Validation of the French version of the Hospital Survey on Patient Safety Culture questionnaire

Assessment of patient safety culture in Moroccan primary health care: a multicentric study

BACKGROUND

Promoting patient safety is a critical concern for developing-countries health systems like Morocco. There is an increasing acknowledgment of the need to create a patient-centered culture with the aim to decrease the number of adverse events related to care and improve health-care quality in Morocco.

OBJECTIVE

The purpose of this study is to examine the perceptions of health professionals working in primary care level of care facilities in Morocco about the concept of patient safety culture.

METHODS

We conducted a multicentric cross-sectional study of a quantitative nature in primary healthcare facilities in ten Moroccan cities, measuring ten patient safety culture dimensions, from February 2022 to June 2022. Data was collected using the French version of the HSOPSC questionnaire.

RESULTS

The most developed dimension of the culture of patient safety was found to be Teamwork within Units (69%), followed by Supervisor/Manager's Expectations & Actions Promoting Patient Safety (59%). The least developed dimensions were Staffing (34%) and Nonpunitive Response to Errors (37%).

CONCLUSION

Improving patient safety culture should be a priority for primary healthcare facility administrators and all stakeholders, addressing, in particular, the shortage of human resources. In addition, health personnel should be encouraged to report errors without fear of punitive consequences.

Development and Validation Process of the Intensive Care Unit Omitted Nursing Care (ICU-ONC) Instrument Among French Canadian Nurses

Background and Purpose: The purpose of this article is to document the development and validation process of an instrument adapted for French-speaking nurses and to measure the occurrence of omitted nursing care (ONC) in the intensive care unit (ICU). Methods: An electronic Delphi panel, involving ICU nursing experts from the province of Quebec (Canada), was used to develop the intensive care unit omitted nursing care (ICU-ONC) instrument. For the validation process, an electronic cross-sectional survey was conducted. Results: A total of 564 nurses participated in the validation study. Exploratory factor analysis performed on 478 complete observations supports the presence of a single-factor structure for the 22-item ICU-ONC instrument. Coefficient alpha for the scale was .93, 95% confidence interval (CI) was [0.92, 0.94], item-partial total correlations ranged from .49 and .68, and the mean/median interitem correlations were .38 and .37, respectively. Moderate negative correlations were found between the ICU-ONC instrument overall score and two related constructs: nurses' perception of the quality as well as the safety of care. Conclusions: Our current understanding of ONC in the ICU is based on the results drawn from the administration of generic instruments to ICU nurses. The novel 22-item ICU-ONC instrument can help better estimate the occurrence of the phenomena in the ICU.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Health staff perceptions of patient safety and associated factors in hospitals in Vietnam

Introduction

Patient safety is a global challenge of preventing and mitigating medical errors which might harm patients during their course of treatment and care. This study was employed to contribute to the existing literature aimed to assess patient safety culture among health staff and to determine predictors of health staff perceptions of patient safety in hospitals in Vietnam.

Methods

A cross-sectional study was conducted in three hospitals of Vietnam with a total of 763 participants. This study used the Hospital Patient Safety Scale developed by the American Health and Quality Research Organization.

Results

In general, 8 of 12 patient safety dimensions in two hospital; and 10 of 12 dimensions in a third hospital had average scores of 60% and above positive responses. The communication openness and organizational learning dimensions were found to be significant different when comparing hospitals. Regarding sample characteristics, department (subclinical department) and health staff positions (nurses/technicians, pharmacists) were significant predictors in the total model including three hospitals (R2 = 0.07).

Conclusion

This study reported that communication openness and organization learning are two aspects that need to be improved they are strongly related to patient safety culture and to knowledge exchange among health staff. It has been suggested that hospitals should deliver patient safety training courses and establish a supportive learning environment to improve these challenges.

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

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

The characteristics and factors associated with omitted nursing care in the intensive care unit: A cross-sectional study

INTRODUCTION

Prior research showed that work environment features in acute care settings influence nurses' capacity to provide care and impacts patient outcomes (e.g., falls). However, little is known about this phenomenon in the intensive care unit. The objectives of this study were to describe the characteristics of omitted nursing care, and to examine the associations between work environment features, omitted nursing care and nurse-reported outcomes in the intensive care unit.

METHODS

An electronic cross-sectional correlational study was conducted in the province of Quebec, Canada. Over September 2021, nurses were asked to complete the Healthy Work Environment Assessment Tool (HWEAT), the Intensive Care Unit Omitted Nursing Care instrument (ICU-ONC) and to report their perceptions of nurse-reported outcomes (e.g., quality of care). The associations between these variables were estimated using multivariable cluster-robust regression models, adjusted for nurse and hospital characteristics.

RESULTS

A total of 493 nurses from 42 distinct hospitals participated to this study. On average, nurses felt that their work environment was acceptable, and that the quality and safety of patient care was good. Basic care activities (e.g., mobilisation) were most frequently reported as omitted as opposed to those related to surveillance and medical interventions. In multivariable analyses, higher work environment scores were associated with reduced omitted nursing care scores (p < 0.001) and better ratings for nurse-reported outcomes (p < 0.001). Also, higher omitted nursing care scores were associated with more negative perceptions about the quality and safety of care (p < 0.001).

CONCLUSION

Our study portrays the characteristics and some factors associated with omitted nursing care in the intensive care unit. Further research should determine whether intensive care nurses' reports of organisational features and omitted nursing care are associated with objectively captured patient outcomes.

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.

Patient safety and its relationship with specific self-efficacy, competence, and resilience among nursing students: A quantitative study

BACKGROUND

Patient safety is a relevant subject in the nursing curriculum. Each university programs patient safety teaching and practical training differently. However, few studies have sought to explore the relationship between patient safety as perceived by nursing students and other important psychosocial competencies in the nursing curriculum, such as self-efficacy, competence, and resilience.

OBJECTIVES

To analyze differential patient safety integration into three nursing education programs, and to assess agreement levels regarding patient safety climate, students' knowledge of patient safety and correlations with specific self-efficacy, competence and resilience.

METHODS

Participants were 647 undergraduate students from three universities. Patient safety climate and knowledge of patient safety (good praxis) were measured using the Hospital Survey on Patient Safety Culture for nursing students, and other psychosocial variables were also analyzed using other instruments: specific self-efficacy, perceived competence and resilience. Nursing education programs and patient safety climate were analyzed using the Rwg(j) and ICC measures of inter-rater agreement across different academic levels.

RESULTS

The ICC and Rwg indexes revealed high inter-rate agreement in all three universities. Differences were observed between Univ-2 and Univ-3 in patient safety climate scores and agreement values between academic levels. Differences in good praxis were found when academic levels were compared in Univ1-and Univ-2. Patient safety climate was found to correlate significantly with the psychosocial variables studied, but only in Univ-1.

CONCLUSIONS

Perceived patient safety climate differs between universities and academic levels. This competency is related to self-efficacy, competence and resilience, which endorses the assessment of patient safety integration from a broader perspective.

