Patient safety culture assessment in oman

Estimation of patient safety culture in private and public hospitals using machine learning methods

BackgroundPatient safety is a critical component of health care systems. Large groups of patients, as a result of medical errors, are at risk of harm. OBJECTIVE: This study evaluated the patient safety culture (PSC) between different work groups in both public and private hospitals, using machine learning approaches.MethodsThe HSOPSC questionnaire was used for evaluating safety culture, and the artificial neural network (ANN), random forest (RF) and linear regression (LR) algorithms were used for data modeling. Orange Data Mining version 3 and SPSS software were used for analysis.ResultsThe overall PSC score in public and private hospitals was 41.99 and 40.96, respectively. According to the results, the examined hospitals have a weak PSC. The safety culture level was correlated with education level, work experience, gender, income, and organizational position of the workers. The ANN showed that the issues mostly effecting PSC, in order of priority, include the feedback and communication about errors, organizational learning and continuous improvement, and management support for patient safety. Also, based on the findings LR model showed better performance for PSC prediction than RF model.ConclusionsThe healthcare experts and policymakers can improve PSC in hospitals through training and allocation of resources. Considering the importance of PSC in preventing accidents and reducing injuries, the results of the present study and the presented models can be used to predict PSC in hospitals.

Assessment of Patient Safety Culture Among Healthcare Professionals in Oman: A Cross-Sectional Study

Background: Patient safety (PS) is a worldwide concern affecting countries at all health system stages. Three million people die each year worldwide due to medical errors and unsafe care. Medical malpractice cases have increased in the Sultanate of Oman, although the reasons for this increase are poorly understood, and there are not many studies on PS. Aim: This study is aimed at assessing PS culture among healthcare professionals in Oman's healthcare facilities. Methods: This cross-sectional study used a national PS culture database maintained by the Directorate General of Quality Assurance at the Ministry of Health. The data was collected using a validated hospital survey on PS culture tool with Cronbach's alpha of 0.87 in the English version which was distributed online to 1599 full-time healthcare professionals in Oman; the response rate was 99%. A stratified random sampling technique was used. The study examined the relationship between items using t-tests, chi-squared tests, regression, and odds ratio. Results: Out of the 1599 healthcare professionals who participated in the study, 16 were excluded and only 1583 healthcare professionals were included; the majority 842 (53.2%) were working in nonprimary healthcare (non-PHC). The global average proportion of reported adverse events' positive response rates (PRRs) was significantly higher in the PHC group compared to the non-PHC group (50.0% vs. 47.6%) (p < 0.04). Staffing (OR 1.55; 95% CI [1.24-1.93]), teamwork across units (OR 1.37; 95% CI [1.07-1.75]), and organizational learning (OR 1.26; 95% CI [1.02-1.57]) were significantly higher than other domains. The female group showed significantly higher PRR in "staffing" (OR 1.27; 95% CI [1.00-1.62]) (p < 0.05). Similarly, older age demonstrated higher PRR in "nonpunitive response to errors" (OR 1.28; 95% CI [1.05-1.57]) (p < 0.02), the nursing profession exhibited higher PRR in "communication openness" (OR 1.57; 95% CI [1.24-1.98]) (p < 0.001), and advanced work experience was significantly higher in "management support" (OR 1.30; 95% CI [1.07-1.60]) (p < 0.01). Conclusion: The study reports that primary healthcare professionals in Omani healthcare institutions have higher PRRs in critical PSC domains like teamwork, supervisor expectations, organizational learning, and staffing compared to non-PHC professionals. They also scored highest in communication openness and management support. The study suggests interventions focusing on staffing adequacy, teamwork, and communication strategies can enhance PS culture among healthcare professionals.

Assessing Patient Safety Culture and Adverse Events Reporting Among Nurses: A Cross-Sectional Study in Ghana

Introduction

Patient safety is a global concern for both health professionals and the public. Research indicates that assessing patient safety culture can help improve patient safety outcomes. Nursing care strategically positions nurses at the center of patient safety promotion, and their proximity to patients makes them the drivers of patient safety. The actions of frontline staff in healthcare organizations have a notable influence on healthcare outcomes, particularly reporting of adverse events. This study aimed to evaluate the actions of frontline staff on adverse event reporting among nurses in three hospitals in the Savannah Region, Ghana.

