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Ellis LA, Falkland E, Hibbert P, Wiig S, Ree E, Schultz TJ, Pirone C, Braithwaite J. Issues and complexities in safety culture assessment in healthcare. Front Public Health 2023; 11:1217542. [PMID: 37397763 PMCID: PMC10309647 DOI: 10.3389/fpubh.2023.1217542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
The concept of safety culture in healthcare-a culture that enables staff and patients to be free from harm-is characterized by complexity, multifacetedness, and indefinability. Over the years, disparate and unclear definitions have resulted in a proliferation of measurement tools, with lack of consensus on how safety culture can be best measured and improved. A growing challenge is also achieving sufficient response rates, due to "survey fatigue," with the need for survey optimisation never being more acute. In this paper, we discuss key challenges and complexities in safety culture assessment relating to definition, tools, dimensionality and response rates. The aim is to prompt critical reflection on these issues and point to possible solutions and areas for future research.
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Affiliation(s)
- Louise A. Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Emma Falkland
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Siri Wiig
- SHARE—Centre for Resilience in Healthcare, Department of Quality and Health Technology, Universitetet i Stavanger, Stavanger, Norway
| | - Eline Ree
- SHARE—Centre for Resilience in Healthcare, Department of Quality and Health Technology, Universitetet i Stavanger, Stavanger, Norway
| | - Timothy J. Schultz
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Christy Pirone
- Southern Adelaide Department of Health, Adelaide, SA, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
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Ahmed FA, Asif F, Munir T, Halim MS, Feroze Ali Z, Belgaumi A, Zafar H, Latif A. Measuring the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMJ Open Qual 2023; 12:bmjoq-2022-002029. [PMID: 36931633 PMCID: PMC10030877 DOI: 10.1136/bmjoq-2022-002029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Patient safety is a top priority for many healthcare organisations worldwide. However, most of the initiatives aimed at the measurement and improvement of patient safety culture have been undertaken in developed countries. The purpose of this study was to measure the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC). METHODS The HSOPSC was used to measure the patient safety culture across 12 dimensions at Aga Khan University Hospital, Karachi. 2,959 individuals, who had been working at the hospital, were administered the HSOPSC in paper form between June and September 2019. RESULTS The response rate of the survey was 50%. In the past 12 months, 979 respondents (33.1%) had submitted at least one event report. Results showed that the personnel viewed the patient safety culture at their hospital favourably. Overall, respondents scored highest in the following dimensions: 'feedback and communication on error' (91%), 'organisational learning and continuous improvement' (85%), 'teamwork within units' (83%), 'teamwork across units' (76%). The dimensions with the lowest positive per cent scores included 'staffing' (40%) and 'non-punitive response to error' (41%). Only the reliability of the 'handoffs and transitions', 'frequency of events reported', 'organisational learning' and 'teamwork within units' was higher than Cronbach's alpha of 0.7. Upon regression analysis of positive responses, physicians and nurses were found to have responded less favourably than the remaining professional groups for most dimensions. CONCLUSION The measurement of safety culture is both feasible and informative in developing countries and could be broadly implemented to inform patient safety efforts. Current data suggest that it compares favourably with benchmarks from hospitals in the USA. Like the USA, high staff workload is a significant safety concern among staff. This study lays the foundation for further context-specific research on patient safety culture in developing countries.
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Affiliation(s)
- Fasih Ali Ahmed
- Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Center for Patient Safety, Aga Khan University Medical College, Karachi, Pakistan
| | - Fozia Asif
- Center for Patient Safety, Aga Khan University Medical College, Karachi, Pakistan
| | - Tahir Munir
- Department of Anaesthesiology, Aga Khan University Medical College, Karachi, Pakistan
| | - Muhammad Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Zehra Feroze Ali
- Quality and Patient Safety Department, Aga Khan University Hospital, Karachi, Pakistan
| | - Asim Belgaumi
- Quality and Patient Safety Department, Aga Khan University Hospital, Karachi, Pakistan
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Hasnain Zafar
- Department of Surgery, Aga Khan University Medical College, Karachi, Pakistan
| | - Asad Latif
- Department of Anaesthesiology, Aga Khan University Medical College, Karachi, Pakistan
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Suryani L, Letchmi S, Binti Moch Said F. Cross-culture adaptation and validation of the Indonesian version of the Hospital Survey on Patient Safety Culture (HSOPSC 2.0). BELITUNG NURSING JOURNAL 2022; 8:169-175. [PMID: 37521894 PMCID: PMC10386797 DOI: 10.33546/bnj.1928] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/15/2021] [Accepted: 03/30/2022] [Indexed: 08/01/2023] Open
Abstract
Background Hospital Survey on Patient Safety Culture (HSOPSC) is considered one of the most scientifically rigorous tools available with excellent psychometric properties. However, it is not yet available in an Indonesian version. Objective This study aimed to determine the validity of the content and psychometric properties of HSOPSC 2.0 for use in Indonesian hospitals. Methods The study was divided into three stages: translation, adaptation, and validation. Culture-adaptation was assessed using cognitive interviews with ten direct care nurses who worked in the hospital to evaluate their perceptions and the coherence of the translated items, response categories, and questionnaire directions. Content validity was also done by ten experts from academic and clinical settings. Finally, Confirmatory Factor Analysis (CFA) and reliability testing were conducted among 220 nurses from two Indonesian hospitals. Results The cognitive test results indicated that the language clarity was 87.8 % and 84.5% for cultural relevance. The Content Validity Index (CVI) ranged between 0.73 to 1.00, while the construct validity results indicated that each factor had factor loadings above 0.4, from 0.47 to 0.65. The fit indices showed an acceptable fit for the data provided by the 10-factor model, with RMSEA = 0.052, SRMR = 0.089, and CFI = 0.87. The Pearson correlation coefficients between the ten subscales ranged from 0.276 to 0.579 (p < 0.05). The Cronbach's alpha for all sub-scales was more than 0.70, except for organizational learning - continuous improvement, response to error, and communication openness. Conclusion This study offers initial evidence of the psychometric properties of the Indonesian-HSOPSC 2.0. Future studies are needed to examine its psychometric features to improve generalizability. However, nurses and other healthcare professionals could use the tool to measure hospital patient safety culture in Indonesia.
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Affiliation(s)
- Lilis Suryani
- Department of Nursing Management, Sekolah Tinggi Ilmu Kesehatan Horizon Karawang, West Java, Indonesia
- Faculty of Nursing, Lincoln University College, Malaysia
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Montgomery AP, Patrician PA, Azuero A. Nurse Burnout Syndrome and Work Environment Impact Patient Safety Grade. J Nurs Care Qual 2022; 37:87-93. [PMID: 34149033 DOI: 10.1097/ncq.0000000000000574] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Burnout impacts nurses' health as well as brain structures and functions including cognitive function, which could lead to work performance and patient safety issues. Yet, few organization-level factors related to patient safety have been identified. PURPOSE This study examined nurse-reported patient safety grade and its relationship to both burnout and the nursing work environment. METHODS A cross-sectional electronic survey was conducted among nurses (N = 928) in acute care Alabama hospitals. RESULTS In multilevel ordinal mixed-effects models with nurses nested within hospitals, all burnout dimensions of the Copenhagen Burnout Inventory (OR for +1 SD ranging 0.63-0.78; P < .05) and work environment (OR for +1 SD ranging 4.35-4.89; P < .001) were related to the outcome of patient safety grade after controlling for nurse characteristics. CONCLUSIONS Results indicate that health care organizations may reduce negative patient safety ratings by reducing nurse burnout and improving the work environment at the organization level.