Adapting the Healthy Work Environment Assessment Tool for French-Canadian Intensive Care Nurses

BACKGROUND

Self-administered instruments are used to measure components of work environments that cannot be measured directly. The Healthy Work Environment Assessment Tool (HWEAT) of the American Association of Critical-Care Nurses is a promising instrument. However, it is available only in English and Japanese, precluding its use in other populations and cross-national comparisons.

OBJECTIVES

To describe the Canadian French translation and cross-cultural adaptation of the HWEAT (F-HWEAT) and to explore its factor structure and psychometric properties.

METHODS

Cross-cultural adaptation of the HWEAT and collection of evidence of validity via an electronic cross-sectional survey.

RESULTS

A total of 564 intensive care unit nurses participated in the validation study. Confirmatory factor analysis supported the presence of a single overarching factor measured by the F-HWEAT. The Cronbach α for the instrument was 0.89 (95% CI, 0.88-0.91). The mean and median interitem correlations were both 0.32, and item-partial total correlations ranged from 0.33 to 0.64. The overall F-HWEAT score indicated that nurses believed their work environment needed improvements. Moderate positive correlations were found between the overall F-HWEAT score and nurses' perceptions of care quality (r = 0.45 [95% CI, 0.38-0.51]) and safety (r = 0.48 [95% CI, 0.40-0.55]).

CONCLUSION

The results support the use of the F-HWEAT in French-speaking populations. Using the F-HWEAT will help elucidate areas needing improvement and expand global dialogues about healthy critical care work environments. With this information, nurse leaders and researchers can develop and implement modern strategies to improve the work conditions of intensive care unit nurses.

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

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

Multilevel approach to individual and organisational predictors of stress and fatigue among healthcare workers of a university hospital: a longitudinal study

OBJECTIVE

Healthcare workers (HCWs) are at high risk of experiencing stress and fatigue due to the demands of their work within hospitals. Improving their physical and mental health and, in turn, the quality and safety of care requires considering factors at both individual and organisational/ward levels. Using a multicentre prospective cohort, this study aims to identify the individual and organisational predictors of stress and fatigue of HCWs in several wards from university hospitals.

METHODS

Our cohort consists of 695 HCWs from 32 hospital wards drawn at random within four volunteer hospital centres in Paris-area. Three-level longitudinal analyses, accounting for repeated measures (level 1) across participants (level 2) nested within wards (level 3) and adjusted for relevant fixed and time-varying confounders, were performed.

RESULTS

At baseline, the sample was composed by 384 registered nurses, 300 auxiliary nurses and 11 midwives. According to the three-level longitudinal models, some predictors were found in common for both stress and fatigue (low social support from supervisors, work overcommitment, sickness presenteeism and number of beds per ward). However, specific predictors for high level of stress (negative life events, low social support from colleagues and breaks frequently cancelled due to work overload) and fatigue (longer commuting duration, frequent use of interim staff in the ward) were also found.

CONCLUSION

Our results may help identify at-risk HCWs and wards, where interventions to reduce stress and fatigue should be focused. These interventions could include manager training to favour better staff support and overall safety culture of HCWs.

The Incident Feedback Committee (IFC): A Useful Tool to Investigate Errors in Clinical Research

In clinical practice, an objective of safety management is to identify preventable causes of adverse events to avoid the incidents from recurring. Likewise, in the field of clinical research adequate methods to investigate incidents that impair the quality of a clinical trial are needed. Understanding the causes of errors and undesirable incidents can help guarantee participant safety, improve the practices of research coordinators, investigators, and clinical research assistants and help to minimize research costs. Here, we present the main features of our Incident Feedback Committees (IFC) in clinical research, with outcomes over 5 years. Methods: The IFC has adapted the ALARM and ORION post-event methods with investigations focused on ‘the incidents’ occurring during research studies. It sought the root causes contributing to these incidents and proposed corrective actions. Results: Since our IFC was set up in 2015 it has examined 52 incidents from nine studies. The most frequent causes mainly concerned the working environment (54%). Most incidents had two or more causes. Some corrective actions were planned for ongoing or future studies. Conclusion: IFCs provide a useful and much-appreciated method of analysing incidents in the performance of clinical research. A multicentre study is needed to evaluate the effect of IFCs on the quality of an establishment’s clinical research, at the individual level (patient safety) and also at the system level (changes in the organization of tasks).

Patient safety culture as perceived by operating room professionals: a mixed-methods study

Background

Routine assessments of patient safety culture within hospitals have been widely recommended to improve patient safety. Experts suggested that mixed-methods studies can help gain a deeper understanding of the concept. However, studies combining quantitative and qualitative approaches exploring patient safety culture are still lacking. This study aimed to explore patient safety culture as perceived by operating room professionals of two university hospitals in Sousse, Tunisia.

Methods

Based on a mixed-methods approach, a cross-sectional survey followed by semi-structured interviews were conducted over a period of two months (December 2019 to January 2020). This study took place in all the operating rooms of two public university hospitals in the district of Sousse, Tunisia. To collect data for this survey, the French version of the Hospital Survey On Patient Safety Culture was used. For interviews, 13 participants were selected purposively using a critical case sampling approach and a topic guide was prepared. Anonymity and confidentiality were respected.

Results

Overall, twelve operating rooms, with different surgical specialties, were included in the study. Survey feedback was provided by 297 professionals representing a response rate of 85.6%. Concerning patient safety culture, the 10 dimensions had low scores (below 50%) and were considered “to be improved”. The highest score was found in ‘teamwork within units’ (45%). Whereas, the lowest scores were allocated to ‘non-punitive response to error’ (22.9%), followed by “frequency of adverse event reported” (25.6%) and “communication openness” (26.3%). Per qualitative data, participants provided a more detailed picture of patient safety issues such as underreporting, absence of an effective reporting system, lack of freedom of expression, and an existing blame culture in operating rooms.

Conclusions

The findings of this study showed a concerning perception held by participants about the lack of a patient safety culture in their operating rooms. It seems essential to design, implement and evaluate strategies that promote a positive patient safety culture and obliterate punitive climate in operating rooms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08175-z.

The impact of huddles on a multidisciplinary healthcare teams' work engagement, teamwork and job satisfaction: A systematic review

BACKGROUND

Job satisfaction and retention of healthcare staff remains an ongoing issue in many health systems. Huddles have been endorsed as a mechanism to improve patient safety by improving teamwork, collaboration, and communication in teams.

AIM

This study aims to synthesises the literature to investigate the impact of huddles on job satisfaction, teamwork, and work engagement in multidisciplinary healthcare teams.

METHODS

Five academic databases were searched to conduct a systematic review of peer-reviewed literature published from January 2000 to January 2020. Articles were included if they (1) featured a daily huddle, were conducted in a healthcare setting, and involved a multidisciplinary team and (2) measured variables including job satisfaction, work engagement, or teamwork. Results were reported in accordance with the systematic synthesis without meta-analysis and preferred reporting items for systematic reviews and meta-analysis guidelines. We identified 445 articles of which 12 met the eligibility criteria and are included in this review.

