Patient safety culture in Iranian teaching hospitals: baseline assessment, opportunities for improvement and benchmarking

Patient safety culture and associated factors of regional public hospitals in Addis Ababa

BACKGROUND

Patient safety culture is the result of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment, style, and proficiency of health providers' safety management. Globally, millions of adverse events occur annually, with a significant burden on low- and middle-income countries. The burden of injuries and other harm to patients from adverse events is likely one of the top 10 causes of death and disability worldwide. This study aimed to assess patient safety culture and its associated factors in regional public hospitals in Addis Ababa.

METHODS

An institution-based cross-sectional study was conducted among 494 healthcare professionals working at regional public hospitals in Addis Ababa. The data were collected using a pretested structured self-administered questionnaire from June 3 to July 30, 2023. The data were entered into Epi info version 7.2 and exported to SPSS version 26.0 for analysis. Binary logistic regression analysis was used to determine the associations between the patient safety culture (dependent variables) and socio-demographic factors, health care providers and system's. Multicollinearity was checked using VIF, and the adequacy of the final model was assessed using the Hosmer and Lemeshow goodness-of-fit test.

RESULT

Overall, 48.8% (95% CI: 44.3-53.1) of participants had a good patient safety culture, for a response rate of 93.3%. Factors significantly associated with patient safety culture, as identified through factor analysis, included having 6-10 years of experience (AOR = 1.81, 95% CI = 1.13-2.88), having more than 11 years of experience (AOR = 3.49, 95% CI = 1.27-9.56), reporting adverse events (AOR = 2.47, 95% CI = 1.37-4.45), participating in patient safety programs (AOR = 3.64, 95% CI = 1.91-6.92), and working in obstetrics and pediatric wards (AOR = 0.47, 95% CI = 0.23-0.94) and (AOR = 0.21, 95% CI = 0.097-0.44), respectively.

CONCLUSION

The overall level of patient safety culture in regional public hospitals was low (< 75%). Factors such as having 6 or more years of experience, reporting adverse events, participating in patient safety programs, and working in obstetrics and pediatric wards were significantly associated with patient safety culture.

Exploring the safety reporting culture among healthcare practitioners in Saudi hospitals: a comprehensive 2022 national study

BACKGROUND

With the rise in medical errors, establishing a strong safety culture and an effective incident reporting system is crucial. As part of the Saudi National Health Transformation Vision of 2030, multiple projects have been initiated to periodically assess healthcare quality measures and ensure a commitment to continuous improvement. Among these is the Hospital Survey on Patient Safety Culture National Project (HSPSC), conducted regularly by the Saudi Patient Safety Center (SPSC). However, comprehensive tools for assessing reporting culture are lacking. Addressing this gap can enhance reporting, efficiency, and health safety.

OBJECTIVE

This paper aims to investigate the reporting practices among healthcare professionals (HCPs) in Saudi Arabian hospitals and examine the relationship between reporting culture domains and other variables such as hospital bed capabilities and HCPs' work positions.

METHODS

The study focuses on measuring the reporting culture-related items measures and employs secondary data analysis using information from the Hospital Survey on Patient Safety Culture conducted by the Saudi Center for Patient Safety in 2022, encompassing hospitals throughout Saudi Arabia. Data incorporated seven items in total: four items related to the Response to Error Domain, two related to the Reporting Patient Safety Events Domain, and one associated with the number of events reported in the past 12 months.

RESULTS

The sample for the analyzed data included 145,657 HCPs from 392 hospitals. The results showed that the average positive response rates for reporting culture-related items were between 50% and 70%. In addition, the research indicated that favorable response rates were relatively higher among managerial and quality/patient safety/risk management staff. In contrast, almost half had not reported any events in the preceding year, and a quarter reported only 1 or 2 events. Pearson correlation analysis demonstrates a strong negative correlation between bed capacity and reporting safety events, response to error, and number of events reported (r = -0.935, -0.920, and - 0.911, respectively; p < 0.05), while a strong positive correlation is observed between reporting safety events and response to error (r = 0.980; p < 0.01).