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Sauro KM, Baker GR, Tomlinson G, Parshuram C. The role of hospital characteristics in patient safety: a protocol for a national cohort study. CMAJ Open 2021; 9:E1041-E1047. [PMID: 34815259 PMCID: PMC8612653 DOI: 10.9778/cmajo.20200266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Substantial expenditures on health care safety programs have been justified by their goal of reducing health care associated-harm (adverse events), but adverse event rates have not changed over the past 4 decades. The objective of this study is to describe hospital-level factors that are relevant to safety in Canadian hospitals and the impact of these factors on hospital adverse events. METHODS This is a protocol for a national cohort study to describe the association between hospital-level factors and adverse events. We will survey at least 90 (35%) Canadian hospitals to describe 4 safety-relevant domains, chosen based on the literature and expert consultation, namely patient safety culture, safety strategies, staffing, and volume and capacity. We will retrospectively identify hospital adverse events from a national data source. We will evaluate organization-level factors using established scales and a survey, codesigned by the study team and hospital leaders. Hospital leaders, clinical unit leaders and front-line staff will complete the surveys once a year for 3 years, with an anticipated start date of winter 2022. We will use national health administrative data to estimate the rate and type of hospital adverse events corresponding to each 1-year survey period. INTERPRETATION Analysis of data from this project will describe hospital organizational factors that are relevant to safety and help identify organizational initiatives that improve hospital patient safety. In addition to biyearly reports to the leaders of the participating hospitals, we have a multifaceted and tailored dissemination strategy that includes integrating the knowledge users into the study team to increase the likelihood that our study will lead to improved hospital patient safety.
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Affiliation(s)
- Khara M Sauro
- Department of Community Health Science and O'Brien Institute for Public Health (Sauro); Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Baker, Tomlinson, Parshuram), University of Toronto, Toronto, Ont.
| | - G Ross Baker
- Department of Community Health Science and O'Brien Institute for Public Health (Sauro); Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Baker, Tomlinson, Parshuram), University of Toronto, Toronto, Ont
| | - George Tomlinson
- Department of Community Health Science and O'Brien Institute for Public Health (Sauro); Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Baker, Tomlinson, Parshuram), University of Toronto, Toronto, Ont
| | - Christopher Parshuram
- Department of Community Health Science and O'Brien Institute for Public Health (Sauro); Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Baker, Tomlinson, Parshuram), University of Toronto, Toronto, Ont
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How to Measure Patient Safety Culture? a Literature Review of Instruments. ACTA MEDICA MARTINIANA 2021. [DOI: 10.2478/acm-2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Patient safety culture is described as employees’ shared values, attitudes, and behaviours in a healthcare organization. Its main goal is to improve patient safety. Assessment of patient safety culture in the hospital environment is most often carried out using self-assessment tools. Although several of these tools have been developed, their comprehensive overview is lacking in literature.
Aim: To provide an overview of instruments measuring patient safety culture in a hospital setting.
Methods: The study has a character of a narrative literature review. The search was performed in the scientific databases Scopus, ProQuest, and PubMed in January 2021. The search produced a total of 1,767 studies and was limited to language (English). The search and the retrieval process reflected PRISMA’s recommendations. The content analysis method was used in the data synthesis.
Results: We identified 24 tools for assessing the patient safety culture in a hospital setting, of which seven were developed for specific workplaces; others are considered general. Eighteen tools might be utilized by all healthcare professionals within the hospital setting and only three were designated explicitly for nurses. The most commonly used instruments were the Hospital Survey on Patient Culture and the Safety Attitudes Questionnaire.
Conclusion: Assessing a patient safety culture is considered one of the strategies for improving patient safety while increasing care quality. An appropriate tool’s choice depends on the target population, the instrument’s validity and reliability, and other aspects. Awareness of the various assessment tools can help hospitals choose the one that best suits their circumstances.
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Draganović Š, Offermanns G, Davis RE. Adaptation of the Agency for Healthcare Research and Quality's 'Hospital Survey on Patient Safety Culture' to the Bosnia and Herzegovina context. BMJ Open 2021; 11:e045377. [PMID: 34385231 PMCID: PMC8362708 DOI: 10.1136/bmjopen-2020-045377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Measuring staff perspectives on patient safety culture (PSC) can identify areas of concern that, if addressed, could lead to improvements in healthcare. To date, there is no validated measure to assess PSC that has been tested and adapted for use in Bosnia and Herzegovina (BiH). This research addresses the gap in the evidence through the psychometric assessment of the Agency for Healthcare Research and Quality's: 'Hospital Survey on Patient Safety Culture' (HSOPSC), to determine its suitability for the health system in BiH. SETTING Nine hospitals. PARTICIPANTS Healthcare professionals (n=1429); nurse (n=823), doctors (n=328), other clinical personnel (n=111), non-clinical personnel (n=60), other (n=64), no response (n=43). PRIMARY AND SECONDARY OUTCOME MEASURES A translated version of HSOPSC was used to conduct psychometric evaluation including exploratory factor analysis and confirmatory factor analysis (CFA). Comparison between the original HSOPSC and the newly adapted 'Hospital Survey on Patient Safety Culture for Bosnia and Herzegovina' (HSOPSC-BiH) was carried out. RESULTS Compared with the original survey, which has 12 factors (42 items), the adapted survey consisted of 9 factors (29 items). The following factors from the original survey were not included in their original form: Communication Openness, Feedback and Communications about error, Overall Perceptions of Patient Safety and Organisational learning-Continuous Improvement. The results of the CFA for HSOPSC-BiH showed a better model fit compared with the original HSOPSC. The absolute and relative fit indices showed excellent model adjustment. CONCLUSIONS The BiH version of Hospital Survey on Patient Safety Culture demonstrated satisfactory psychometric properties, with acceptable to good internal consistency and construct validity. Therefore, we recommend the HSOPSC-BiH as a basis for assessing PSC in BiH. This survey could provide insight into patient safety concerns in BiH so that strategies to overcome these issues could be formulated and implemented.
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Affiliation(s)
- Šehad Draganović
- Faculty of Management and Economics, Department of Human Resource Management, Leadership and Organizational Behavior, University of Klagenfurt, Klagenfurt, Austria
| | - Guido Offermanns
- Faculty of Management and Economics, Department of Human Resource Management, Leadership and Organizational Behavior, University of Klagenfurt, Klagenfurt, Austria
- Karl Landsteiner Society, Institute for Hospital Organization, Vienna, Austria
| | - Rachel E Davis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
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Churruca K, Ellis LA, Pomare C, Hogden A, Bierbaum M, Long JC, Olekalns A, Braithwaite J. Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals. BMJ Open 2021; 11:e043982. [PMID: 34315788 PMCID: PMC8317080 DOI: 10.1136/bmjopen-2020-043982] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The study of safety culture and its relationship to patient care have been challenged by variation in definition, dimensionality and methods of assessment. This systematic review aimed to map methods to assess safety culture in hospitals, analyse the prevalence of these methods in the published research literature and examine the dimensions of safety culture captured through these processes. METHODS We included studies reporting on quantitative, qualitative and mixed methods to assess safety culture in hospitals. The review was conducted using four academic databases (PubMed, CINAHL, Scopus and Web of Science) with studies from January 2008 to May 2020. A formal quality appraisal was not conducted. Study purpose, type of method and safety culture dimensions were extracted from all studies, coded thematically, and summarised narratively and using descriptive statistics where appropriate. RESULTS A total of 694 studies were included. A third (n=244, 35.2%) had a descriptive or exploratory purpose, 225 (32.4%) tested relationships among variables, 129 (18.6%) evaluated an intervention, while 13.8% (n=96) had a methodological focus. Most studies exclusively used surveys (n=663; 95.5%), with 88 different surveys identified. Only 31 studies (4.5%) used qualitative or mixed methods. Thematic analysis identified 11 themes related to safety culture dimensions across the methods, with 'Leadership' being the most common. Qualitative and mixed methods approaches were more likely to identify additional dimensions of safety culture not covered by the 11 themes, including improvisation and contextual pressures. DISCUSSION We assessed the extent to which safety culture dimensions mapped to specific quantitative and qualitative tools and methods of assessing safety culture. No single method or tool appeared to measure all 11 themes of safety culture. Risk of publication bias was high in this review. Future attempts to assess safety culture in hospitals should consider incorporating qualitative methods into survey studies to evaluate this multi-faceted construct.