RESULTS

All 12 included studies found a predominantly positive impact on teamwork and job satisfaction. None of the studies discussed or reported evidence of the impact of huddles on work engagement. This review highlights the value of a daily multidisciplinary healthcare team huddle in improving job satisfaction and teamwork for the healthcare staff involved. However, there is a dearth of high-quality, peer-reviewed evidence regarding the direct impact of huddles on job satisfaction, teamwork and in particular on work engagement. Further research-particularly controlled studies on adoption, implementation and outcomes for healthcare team culture-is needed to further assess this intervention.

[Patient safety culture in neonatal intensive care units as seen by nurses]

Neonatal intensive care units (NICUs) are critical environments in terms of safety of care, with a high risk of adverse events. Measuring the patient safety culture of the professionals working there should help to improve the care offered. A descriptive cross-sectional study, conducted among 141 nurses and childcare workers in 2020 in 5 Tunisian hospitals, examined this question.

Assessing patient safety culture in 15 intensive care units: a mixed-methods study

BACKGROUND

Within hospitals, intensive care units (ICUs) are particularly high-risk areas for medical errors and adverse events that could occur due to the complexity of care and the patients' fragile medical conditions. Assessing patient safety culture (PSC) is essential to have a broad view on patient safety issues, to orientate future improvement actions and optimize quality of care and patient safety outcomes. This study aimed at assessing PSC in 15 Tunisian ICUs using mixed methods approach.

METHODS

A cross-sectional mixed methods approach using a sequential explanatory design was conducted from December 2019 to January 2020. The first quantitative stage was conducted in 15 ICUs belonging to the two university hospitals in the region of Sousse (Tunisia). All the 344 healthcare professionals (clinical staff) working for more than 1 month in these ICUs were contacted in order to take part in the study. In the second qualitative stage 12 participants were interviewed based on purposive sampling.

RESULTS

All of the PSC dimensions had a score of less than 50%. The developed dimension was 'teamwork within units' (48.8%). The less developed dimensions were 'frequency of event reporting' (20.8%), 'communication openness' (22.2%) and 'non-punitive response to error' (19.7%). Interviews' thematic analysis revealed four main themes including "Hospital management/system failure", "Teamwork and communication", "Error management" and "Working conditions".

CONCLUSION

This research revealed that PSC is still in need of improvement and provided a clearer picture of the patient safety issues that require specific attention. Improving PSC through the use of quality management and error reporting systems may help to improve patient safety outcomes.

What is the level of safety culture in French nursing homes? The EHPAGE study

Background

French nursing homes (NHs) are in the early stages of implementing their risk management approach. The latter includes the development of a safety culture (SC) among professionals. A training package to support NHs in implementing a risk management strategy has been designed by QualiREL Santé, a regional body that provides support in quality and risk management. The aim is to improve SC. No data are available about the level of SC in French NHs. This study evaluates the level of SC and identifies predictors of SC scores in NHs that will subsequently benefit from the training package.

Method

The study was proposed to NHs who are members of QualiREL Santé in 2 French departments. Inclusion criteria were voluntary participation, the commitment of top management to benefit from the training package, and the absence of previous risk management support provided by QualiREL Santé. The NHSOPS-F questionnaire (22 items measuring 7 dimensions of SC) was administered to professionals between January and March 2016. 14 variables related to the structural profile of the NHs and the strategic choices of top management in terms of healthcare safety were recorded. Scores for 7 dimensions were calculated for all of the included NHs. Further modelling identified predictive factors.

Results

58 NHs were included. The response rate for the NHSOPS-F (n = 1946 professionals) was 64% (Q1-Q3 = [49.4;79.0]). Staffing was the least-developed dimension (11.8%), while scores were highest for Feedback and communication about incidents (84.8%). Being attached to a public hospital was associated with poorer perceptions of SC, notably for the dimension “Overall perceptions of resident safety and organizational learning” (β = − 19.59;p-value< 0.001). A less-developed SC was also significantly linked to existing Quality initiatives.

Conclusions

Overall, French NHs must prioritise issues of staffing, teamwork and compliance with procedures. The role of human factors within teams should be exploited by top management. Our initial findings will help to adapt improvement approaches and are particularly relevant to local and national policies during the ongoing pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07336-w.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Involvement in Root Cause Analysis and Patient Safety Culture Among Hospital Care Providers

BACKGROUND

The experience feedback committee (EFC) is a tool designed to involve medical teams in patient safety management, through root cause analysis within the team.

OBJECTIVE

The aim of the study was to determine whether patient safety culture, as measured by the Hospital Survey on Patient Safety Culture (HSOPS), differed regarding care provider involvement in EFC activities.

METHODS

Using the original data from a cross-sectional survey of 5064 employees at a single university hospital in France, we analyzed the differences in HSOPS dimension scores according involvement in EFC activities.

RESULTS

Of 5064 eligible employees, 3888 (76.8%) participated in the study. Among the respondents, 440 (11.3%) participated in EFC activities. Experience feedback committee participants had a more developed patient safety culture, with 9 of the 12 HSOPS dimension scores significantly higher than EFC nonparticipants (overall effect size = 0.31, 95% confidence interval = 0.21 to 0.41, P < 0.001). A multivariate analysis of variance indicated that all 12 dimension scores, taken together, were significantly different between EFC participants and nonparticipants (P < 0.0001), independently of sex, hospital department, and healthcare profession category. The largest differences in scores related to the "feedback and communication about error," "organizational learning," and "Nonpunitive response to error" dimensions. The analysis of the subgroup of professionals who worked in a department with a productive EFC, defined as an EFC implementing at least five actions per year, showed a higher patient safety culture level for seven of the 12 HSOPS dimensions (overall effect size = 0.19, 95% confidence interval = 0.10 to 0.27, P < 0.001).

DISCUSSION AND CONCLUSIONS

Participation in EFC activities was associated with higher patient safety culture scores. The findings suggest that root cause analysis in the team's routine may improve patient safety culture.

Impact of a large interprofessional simulation-based training course on communication, teamwork, and safety culture in the operating theatre: a mixed-methods interventional study

BACKGROUND

Communication and teamwork are critical non-technical skills in the operating theatre. However, prevention of events associated with communication failures by large simulation-based programs remains to be evaluated. The objective was to assess the impact of an interprofessional simulation-based training course on communication, teamwork, checklist adherence, and safety culture.

METHODS

We aimed to assess the impact of an interprofessional simulation-based training course on communication, teamwork, checklist adherence, and safety culture. We conducted a before-and-after interventional study based on a mixed-methods approach combining qualitative and quantitative evaluation criteria. The study was performed in a University Hospital with 39 operating theatres operated by 300 providers before (period 1) and after (period 2) an interprofessional simulation-based training course. Surgical procedures were observed, and the primary outcome measure was the rate of procedures with at least one communication failure associated with adverse event. Additional outcomes measured included the rate of or other communication failures, checklist adherence, while teamwork and safety culture as assessed by questionnaires.