CONCLUSIONS

Almost 75% of the HCPs reported fewer safety events over the last 12 months, indicating an unexpectedly minimal recorded occurrence variance ranging from 0 to 2 incidents.

Influence of work-related stress on patient safety culture among nurses in a tertiary hospital: a cross-sectional study

BACKGROUND

One of the global issues facing the nursing profession is work-related stress because it interferes with care quality and organisational competency. These kinds of stressful situations can cause damage to the mental ability of the affected individual resulting in low job productivity. In a Nigerian healthcare setting, patient safety is under-researched.

AIM

This study aimed to assess the influence of work-related stress on patient safety culture among nurses in a tertiary hospital.

MATERIALS AND METHODS

The study adopted a descriptive cross-sectional survey. The Population of the study was nurses who are currently serving as employees at Federal Medical Center Birnin-Kebbi. Proportional and systematic sampling methods were used in the selection of the sample of the study. The tools used for this study were adapted Hospital Survey on Patient Safety (HSOPS) and Nurses' Occupational Stressor Scale. Ethical approval was obtained from the research ethical committee of the hospital.

RESULTS

The moderate stress experience was having the highest percentage (45.0%). The highest percentage of the nurses (69.9%) practised a moderate safety culture. There were weak or very weak significant negative correlations (P < 0.01) between patient safety culture practices and occupational stress across all the subscales of the nurses' occupational stressors scale except in the occupational hazards subscale in which there was extremely weak and non-significant negative correlation. Work-family conflict was a significant predictor of patient safety culture, t (208) = -2.341, P < 0.05. Difficulty in taking leave was a significant predictor of patient safety culture, t (208) = -2.190, P < 0.05.

CONCLUSION

There was a significant negative correlation between stress and safety practice which implies that as stress increased safety practice decreased. These study findings can be used to develop ongoing strategies and targeted interventions in addressing work-related stress.

Patient safety culture and satisfaction in Ghana: a facility-based cross-sectional study

BACKGROUND

Globally, one of the measures of high performing healthcare facilities is the compliance of patient safety culture, which encompasses the ability of health institutions to avoid or drastically reduce patient harm or risks. These risks or harm is linked with numerous adverse patient outcomes such as medication error, infections, unsafe surgery and diagnosis error.

OBJECTIVES

The general objective of this study was to investigate into the impact of patient safety culture practices experienced on patient satisfaction among patients who attend the Kwesimintsim Government Hospital in the Takoradi municipality.

METHODS

This study was a descriptive cross-sectional study and a consecutive sampling technique was used to select 336 respondents for the study. Data was collected using a structured questionnaire and processed using Statistical Package for Social Sciences, V.21. Both descriptive and inferential statistics were carried out and result were presented using figures and tables.

RESULTS

The study found that the overall patient safety compliance level observed by the respondents was poor (29.2%). The prevalence of adverse events experienced among the respondents was high (58%). The leading adverse events mentioned were medication errors, followed by wrong prescriptions and infections. The consequences of these adverse events encountered by the respondents were mentioned as increased healthcare costs (52%), followed by hospitalisation (43%), worsening of health conditions (41%) and contraction of chronic health conditions (22%). Patient safety cultural practices such as teamwork (β=0.17, p=0.03), response to error (β=0.16, p=0.005), communication openness (β=0.17, p=0.003) and handoffs and information exchange (β=0.17, p=0.002) were found to positively influence patient satisfaction.

CONCLUSION

The poor general compliance of the patient safety culture in the facility is unfortunate, and this can affect healthcare outcomes significantly. The study therefore entreats facility managers and various stakeholders to see patient safety care as an imperative approach to delivering quality essential healthcare and to act accordingly to create an environment that supports it.