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Affiliation(s)
- Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Anne Hogden
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Institute of Health Service Management, University of Tasmania, Hobart, Tasmania, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Aleksandra Olekalns
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Fourar YO, Djebabra M, Benhassine W, Boubaker L. Contribution of PCA/K-means methods to the mixed assessment of patient safety culture. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-05-2020-0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe 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/approachThe 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.FindingsPSC 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/valueA 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.
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Braun BI, Chitavi SO, Suzuki H, Soyemi CA, Puig-Asensio M. Culture of Safety: Impact on Improvement in Infection Prevention Process and Outcomes. Curr Infect Dis Rep 2020; 22:34. [PMID: 33288982 PMCID: PMC7710367 DOI: 10.1007/s11908-020-00741-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/21/2022]
Abstract
Purpose Safety culture is known to be related to a wide range of outcomes, and measurement of safety culture is now required for many hospitals in the U.S.A. In previous reviews, the association with outcomes has been limited by the research design and strength of the evidence. The goal of this review was to examine recent literature on the relationship between safety culture and infection prevention and control-related (IPC) processes and healthcare-associated infections (HAIs) in U.S. healthcare organizations. We also sought to quantitatively characterize the challenges to empirically establishing these relationships and limitations of current research. Recent Findings A PubMed search for U.S. articles published 2009–2019 on the topics of infection prevention, HAIs, and safety culture yielded 448 abstracts. After screening, 55 articles were abstracted for information on purpose, measurement, analysis, and conclusions drawn about the role of safety culture in the outcome. Approximately ½ were quality improvement (QI) initiatives and ½ were research studies. Overall, 51 (92.7%) concluded there was an association between safety culture and IPC processes or HAIs. However, only 39 studies measured safety culture and 26 statistically analyzed safety culture data for associations. Though fewer QI initiatives analyzed associations, a higher proportion concluded an association exists than among research studies. Summary Despite limited empirical evidence and methodologic challenges to establishing associations, most articles supported a positive relationship between safety culture, improvement in IPC processes, and decreases in HAIs. Authors frequently reported experiencing improvements in safety culture when not directly measured. The findings suggest that associations between improvement and safety culture may be bi-directional such that positive safety culture contributes to successful interventions and implementing effective interventions drives improvements in culture. Greater attention to article purpose, design, and analysis is needed to confirm these presumptive relationships.
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Affiliation(s)
- Barbara I Braun
- Department of Research, The Joint Commission, Oakbrook Terrace, IL USA
| | - Salome O Chitavi
- Department of Research, The Joint Commission, Oakbrook Terrace, IL USA
| | - Hiroyuki Suzuki
- Department of Internal Medicine - Infectious Diseases, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Caroline A Soyemi
- Neihoff School of Nursing, Loyola University Chicago, Chicago, IL USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, Carver College of Medicine, Iowa City, IA USA.,Present Address: Department of Infectious Diseases, Hospital Universitari de Bellvitge: L'Hospitalet de Llobregat, Barcelona, Catalunya Spain
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Mbuthia N, Moleki M. Assessing Patient Safety Culture: Application of the Safety Attitudes Questionnaire in a Kenyan Setting. Open Nurs J 2020. [DOI: 10.2174/1874434602014010203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Patient safety has recently been declared a global health priority. Achievement and sustenance of a culture of patient safety require a regular and timely assessment of the organization. The Safety Attitudes Questionnaire is a patient safety culture assessment tool whose usefulness has been established in countries, but a few studies have been published from Africa, more so, in Kenyan settings.
Objective:
To evaluate the reliability of the Safety Attitudes Questionnaire in assessing the patient safety culture in a Kenyan setting and to assess healthcare workers' perceptions of patient safety culture.
Methods:
A descriptive quantitative approach was utilized whereby the Safety Attitudes Questionnaire was administered to 241 healthcare workers in two public hospitals. The Cronbach’s α was calculated to determine the internal consistency of the SAQ. Descriptive and inferential statistics were used to analyze and describe the data on patient safety culture.
Results:
The total scale Cronbach’s alpha of the SAQ was 0.86, while that of the six dimensions was 0.65 to 0.90. The overall mean score of the total SAQ was 65.8 (9.9). Participants had the highest positive perception for Job Satisfaction with a mean score of 78.3 (16.1) while the lowest was evaluated for Stress Recognition with a mean score of 53.8 (28.6).
Conclusion:
The SAQ demonstrated satisfactory internal consistency and is suitable for use in the Kenyan context. The perception of patient safety culture in the Kenyan hospital is below international recommendations. There is a need for implementation of strategies for the improvement of the organization culture in Kenyan hospitals.
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Examination of the relationship between management and clinician perception of patient safety climate and patient satisfaction. Health Care Manage Rev 2020; 44:79-89. [PMID: 28445323 DOI: 10.1097/hmr.0000000000000156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this study was to explore the relationship between managers and clinicians' agreement on deeming the patient safety climate as high or low and the patients' satisfaction with those organizations. DATA SOURCES/STUDY SETTING We used two secondary data sets: the Hospital Survey on Patient Safety Culture (2012) and the Hospital Consumer Assessment of Healthcare Providers and Systems (2012). METHODOLOGY/APPROACH We used ordinary least squares regressions to analyze the relationship between the extent of agreement between managers and clinicians' perceptions of safety climate in relationship to patient satisfaction. The dependent variables were four Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores: communication with nurses, communication with doctors, communication about medicines, and discharge information. The main independent variables were four groups that were formed based on the extent of managers and clinicians' agreement on four patient safety climate domains: communication openness, feedback and communication about errors, teamwork within units, and teamwork across units. FINDINGS After controlling for hospital and market-level characteristics, we found that patient satisfaction was significantly higher if managers and clinicians reported that patient safety climate is high or if only clinicians perceived the climate as high. Specifically, manager and clinician agreement on high levels of communication openness (β = 2.25, p = .01; β = 2.46, p = .05), feedback and communication about errors (β = 3.0, p = .001; β = 2.89, p = .01), and teamwork across units (β = 2.91, p = .001; β = 3.34, p = .01) was positively and significantly associated with patient satisfaction with discharge information and communication about medication. In addition, more favorable perceptions about patient safety climate by clinicians only yielded similar findings. PRACTICE IMPLICATIONS Organizations should measure and examine patient safety climate from multiple perspectives and be aware that individuals may have varying opinions about safety climate. Hospitals should encourage multidisciplinary collaboration given that staff perceptions about patient safety climate may be associated with patient satisfaction.
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Abstract
Objective Using the Hospital Survey on Patient Culture, our aim was to investigate the patient safety culture in all Swedish hospitals and to compare the culture among managers, physicians, registered nurses, and enrolled nurses and to identify factors associated with high overall patient safety. Methods The study used a correlational design based on cross-sectional surveys from health care practitioners in Swedish health care (N = 23,781). We analyzed the associations between overall patient safety (outcome variable) and 12 culture dimensions and 5 background characteristics (explanatory variables). Simple logistic regression analyses were conducted to determine the bivariate association between each explanatory variable and the outcome variable. The explanatory variables were entered to determine the multivariate associations between the variables and the outcome variable. Results The highest rated culture dimensions were “teamwork within units” and “nonpunitive response to error,” and the lowest rated dimensions were “management support for patient safety” and “staffing.” The multivariate analysis showed that long professional experience (>15 years) was associated with increased probability for high overall patient safety. Compared with general wards, the probability for high overall patient safety was higher for emergency care but lower for psychiatric care. The probability for high overall patient safety was higher for both enrolled nurses and physicians compared with managers. Conclusions The safety culture dimensions of the Hospital Survey on Patient Culture contributed far more to overall patient safety than the background characteristics, suggesting that these dimensions are very important in efforts to improve the overall patient safety culture.