RESULTS

In total, 46 970 communication episodes were analysed during 131 (period 1) and 122 (period 2) surgical procedures. One hundred sixty-four professionals attended 40 simulation-based sessions. The rate of procedures with at least one communication failure associated with adverse events was not significantly different between the 2 periods (38% in period 1 and 43% in period 2; P = 0.47). Nevertheless, the rate of communication failures reduced between period 1 and 2 (8117/28 303 (29%) vs. 3868/18 667 (21%), respectively; P < 0.01). Teamwork scores and checklist adherence increased significantly after the intervention (8.1 (7.2 to 8.7) in period 1 vs. 8.6 (8.0 to 9.2) in period 2; P < 0.01 and 17% (0-35%) in period 1 vs. 44% (26-57%) in period 2; P < 0.01). Safety culture ratings did not change significantly.

CONCLUSION

This study shows that although the rate of procedures with at least one communication failure associated with adverse event (primary endpoint) was not significantly different, a large interprofessional simulation-based training course has a positive effect on communication failures, teamwork, and checklist adherence.

Psychometric Properties of the Latin American Spanish Version of the Hospital Survey on Patient Safety Culture Questionnaire in the Surgical Setting

OBJECTIVE

The Hospital Survey on Patient Safety Culture (HSPSC) was designed to assess staff views on patient safety and has been translated and validated into several languages and settings. This study developed a Latin American Spanish version of the HSPSC for use in perioperative settings and examines its psychometric properties.

METHODS

After translation and adjustments, a web-based questionnaire was administered to all health care personnel at operating room in a public university-affiliated hospital in Popayán, Colombia. Descriptive statistics, internal reliability, confirmatory and exploratory factor analysis, and intercorrelations among survey composites were calculated.

RESULTS

Confirmatory factor analysis showed inadequate model fit for the original 12-factor structure of the HSPSC. Rather, a 9-factor, 36-item instrument showed acceptable factor loadings, internal consistency, and psychometric properties. Five factors were formed with minor changes. Adjusted factors emerged, like "staffing and work pressure" and "supervisor/manager expectations and actions promoting patient safety," "organizational learning-continuous improvement," and "hospital management support for safety," as well as "repeated errors and perception of safety." Internal consistency for each remaining composite met or exceeded a Cronbach α value of 0.60.

CONCLUSIONS

Psychometric analyses provided overall support for 9 of the 12 initial factors of patient safety culture. Our findings suggest that more validation studies need to be conducted before applying safety dimensions from the original HSPSC to perioperative settings only. By providing this initial tool, we hope to stimulate further studies and the patient safety research agenda in this part of the world.

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

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

Contribution of PCA/K-means methods to the mixed assessment of patient safety culture

Purpose

The assessment of patient safety culture (PSC) is a major priority for healthcare providers. It is often realized using quantitative approaches (questionnaires) separately from qualitative ones (patient safety culture maturity model (PSCMM)). These approaches suffer from certain major limits. Therefore, the aim of the present study is to overcome these limits and to propose a novel approach to PSC assessment.

Design/methodology/approach

The proposed approach consists of evaluating PSC in a set of healthcare establishments (HEs) using the HSOPSC questionnaire. After that, principal component analysis (PCA) and K-means algorithm were applied on PSC dimensional scores in order to aggregate them into macro dimensions. The latter were used to overcome the limits of PSC dimensional assessment and to propose a quantitative PSCMM.

Findings

PSC dimensions are grouped into three macro dimensions. Their capitalization permits their association with safety actors related to PSC promotion. Consequently, a quantitative PSC maturity matrix was proposed. Problematic PSC dimensions for the studied HEs are “Non-punitive response to error”, “Staffing”, “Communication openness”. Their PSC maturity level was found underdeveloped due to a managerial style that favors a “blame culture”.

Originality/value

A combined quali-quantitative assessment framework for PSC was proposed in the present study as recommended by a number of researchers but, to the best of our knowledge, few or no studies were devoted to it. The results can be projected for improvement and accreditation purposes, where different PSC stakeholders can be implicated as suggested by international standards.

Exploring patient safety culture in emergency departments: A Tunisian perspective

BACKGROUND

Emergency departments (EDs) are considered a high-risk environment because of the high frequency of adverse events that occur within. Measuring patient safety culture is an important step that assists healthcare facilities in planning actions to improve the quality of care provided to patients. This study aims to assess patient safety culture within EDs and to determine its associated factors.

METHODS

A cross-sectional study conducted among professionals from all the EDs of public and private healthcare institutions in Tunisia. It spread from June to September 2017. We used the validated French version of the Hospital Survey on Patient Safety Culture questionnaire.

RESULTS

In total, 11 EDs were included in the study, with 442 participants and a participation rate of 80.35%. All the ten dimensions of patient safety culture were in need of improvement. 'Teamwork within units' scored the highest with 46%, however, the lowest score was attributed to 'the frequency of adverse events reporting' (19.6%). Several factors have been found significantly related to safety culture. Private EDs have shown significantly higher scores regarding nine patient safety culture dimensions.

CONCLUSION

This study showed a concerning perception held by participants about the lack of a patient safety culture in their EDs. Also, it provided baseline results giving a clearer vision of the aspects of safety that need improvement.

A baseline assessment of patient safety culture and its associated factors from the perspective of critical care nurses: Results from 10 hospitals

INTRODUCTION

Critical care nurses are considered the key to patient safety improvement and play a vital role in enhancing quality of care in intensive care units (ICUs) where adverse events are frequent and have severe consequences. Moreover, there is recognition of the importance of the assessment and the development of patient safety culture (PSC) as a strategic focus for the improvement of patient safety and healthcare quality, notably in critical care settings.

OBJECTIVES

This study aimed to assess critical care nurses' perception of PSC and to determine its associated factors.

METHODS

This cross-sectional study was conducted among nurses working in the ICUs of the Tunisian centre (six Tunisian governorates). The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture questionnaire, comprising 10 dimensions and a total of 50 items.

RESULTS

A total of 249 nurses from 18 ICUs participated in the study, with a participation rate of 87.36%. The dimensions scores ranged between 17.2% for the dimension "frequency of events reported" and 50.1% for the dimension "teamwork within units". Multivariable logistic regression indicated that respondents who worked in private hospitals were five times more likely to have a developed PSC (adjusted odds ratio [AOR]: 5.34; 95% confidence interval [CI], [2.28, 12.51]; p < 10^-3). Similarly, participants who worked in a certified hospital were two times more likely to have a more developed PSC than respondents who work in noncertified hospitals (AOR: 2.51; 95% CI, [.92-6.82]; p = 0.041). In addition, an increased nurse-per-patient ratio (i.e., reduced workload) increased PSC (AOR: 1.10; 95% CI, [1.02-1.12]; p = 0.018).

CONCLUSION

This study has shown that the state of critical care nurses' PSC is critically low and these baseline results can help to form a plan of actions for improvements.

