administrative services. The main outcome was the percentage of positive responses, and the independent variables included the type of work, schooling and length of experience.

FINDINGS

None of the twelve dimensions was strengthened. The percentage of positive responses was the highest for "Hospital management support for patient safety" (67.5%), and the lowest was for "Nonpunitive response to error" (29%). The healthcare staff had a slightly higher average than the administrative staff. The percentage of positive responses from professionals with undergraduate or graduate degrees was higher for the eight dimensions of safety culture. The length of hospital experience was not associated with any dimensions.

ORIGINALITY/VALUE

This study explored the influence of education and professional experience on the perception of patient safety in healthcare and administrative staff from a private institution. These approaches allow to know with greater depth and clarity factors that are related to the patient safety culture and, thus, have more consistent evidence to support interventions in specific needs.

Assessment and analysis of patient safety competency of Chinese nurses with associate degrees: A cross-sectional study

Aim

To analyse the patient safety competency (PSC) of Chinese nurses with associate degrees (ADNs) and explore factors.

Design

A cross-sectional study.

Methods

A convenience sample of 451 ADNs working in 18 hospitals located in Chongqing city of China was investigated using the Patient Safety Competency Nurse Evaluation Scale (PSCNES). Descriptive and inferential statistics were used to analyse the data.

Results

ADNs had a moderate level of PSC. In terms of the six dimensions of PSC, ADNs performed well in clinical practice and safety risk management, while they performed poorly in patient-centred care and patient safety culture. Statistically significant differences were reported in two items. Firstly, ADNs who have participated in patient safety training had a higher level in all dimensions of PSC than those who have not participated in related training. Secondly, ADNs without professional titles had a higher level of patient safety culture than those with professional titles.