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Majidi SA, Alizadeh S, kouchakzadeh Talami S, Safarmohammadi H, Kazemnezhad Leily E, Motagi M, Barzegar M. Patient Safety Culture from the Viewpoint of Nurses: A Cross-Sectional Study in 2016. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2019. [DOI: 10.29252/jgbfnm.16.2.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Jones KJ, Crowe J, Allen JA, Skinner AM, High R, Kennel V, Reiter-Palmon R. The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project. BMC Health Serv Res 2019; 19:650. [PMID: 31500609 PMCID: PMC6734353 DOI: 10.1186/s12913-019-4453-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 08/22/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Conducting post-fall huddles is considered an integral component of a fall-risk-reduction program. However, there is no evidence linking post-fall huddles to patient outcomes or perceptions of teamwork and safety culture. The purpose of this study is to determine associations between conducting post-fall huddles and repeat fall rates and between post-fall huddle participation and perceptions of teamwork and safety culture. METHODS During a two-year demonstration project, we developed a system for 16 small rural hospitals to report, benchmark, and learn from fall events, and we trained them to conduct post-fall huddles. To calculate a hospital's repeat fall rate, we divided the total number of falls reported by the hospital by the number of unique medical record numbers associated with each fall. We used Spearman correlations with exact P values to determine the association between the proportion of falls followed by a huddle and the repeat fall rate. At study end, we used the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) to assess perceptions of teamwork support for fall-risk reduction and the Hospital Survey on Patient Safety Culture (HSOPS) to assess perceptions of safety culture. We added an item to the T-TPQ for respondents to indicate the number of post-fall huddles in which they had participated. We used a binary logistic regression with a logit link to examine the effect of participation in post-fall huddles on respondent-level percent positive T-TPQ and HSOPS scores. We accounted for clustering of respondents within hospitals with random effects using the GLIMMIX procedure in SAS/STAT. RESULT Repeat fall rates were negatively associated with the proportion of falls followed by a huddle. As compared to hospital staff who did not participate in huddles, those who participated in huddles had more positive perceptions of four domains of safety culture and how team structure, team leadership, and situation monitoring supported fall-risk reduction. CONCLUSIONS Post-fall huddles may reduce the risk of repeat falls. Staff who participate in post-fall huddles are likely to have positive perceptions of teamwork support for fall-risk reduction and safety culture because huddles are a team-based approach to reporting, adapting, and learning.
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Affiliation(s)
- Katherine J. Jones
- College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420 USA
| | - John Crowe
- Department of Psychology, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE 68182-0274 USA
| | - Joseph A. Allen
- Department of Psychology, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE 68182-0274 USA
| | - Anne M. Skinner
- College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420 USA
| | - Robin High
- College of Public Health, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375 USA
| | - Victoria Kennel
- College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420 USA
| | - Roni Reiter-Palmon
- Department of Psychology, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE 68182-0274 USA
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16
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Al Salem G, Bowie P, Morrison J. Hospital Survey on Patient Safety Culture: psychometric evaluation in Kuwaiti public healthcare settings. BMJ Open 2019; 9:e028666. [PMID: 31152040 PMCID: PMC6549604 DOI: 10.1136/bmjopen-2018-028666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE As healthcare organisations endeavour to improve the quality and safety of their services, there is increasing recognition of the importance of building a culture of safety to promote patient safety and improve the outcomes of patient care. Surveys of safety culture/climate have not knowingly been conducted in Kuwait public hospitals, nor are valid or reliable survey instruments available for this context. This study aims to investigate the psychometric properties of the HSOPSC (Hospital Survey on Patient Safety Culture) tool in Kuwaiti public hospitals in addition to constructing an optimal model to assess the level of safety climate in this setting. DESIGN Cross-sectional study. SETTING Three public hospitals in Kuwait. PARTICIPANTS About 1317 healthcare professionals. MAIN OUTCOME MEASURE An adapted and contextualised version of HSOPSC was used to conduct psychometric evaluation including exploratory factor analysis, confirmatory factor analysis reliability and correlation analysis. RESULTS 1317 questionnaires (87%) were returned. Psychometric evaluation, showed an optimal model of eight factors and 22 safety climate items. All items have strong factor loadings (0.42-0.86) and are theoretically related. Reliability analysis showed satisfactory results (α >0.60). CONCLUSIONS This is the first validation study of a standardised safety climate measure in a Kuwaiti healthcare setting. An optimal model for assessing patient safety climate was produced that mirrors other international studies and which can be used for measuring the prevailing safety climate. More importance should be attached to the psychometric fidelity of safety climate questionnaires before extending their use in other healthcare culture and contexts internationally.
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Affiliation(s)
- Gheed Al Salem
- Institute of Health and Well-being, University of Glasgow, Glasgow, UK
- Quality and Accreditation Directorate, Ministry of health, Kuwait City, Kuwait
| | - Paul Bowie
- Safety & Improvement, NHS Education for Scotland, Glasgow, Scotland, UK
| | - Jill Morrison
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
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O’Donovan R, Ward M, De Brún A, McAuliffe E. Safety culture in health care teams: A narrative review of the literature. J Nurs Manag 2019; 27:871-883. [DOI: 10.1111/jonm.12740] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/30/2018] [Accepted: 12/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Roisin O’Donovan
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre University College Dublin Dublin Ireland
| | - Marie Ward
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre University College Dublin Dublin Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre University College Dublin Dublin Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre University College Dublin Dublin Ireland
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18
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Kuosmanen A, Tiihonen J, Repo-Tiihonen E, Eronen M, Turunen H. Changes in patient safety culture: A patient safety intervention for Finnish forensic psychiatric hospital staff. J Nurs Manag 2019; 27:848-857. [PMID: 30784144 DOI: 10.1111/jonm.12760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/21/2019] [Accepted: 02/17/2019] [Indexed: 11/29/2022]
Abstract
AIM To evaluate how a 3-year patient safety intervention, more specifically, the implementation of a patient safety incident reporting system, influences patient safety culture. BACKGROUND Positive patient safety culture improves both the quality of health care and patient safety. Nevertheless, nursing managers need tools that can help them develop and evaluate patient safety culture. METHODS The Hospital Survey on Patient Safety Culture was used to evaluate patient safety culture at two Finnish forensic psychiatric hospitals (study and control) over two periods, baseline and follow-up. Data were analysed using Z-score and T test statistics. RESULTS The follow-up results from the study hospital showed that five patient safety culture dimensions exhibited a significantly (p < 0.05) positive change in positive response rates over the 3-year period. Furthermore, nine out of twelve patient safety culture dimensions at the study hospital showed a significant improvement in mean score. At the control hospital, only the dimension of frequency of reporting events showed a significantly positive change (p < 0.05) in mean score. CONCLUSION This research shows that the studied patient safety intervention (implementation of the patient safety incident reporting system) significantly influences patient safety culture. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers should utilize a variety of patient safety interventions to improve patient safety and focus on leveraging information from patient safety incidents to advance patient safety culture.
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Affiliation(s)
- Anssi Kuosmanen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland.,Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eila Repo-Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
| | | | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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Alingh CW, Strating MMH, van Wijngaarden JDH, Paauwe J, Huijsman R. The ConCom Safety Management Scale: developing and testing a measurement instrument for control-based and commitment-based safety management approaches in hospitals. BMJ Qual Saf 2018; 27:807-817. [PMID: 29511092 DOI: 10.1136/bmjqs-2017-007162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/09/2017] [Accepted: 02/12/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Nursing management is considered important for patient safety. Prior research has predominantly focused on charismatic leadership styles, although it is questionable whether these best characterise the role of nurse managers. Managerial control is also relevant. Therefore, we aimed to develop and test a measurement instrument for control-based and commitment-based safety management of nurse managers in clinical hospital departments. METHODS A cross-sectional survey design was used to test the newly developed questionnaire in a sample of 2378 nurses working in clinical departments. The nurses were asked about their perceptions of the leadership behaviour and management practices of their direct supervisors. Psychometric properties were evaluated using confirmatory factor analysis and reliability estimates. RESULTS The final 33-item questionnaire showed acceptable goodness-of-fit indices and internal consistency (Cronbach's α of the subscales range: 0.59-0.90). The factor structure revealed three subdimensions for control-based safety management: (1) stressing the importance of safety rules and regulations; (2) monitoring compliance; and (3) providing employees with feedback. Commitment-based management consisted of four subdimensions: (1) showing role modelling behaviour; (2) creating safety awareness; (3) showing safety commitment; and (4) encouraging participation. Construct validity of the scale was supported by high factor loadings and provided preliminary evidence that control-based and commitment-based safety management are two distinct yet related constructs. The findings were reconfirmed in a cross-validation procedure. CONCLUSION The results provide initial support for the construct validity and reliability of our ConCom Safety Management Scale. Both management approaches were found to be relevant for managing patient safety in clinical hospital departments. The scale can be used to deepen our understanding of the influence of patient safety management on healthcare professionals' safety behaviour as well as patient safety outcomes.