Methods

A quantitative cross-sectional method was used to gather data from 210 respondents across three hospitals. Data were analyzed with descriptive statistics, Pearson correlation, and hierarchical linear regression.

Results

The findings revealed that teamwork within units had a good positive rating score of 82.9%. This was followed by teamwork across hospital units (68.0%) and handover of care (69.8%). Overall, nurses demonstrated a negative attitude toward adverse events reporting (37.3%). Furthermore, enacting safety practices that had a significant relationship with adverse events reporting were teamwork across units (r = .24, p < 0.001) and handover and transition of patient care (r = .19, p < 0.001). Again, the significant predictor of adverse events reporting was teamwork across units (β = .20, p < 0.001).

Conclusion

Nurses' perceptions of patient safety culture within and across hospital units as well as handover of patient care were positive. Though the attitude of nurses toward adverse event reporting was low, teamwork across hospital units significantly predicted adverse event reporting. Therefore, frontline staff should continually strengthen teamwork processes and handover practices to achieve the best healthcare outcomes.

Evaluating the Impact of Hospital Accreditation on Patient Safety Culture in Saudi Arabia Healthcare Facilities

Background

The impact of hospital accreditation on the organizational safety culture among healthcare workers, an essential indicator of patient safety, has yet to be directly quantified in Saudi Arabia's healthcare system. This study aims to investigate this impact to sustain and maintain a positive safety culture in Saudi Arabia's healthcare institutions.

Methods

A cross-sectional assessment was conducted in five public hospitals in Makkah. Three hundred forty healthcare workers participated using a self-administered questionnaire. Data were analyzed using descriptive statistics, ANOVA, one-sample t-test, and multiple regression for a comprehensive understanding.

Results and Discussion

Regression analysis revealed significant gender differences in patient safety ratings (B = 0.480, p < 0.001). Age positively influenced scores, with higher ages resulting in higher scores (B = 0.127, p = 0.041). The ratings were also associated with respondents' nationality (B = 0.169, p < 0.001) and education levels (B = -0.186, p < 0.001). Respondents rated disasters and training as the highest in patient safety culture, followed by facility safety and security, hazards and hazardous materials safety, utility and building safety, fire safety, and quality improvement. At the same time, leadership, commitment, and support received the lowest score.

Conclusion

This study illustrates a strong connection between accreditation and improved patient safety, emphasizing the importance of quality improvement and leadership commitment. These insights can guide policymakers and healthcare executives in Saudi Arabia and similar countries toward developing a robust patient safety culture. It stresses the importance of considering human factors and organizational culture when developing patient safety models.

What Do We Know About Patient Safety Culture in Saudi Arabia? A Descriptive Study

BACKGROUND

Patient safety is described as the prevention and mitigation of medical errors that can result in harm while a patient is receiving care. One important way to improve safety is through improving the patient safety culture in healthcare. The purposes of this study are to evaluate the patient safety culture trend in Saudi Arabia and assess the improvement over time.

METHODS

This study is a descriptive study that used a retrospective analysis of a national data set for 3 cycles from 2019 to 2022. To generate a baseline and allow comparison of the hospital's survey results with the aggregated findings from the database, the 10th, 25th, 50th, 75th, and 90th percentiles were calculated to set the percentage of values.

RESULT

Our results found that one of the barriers to developing a strong patient safety culture in Saudi Arabia is management support of patient safety, which caused a blame culture. This could explain the absence of improvement in the average percentage of reporting patient safety events for all 3 cycles. On the other hand, a decrease was observed in organizational learning/continuous improvement as well as a reduction in the positive percentage of patient safety ratings in the last cycle. Moreover, areas of strength in all 3 cycles did not reach the 75th percentile, whereas staffing and response to error domains remained the lowest-scoring composites in all cycles.

