Safety culture in the perception of public-hospital health professionals

Patient safety culture through the perspectives of healthcare workers: a longitudinal study in a private healthcare network in Brazil

BACKGROUND

Enhancing security and dependability of health systems necessitates resource allocation, a well-defined infrastructure and a steadfast commitment to ensuring its safety and stability over time.

OBJECTIVE

The aim of this study was to evaluate the temporal trend of patient safety culture according to the perception of professionals working in a private healthcare network in Brazil over a 7-year period (2015-2022).

METHODS

The Hospital Survey on Patient Safety Culture questionnaire was distributed to 34 hospitals between 2015 and 2022 with 160 607 responders. A linear mixed-effects regression model was applied to fit the trend for the dimension score over time.

RESULTS

Out of the 12 measured dimensions in the HSOPSC Survey, 8 showed significant improvement over a 7-year period (p<0.05). The dimensions of communication openness (p=0.22), non-punitive response to errors (p=0.08), staffing (p=0.06) and the frequency of reported events (p=0.22) have not demonstrated improvement over time. Management support for patient safety and organisational learning received positive responses from at least 75% of those surveyed in 2022, earning the distinction as 'strong areas of patient safety'. Comparing 2015 and 2022, the proportion of participants who rated their unit/work area on patient safety as 'fair' or 'good' decreased, while the proportion of participants who considered it 'very good' increased (p<0.001).

CONCLUSIONS

Findings indicate an improvement in patient safety culture from 2015 to 2022. Key challenges identified in enhancing safety culture included communication openness, staffing, frequency of reported events, and nonpunitive response to errors.

Application of Multidimensional Quality Management Tools in the Management of Medical Adverse Events

Purpose

This study aims to investigate the impact of multidimensional quality management tools in establishing a medical adverse event management system, with the aim of continuously improving medical quality and safety while ensuring patient well-being.

Methods

This study introduces risk management theories, such as the "Gray Rhino Theory", and employs quality management tools like the Plan-Do-Check-Act (PDCA) cycle, Quality Control Circle (QCC), and Root Cause Analysis (RCA), to provide relevant quality management education and training to employees. This approach facilitates the establishment of a medical adverse event management system that encourages reporting and fosters a blame-free reporting culture, while simultaneously implementing quality management across the entire process. The regular utilization of the QCC facilitates ongoing quality improvement. Furthermore, for sentinel events and patient harm incidents with educational values, the study employs the Incident Decision Tree (IDT) to determine appropriate actions. Additionally, the hospital initiates RCA for system-wide improvements, focusing on areas such as management, institutional processes, and environmental aspects. Moreover, an internal medical quality improvement case competition is organized, with outstanding cases being selected to participate in the multidimensional quality management competition organized by the National Quality Management Alliance.

Results

The study reveals a significant improvement in employees' awareness of adverse events, the percentage of employees reporting adverse events increased significantly from 39.15% in 2019 to 49.77% in 2022, P=0.002. Furthermore, the adverse event reporting rate has risen significantly from 2.78% (2019) to 5.96% (2022), P=0.002. Additionally, each department has been able to utilize QCC or RCA tools for quality improvement, thereby further reinforcing the development of a patient safety culture.

Conclusion

Multidimensional quality management tools play a crucial role in establishing a hospital's adverse event management system, promoting continuous improvement in medical quality, ensuring patient safety, and effectively implementing a culture of patient safety.