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Affiliation(s)
- Carien W Alingh
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Human Resource Studies, Tilburg University, Tilburg, The Netherlands
| | - Mathilde M H Strating
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Jaap Paauwe
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Human Resource Studies, Tilburg University, Tilburg, The Netherlands
| | - Robbert Huijsman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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20
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Willmott J, Mould J. Health professionals’ perception of patient safety culture in acute hospitals: an integrative review. AUST HEALTH REV 2018; 42:387-394. [DOI: 10.1071/ah16274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/02/2017] [Indexed: 11/23/2022]
Abstract
Objective Globally, the degree of patient harm occurring in healthcare was first publicised in the 1990s. Although many factors affect patient safety, in the US the Institute of Medicine identified hospital organisational culture as one factor contributing to a reduction in errors. This led to the development of many tools for measuring the safety culture of hospital staff. The aim of the present study was to review the literature on patient safety culture in acute hospitals to identify: (1) how patient safety is viewed by health professionals; (2) whether patient safety culture is perceived differently at the hospital versus ward level; and (3) whether clinicians and managers place the same importance on patient safety. Methods Following a search of electronic databases using OneSearch and a manual search of grey literature, an integrative review method identified 11 articles as being suitable to meet the review’s aims. The search terms of patient safety culture, patient safety and safety climate were used. To ensure relevancy to current practice, the search was restricted to the period 2010–15. Results Hospital patient safety culture is not a shared vision, because health professional groups have different views. In the present study, 67% of articles examined found doctors to have a poorer perception of the patient safety culture than nurses and allied health professionals. All health professional groups reported a more positive view of their ward safety culture than that of the hospital safety culture. Furthermore, managers of the health professionals reported more positively on patient safety culture than bedside clinicians. Conclusion This review provides an international understanding of health professionals’ views of patient safety. From an Australian context, the review highlights the need for further investigation, because there is a lack of recent Australian literature in the acute hospital setting relating to patient safety culture. What is known about the topic? Globally, many research papers have reported upon the correlation between a positive patient safety culture and a reduction in healthcare errors. What does this paper add? The present integrative review highlights that regardless of the country of origin, there are differences in the way that a hospital patient safety culture is perceived among different health professional groups, particularly between managers and bedside clinicians. What are the implications for practitioners? Individual health professional groups, and managers and clinicians, have different views on the patient safety culture; therefore, training needs to involve everyone to create a shared vision for patient safety.
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21
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Li W, Liu K, Yang H, Yu C. Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture. EUR J INFORM SYST 2017. [DOI: 10.1057/ejis.2013.9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Weizi Li
- Informatics Research Centre, Henley Business School, University of Reading Reading U.K
| | - Kecheng Liu
- Informatics Research Centre, Henley Business School, University of Reading Reading U.K
| | - Hongqiao Yang
- Informatics Research Centre, Henley Business School, University of Reading Reading U.K
| | - Changrui Yu
- Shanghai University of Finance and Economics Shanghai China
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Olds DM, Aiken LH, Cimiotti JP, Lake ET. Association of nurse work environment and safety climate on patient mortality: A cross-sectional study. Int J Nurs Stud 2017; 74:155-161. [PMID: 28709013 DOI: 10.1016/j.ijnurstu.2017.06.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/09/2017] [Accepted: 06/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are two largely distinct research literatures on the association of the nurse work environment and the safety climate on patient outcomes. OBJECTIVE To determine whether hospital safety climate and work environment make comparable or distinct contributions to patient mortality. DESIGN Cross-sectional secondary analysis of linked datasets of Registered Nurse survey responses, adult acute care discharge records, and hospital characteristics. SETTING Acute care hospitals in California, Florida, New Jersey, and Pennsylvania. PARTICIPANTS The sample included 600 hospitals linked to 27,009 nurse survey respondents and 852,974 surgical patients. METHODS Nurse survey data included assessments of the nurse work environment and hospital safety climate. The outcome of interest was in-hospital mortality. Data analyses included descriptive statistics and multivariate random intercept logistic regression. RESULTS In a fully adjusted model, a one standard deviation increase in work environment score was associated with an 8.1% decrease in the odds of mortality (OR 0.919, p<0.001). A one-standard deviation increase in safety climate score was similarly associated with a 7.7% decrease in the odds of mortality (OR 0.923, p<0.001). However, when work environment and safety climate were modeled together, the effect of the work environment remained significant, while safety climate became a non-significant predictor of mortality odds (OR 0.940, p=0.035 vs. OR 0.971, p=0.316). CONCLUSIONS We found that safety climate perception is not predictive of patient mortality beyond the effect of the nurse work environment. To advance hospital safety and quality and improve patient outcomes, organizational interventions should be directed toward improving nurse work environments.
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Affiliation(s)
- Danielle M Olds
- University of Kansas Medical Center, School of Nursing, 3901 Rainbow Blvd., Mail Stop 4043, Kansas City, KS 66160 913-588-0426, United States.
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, The Claire M. Fagin Leadership Professor of Nursing, Professor of Sociology, University of Pennsylvania School of Nursing, Philadelphia, PA, United States.
| | - Jeannie P Cimiotti
- Florida Blue Center for Health Care Quality, Associate Professor and Dorothy M. Smith Endowed Chair, University of Florida, Gainesville, FL, United States.
| | - Eileen T Lake
- Center for Health Outcomes and Policy Research, Jessie M. Scott Endowed Term Associate Professor in Nursing and Health Policy, Associate Professor of Sociology, University of Pennsylvania School of Nursing, Philadelphia, PA, United States.
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23
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Zecevic AA, Li AHT, Ngo C, Halligan M, Kothari A. Improving safety culture in hospitals: Facilitators and barriers to implementation of Systemic Falls Investigative Method (SFIM). Int J Qual Health Care 2017; 29:371-377. [PMID: 28340250 DOI: 10.1093/intqhc/mzx034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
Objective The purpose of this study was to assess the facilitators and barriers to implementation of the Systemic Falls Investigative Method (SFIM) on selected hospital units. Design A cross-sectional explanatory mixed methods design was used to converge results from a standardized safety culture survey with themes that emerged from interviews and focus groups. Findings were organized by six elements of the Ottawa Model of Research Use framework. Setting A geriatric rehabilitation unit of an acute care hospital and a neurological unit of a rehabilitation hospital were selected purposefully due to the high frequency of falls. Participants Hospital staff who took part in: surveys (n = 39), interviews (n = 10) and focus groups (n = 12), and 38 people who were interviewed during falls investigations: fallers, family, unit staff and hospital management. Intervention Implementation of the SFIM to investigate fall occurrences. Main Outcome Measure(s) Percent of positive responses on the Modified Stanford Patient Safety Culture Survey Instrument converged with qualitative themes on facilitators and barriers for intervention implementation. Results Both hospital units had an overall poor safety culture which hindered intervention implementation. Facilitators were hospital accreditation, strong emphasis on patient safety, infrastructure and dedicated champions. Barriers included heavy workloads, lack of time, lack of resources and poor communication. Conclusions Successful implementation of SFIM requires regulatory and organizational support, committed frontline staff and allocation of resources to identify active causes and latent contributing factors to falls. System-wide adjustments show promise for promotion of safety culture in hospitals where falls happen regularly.