Nurses' perceptions of patient safety competency: A cross-sectional study of relationships with occurrence and reporting of adverse events

Although, strengthening patient safety competencies in nursing has been emphasized for enhancing quality care and patient safety. However, little is known about the association of nurses' perceptions of patient safety competency with adverse nurse outcomes in Iranian hospitals. This study aimed to measure nurses' levels of patient safety competency in the hospitals of Iran and examines the relationship between patient safety competency with the occurrence and reporting of adverse events (AEs). This cross-sectional research was applied in eight teaching hospitals in Tehran, Iran, between August and December 2021. A sample of 511 nurses was randomly selected using the table of random numbers. The validated Patient Safety Competency Self-Evaluation questionnaire was used. Furthermore, two questions were used to measure the incidence and reporting of AEs. Data analysis was performed using descriptive statistics, independent t-tests, and two binary logistic regression models through SPSS version 24.0. The mean patient safety competency score was 3.34 (SD = 0.74) out of 5.0; 41.5% of nurses rated their patient safety competency as less than 3. Among subscales, "skills of patient safety" scores were the highest, and "knowledge of patient safety" scores were the lowest. Nurses with higher Knowledge and Attitude scores were less likely to experience the occurrence of AEs (OR = 1.50 and OR = 0.58, respectively). Regarding AEs reporting, nurses with higher Skill and Attitude scores were 2.84 and 1.67 times, respectively, more likely to report AEs (OR = 2.84 and OR = 3.44, respectively). Our results provide evidence that enhancing PSC leads to reduced incidence of AEs and increased nurses' performance in reporting. Therefore, it is recommended that managers of hospitals should enhance the patient safety competency of nurses in incidents and reporting of patient safety adverse outcomes through quality expansion and training. Additionally, researchers should carry out further research to confirm the findings of the current study and identify interventions that would strengthen patient safety competencies and reduce the occurrence of AEs, and rise their reporting among nurses.

Cultura de segurança do doente na prática clínica dos enfermeiros

Resumo Objetivo: avaliar as caraterísticas psicométricas do Hospital Survey on Patient Safety Culture, caracterizar a cultura de segurança do doente e avaliar a influência das variáveis sociodemográficas e profissionais nas dimensões da cultura de segurança. Método: estudo metodológico, observacional, analítico, transversal, realizado com 360 enfermeiros, utilizando o questionário Hospital Survey on Patient Safety Culture. Os dados foram submetidos à análise descritiva, inferencial e estudos de fiabilidade e validade. Resultados: os enfermeiros possuem em média 42 anos de idade, 19 anos de experiência profissional e são maioritariamente do sexo feminino. Obteve-se boa consistência interna (alfa de Cronbach - 0,83) e índices aceitáveis de qualidade de ajustamento do modelo. O trabalho em equipa dentro das unidades, expetativas do supervisor, feedback e comunicação sobre o erro, foram dimensões que apresentaram scores acima dos 60%. A resposta ao erro não punitiva, frequência da notificação, apoio à segurança pela gestão, dotação de profissionais, apresentaram scores abaixo dos 40%. Estas dimensões são influenciadas pela idade, escolaridade e experiência profissional. Conclusão: as propriedades psicométricas do questionário certificam a sua qualidade. O trabalho em equipa pode ser considerado um fator potenciador da cultura de segurança. Avaliar a cultura de segurança permitiu identificar dimensões problemáticas, possibilitando o planeamento de intervenções futuras.

Cultura de seguridad del paciente en la práctica clínica de enfermería

Resumen Objetivo: evaluar las características psicométricas de la Hospital Survey on Patient Safety Culture, caracterizar la cultura de seguridad del paciente y evaluar la influencia de variables sociodemográficas y profesionales en las dimensiones de la cultura de seguridad. Método: estudio metodológico, observacional, analítico, transversal, realizado con 360 enfermeros, utilizando el cuestionario Hospital Survey on Patient Safety Culture. Los datos fueron sometidos a análisis descriptivo e inferencial y estudios de confiabilidad y validez. Resultados: los enfermeros tienen en promedio 42 años de edad, 19 años de experiencia profesional y la mayoría es de sexo femenino. Se obtuvo buena consistencia interna (alfa de Cronbach - 0,83) e índices aceptables de bondad de ajuste del modelo. El trabajo en equipo dentro de las unidades, las expectativas del supervisor, el feedback y la comunicación del error fueron las dimensiones que presentaron puntajes superiores al 60%. La respuesta al error no punitiva, la frecuencia de notificación, el apoyo a la seguridad por parte de los gestores, la dotación de personal, presentaron puntajes por debajo del 40%. Estas dimensiones son influenciadas por la edad, la educación y la experiencia profesional. Conclusión: las propiedades psicométricas del cuestionario certifican su calidad. El trabajo en equipo puede considerarse un factor que potencia la cultura de seguridad. La evaluación de la cultura de seguridad permitió identificar las dimensiones que tenían problemas y poder planificar futuras intervenciones.