CONCLUSION

Our results have determined the percentile of the positive rate that could guide hospitals to improve their culture survey results. More investigations can focus on change over the years in both patient safety culture and the effectiveness of implementing interventions to measure the impact on quality of care.

Medical malpractice in Oman: A 12-year retrospective record review

BACKGROUND

There is a paucity of studies documenting medical malpractice litigation in countries of the Arabian Gulf, such as Oman.

OBJECTIVES

To describe the characteristics of malpractice claims, the outcomes decided by the medical liability committee, and predictors of medical errors.

METHODS

This is a retrospective observational study that reviewed medical malpractice cases registered in Oman over a 12-year period (2010-2021) with the medical liability committee, known as the Higher Medical Committee (HMC). Descriptive and inferential statistical techniques, including multiple logistic regression techniques, were used for data analysis.

RESULTS

Between 2010 and 2021, the HMC registered 1284 medical malpractice cases, out of which 1048 were fully investigated. The number of registered cases increased during this period. These cases included those raised by Omani nationals and expatriates, with a majority (86%) raised by Omani complainants. Two-thirds (67%) of the cases involved adult complainants aged 18-60 years. About 43% of the cases were from the urban Muscat region, and 68% were related to public hospitals. The most common specialties involved were obstetrics and gynecology (20.1%), internal medicine (19.7%), surgery (17.6%) and orthopedics (13.8%). Half (51%) of the appeals or grievances were dismissed because they were not preceded by medical negligence or malpractice. The average waiting time to initiate the investigation was 10 months. Errors were more common among non-Omani complainants and cases related to private hospitals. Significant predictors of errors included nationality (i.e. Omani vs. non-Omani), the referring institution, the medical specialty and the type of health institution involved, and the waiting time to initiate the investigation.

CONCLUSION

To date, the number of cases of medical malpractice in Oman is lower compared to international trends, although there has been an upsurge in recent years. More research using a more robust methodology is warranted to contextualise the factors that contribute to this upward trend, as well as the preponderance in urban settings and among certain demographic populations.

An Evaluation of Healthcare Safety Culture Among Healthcare Professionals in Secondary and Tertiary Public Hospitals in the Middle East Region

Background and aim The provision of quality healthcare is initiated by a culture of patient safety. Understanding the patient safety culture (PSC) is a critical concept for all healthcare workers. We conducted this study to evaluate the PSC understanding among the Hamad Medical Corporation (HMC) staff members. Furthermore, to establish a local (HMC) reference point for providing quality health care based on a culture of patient safety. Method A Hospital Patient Safety Culture Survey (HSOPSC) was presented to our health system employees to assess their perceptions and understandings of PSC. The survey was self-administered. STATA Package version 12.0 culture software was used to analyze these data in terms of descriptive, correlational, and multivariate ordinal regression. Results This study targeted to survey 6,538 employees in HMC facilities, but only 5,583 responded, resulting in a percentage response rate of 85.4%. Ten facilities achieved 100% participation, and other HMC facilities had response rates ranging from 71.2% to 97.5%. Approximately 88.0% of the responders had direct patient contact. The HSOPSC survey resulted in an overall positive response rate of 62.4%. The dimensions with the highest positive response score were "teamwork within the Unit" followed by "organizational learning/continuous improvement" and "management support for patient safety" with a mean percent positive response (PPR) of 83.1%, 82.0%, and 79.2%, respectively. Conversely, there are three dimensions with the lowest positive response score, including "communication openness," "staffing," and "nonpunitive response to errors," with a mean PPR of 46.6%, 40.1%, and 27.7%, respectively. ANOVA and the student t-test revealed that men (64.3% ± 8.1%), employees with 11-15 years of experience in their specialty (65.8% ± 6.5%), and general hospital type (64.4% ±7.2%), were all significantly associated with differences in the overall perceptions of PSC. According to the study results, there was a moderate correlation between perceptions of PSC at the hospital and the following: Teamwork Across Units (RS= 0.43; p < 0.05), and Frequency of Events Reported (RS= 0.40; p < 0.05.). A regression analysis found that men, workers under 40 years of age, professionals with no direct contact with patients, employees with 11-15 years of experience in their specialty, intensive care staff, and general hospital staff were all significant predictors of overall favorable perceptions of the PSC. Conclusion PSC's understanding of HMC staff is moderate. Furthermore, this is the first study conducted for PSC understanding by the HMC staff in Qatar State. It is eligible to be considered a backbone and reference for new research projects about PSC in Qatari health facilities, if not worldwide.