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Affiliation(s)
| | - Alvin Ho-Ting Li
- Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Charity Ngo
- Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Michelle Halligan
- Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Anita Kothari
- Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
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Rashvand F, Ebadi A, Vaismoradi M, Salsali M, Yekaninejad MS, Griffiths P, Sieloff C. The assessment of safe nursing care: development and psychometric evaluation. J Nurs Manag 2016; 25:22-36. [DOI: 10.1111/jonm.12424] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Farnoosh Rashvand
- Faculty of Nursing & Midwifery; Tehran University of Medical Sciences; Tehran Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center; Nursing Faculty of Baqiyatallah University of Medical Sciences; Tehran Iran
| | | | - Mahvash Salsali
- Faculty of Nursing & Midwifery; Tehran University of Medical Sciences; Tehran Iran
| | | | - Pauline Griffiths
- College of Human and Health Sciences; Swansea University; Swansea UK
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Parker D, Wensing M, Esmail A, Valderas JM. Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract 2016; 21 Suppl:26-30. [PMID: 26339832 PMCID: PMC4828620 DOI: 10.3109/13814788.2015.1043732] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. Objective: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care. Methods: Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care. Results: The two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events. Conclusion: Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care.
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Affiliation(s)
- Dianne Parker
- a University of Manchester and Safety Culture Associates Ltd , Manchester , UK
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Ford EW, Silvera GA, Kazley AS, Diana ML, Huerta TR. Assessing the relationship between patient safety culture and EHR strategy. Int J Health Care Qual Assur 2016; 29:614-27. [DOI: 10.1108/ijhcqa-10-2015-0125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to explore the relationship between hospitals’ electronic health record (EHR) adoption characteristics and their patient safety cultures. The “Meaningful Use” (MU) program is designed to increase hospitals’ adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated.
Design/methodology/approach
– Providers’ perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality’s surveys on patient safety culture (level 1) and the American Hospital Association’s survey and healthcare information technology supplement (level 2).
Findings
– The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers’ perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research.
Originality/value
– Relating EHR MU and providers’ care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.
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27
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Castel ES, Ginsburg LR, Zaheer S, Tamim H. Understanding nurses' and physicians' fear of repercussions for reporting errors: clinician characteristics, organization demographics, or leadership factors? BMC Health Serv Res 2015; 15:326. [PMID: 26272228 PMCID: PMC4542128 DOI: 10.1186/s12913-015-0987-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 08/05/2015] [Indexed: 11/15/2022] Open
Abstract
Background Identifying and understanding factors influencing fear of repercussions for reporting and discussing medical errors in nurses and physicians remains an important area of inquiry. Work is needed to disentangle the role of clinician characteristics from those of the organization-level and unit-level safety environments in which these clinicians work and learn, as well as probing the differing reporting behaviours of nurses and physicians. This study examines the influence of clinician demographics (age, gender, and tenure), organization demographics (teaching status, location of care, and province) and leadership factors (organization and unit leadership support for safety) on fear of repercussions, and does so for nurses and physicians separately. Methods A cross-sectional analysis of 2319 nurse and 386 physician responders from three Canadian provinces to the Modified Stanford patient safety climate survey (MSI-06). Data were analyzed using exploratory factor analysis, multiple linear regression, and hierarchical linear regression. Results Age, gender, tenure, teaching status, and province were not significantly associated with fear of repercussions for nurses or physicians. Mental health nurses had poorer fear responses than their peers outside of these areas, as did community physicians. Strong organization and unit leadership support for safety explained the most variance in fear for both nurses and physicians. Conclusions The absence of associations between several plausible factors including age, tenure and teaching status suggests that fear is a complex construct requiring more study. Substantially differing fear responses across locations of care indicate areas where interventions may be needed. In addition, since factors affecting fear of repercussions appear to be different for nurses and physicians, tailoring patient safety initiatives to each group may, in some instances, be fruitful. Although further investigation is needed to examine these and other factors in detail, supportive safety leadership appears to be central to reducing fear of reporting errors for both nurses and physicians. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0987-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Evan S Castel
- Department of Geography and Planning / Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | | | - Shahram Zaheer
- Health Policy & Management, York University, Toronto, Canada.
| | - Hala Tamim
- School of Kinesiology & Health Science, York University, Toronto, Canada.
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Patient safety climate (PSC) perceptions of frontline staff in acute care hospitals: examining the role of ease of reporting, unit norms of openness, and participative leadership. Health Care Manage Rev 2015; 40:13-23. [PMID: 24378403 DOI: 10.1097/hmr.0000000000000005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increased awareness regarding the importance of patient safety issues has led to the proliferation of theoretical conceptualizations, frameworks, and articles that apply safety experiences from high-reliability industries to medical settings. However, empirical research on patient safety and patient safety climate in medical settings still lags far behind the theoretical literature on these topics. PURPOSE The broader organizational literature suggests that ease of reporting, unit norms of openness, and participative leadership might be important variables for improving patient safety. The aim of this empirical study is to examine in detail how these three variables influence frontline staff perceptions of patient safety climate within health care organizations. METHODOLOGY A cross-sectional study design was used. Data were collected using a questionnaire composed of previously validated scales. FINDINGS The results of the study show that ease of reporting, unit norms of openness, and participative leadership are positively related to staff perceptions of patient safety climate. PRACTICE IMPLICATIONS Health care management needs to involve frontline staff during the development and implementation stages of an error reporting system to ensure staff perceive error reporting to be easy and efficient. Senior and supervisory leaders at health care organizations must be provided with learning opportunities to improve their participative leadership skills so they can better integrate frontline staff ideas and concerns while making safety-related decisions. Finally, health care management must ensure that frontline staff are able to freely communicate safety concerns without fear of being punished or ridiculed by others.
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Hewko SJ, Brown P, Fraser KD, Wong CA, Cummings GG. Factors influencing nurse managers' intent to stay or leave: a quantitative analysis. J Nurs Manag 2014; 23:1058-66. [DOI: 10.1111/jonm.12252] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah J. Hewko
- Faculty of Nursing; University of Alberta; Edmonton AB Canada
| | | | | | - Carol A. Wong
- Arthur Labatt Family School of Nursing; Western University; London ON Canada
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Kobuse H, Morishima T, Tanaka M, Murakami G, Hirose M, Imanaka Y. Visualizing variations in organizational safety culture across an inter-hospital multifaceted workforce. J Eval Clin Pract 2014; 20:273-80. [PMID: 24661540 DOI: 10.1111/jep.12123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2014] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES To develop a reliable and valid questionnaire that can distinguish features of organizational culture for patient safety across subgroups such as hospitals, professions, management/non-management positions and units/wards. METHODS We developed a Hospital Organizational Culture Questionnaire based on a conceptual framework incorporating items from a review of existing literature. The questionnaire was administered to hospital staff including doctors, nurses, allied health personnel, and administrative staff at six public hospitals in Japan. Reliability and validity were assessed through exploratory factor analysis, multitrait scaling analysis, Cronbach's alpha coefficient and multiple regression analysis using staff-perceived achievement of safety as the response variable. Discriminative power across subgroups was assessed with radar chart profiling. RESULTS Of the 3304 hospital staff surveyed, 2924 (88.5%) responded. After exploratory factor analysis and multitrait analysis, the finalized questionnaire was composed of 24 items in the following eight dimensions: improvement orientation, passion for mission, professional growth, resource allocation prioritization, inter-sectional collaboration, responsibility and authority, teamwork, and information sharing. Construct validity and internal consistency of dimensions were confirmed with multitrait analysis and Cronbach's alpha coefficients, respectively. Multiple regression analysis showed that improvement orientation, passion for mission, resource allocation prioritization and information sharing were significantly associated with higher achievement in safety practices. Our questionnaire tool was able to distinguish features of safety culture among different subgroups. CONCLUSIONS Our questionnaire demonstrated excellent validity and reliability, and revealed distinct cultural patterns among different subgroups. Quantitative assessment of organizational safety culture with this tool may further the understanding of associated characteristics of each subgroup and provide insight into organizational readiness for patient safety improvement.