Maturity degree assessment of hospital ward system using integrated fuzzy AHP-TOPSIS model

BACKGROUND

The hospital ward system is the core service unit of a hospital and an important aspect of hospital management. The maturity of the hospital ward system represents the level of development and improvement in ward management and services. In order to improve the quality of hospital services, it is significant to assess the maturity of the ward system. Although various assessment methods have been proposed in existing studies, there are some issues such as a single-dimensional factor system, subjectivity in qualitative factor values, and insufficient objectivity in the evaluation methods.

METHODS

Therefore, based on the data collection of the factors used in the existing literature, this study made correlation analysis, determined the similarity of factors, and established a maturity assessment factor system satisfying distinctiveness and comprehensiveness. Furthermore, an evaluation method for the weights of each factor was proposed based on the fuzzy analytic hierarchy process, while taking account of the ambiguity of expert information. In addition, through the technique for order of preference by similarity to ideal solution method, an objective evaluation method for the maturity of the hospital ward system was established. Finally, a case study involving 6 hospitals in a specific location was conducted.

RESULTS

There are a total of 16 factors used to assess the maturity of the hospital ward system, among which the most important is Doctor service. The maturity degree of the 6 researched hospitals are 0.4517, 0.0035, 0.4254, 0.8681, 0.6636, 0.1586, and the maturity degree of the 6 researched hospitals are II, I, II, IV, III, I.

CONCLUSION

The factor system constructed in this study effectively reflected the importance of human-related factors in the development process of ward system. The evaluation results were consistent with the actual situation, demonstrating the effectiveness of the proposed method.

Response to patient safety incidents in healthcare settings in Ghana: the role of teamwork, communication openness, and handoffs

BACKGROUND

Patient safety incidents (PSIs) in healthcare settings are a critical concern globally, and Ghana is no exception. Addressing PSIs to improve health outcomes requires various initiatives to be implemented including improving patient safety culture, teamwork and communication between healthcare providers during handoffs. It is essential to acknowledge the significance of teamwork, communication openness, and effective handoffs in preventing and managing such incidents. These factors play a pivotal role in ensuring the well-being of patients and the overall quality of healthcare services.

AIM

This study assessed the occurrence and types of PSIs in health facilities in Ghana. It also examined the role of teamwork, handoffs and information exchange, and communication openness in response to PSIs by health professionals.

METHODS

A cross-sectional study was conducted among 1651 health workers in three regions of Ghana. Using a multi-staged sampling technique, the Survey on Patient Safety Culture Hospital Survey questionnaire and the nurse-reported scale were used to collect the data and it was analysed by descriptive statistics, Pearson correlation, and linear multiple regression model at a significance of 0.05.

RESULTS

There was a reported prevalence of PSIs including medication errors (30.4%), wound infections (23.3%), infusion reactions (24.7%), pressure sores (21.3%), and falls (18.7%) at least once a month. There was a satisfactory mean score for responses to adverse events (3.40), teamwork (4.18), handoffs and information exchange (3.88), and communication openness (3.84) among healthcare professionals. Teamwork, handoffs and information exchange and communication openness were significant predictors of response to PSIs, accounting for 28.3% of the variance.