Trends in the Staff's Perception of Patient Safety Culture in Romanian Hospitals

Introduction. The IRIS-2 project (2019) expanded the application of the HSOPSC in Romanian hospitals, yet applied, for the first time in the country, in 2014 (IRIS-1). The aim is an update on patient safety culture for staff, by geographic region and overall, by year of survey. Materials and methods. A cross-sectional study was carried out in voluntary staff in four hospitals in four regions (n. 1,121 staff) and compared with a previous study based on six hospitals in four regions (n. 969 staff). The instrument was the Romanian version of the HSOPSC with 31 items and 9 dimensions. Statistics to analyze trend were computed using “R”. Results No significant differences between the proportion of positive response (PPRs) by dimension were observed in IRIS-2 with respect to IRIS-1, with two exceptions: significantly lower PPR for “teamwork across hospital units“ (65% versus 73%) and significantly higher PPR for “frequency of events reporting” (65% versus 59%). Four dimensions were well developed and five dimensions needed to be improved. The poorest PPRs were for the “teamwork across hospital units”, the “frequency of event reporting” and the “non punitive response to error” dimensions. Besides, one outcome indicator changed through time: the proportion of the staff who did not report any event was significantly lower (64% versus 73%) and the proportion of the staff who reported “1-2 events” was significantly higher (21% versus 15%). Conclusion. Despite some small progress related to the frequency of events reporting, there is room for further patient safety culture improvement.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

Psychometric properties of the Bulgarian version of Hospital Survey on Patient Safety Culture

OBJECTIVE

To explore the psychometrics of the Bulgarian version of the Hospital Survey on Patient Safety Culture (B-HSOPSC) and its suitability for use in Bulgaria.

DESIGN

A national web-based cross-sectional survey of the safety patient culture.

SETTING

The hospitals' staffs from 28 administrative areas in the country.

INTERVENTIONS

Web-based self-administered questionnaire.

PARTICIPANTS

Physicians and non-physicians such as nurses, midwifes, etc., working at hospitals.

MAIN OUTCOME MEASURES

Confirmatory factor analysis (CFA) was performed to assess the psychometric properties of the original US structure. Assessment of construct validity included convergent validity, discriminant validity, and nomological validity of constructs.

RESULTS

A total of 525 valid cases were included in the analysis. The results of CFA revealed acceptable values for absolute indices and lower for the incremental index, comparative fit index. Due to the very low convergence validity, the dimension 'staffing' was removed from the model. Additionally, one item was removed from another dimension. The B-HSOPSC included 11 dimensions and 37 items.

CONCLUSIONS

The B-HSOPSC had acceptable levels of global and local fits. Its safety culture dimensions were sufficiently distinguishable and correlated with outcome variables.

Baseline Patient Safety Culture in Cameroon: Setting a Foundation for Trauma Quality Improvement

BACKGROUND

Trauma quality improvement (QI) has resulted in decreased trauma mortality and morbidity in high-income countries and has the potential to do the same in low- and middle-income countries. Effective implementation of QI programs relies on a foundational culture of patient safety; however, studies on trauma-related patient safety culture in Sub-Saharan Africa remain scarce. This study assesses baseline patient safety culture in Cameroon to best identify opportunities for improvement.

MATERIALS AND METHODS

Over a 3-week period, the Hospital Survey on Patient Safety Culture was administered in three hospitals in the Littoral region of Cameroon. Percentages of positive responses (PPRs) were calculated across 42 items in 12 survey dimensions. A mixed-effects logistic regression model was used to summarize dimension-level percentages and confidence intervals.

RESULTS

A total of 179 trauma-related hospital personnel were surveyed with an overall response rate of 76.8%. High PPRs indicate favorable patient safety culture. Of the 12 dimensions evaluated by the Hospital Survey on Patient Safety Culture, nine had a PPR below 50%. Dimensions particularly pertinent in the context of QI include Nonpunitive Response to Errors with a PPR of 25.8% and Organization Learning-Continuous Improvement with a PPR of 64.7%.

CONCLUSIONS

The present study elucidates an opportunity for the development of trauma patient safety culture in Cameroon. Low PPR for Nonpunitive Response to Errors indicates a need to shift cultural paradigms from ascribing individual blame to addressing systemic shortcomings of patient care. Moving forward, data from this study will inform interventions to cultivate patient safety culture in partnering Cameroonian hospitals.

Nurses' perceptions of patient safety culture: a mixed-methods study

BACKGROUND

There are relatively few qualitative studies concerning patient safety culture.

METHODS

We aimed to explore patient safety culture as perceived by the nursing staff in two public hospitals in Catalonia, Spain. A mixed-methods design was employed using a questionnaire, in-depth interviews, and non-participant observations.

RESULTS

Sixty-two percent of the nursing staff rated patient safety as "Acceptable" but was not higher because of work pressure and lack of resources as perceived by staff. "Teamwork within units" had the highest rate of positive responses, and "Staffing" had the lowest rate. Emergency units showed more negative results than the other two units.

CONCLUSIONS

Safety incidents are not always reported due to fear of punishment, reflecting a lack of positive safety culture. It is necessary to design and implement strategies that promote a positive culture to avoid punitive responses and apply and evaluate these changes.

Exploring the role of managers in the development of a safety culture in seven French healthcare facilities: a qualitative study

BACKGROUND

Numerous studies have been conducted over the past 15 years to assess safety culture within healthcare facilities; in general, these studies have shown the pivotal role that managers play in its development. However, little is known about what healthcare managers actually do to support this development, and how caregivers and managers represent managers'role. Thus the objectives of this study were to explore: i) caregivers and managers' perceptions and representations of safety, ii) the role of managers in the development of safety culture as perceived by themselves and by caregivers, iii) managers' activities related to the development of safety culture.

METHODS

An exploratory, multicentre, qualitative study was conducted from May 2014 to March 2015 in seven healthcare facilities in France. Semi-structured interviews were conducted with managers (frontline, middle and top level) and caregivers (doctors, nurses and nurse assistants) and on-site observations of two managers were carried out in all facilities. A thematic analysis of semi-structured interviews was performed. Observed activities were categorised using Luthans' typology of managerial activities.

RESULTS

Participants in semi-structured interviews (44 managers and 21 caregivers) expressed positive perceptions of the level of safety in their facility. Support from frontline management was particularly appreciated, while support from top managers was identified as an area for improvement. Six main categories of safety-related activities were both observed among managers and regularly expressed by participants. However, caregivers' expectations of their managers and managerial perceptions of these expectations only partially overlapped.

CONCLUSIONS

The present study highlights current categories of managerial activities that foster safety culture, and points out an important gap between caregivers' expectations of their managers, and managerial perceptions of these expectations. The findings underline the need to allow more time for managers and caregivers to talk about safety issues. The results could be used to develop training programs to help healthcare managers to understand their role in the development of safety culture.

Assessment of the Safety Climate at University Hospitals in the Slovak Republic from the Nurses’ Perspective

Introduction: Safety climate consists of individual dimensions that might be assessed using specific instruments, e.g., the Hospital Survey on Patient Safety Culture (HSOPS). Establishing the safety climate in healthcare facilities leads to improvements in patient safety.

Aim: To assess the safety climate at university hospitals in the Slovak Republic from the nurses’ perspective and to determine the relationship between organisational variables and the particular components of the safety climate.