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Affiliation(s)
- Hiroe Kobuse
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ginsburg LR, Tregunno D, Norton PG, Mitchell JI, Howley H. 'Not another safety culture survey': using the Canadian patient safety climate survey (Can-PSCS) to measure provider perceptions of PSC across health settings. BMJ Qual Saf 2013; 23:162-70. [PMID: 24122954 PMCID: PMC3913119 DOI: 10.1136/bmjqs-2013-002220] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The importance of a strong safety culture for enhancing patient safety has been stated for over a decade in healthcare. However, this complex construct continues to face definitional and measurement challenges. Continuing improvements in the measurement of this construct are necessary for enhancing the utility of patient safety climate surveys (PSCS) in research and in practice. This study examines the revised Canadian PSCS (Can-PSCS) for use across a range of care settings. Methods Confirmatory factor analytical approaches are used to extensively test the Can-PSCS. Initial and cross-validation samples include 13 126 and 6324 direct care providers from 119 and 35 health settings across Canada, respectively. Results Results support a parsimonious model of direct care provider perceptions of patient safety climate (PSC) with 19 items in six dimensions: (1) organisational leadership support for safety; (2) incident follow-up; (3) supervisory leadership for safety; (4) unit learning culture; (5) enabling open communication I: judgement-free environment; (6) enabling open communication II: job repercussions of error. Results also support the validity of the Can-PSCS across a range of care settings. Conclusions The Can-PSCS has several advantages: (1) it is a theory-based instrument with a small number of actionable dimensions central to the construct of PSC; (2) it has robust psychometric properties; (3) it is validated for use across a range of care settings, therefore suitable for use in regionalised health delivery systems and can help to raise expectations about acceptable levels of PSC across the system; (4) it has been tested in a publicly funded universal health insurance system and may be suitable for similar international systems.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy and Management, , York University, Toronto, Ontario, Canada
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Cox ED, Carayon P, Hansen KW, Rajamanickam VP, Brown RL, Rathouz PJ, DuBenske LL, Kelly MM, Buel LA. Parent perceptions of children's hospital safety climate. BMJ Qual Saf 2013; 22:664-71. [PMID: 23542553 PMCID: PMC3724532 DOI: 10.1136/bmjqs-2012-001727] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Because patients are at the frontline of care where safety climate is closely tied to safety events, understanding patient perceptions of safety climate is crucial. We sought to develop and evaluate a parent-reported version of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture and to relate parent-reported responses to parental need to watch over their child's care to ensure mistakes are not made. METHODS Parents (n=172) were surveyed about perceptions of hospital safety climate (14 items representing four domains-overall perceptions of safety, openness of staff and parent communication, and handoffs and transitions) and perceived need to watch over their child's care. Confirmatory factor analysis (CFA) was used to validate safety climate domain measures. Logistic regression was used to relate need to watch over care to safety climate domains. RESULTS CFA indices suggested good model fit for safety climate domains. Thirty-nine per cent of parents agreed or strongly agreed they needed to watch over care. In adjusted models, need to watch over care was significantly related to overall perceptions of safety (OR 0.20, 95% CI 0.11 to 0.37) and to handoffs and transitions (0.25, 0.14 to 0.46), but not to openness of staff (0.67, 0.40 to 1.12) or parent (0.83, 0.48 to 1.45) communication. CONCLUSIONS Findings suggest parents can provide valuable data on specific safety climate domains. Opportunities exist to improve our safety climate's impact on parent burden to watch over their child's care, such as targeting overall perceptions of safety as well as handoffs and transitions.
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Affiliation(s)
- Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
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Bahari SF, Clarke S. Cross-validation of an employee safety climate model in Malaysia. JOURNAL OF SAFETY RESEARCH 2013; 45:1-6. [PMID: 23708470 DOI: 10.1016/j.jsr.2012.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 11/26/2012] [Accepted: 12/20/2012] [Indexed: 06/02/2023]
Abstract
PROBLEM Whilst substantial research has investigated the nature of safety climate, and its importance as a leading indicator of organisational safety, much of this research has been conducted with Western industrial samples. The current study focuses on the cross-validation of a safety climate model in the non-Western industrial context of Malaysian manufacturing. METHOD The first-order factorial validity of Cheyne et al.'s (1998) [Cheyne, A., Cox, S., Oliver, A., Tomas, J.M., 1998. Modelling safety climate in the prediction of levels of safety activity. Work and Stress, 12(3), 255-271] model was tested, using confirmatory factor analysis, in a Malaysian sample. RESULTS Results showed that the model fit indices were below accepted levels, indicating that the original Cheyne et al. (1998) safety climate model was not supported. An alternative three-factor model was developed using exploratory factor analysis. DISCUSSION Although these findings are not consistent with previously reported cross-validation studies, we argue that previous studies have focused on validation across Western samples, and that the current study demonstrates the need to take account of cultural factors in the development of safety climate models intended for use in non-Western contexts. IMPACT ON INDUSTRY The results have important implications for the transferability of existing safety climate models across cultures (for example, in global organisations) and highlight the need for future research to examine cross-cultural issues in relation to safety climate.
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Affiliation(s)
- Siti Fatimah Bahari
- Faculty of Management and Human Resource Development, Universiti Teknologi Malaysia, Johor Bahru Campus, 81310 Skudai, Johor Malaysia.
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Nygren M, Roback K, Öhrn A, Rutberg H, Rahmqvist M, Nilsen P. Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils. BMC Health Serv Res 2013; 13:52. [PMID: 23391301 PMCID: PMC3579677 DOI: 10.1186/1472-6963-13-52] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 01/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND National, regional and local activities to improve patient safety in Sweden have increased over the last decade. There are high ambitions for improved patient safety in Sweden. This study surveyed health care professionals who held key positions in their county council's patient safety work to investigate their perceptions of the conditions for this work, factors they believe have been most important in reaching the current level of patient safety and factors they believe would be most important for achieving improved patient safety in the future. METHODS The study population consisted of 218 health care professionals holding strategic positions in patient safety work in Swedish county councils. Using a questionnaire, the following topics were analysed in this study: profession/occupation; number of years involved in a designated task on patient safety issues; knowledge/overview of the county council's patient safety work; ability to influence this work; conditions for this work; and the importance of various factors for current and future levels of patient safety. RESULTS The response rate to the questionnaire was 79%. The conditions that had the highest number of responses in complete agreement were "patients' involvement is important for patient safety" and "patient safety work has good support from the county council's management". Factors that were considered most important for achieving the current level of patient safety were root cause and risk analyses, incident reporting and the Swedish Patient Safety Law. An organizational culture that encourages reporting and avoids blame was considered most important for improved patient safety in the future, closely followed by improved communication between health care practitioners and patients. CONCLUSION Health care professionals with important positions in the Swedish county councils' patient safety work believe that conditions for this work are somewhat constrained. They attribute the current levels of patient safety to a broad range of factors and believe that many different solutions can contribute to enhanced patient safety in the future, suggesting that this work must be multifactorial.
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Affiliation(s)
- Mikaela Nygren
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linkoping University, 581 83 Linköping, Sweden.