CONCLUSIONS

Effective teamwork, handoffs and information exchange, and communication openness in the healthcare environment are critical strategies to enhance PSI response. Creating a culture that encourages error response through teamwork, communication and handoffs provides healthcare professionals with opportunities for learning and improving patient outcomes. Training programs should therefore target health professionals to improve patient safety and competency. Through the implementation of evidence-based practices and learning from past incidents, the healthcare system will be able to deliver safe and high-quality care to patients nationwide. Patient safety must be recognized as an ongoing process. Therefore, a meaningful improvement in patient outcomes requires all stakeholders' commitment.

Patient Safety Culture: Effects on Errors, Incident Reporting, and Patient Safety Grade

OBJECTIVES

This study mainly examines the effects of patient safety culture dimensions on 4 outcomes (self-reported errors, witnessing errors, incident reporting, and patient safety grade).

METHODS

The data were collected using the Turkish version of the Safety Attitudes Questionnaire, which consists of 6 dimensions (teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions). Of 1679 personnel working in 6 hospitals in Ankara, 860 were randomly selected. The data were analyzed using descriptive statistics, the Spearman correlation coefficient, and binary logistic regression analyses.

RESULTS

The response rate was 62.7%. When the overall patient safety culture score increased by 1 point; the probability of witnessing an error was 2 times lower (P < 0.001), the probability of incident reporting was 4.22 times higher (P < 0.001), and the probability of assessing the patient safety grade as excellent was 29.86 times higher (P < 0.001). The teamwork climate was negatively related to making errors and witnessing errors (P < 0.001). The safety climate and working conditions were positively related to incident reporting and patient safety grade (P < 0.001). Job satisfaction was negatively related to incident reporting (P < 0.001). Perceptions of management were positively related to making errors and patient safety grade (P < 0.001).

CONCLUSIONS

The patient safety culture scores were positively correlated with incident reporting and patient safety grade but negatively correlated with the occurrence of errors. Each dimension of the patient safety culture, except stress recognition, affected different outcomes. Therefore, managers should focus on different dimensions of patient safety culture to improve different outcomes.

The relationship between patient safety culture and adverse events in Iranian hospitals: a survey among 360 nurses

BACKGROUND

Adverse events have become a global problem and are an important indicator of patient safety. Patient safety culture is essential in efforts to reduce adverse events in the hospital. This study aimed to investigate the status of the patient safety culture, the frequency of adverse events, and the relationship between them in Qazvin's hospitals in Iran.

METHODS

The present study is a descriptive-analytical study conducted in six hospitals in Qazvin, Iran, in 2020. The study population was nurses working in Qazvin hospitals. We collected data via a patient safety culture questionnaire and an adverse event checklist. Three hundred sixty nurses completed questionnaires. Multiple logistic regression was used to investigate the relationship between variables.

RESULTS

The highest mean of patient safety culture was related to the organizational learning dimension (3.5, SD = .074) and feedback and communication about errors (3.4, SD = 0.82). The participants gave the lowest score to dimensions of exchanges and transfer of information (2.45,=0.86) and management support for patient safety (2.62,Sd = 0.65). Management's support for patient safety, general understanding of patient safety culture, teamwork within organizational units, communication and feedback on errors, staff issues, and information exchange and transfer were significant predictors of adverse events.

CONCLUSION

This study confirms patient safety culture as a predictor of adverse events. Healthcare managers should provide the basis for improving the patient safety culture and reducing adverse events through methods such as encouraging the reporting of adverse events and also holding training courses for nurses.

The effects of electronic nursing handover on patient safety in the general (non-COVID-19) and COVID-19 intensive care units: a quasi-experimental study

BACKGROUND

The unprecedented increase in the nurses' workload is one of the issues affecting the quality and safety of patient care in the Intensive Care Units (ICUs). The electronic nursing handover can share sufficient, relevant, and necessary data about patients with greater efficiency and accuracy and prevent their information from being deleted. Therefore, this study aimed to determine and compare the effect of the Electronic Nursing Handover System (ENHS) on patient safety in General ICU and COVID-19 ICU.