Methods: The study has a cross-sectional design. Data were collected using the HSOPS between December 2017 and July 2018. Two university hospitals participated in the study and overall 280 respondents were included. Respondents were recruited through the purposive sampling method. Data were analysed by descriptive and inductive statistics in the statistical programme SPSS 25.0.

Results: Results indicate that in the university hospitals there is a low-level of safety climate. The significant relationship was proved between organisational variables such as the experience in the current position, leaving intention, overtime, perception of staff adequacy, unit type, nurse-patient ratio, and the particular components of the safety climate.

Conclusion: Our findings may help hospital management to raise the awareness of the safety climate and to gain a sophisticated overview of the particular components of the safety climate. Adding new organisational variables may help to assess the safety climate from multiple perspectives and, thus, identify areas contributing to patient safety.

Study of safety culture in healthcare institutions: case of an Algerian hospital

PURPOSE

For many years, the concept of safety culture has attracted researchers from all over the world, and more particularly in the area of healthcare services. The purpose of this paper is to measure safety culture dimensions in order to improve and promote healthcare in Algeria.

DESIGN/METHODOLOGY/APPROACH

The used approach consists of getting a better understanding of healthcare safety culture (HSC) by measuring the perception of healthcare professionals in order to guide promotion actions. For this, the Hospital Survey on Patient Safety Culture questionnaire was used in a pilot hospital setting where it was distributed on a number of 114 health professionals chosen by stratified random sampling.

FINDINGS

The results showed that the identified priority areas for HSC improvement help in establishing a trust culture and a non-punitive environment based on the system and not on the individual.

ORIGINALITY/VALUE

Safety is recognized as a key aspect of service quality, thus measuring the HSC can help establish an improvement plan. In Algerian health facilities, this study is considered the first to examine perceptions in this particular area. The current results provide a baseline of strengths and opportunities for healthcare safety improvement, allowing the managers of this type of facilities to take steps that are more effective.

Assessing patient safety culture in 18 Tunisian adult intensive care units and determination of its associated factors: A multi-center study

PURPOSE

This study aimed to assess patient safety culture (PSC) in intensive care units (ICUs) and to determine the factors affecting it.

MATERIALS AND METHODS

This is a cross-sectional study, conducted from October to November 2017 among professionals practicing in the ICUs of the Tunisian center. After obtaining institutional ethics committee's approval and administrative authorizations, an anonymous paper-based questionnaire was distributed to the participants after obtaining their consent to take part in the study. The measuring instrument used is the French validated version of the "Hospital Survey on Patient Safety Culture" questionnaire.

RESULTS

A total of 402 professionals, from 18 ICUs and 10 hospitals, participated in the study with a participation rate of 82.37%. All dimensions were to be improved. The most developed dimension was teamwork within the unit (47.87%) and the least developed dimension was the non-punitive response to error (18.6%). Seven dimensions were significantly more developed in private institutions than in public ones. Results also show that when workload is reduced, the PSC was significantly increased.

CONCLUSION

This study has shown that the PSC in ICUs needs improvement and provided a baseline results to get a clearer vision of the aspects of security that require special attention.

Patient safety culture in Hungarian hospitals

PURPOSE

The Hospital Survey on Patient Safety Culture (HSOPSC) is a rigorously designed tool for measuring inpatient safety culture. The purpose of this paper is to develop a cross-cultural HSOPSC for Hungary and determine its strengths and weaknesses.

DESIGN/METHODOLOGY/APPROACH

The original US version was translated and adapted using existing guidelines. Healthcare workers (n=371) including nurses, physicians and other healthcare staff from six Hungarian hospitals participated. Answers were analyzed using exploratory factor analyses and reliability tests.

FINDINGS

Positive responses in all dimensions were lower in Hungary than in the USA. Half the participants considered their work area "acceptable" regarding patient safety. Healthcare staff worked in "crisis mode," trying to accomplish too much and too quickly. The authors note that a "blame culture" does not facilitate patient safety improvements in Hungary.

PRACTICAL IMPLICATIONS

The results provide valuable information for promoting a more positive patient safety culture in Hungary and for evaluating future strategies to improve patient safety.

ORIGINALITY/VALUE

Introducing a validated scale to measure patient safety culture in Hungary improves healthcare quality.

Assessing the Perceptions of the Health Care Workforce Toward the Patient Safety Culture in Vietnamese Hospitals

The main objective of this study was to use the translated version of Hospital Survey on Patient Safety Culture, the English-Vietnamese Hospital Survey on Patient Safety Culture (E-V HSOPSC), to assess the patient safety culture in Vietnamese hospitals and examine the extent to which safety attitudes vary between staff, hospitals, and health care systems. In addition, this study aimed to evaluate the psychometric properties of the instrument in Vietnamese dataset. We evaluated whether patient safety culture contributes to establish a positive patient safety culture—the cornerstone of a quality health care. In May 2015, the E-V HSOPSC was conducted with 1500 staff from 10 hospitals in Vietnam. The respondents were asked to return the completed surveys after a 3-month period. Before assessing the perceptions of health care workforce toward organizational safety culture, a confirmatory factor analysis, construct validity, and reliability were performed using SPSS and Amos 23.0. A total of 1116 questionnaires were eligible for data analysis. The outcomes from factor analysis verified the fitness and validity of the instrument. The positive response rate across 12 safety culture dimensions in the questionnaire ranged from 30% (Hospital Handoffs and Transitions) to 77% (Teamwork within Hospital Units). Overall, the mean positive score was 58.9%, which was slightly lower than of the United States. The safety was graded as “Very Good” by 52.6% of respondents in Vietnam. The E-V HSOPSC was appropriate to assess the patient safety culture in Vietnam, because the instrument provided adequate evidence of validity and reliability and patient safety culture strengths and deficiencies.

Hospital Survey on Patient Safety Culture (HSPSC): a systematic review of the psychometric properties of 62 international studies

OBJECTIVE

To carry out a systematic review of the psychometric properties of international studies that have used the Hospital Survey on Patient Safety Culture (HSPSC).

DESIGN

Literature review and an analysis framework to review studies.

SETTING

Hospitals and other healthcare settings in North and South America, Europe, the Near East, the Middle East and the Far East.

DATA SOURCES

A total of 62 studies and 67 datasets made up of journal papers, book chapters and PhD theses were included in the review.

PRIMARY AND SECONDARY OUTCOME MEASURES

Psychometric properties (eg, internal consistency) and sample characteristics (eg, country of use, participant job roles and changes made to the original version of the HSPSC).

RESULTS

Just over half (52%) of the studies in our sample reported internal reliabilities lower than 0.7 for at least six HSPSC dimensions. The dimensions 'staffing', 'communication openness', 'non-punitive response to error', 'organisational learning' and 'overall perceptions of safety' resulted in low internal consistencies in a majority of studies. The outcomes from assessing construct validity were reported in 60% of the studies. Most studies took place in a hospital setting (84%); the majority of survey participants (62%) were drawn from nursing and technical staff. Forty-two per cent of the studies did not state what modifications, if any, were made to the original US version of the instrument.

