Patient safety initiatives in Central and Eastern Europe: A mixed methods approach by the LINNEAUS collaboration on patient safety in primary care

Assessing safety culture and second victim experience following adverse events among Romanian nurses: a cross-sectional study

BACKGROUND

Healthcare adverse events (AEs) significantly impact professionals, often leading to emotional distress and lasting effects. This study investigates the impact of AEs on healthcare professionals in Romania, focusing on nurses to examine their experiences within the patient safety culture and the psychological consequences of AEs. With a limited body of research on patient safety, adverse events, and second victims (SVs) in Romania, this study addresses a crucial gap, highlighting the need for enhanced safety culture and support mechanisms for SVs.

METHODS

A cross-sectional study in Romania targeted healthcare professionals, focusing on nurses. Utilizing online and onsite surveys facilitated by the Order of Nurses, Midwives, and Medical Assistants in Romania, data were collected between April and June 2022, exploring AEs and related experiences. Statistical analysis included chi-square tests, Student's t-tests, one-way ANOVA, and logistic regression, using SPSS version 29.0.

RESULTS

This study surveyed 995 nurses in Romania, primarily aged 31-50 (67.8%). Over half (57.9%) reported near-miss incidents, and 30.8% were aware of serious adverse events. Nurses over 50 scored higher on safety culture (20.98 vs. 20.45, p = .024) than younger nurses. Higher safety culture scores were associated with reduced negative emotional responses (e.g., guilt, anxiety, insomnia, tiredness) following AEs. Higher safety culture scores were associated with reduced negative emotional responses. Additionally, 88.9% of nurses showed interest in training for coping with adverse events, highlighting the need for supportive interventions in healthcare settings.

DISCUSSION

This study underscores the significant emotional and professional impact of AEs on nurses in Romania, highlighting ongoing challenges in healthcare environments. The positive perception of safety culture among nurses suggests a basis for improvement, while training needs underscore areas for intervention. Tackling the second victim phenomenon is crucial for maintaining patient safety.

Patient Safety Climate in Danish Primary Care: Adaption and Validation of the Danish Safety Attitudes Questionnaire (SAQ-DK-PRIM)

Background

A lack of instruments to assess patient safety climate within primary care exists. The objectives of this study were as follows: 1) To adapt the Danish hospital version of the Safety Attitudes Questionnaire (SAQ-DK) for use in primary care; 2) Test the internal consistency and the construct validity of this version; 3) Present benchmark data; and 4) Analyze variance.

Methods

The SAQ-DK was adapted for use in Danish primary care settings (SAQ-DK-PRIM) and distributed to healthcare staff members from nursing homes (N = 11), homecare units (N = 4) and healthcare units (N = 2), within the municipality of Aarhus, Central Denmark Region, Denmark. Face- and content validity were assessed. The construct validity was evaluated by a set of goodness-of-fit indices. The internal reliability was evaluated using the item-rest correlations, the inter-item correlations, and Cronbach's alpha (α).

Results

The adaptation process resulted in a questionnaire of 10 items. Eight hundred and thirty healthcare staffs participated (78% of the eligible respondents). In total 586 (70.6%) responses were complete and were included in the analysis. Goodness-of-fit indices from the confirmatory factor analysis showed: Chi2=46.90CFI=0.97, RMSEA = 0.063 (90% CI: 0.044-0.084), Probability RMSEA (p close)=0.12. Internal reliability was high (Cronbach's α=0.76). Proportions of participants with a positive attitude was 41.1% and did not differ between the healthcare services. Scale mean score was 70.19 (SD: 18.05) and differed between healthcare services. The safety climate scale scores did not vary according to healthcare service type. ICC was 0.68% indicating no clustering of scores by healthcare service type.

Conclusion

Considering the questionnaire's applicability, short length, strengthened focus on one area of interest and validity, the SAQ-DK-PRIM can serve as a valuable tool for measuring patient safety climate within primary care settings in Denmark.

Structural equation modeling for identification of patient safety antecedents in primary care

Background

Patient safety is defined as an activity that minimizes and removes possible errors and injuries to patients. A number of factors have been found to influence patient safety management, including the facilities available in the practice, communication and collaboration, education regarding patient safety and generic conditions. This study tested a theoretical model of patient safety interventions based on safety antecedents.