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Fassier T, Favre H, Piriou V. [How to assess the impact of morbimortality conferences on healthcare quality and safety in ICU ?]. ACTA ACUST UNITED AC 2012; 31:609-16. [PMID: 22766465 DOI: 10.1016/j.annfar.2012.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 04/19/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate the morbidity and mortality conferences (MMC) impact in intensive care unit (ICU) setting on quality of care and patients' safety. DATA SOURCES A review of English and French articles in Medline database (1990-2011) related to MMC in the ICU. Keywords used: "morbidity (and) mortality conference(s)", "intensive care unit", "intensive/critical care medicine". Additional studies identified by hand search in French national guidelines about MMCs and in the Annales Françaises d'Anesthésie Réanimation and Réanimation journals index. Identification and preliminary analysis performed using title and abstract, for every study related to MMC in the ICU. STUDY SELECTION Only original studies about MMC in the ICU setting that reported an assessment were included. Papers reporting guidelines and methods for MMC implementation were excluded. DATA EXTRACTION Extraction used predefined data fields, including study design, MMC characteristics, assessment methods and results. DATA SYNTHESIS Studies about MMC in the ICU are recent and scarce. Results comparison and synthesis are impaired by discrepancies in study designs. Although the effectiveness of MMC is not evidence-based, data are consistent for their positive impact on quality of care and patient safety in the ICU. CONCLUSION Further studies are required to assess the impact of MMC in the ICU. Based on this literature review, a 4-level evaluation scheme can be suggested: 1) evaluation of MMC implementation in care units and facilities; 2) evaluation of MMC organization; 3) evaluation of MMC on quality of care; 4) evaluation of MMC impact on patients' mortality and morbidity.
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Affiliation(s)
- T Fassier
- EAM, « Santé, Individus, Société », faculté de médecine Laënnec, université de Lyon, France
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PERNG SHOAJEN, YU MANLING. Psychometric testing of an instrument measuring nurse aides’ patient safety attitudes. J Nurs Manag 2012; 21:1001-7. [DOI: 10.1111/j.1365-2834.2012.01431.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mitchell JI, Nicklin W, MacDonald B. The determinants of quality healthcare: implications for Canadian health leaders. Healthc Manage Forum 2012; 25:138-141. [PMID: 23252328 DOI: 10.1016/j.hcmf.2012.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Accreditation Canada program supports organizations in delivering quality healthcare using a quality framework that recognizes the complex interplay of multiple factors that define quality. This article highlights the Accreditation Canada quality framework and how these dimensions of quality together promote quality care. Using three dimensions of quality--population focus, safety, and worklife--we discuss how these quality dimensions can be utilized by healthcare leaders to improve quality in their organizations.
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Abstract
PURPOSE This study was conducted to investigate the clear concept of patient safety and obtain theoretical evidences. METHODS Research was conducted using Walker & Avant's conceptual analysis process. RESULTS Patient safety was defined as an activity that minimizes and removes possible errors and injuries to patients. It includes a basic desire to secure the patient's right to safety, and the legal regulations and duties of medical teams. The results of the establishment of a safety culture are patient-centered medical treatment and caring. Antecedents were found to be open and clear communications, continuous education and training for health care personnel, sufficient allocation of qualified personnel, cooperation among departments, improvements in the recognition of patient safety. Consequences were found to be the provision of high quality medical care and treatment, and increase in patient satisfaction. CONCLUSION Patient safety as defined by the results of this study will contribute to the foundation of institutionalization of the pursuit of patient safety and creation of a hospital culture focusing on patient safety as a first priority.
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Affiliation(s)
- Mi Ran Kim
- Department of Nursing, Konyang University, Daejeon, Korea.
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Korst LM, Aydin CE, Signer JMK, Fink A. Hospital readiness for health information exchange: development of metrics associated with successful collaboration for quality improvement. Int J Med Inform 2011; 80:e178-88. [PMID: 21330191 DOI: 10.1016/j.ijmedinf.2011.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 10/26/2010] [Accepted: 01/09/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The development of readiness metrics for organizational participation in health information exchange is critical for monitoring progress toward, and achievement of, successful inter-organizational collaboration. In preparation for the development of a tool to measure readiness for data-sharing, we tested whether organizational capacities known to be related to readiness were associated with successful participation in an American data-sharing collaborative for quality improvement. DESIGN Cross-sectional design, using an on-line survey of hospitals in a large, mature data-sharing collaborative organized for benchmarking and improvement in nursing care quality. MEASUREMENTS Factor analysis was used to identify salient constructs, and identified factors were analyzed with respect to "successful" participation. "Success" was defined as the incorporation of comparative performance data into the hospital dashboard. RESULTS The most important factor in predicting success included survey items measuring the strength of organizational leadership in fostering a culture of quality improvement (QI Leadership): (1) presence of a supportive hospital executive; (2) the extent to which a hospital values data; (3) the presence of leaders' vision for how the collaborative advances the hospital's strategic goals; (4) hospital use of the collaborative data to track quality outcomes; and (5) staff recognition of a strong mandate for collaborative participation (α=0.84, correlation with Success 0.68 [P<0.0001]). CONCLUSION The data emphasize the importance of hospital QI Leadership in collaboratives that aim to share data for QI or safety purposes. Such metrics should prove useful in the planning and development of this complex form of inter-organizational collaboration.
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Affiliation(s)
- Lisa M Korst
- University of Southern California, Department of Obstetrics & Gynecology, Keck School of Medicine, Los Angeles, CA 90033, United States.
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Ginsburg LR, Chuang YT, Berta WB, Norton PG, Ng P, Tregunno D, Richardson J. The relationship between organizational leadership for safety and learning from patient safety events. Health Serv Res 2010; 45:607-32. [PMID: 20337737 PMCID: PMC2875751 DOI: 10.1111/j.1475-6773.2010.01102.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the relationship between organizational leadership for patient safety and five types of learning from patient safety events (PSEs). STUDY SETTING Forty-nine general acute care hospitals in Ontario, Canada. STUDY DESIGN A nonexperimental design using cross-sectional surveys of hospital patient safety officers (PSOs) and patient care managers (PCMs). PSOs provided data on organization-level learning from (a) minor events, (b) moderate events, (c) major near misses, (d) major event analysis, and (e) major event dissemination/communication. PCMs provided data on organizational leadership (formal and informal) for patient safety. EXTRACTION METHODS Hospitals were the unit of analysis. Seemingly unrelated regression was used to examine the influence of formal and informal leadership for safety on the five types of learning from PSEs. The interaction between leadership and hospital size was also examined. PRINCIPAL FINDINGS Formal organizational leadership for patient safety is an important predictor of learning from minor, moderate, and major near-miss events, and major event dissemination. This relationship is significantly stronger for small hospitals (<100 beds). CONCLUSIONS We find support for the relationship between patient safety leadership and patient safety behaviors such as learning from safety events. Formal leadership support for safety is of particular importance in small organizations where the economic burden of safety programs is disproportionately large and formal leadership is closer to the front lines.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, HNES Bldg., 413, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
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Umfrage zur Einschätzung von kritischen Ereignissen im Rettungswesen. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ginsburg LR, Chuang YT, Norton PG, Berta W, Tregunno D, Ng P, Richardson J. Development of a measure of patient safety event learning responses. Health Serv Res 2009; 44:2123-47. [PMID: 19732166 DOI: 10.1111/j.1475-6773.2009.01021.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To define patient safety event (PSE) learning response and to provide preliminary validation of a measure of PSE learning response. DATA SOURCES Ten focus groups with front-line staff and managers, an expert panel, and cross-sectional survey data from patient safety officers in 54 general acute hospitals. STUDY DESIGN A mixed methods study to define a measure of learning responses to patient safety failures that is rooted in theory, expert knowledge, and organizational practice realities. EXTRACTION METHODS Learning response items developed from the literature were modified and validated in front-line staff and manager focus groups and by an expert panel and second group of external experts. Actual learning responses gleaned from survey data were examined using exploratory factor analyses and reliability analysis. PRINCIPAL FINDINGS Unique learning response items were identified for minor, moderate, major events, and major near misses by an expert panel. A two-factor model of major event learning response was identified (factor 1=event analysis, factor 2=dissemination/communication of learnings). Organizations engage in greater learning responses following major events than less severe events and, for major events, organizations engage in more factor 1 responses than factor 2 learning responses. CONCLUSIONS Eleven to 13 items can measure learning responses to PSEs of differing severity. The items are feasible, grounded in theory, and reflect expert opinion as well as practice setting realities. The items have the potential for use to assess current practice in organizations and set future improvement goals.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, 4700 Keele Street, Toronto, Ontario
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Correction to “Advancing Measurement of Patient Safety Culture”. Health Serv Res 2009. [DOI: 10.1111/j.1475-6773.2008.00945.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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