CONCLUSIONS

While there is evidence of a growing worldwide trend in the use of the HSPSC, particularly within Europe and the Near/Middle East, our review underlines the need for caution in using the instrument. Future use of the HSPSC needs to be sensitive to the demands of care settings, the target population and other aspects of the national and local healthcare contexts. There is a need to develop guidelines covering procedures for using, adapting and translating the HSPSC, as well as reporting findings based on its use.

Transcultural adaptation and psychometric study of the French version of the nursing home survey on patient safety culture questionnaire

BACKGROUND

The Nursing Home Survey on Patient Safety Culture (NHSOPS) questionnaire was developed by the Agency for Healthcare Research and Quality (AHRQ), particularly as an intervention to raise staff awareness about patient safety issues. The main objective of the present study was to provide a validated French-language measure of the safety culture (SC) in nursing homes. Thus the aim was i) to carry out a transcultural adaptation into French of the NHSOPS questionnaire, ii) to assess its psychometric properties in a sample of professionals working in French EHPAD facilities and iii) to develop our own tool.

METHODS

The study was carried out on volunteering professionals from 61 nursing homes (from January to March 2016). Two phases were conducted: an initial phase involving the translation and cultural adaptation of the questionnaire, and a second phase in which the psychometric properties of the questionnaire were assessed. A Structural Equation Model (SEM) with a maximum likelihood estimation method was used to evaluate the construct validity of the questionnaire. As the fit of the structure was not sufficient, an exploratory factor analysis using a principal axis factoring with an oblique rotation was then performed. Internal consistency was evaluated and we examined test-retest reliability using Intra-class Correlation Coefficients (ICC).

RESULTS

During the initial phase, all items were retained and minor adjustments were made. The participation rate by professionals was 58.4%. The exploratory analysis led to the identification of seven dimensions: Teamwork, Staffing, Compliance with procedures, Handoffs, Feedback and communication about incidents, Supervisor expectations and actions promoting resident safety, Overall perceptions of resident safety and Organizational learning. The SEM confirmed the existence of the seven latent dimensions (CFI = 0.946; TLI = 0.933; SRMR = 0.059; RMSEA = 0.061); internal consistency was acceptable. ICC per item ranged from 0.19 to 0.88.

CONCLUSIONS

The results from this study were robust on seven dimensions. This French version is the first on Patient SC to have been applied to the medical-social sector caring for dependent elderly people in France. The NHSOPS questionnaire provides the opportunity to broach this subject. A national evaluation campaign should provide the opportunity to confirm or improve this measure.

TRIAL REGISTRATION

NCT02908373 (September 21, 2016) «Retrospectively registered».

Refining the medical student safety attitudes and professionalism survey (MSSAPS): adaptation and assessment of patient safety perception of French medical residents

BACKGROUND

Implementing a patient safety curriculum for medical students requires to identify their needs and current awareness of the topic. Several tools have been developed to measure patient safety culture, but none of them have been developed in the French context. Our objective was to adapt and refine the psychometric properties of the MSSAPS, developed by Liao et al, to use it among general practice (GP) residents.

METHODS

1-We conducted a translation and transcultural adaptation of the MSSAPS questionnaire (28 items, 5 dimensions: safety culture, teamwork culture, experiences with professionalism, error disclosure culture and comfort expressing professional concerns) in accordance with the international recommendations. 2-We studied the new questionnaire' psychometric properties on a sample of GP residency students in 2016. This validation comprised 2 steps: a confirmatory factor analysis (CFA) for each dimension of the MSAPPS to explore the adequacy of the structure of the questionnaire; an exploratory factor analysis to refine the instrument, using a principal component analysis and Cronbach's α-coefficients calculation. A final CFA examined the structure validity of the refined questionnaire. 3-We described the items and the safety cultural scores in our sample of residents.

RESULTS

Among 391 eligible students, 213 responded (54%). The initial structure was not confirmed by CFAs, showing a poor fit for 3 of the 5 dimensions: safety culture, teamwork culture and professionalism. Exploratory PCA led to 3 dimensions: Safety culture (PVE: 18.5% and 7 of 8 initial items), Experiences with professionalism (PVE: 17.8% and 5 of 7 initial items) and Error disclosure culture (PVE: 13.6% and 3 of 4 original items). Cronbach's α-coefficients were 0.74, 0.78 and 0.76 respectively. The final CFA confirmed the existence of the 3 latent dimensions with a good fit to the and highly significant structural coefficients (P < 0.001). Mean scores were equal to 65.4 [63.6; 67.6] for the safety culture, 66.9 [63.8; 70.1] for the experience with professionalism, and 54.4 [51.6; 57.2] for the error disclosure culture.

CONCLUSION

This study reports satisfactory psychometrics properties of the French version of the MSAPPS and provides evidence of important training needs for GP residents in the field of patient safety culture.

The patient safety culture: a systematic review by characteristics of Hospital Survey on Patient Safety Culture dimensions

Purpose

To learn the weaknesses and strengths of safety culture as expressed by the dimensions measured by the Hospital Survey on Patient Safety Culture (HSOPSC) at hospitals in the various cultural contexts. The aim of this study was to identify studies that have used the HSOPSC to collect data on safety culture at hospitals; to survey their findings in the safety culture dimensions and possible contributions to improving the quality and safety of hospital care.

Data sources

Medline (via PubMed), Web of Science and Scopus were searched from 2005 to July 2016 in English, Portuguese and Spanish.

Study selection

Studies were identified using specific search terms and inclusion criteria. A total of 33 articles, reporting on 21 countries, was included.

Data extraction

Scores were extracted by patient safety culture dimensions assessed by the HSOPSC. The quality of the studies was evaluated by the STROBE Statement.

Results

The dimensions that proved strongest were 'Teamwork within units' and 'Organisational learning-continuous improvement'. Particularly weak dimensions were 'Non-punitive response to error', 'Staffing', 'Handoffs and transitions' and 'Teamwork across units'.

Conclusion

The studies revealed a predominance of hospital organisational cultures that were underdeveloped or weak as regards patient safety. For them to be effective, safety culture evaluation should be tied to strategies designed to develop safety culture hospital-wide.

Improving the safety climate in hospitals by a vignette-based analysis of adverse events: a cluster randomised study

OBJECTIVE

To assess the impact of a vignette-based analysis of adverse events (AEs) on the safety climate (SC) of care units.

DESIGN

Prospective, open, cluster (a unit) randomised controlled trial.

SETTING

Eighteen acute care units of seven hospitals in France.

PARTICIPANTS

Healthcare providers who worked in the units.

INTERVENTION

Vignette-based analyses of AEs were conducted with unit's providers once per month for six consecutive months. The AEs were real cases that occurred in other hospitals. The hospital risk manager conducted each analysis as follows: analysis of the immediate and root causes of the AE; assessment of the care unit's vulnerabilities and existing barriers in the occurrence of an identical AE and search for solutions.

MAIN OUTCOME MEASURE

SC was measured using the French version of the Hospital Survey on Patient Safety Culture questionnaire. The primary outcome was the difference in the 'Organisational learning and continuous improvement' dimension score, from before to after the analyses.

