Patient safety climate in a Brazilian general hospital

Study and promotion of safety culture using mixed methods research

Objective

With a positive safety culture, institutions offer the best quality and safe care to their patients. The objective of this study was to analyze patient safety culture from the perspective of the multidisciplinary team, to identify factors that influence patient safety culture, and to create/promote—jointly with the study participants—strategies for improving processes of change.

Methods

The study design represented a mixed methods research approach, with a sequential explanatory design. A multidisciplinary team of workers at a general hospital was eligible for the study. To collect quantitative data, we administered the Safety Attitudes Questionnaire (SAQ). The qualitative phase was accomplished via focus groups (FGs), with participants from the first phase of the study using the principles of deliberative dialogue (DD) as a knowledge-translation strategy. The STROBE guideline was used to develop the study.

Results

The overall SAQ score was positive (75.1 ± 10.4). Negative scores were found in the fields of Safety Climate, Working Conditions, and Stress Recognition. Focus group discussions identified the aspects that create a negative impact on safety culture, such as ineffective communication, punitive approach in the event of errors, the lack of commitment and adherence to the protocols, and the non-recognition of the stress and the mistakes. Actions for the promotion of safety culture were developed and implemented during the study.

Conclusions

The use of the principles of DD as a strategy for knowledge translation (KT) made it possible to identify and plan for joint actions to generate improvements in safety culture.

Safety culture in healthcare: mixed method study

PURPOSE

Healthcare providers' perceptions of management's effectiveness in achieving safety culture improvements are low, and there is little information in the literature on the subject. Objective: The overall aim of this study was to examine the patient safety culture within an interprofessional team - physicians, nurses, nurse technicians, speech therapist, psychologist, social worker, administrative support - practicing in an advanced neurology and neurosurgery center in Southern Brazil.

DESIGN/METHODOLOGY/APPROACH

The authors applied the safety attitudes questionnaire (SAQ) in a mixed methods study, with a quan→QUAL sequential explanatory approach.

FINDINGS

In the quantitative phase, the authors found a negative safety climate through the SAQ. In the qualitative phase, the approach enabled participants to identify specific safety problems. For that, participants proposed improvements that were directly and quickly implemented in the workplace during the study. The joint analysis of the quantitative and qualitative data inferred that the information and reflections of the focus group participants supported and validated the SAQ statistical analysis results. This integrated approach illustrated the importance of various safety culture aspects as a multifaceted phenomenon related to healthcare quality.

ORIGINALITY/VALUE

This study provides explanations for why management is associated negatively with safety climate in healthcare institutions. In addition, the study provides a novel contribution adding value to mixed methods research methodology.

Near-miss analysis in a large hospital in southern Brazil: A 5-year retrospective study

BACKGROUND

Near-miss analysis is an effective method for preventing serious adverse events, including never events such as wrong-site surgery.

OBJECTIVE

To analyze all near-miss incidents reported in a large general hospital in southern Brazil between January 2013 and August 2017.

METHOD

We performed a descriptive retrospective study of near-miss incidents recorded in the hospital's electronic reporting system in a large non-profit hospital (497 beds). The results are expressed as absolute (n) and relative frequencies (%). Pearson's chi-square test, Fisher's exact test (Monte Carlo simulation) and linear regression were used.

RESULTS

A total of 12,939 near-miss incidents were recorded during the study period, with linear growth in the number of reports. Near-miss incidents were most frequent for medication, followed by processes unspecified in the International Classification for Patient Safety framework, followed by information control (patient chart and fluid balance data), followed by venous/vascular puncture. The highest prevalence of reports was observed in inpatient wards, in adult, pediatric, and neonatal intensive care units, and in the surgical center/post-anesthesia care unit. Pharmacists and nursing personnel recorded most of the reports during the day shift.

CONCLUSION

The most frequent categories of near-miss incidents were medication processes, other institutional protocols, information control issues, and venous/vascular puncture. The significant number of reported near-miss incidents reflects good adherence to the reporting system.

Quality improvement strategy to enhance compliance with the World Health Organization Surgical Safety Checklist in a large hospital: Quality improvement study

Background

The World Health Organization Surgical Safety Checklist is an effective tool to reduce morbidity, mortality, perioperative complications, and hospital length of stay. However, its implementation that involves complex social interaction is still challenging.

Objectives

The aim was to increase use of the Surgical Safety Checklist to 100% of performed surgeries compared to current practice at Hospital Moinhos de Vento, in Porto Alegre, Brazil.

Methods

A quality improvement strategy was implemented based on the Plan, Do, Study, Act cycle. During the intervention, Surgical Safety Checklist structure and content were adjusted to the local context and surgeons were engaged in discussions of the medical and scientific basis of the Surgical Safety Checklist. Also, the surgery center nursing team was trained as well as empowered to use the Surgical Safety Checklist.

Results

As compared to baseline data, there was an increase in the use of the tool and data was monitored to evaluate sustainability of the strategy over 26 months. Mean compliance with the Surgical Safety Checklist after the intervention reached 89%. Compliance with the most critical phase – time out – began at 26%. After the intervention, an increase in time out compliance was noted, varying from 60% to 90%.

Conclusion

The proposed quality improvement strategy, implemented at no additional cost to the institution, was effective to increase Surgical Safety Checklist compliance and produced sustainable results.

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It is the first article of this kind in Brazil. This paper describes the implementation of a quality improvement strategy based on the Plan, Do, Study, Act (PDSA) cycle. The aim was to increase use of the Surgical Safety Checklist to 100% of performed surgeries compared to current practice at Hospital Moinhos de Vento, in Porto Alegre, Brazil.

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Our data show that adjustment of World Health Organization Surgical Safety Checklist (WHO SSC) structure and content to the local context, as well as engagement of decision-makers and risk management staff to promote WHO SSC compliance contributed to the success of the proposed intervention.

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Strong points of our quality improvement strategy include the use of an explicit method, namely the Institute for Healthcare Improvement's Plan-Do-Study-Act model, which facilitated the understanding of the intervention/improvement process and allowed us to explore the method's full potential.