Methods

Medical professionals were surveyed using a questionnaire developed by Gaal et al. The results were analyzed with SPSS 20 and AMOS. A hypothetical model of direct and indirect effects on patient safety in a primary care environment was created and analyzed using structural equation modeling (SEM).

Results

SEM proved to be an effective tool to analyse safety in primary care. The facilities in the practice appear to have no significant influence on patient safety management in the case of female respondents, those below mean age, those who are not GPs (general practitioner) and respondents not working in counselling centres.

Conclusions

The integrated safety model described in the study can improve patient safety management.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01533-6.

The Perception of Patient Safety Strategies by Primary Health Professionals

Almost all European citizens rank patient safety as very or fairly important in their country. However, few patient safety initiatives have been undertaken or implemented in Poland. The aim was to identify patient safety strategies perceived as important in Poland and compare them with those identified in an earlier Dutch study. A web-based survey was conducted among primary healthcare providers in Poland. The findings were compared with those obtained from eight other countries. The strategies regarded as most important in Poland included the use of integrated medical records for communication with specialists and others, patient-held medical records, acceptable workload in general practice, and availability of information technology. However, despite being seen as important, these strategies have not been widely implemented in Poland. This is the first study to identify strategies considered by primary care physicians in Poland to be important for improving patient safety. These strategies differed significantly from those indicated in other countries.

Survey on patient safety culture in the Republic of Moldova: a baseline study in three healthcare settings

BACKGROUND AND AIMS

The Republic of Moldova is a small ex-soviet country in the Central Eastern European group of states, whose official language is Romanian. In countries with limited resources, quality improvement in healthcare and patient safety are very challenging. This study aims to identify which areas of the patient safety culture (PSC) need prompt intervention.

METHODS

A cross-sectional study was conducted in three Moldovan healthcare settings, using the Romanian translation of the US Hospital Survey on Patient Safety Culture HSOPSC. Descriptive statistics were carried out, based on the responses from n. 929 staff. Percentages of positive responses (PPRs) by item (41 items) and composite (12 PSC areas) were computed.

RESULTS

Most respondents were nurses (53%), followed by doctors (35%). The main work areas were: primary care (27%), medical specialties (20%), gynecology and obstetrics (16%), and general surgery (11%). The highest composite PPRs were for: teamwork within units (80%), feedback & communication about error, organizational learning-continuous improvement and supervisor/manager expectations & actions promoting patient safety (78%), and management support for patient safety (75%). The lowest composites were for: frequency of events reported (57%), non-punitive response to errors (53%), communication openness (51%) and staffing (37%).

CONCLUSION

Our results suggest that staffing issues should be tackled to provide safe care. Staff avoid to openly report adverse events and/or discuss errors, likely because a poor understanding of the potential of these events for learning and because of fear of blame or punitive actions. Future research should check psychometrics of the Romanian version of the HSOPSC applied to Moldovan staff.

Variations in patient safety climate and perceived quality of collaboration between professions in out-of-hours care

Purpose

To get an overview of health care workers perceptions of patient safety climates and the quality of collaboration in Slovenian out-of-hours health care (OOHC) between professional groups.

Materials and methods

This was a cross-sectional study carried out in all (60) Slovenian OOHC clinics; 37 (61.7%) agreed to participate with 438 employees. The questionnaire consisted of the Slovenian version of the Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV).

Results

The study sample consisted of 175 (70.0%) physicians, nurse practitioners, and practice nurses. Practice nurses reported the highest patient safety climate scores in all dimensions. Total mean (standard deviation) SAQ-AV score was 60.9±15.2. Scores for quality of collaboration between different professional groups were high. The highest mean scores were reported by nurse practitioners on collaboration with practice nurses (4.4±0.6). The lowest mean scores were reported by practice nurses on collaboration with nurse practitioners (3.8±0.9).

Conclusion

Due to large variations in Slovenian OOHC clinics with regard to how health care workers from different professional backgrounds perceive safety culture, more attention should be devoted to improving the team collaboration in OOHC. A clearer description of professional team roles should be provided.

Measuring Patient Safety Culture in Romania Using the Hospital Survey on Patient Safety Culture (HSOPSC)

Purpose To explore patient safety culture among Romanian staff, using the U.S. Hospital Survey on Patient Safety Culture (HSOPSC).