RESULTS

Median participation rate in the analyses was 20% (range: 7-45%). Before intervention, the response rate to the SC survey was 80% (n = 210) in the intervention group and 73% (n = 191) in the control group. After intervention, it was 59% (n = 141) and 63% (n = 148), respectively. The dimension score evolved differently for the groups from before to after intervention (intervention: +10.2 points ±8.8; control: -3.0 points ±8.5, P = 0.04). Side effects were not measured.

CONCLUSIONS

Vignette-based analysis was associated with the improvement of the perception of participants regarding their institution's capacity for organisational learning and continuous improvement.

Exploring pathways to outpatients' satisfaction with health care in Chinese public hospitals in urban and rural areas using patient-reported experiences

Background

This study aimed to measure outpatients’ general satisfaction with and experiences of different aspects of health care in Chinese public hospitals and to investigate to what extent general satisfaction could be explained by patients’ experiences in public hospitals located at urban and rural areas.

Methods

Data on 4782 outpatients were derived from a patient survey in 9 city-level (urban) and 16 county-level (rural) public hospitals across China in 2016. According to Donabedian’s model, questions on patients’ experiences were categorized into six aspects under “structure” and “process”, with general satisfaction representing “outcome”. The Chi-square tests were used to test the differences in patients’ experiences and general satisfaction between urban and rural areas. The Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to estimate effects of patients’ experiences on general satisfaction.

Results

Compared with respondents in rural areas, there were significantly higher percentages of respondents in urban areas reporting satisfaction and positive experiences in most aspects. As manifested by the path coefficients in PLS models, the positive effect of professional competence (0.197) on general satisfaction was the most significant in respondents at urban areas, followed by communication and information (0.183), and caring attitudes and emotional support (0.174). Among respondents at rural areas, the positive effect of environment facilities (0.199) was the most significant, followed by caring attitudes and emotional support (0.188), and professional competence (0.179). The PLS models explained 44.9 and 46.0% of variations in patient satisfaction at urban and rural areas, respectively.

Conclusions

Levels of patient satisfaction and experiences at Chinese public hospitals were higher in urban than in rural areas. Outpatients’ experiences of professional competence, caring attitudes and emotional support were strongly related to their satisfaction in both settings. However, among respondents in urban areas, experiences of communication and information were more strongly related to satisfaction, whereas among respondents in rural areas, experiences of environment and facilities were more strongly related to satisfaction.

Electronic supplementary material

The online version of this article (10.1186/s12939-019-0932-3) contains supplementary material, which is available to authorized users.

[Not Available]

PROGRAMME FOR THE CONTINUOUS IMPROVEMENT OF TEAM WORK TO IMPROVE THE SAFETY OF PATIENT CARE.: The analysis of the causes of care-related adverse events shows that in order to improve safety, human and organisational factors must be taken into account, and action taken to target team work. Based on this observation, the French National Health Authority designed and tested with volunteer teams the Programme for the Continuous Improvement of Team Work, between 2013 and 2016. This programme provides professionals with a series of tools and methods to improve they way they work in a team. Eventually, the implementation of the programme will be a requirement for the certification of healthcare facilities.

Assessment of patient safety culture in private and public hospitals in Peru

Objective

To assess the patient safety culture in Peruvian hospitals from the perspective of healthcare professionals, and to test for differences between the private and public healthcare sectors. Patient safety is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of healthcare delivery.

Design

A non-random cross-sectional study conducted online.

Setting

An online survey was administered from July to August 2016, in Peru. This study reports results from Lima and Callao, which are the capital and the port region of Peru.

Participants

A total of 1679 healthcare professionals completed the survey. Participants were physicians, medical residents and nurses working in healthcare facilities from the private sector and public sector.

Main outcomes

Assessment of the degree of patient safety and 12 dimensions of patient safety culture in hospital units as perceived by healthcare professionals.

Results

Only 18% of healthcare professionals assess the degree of patient safety in their unit of work as excellent or very good. Significant differences are observed between the patient safety grades in the private sector (37%) compared to the public sub-sectors (13-15%). Moreover, in all patient safety culture dimensions, healthcare professionals from the private sector give more favorable responses for patient safety, than those from the public sub-systems. The most significant difference in support comes from patient safety administrators through communication and information about errors.

Conclusions

Overall, the degree of patient safety in Peru is low, with significant gaps that exist between the private and the public sectors.

Hospital survey on patient safety culture (HSOPS): variability of scoring strategies

Objective

To assess the variability of safety culture dimension scores and their associated rankings depending on three different scoring strategies using the Hospital Survey On Patient Safety Culture (HSOPS).

Design

Cross-sectional study using a self-administered questionnaire.

Setting

The study was conducted in an 1836-bed acute-care French university hospital with an annual volume of 135 999 stays, between April 2013 and November 2014.

Participants

All caregivers and technical-administrative staff with at least 6 months of employment, spending at least half of their working time in the hospital, were asked to participate.

Intervention

None.

Main outcome measure

The variability of the HSOPS results using three different scoring methods: the percentage of positive responses recommended by the Agency for Healthcare Research and Quality, the averaged individual means and the averaged individual sums.

Results

The response rate was 78.6% (n = 3978). The percentage of positive responses resulted in lower scores compared to averaged individual means and averaged individual sums in the six least developed dimensions, and gave more widely spread scores and greater 95CIs in the six most developed dimensions. Department rankings also varied greatly depending on the scoring methods.

Conclusion

The values of the HSOPS scores and their corresponding rankings greatly depended on the computation method. This finding shows how important it is to agree on the use of the same scoring strategies, before broadly comparing results within and across organizations.

Linguistic Validation and Cultural Adaptation of Bulgarian Version of Hospital Survey on Patient Safety Culture (HSOPSC)

BACKGROUND:

Patient safety (PS) is one of the essential elements of health care quality and a priority of healthcare systems in most countries. Thus the creation of validated instruments and the implementation of systems that measure patient safety are considered to be of great importance worldwide.

AIM:

The present paper aims to illustrate the process of linguistic validation, cross-cultural verification and adaptation of the Bulgarian version of the Hospital Survey on Patient Safety Culture (B-HSOPSC) and its test-retest reliability.

METHODS:

The study design is cross-sectional. The HSOPSC questionnaire consists of 42 questions, grouped in 12 different subscales that measure patient safety culture. Internal con­sistency was assessed using Cronbach’s alpha. The Wilcoxon signed-rank test and the split-half method were used; the Spear­man-Brown coefficient was calculated.

RESULTS:

The overall Cronbach’s alpha for B-HSOPSC is 0.918. Subscales 7 Staffing and 12 Overall perceptions of safety had the lowest coefficients. The high reliability of the instrument was confirmed by the Split-half method (0.97) and ICC-coefficient (0.95). The lowest values of Spearmen-Broun coefficients were found in items A13 and A14.

CONCLUSION:

The study offers an analysis of the results of the linguistic validation of the B-HSOPSC and its test-retest reliability. The psychometric characteristics of the questions revealed good validity and reliability, except two questions. In the future, the instrument will be administered to the target population in the main study so that the psychometric properties of the instrument can be verified.