Estimation of Prevalence of Hospital-Acquired Blood Infections among Patients Admitted at a Tertiary Hospital in Oman over a Period of Five Years: A Cross-Sectional Study

Background

Data from developed/developed countries have shown that hospital-acquired blood infections (HA-BSIs) are one of the most severe nosocomial infections and constitute 20%-60% of hospitalization-related deaths. Despite the high morbidity and mortality rates and the enormous burden of health care costs associated with HA-BSIs, to our knowledge, there are few published reports on HA-BSI prevalence estimates in Arab countries, including Oman.

Objectives

This study aims to explore the HA-BSI prevalence estimates over selected sociodemographic characteristics among admitted patients at a tertiary hospital in Oman over five years of follow-up. The regional variations in Oman were also examined in this study.

Methods

This hospital-based cross-sectional study reviewed reports of hospital admissions over 5 years of retrospective follow-ups at a tertiary hospital in Oman. HA-BSI prevalence estimates were calculated over age, gender, governorate, and follow-up time.

Results

In total, 1,246 HA-BSI cases were enumerated among a total of 139,683 admissions, yielding an overall HA-BSI prevalence estimate of 8.9 cases per 1000 admissions (95% CI: 8.4, 9.4). HA-BSI prevalence was higher among males compared to females (9.3 vs. 8.5). HA-BSI prevalence started as relatively high in the group aged 15 years or less (10.0; 95% CI 9.0, 11.2) and then declined as age increased from 36 to 45 years (7.0; 95% CI 5.9, 8.3) when it started to increase steadily with increasing age in the group aged 76 or more (9.9; 95% CI 8.1, 12.1). The governorate-specific estimate of HA-BSI prevalence was the highest among admitted patients who resided in Dhofar governorate, while the lowest estimate was reported from the Buraimi governorate (5.3).

Conclusion

The study provides supportive evidence for a steady increase in HA-BSI prevalence over age categories and years of follow-up. The study calls for the timely formulation and adoption of national HA-BSI screening and management programs centered on surveillance systems based on real-time analytics and machine learning.

Assessing managerial patient safety practices that influence adverse events reporting among nurses in the Savannah Region, Ghana

Introduction

Patient safety is a global concern for both health professionals and the public. Studies show that evaluating patient safety culture can help improve patient safety outcomes. Nursing care strategically places nurses at the centre of patient safety promotion and their proximity to patients makes them the drivers of patient safety. Managerial decisions regarding patient safety impact greatly on patient safety outcomes in the healthcare organization. This study aimed to assess the managerial patient safety practices that influence adverse event reporting in three hospitals in the Savannah Region of Ghana.

Methods

A quantitative cross-sectional design was used to collect data from 210 participants in three hospitals. Data were analysed using descriptive, Pearson's correlation and linear regression.

Results

It was found that patient safety practices with good positive rating scores were management support (56.6%), managers' expectations (62.8%) and feedback about errors (56.2%). Areas with weak patient safety practices were staffing levels (42.4%), open communication (40.2%) and non-punitive response to errors (36.7%). Again, nurses' attitude towards adverse events reporting was generally low (37.3%). Managerial patient safety practices that had significant associations with adverse events reporting were management support ( r = .18, p < .001), open communication ( r = .19, p < .001), non-punitive to errors ( r = .21, p < .001) and feedback about errors ( r = .37, p < .001). Again, the significant predictors of adverse events reporting were feedback about errors ( β  =  .36, p < .001) and non-punitive response to errors ( β  =  .21, p  < .01).

Conclusion

Nurses perceived patient safety culture in their units to be good. Although nurses' attitude towards adverse events reporting was low, the significant predictors of adverse events reporting were feedback about errors and non-punitive response to errors. Therefore, healthcare managers should continually strengthen patient safety to ensure optimal care outcomes.