MATERIAL AND METHODS

A cross-sectional study was carried out in six hospitals, located in four Romanian regions (Craiova, Cluj-Napoca, Bucharest and Brasov), based on staff census in the Units/hospitals which volunteered to participate in the study (N=1,184). The response rate was 84%. The original questionnaire designed by the American Agency for Healthcare Research and Quality was translated into Romanian (with back translation), pre-tested before application and psychometrically checked. It consists of 42 questions grouped in 12categories, covering multiple aspects of patient safety culture (dimensions). Percentages of positive responses (PPRs) by question and category were analyzed overall and by staff profession.

RESULTS

Most respondents were nurses (69%). The main work areas were surgery (24%) and medicine (22%). The highest PPRs were for Supervisor/Manager Expectations & Actions Promoting Safety (88%), Teamwork Within Units (86%), Handoffs and Transitions (84%), Organizational Learning-Continuous Improvement (81%), Overall Perceptions of Safety (80%), Feedback & Communication About Error (75%). The lowest PPRs were for: Staffing (39%), Frequency of Events Reported (59%) and Non-punitive Response to Errors (61%). Nurses exhibited significantly higher PPRs than doctors.

CONCLUSIONS

This small-scale study of staff's attitude towards patient safety in Romanian hospitals suggests that there is room for future improvement, especially within the doctor category. Further research should assess the relationship between patient safety culture and frequency of adverse events.

Developing a research agenda for patient safety in primary care. Background, aims and output of the LINNEAUS collaboration on patient safety in primary care

This paper is an introduction to a supplement to The European Journal of General Practice, bringing together a body of research focusing on the issue of patient safety in relation to primary care. The supplement represents the outputs of the LINNEAUS collaboration on patient safety in primary care, which was a four-year (2009-2013) coordination and support action funded under the Framework 7 programme by the European Union. Being a coordination and support action, its aim was not to undertake new research, but to build capacity through engaging primary care researchers and practitioners in identifying some of the key challenges in this area and developing consensus statements, which will be an essential part in developing a future research agenda. This introductory article describes the aims of the LINNEAUS collaboration, provides a brief summary of the reasons to focus on patient safety in primary care, the epidemiological and policy considerations, and an introduction to the papers included in the supplement.

A safety incident reporting system for primary care. A systematic literature review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care

Background: Incident reporting is widely used in both patient safety improvement programmes, and in research on patient safety.

Objective: To identify the key requirements for incident reporting systems in primary care; to develop an Internet-based incident reporting and learning system for primary care.

Methods: A literature review looking at the purpose, design and requirements of an incident reporting system (IRS) was used to update an existing incident reporting system, widely used in Germany. Then, an international expert panel with knowledge on IRS developed the criteria for the design of a new web-based incident reporting system for European primary care. A small demonstration project was used to create a web-based reporting system, to be made freely available for practitioners and researchers. The expert group compiled recommendations regarding the desirable features of an incident reporting system for European primary care. These features covered the purpose of reporting, who should be involved in reporting, the mode of reporting, design considerations, feedback mechanisms and preconditions necessary for the implementation of an IRS.

Results: A freely available web-based reporting form was developed, based on these criteria. It can be modified for local contexts. Practitioners and researchers can use this system as a means of recording patient safety incidents in their locality and use it as a basis for learning from errors.

Conclusion: The LINNEAUS collaboration has provided a freely available incident reporting system that can be modified for a local context and used throughout Europe.

First experiences with patient safety initiatives in Greek rural primary care. Action research by the LINNEAUS collaboration on patient safety in primary care

BACKGROUND

Accreditation of primary care organizations within Greece is still in its infancy. Our task in Greece was to attempt to introduce a patient safety initiative in a local area, focusing on developing minimum standards for accreditation, assess whether a pragmatic approach would engage physicians, and provide evidence of improvement.

OBJECTIVE

To use monitoring of clinical performance as the basis for the launch of an accreditation system for primary care in Greece and to report on the process and lessons learnt.

METHODS

An established set of clinical indicators for patient safety was introduced in five Greek primary health centres. A web-based platform, for reporting practitioners' scores on the selected indicators, was used to record the activity of the practitioners.

RESULTS

There was considerable variation in the use of clinical indicators by individual GPs. Following the intervention, the reporting on the indicators had increased while the scores on indicators only increased slightly. However, GPs engaged with the process and recognized its relevance to improving patient safety.

CONCLUSION

We successfully piloted a means of engaging with GPs to improve patient safety using established indicators even where there was limited infrastructure to support such initiatives.