METHOD

This is a quasi-experimental study conducted during an 8-month period from 22 to 2021 to 26 June 2022 using a test-retest design. A total of 29 nurses working in the General and COVID-19 ICUs participated in this study. Data were collected using a five-part questionnaire consisting of demographic information, handover quality, handover efficiency, error reduction, and handover time. Data analysis was conducted in IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA) using the chi-squared test, paired t-test, and Analysis of Covariance (ANCOVA).

RESULTS

The results showed that the mean scores of handover quality and efficiency, reduction of clinical error, and handover time in the electronic handover were significantly higher than those obtained in the paper-based method. The results showed that the mean score of patient safety in the COVID-19 ICU was 177.40 ± 30.416 for the paper-based handover and 251.40 ± 29.049 for the electronic handover (p = .0001). Moreover, the mean score of patient safety in the general ICU was 209.21 ± 23.072 for the paper-based handover and 251.93 ± 23.381 for the electronic one (p = .0001).

CONCLUSION

The use of ENHS significantly improved the quality and efficiency of shift handover, reduced the possibility of clinical error, saved handover time, and finally increased patient safety compared to the paper-based method. The results also showed the positive perspectives of ICU nurses toward the positive effect of ENHS on the patient safety improvement.

An Evaluation of Healthcare Safety Culture Among Healthcare Professionals in Secondary and Tertiary Public Hospitals in the Middle East Region

Background and aim The provision of quality healthcare is initiated by a culture of patient safety. Understanding the patient safety culture (PSC) is a critical concept for all healthcare workers. We conducted this study to evaluate the PSC understanding among the Hamad Medical Corporation (HMC) staff members. Furthermore, to establish a local (HMC) reference point for providing quality health care based on a culture of patient safety. Method A Hospital Patient Safety Culture Survey (HSOPSC) was presented to our health system employees to assess their perceptions and understandings of PSC. The survey was self-administered. STATA Package version 12.0 culture software was used to analyze these data in terms of descriptive, correlational, and multivariate ordinal regression. Results This study targeted to survey 6,538 employees in HMC facilities, but only 5,583 responded, resulting in a percentage response rate of 85.4%. Ten facilities achieved 100% participation, and other HMC facilities had response rates ranging from 71.2% to 97.5%. Approximately 88.0% of the responders had direct patient contact. The HSOPSC survey resulted in an overall positive response rate of 62.4%. The dimensions with the highest positive response score were "teamwork within the Unit" followed by "organizational learning/continuous improvement" and "management support for patient safety" with a mean percent positive response (PPR) of 83.1%, 82.0%, and 79.2%, respectively. Conversely, there are three dimensions with the lowest positive response score, including "communication openness," "staffing," and "nonpunitive response to errors," with a mean PPR of 46.6%, 40.1%, and 27.7%, respectively. ANOVA and the student t-test revealed that men (64.3% ± 8.1%), employees with 11-15 years of experience in their specialty (65.8% ± 6.5%), and general hospital type (64.4% ±7.2%), were all significantly associated with differences in the overall perceptions of PSC. According to the study results, there was a moderate correlation between perceptions of PSC at the hospital and the following: Teamwork Across Units (RS= 0.43; p < 0.05), and Frequency of Events Reported (RS= 0.40; p < 0.05.). A regression analysis found that men, workers under 40 years of age, professionals with no direct contact with patients, employees with 11-15 years of experience in their specialty, intensive care staff, and general hospital staff were all significant predictors of overall favorable perceptions of the PSC. Conclusion PSC's understanding of HMC staff is moderate. Furthermore, this is the first study conducted for PSC understanding by the HMC staff in Qatar State. It is eligible to be considered a backbone and reference for new research projects about PSC in Qatari health facilities, if not worldwide.

Patient safety culture in nurses' clinical practice

OBJECTIVE

to assess the psychometric characteristics of the Hospital Survey on Patient Safety Culture, to characterize the patient safety culture, and to assess the influence of the sociodemographic and professional variables on the safety culture dimensions.

METHOD

a methodological, observational, analytical and cross-sectional study conducted with 360 nurses in which the Hospital Survey on Patient Safety Culture questionnaire was used. The data were submitted to descriptive and inferential analysis, as well as to feasibility and validity studies.

RESULTS

the nurses' mean age is 42 years old, their mean time of professional experience is 19 years, and they are mostly female. Good internal consistency was obtained (Cronbach's alpha: 0.83), as well as acceptable model fit quality indices. Teamwork within units, Supervisor expectations and Feedback and communication about errors were the dimensions that obtained scores above 60%. Non-punitive response to error, Frequency of events reported, Support for patient safety and Staffing presented scores below 40%. These dimensions are influenced by age, schooling level and professional experience.

CONCLUSION

the psychometric properties of the questionnaire certify its good quality. Teamwork can be considered as an enhancing factor for the safety culture. Assessing the safety culture allowed identifying problematic dimensions, thus enabling planning of future interventions.

Patient safety culture as a space of social struggle: understanding infection prevention practice and patient safety culture within hospital isolation settings - a qualitative study

BACKGROUND

In recent times, infection prevention and patient safety have become a global health policy priority with thought being given to understanding organisational culture within healthcare, and of its significance in initiating sustained quality improvement within infection prevention and patient safety. This paper seeks to explore the ways in which engagement of healthcare workers with infection prevention principles and practices, shape and inform patient safety culture within the context of hospital isolation settings; and vice-versa.

RESEARCH METHODS

In this paper, we utilise focus group interviews at two hospital sites within one health board in order to engage healthcare staff in elaborating on their understandings of infection prevention practices and patient safety culture within isolation settings in their organisation. Focus group transcripts were analysed inductively using thematic analysis in order to identify and develop emerging empirical themes.

RESULTS

Positioned against a background of healthcare restructuring and ever-increasing uncertainty, our study found two very different hospitals in regard to patient safety culture and infection prevention practice. While one hospital site embodies a mixed picture in regard to patient safety culture, the second hospital is best characterised as being highly fragmented. The utilisation of focus group interviews revealed themes that capture the ways in which interviewees position and understand the work they perform within the broader structural, political and cultural context, and what that means for infection prevention practice and patient safety culture.

CONCLUSION

Drawing on the insights of Bourdieu, this paper theorises the field of patient safety as a space of social struggle. Patient safety is thus positioned within its structural, cultural and political context, rather than as merely an epidemiological dilemma.

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

INTRODUCTION

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

Background

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

Objective

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

Methodology

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

Findings

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

Conclusion

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

Patient safety culture in Palestine: university hospital nurses' perspectives

Background

Understanding the perspectives of healthcare workers toward patient safety-related activities is critical in maintaining a healthy safety climate. The objectives of this research are 1) to examine the perception of Patient Safety Culture (PSC) at a university hospital in Palestine, and to highlight areas in need of improvement, and 2) to assess the relationship between the outcome dimensions (frequency of events reported, and overall perceptions of safety) and the other dimensions of PSC, and 3) to determine the relationship among selected demographic variables (gender, age, hospital tenure, work tenure, profession tenure, and hours worked per week) and nurses’ perceptions of PSC.

Methods

A cross-sectional study design was used with a convenience sample of 107 nurses. Nurses were asked by email to complete the Arabic version of the Hospital Survey of Patients’ Safety Culture (HSOPSC) using the SurveyMonkey® online account form within two weeks. The survey data were analyzed using descriptive and inferential statistics. Univariate and multiple regression were used to examine the relationships.

Results

The dimensions of patient safety with the highest positive response were organizational learning and continuous improvement (87%) and teamwork within units (86%). The dimension with the lowest positive score was the nonpunitive response to error (22%). Multiple regression revealed that the dimension of communication openness was a predictor of the overall perceptions of safety (β = 0.257, p = 0.019). In addition, the dimension of feedback and communication about error was a predictor of the frequency of the reported events (β = 0.334, p = 0.005). Furthermore, age was found to be a predictor of PSC (p < 0.05).

Conclusions

This study provides a general assessment of perceived safety among nurses in a hospital. However, we found that nurses negatively perceive a nonpunitive response to error. Therefore, strenuous efforts are required by hospital management to improve the culture of incident reporting.