Implications for nursing practice

Feedback on errors and non-punitive response to errors had a great influence on adverse events reporting, managerial failure to provide feedback and a non-punitive work environment could result in under-reporting of adverse events. This can be a major threat to patient safety; hence clinical practice should be aware of this and put in strategies to appropriately address them.

Development of the German version of the patient safety climate inventory to the Austrian context

OBJECTIVES

In recent years, patient safety culture (PSC) in hospitals, including its development and measurement, has increasingly received attention in Europe. Even though several instruments have been developed for PSC measurement in European countries, there is, to date, no validated measure to assess PSC in Austria. The study at hand addresses this gap in the evidence base by psychometrically assessing the German 'Patient Safety Climate Inventory' (PaSKI) in terms of its potential suitability for the Austrian healthcare system. The goal is to theoretically develop and empirically verify a separate instrument for PSC measurement in Austria.

SETTING

Ten hospitals.

PARTICIPANTS

Healthcare professionals (n=1202); doctors (n=142), nurse (n=645), other health workers (n=51), medical technology professions (n=170), management/administration (n=76), other (n=20), no response (n=98).

PRIMARY AND SECONDARY OUTCOME MEASURES

The pretest was conducted with 101 health professionals. Psychometric evaluations, including exploratory factor analysis and confirmatory factor analysis, were performed with both an original version of the PaSKI and an adapted one. The original PaSKI and the newly adapted 'Austrian Patient Safety Climate Inventory' (A-PaSKI) were then compared.

RESULTS

The A-PaSKI's factor structure developed in our study differs from the original 14-factor structure (49 items) of the PaSKI. The new instrument consists of 10 factors (30 items), comprising seven departmental factors, two hospital factors, and one outcome factor. The new instrument A-PaSKI revealed satisfactory results on the model-level and internal consistency. The confirmatory factor analysis for the A-PaSKI (χ2 (360)=1408.245, p=0.0001) showed a good model fit, and the absolute and relative fit indices showed an excellent model adjustment. The construct validity was acceptable for nine and unacceptable for one factor.

CONCLUSIONS

This is the first validation study of a standardised safety culture measure in Austrian hospitals. The Austrian version of PaSKI demonstrated good psychometric properties, with acceptable to good internal consistency and construct validity for use in Austrian hospitals.

[Patient safety culture among nursing professionals in a philanthropic hospital in Minas GeraisCultura de seguridad del paciente entre los profesionales de enfermería en un hospital filantrópico de Minas Gerais]

Introduction

Different initiatives have been carried out with a view to improving the quality of patient care and safety in Brazil. However, compliance with these standards as a number of requirements does not seem to correspond to the actual incorporation of changes and improvement in security.

Objectives

Evaluate the patient's safety culture in a philanthropic hospital in Minas Gerais, also possible differences between work, day and night shiftes.

Methods

This is an observational cross-sectional study. The study population consisted of nursing professionals working in this philanthropic institution. For the evaluation of the safety culture, the Hospital Survey on Patient Safety Culture (HSOPSC), created by the Agency for Healthcare Research and Quality (AHRQ), validated, translated and adapted transculturally in Brazil was used. In the analysis and interpretation of the data, the guidelines of the AHRQ were followed, and strengthened and fragile dimensions were observed. This work was approved by the Research Ethics Committee.

Results

We included 118 participants in the study, 17.2% of these total nurses and the rest of the nursing technicians. No dimension of the security culture has been identified as strengthened in the institution. Fragile areas were considered: "communication openness", the "teamwork within units", the "staffing", the "handoffs and transitions", and the "nonpunitive response to error". In some dimensions, differences were observed by work shift, day and night. Conclusion: The analysis of the safety culture in this hospital can contribute to a better direction of conduct so as to ensure safer care.

Patient Safety Culture and Associated Factors Among Health-Care Providers in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Introduction

Patient safety is an issue of global concern; however, health-care organizations have lately observed to pay more attention to the importance of establishing a culture of safety. The study aimed to assess the level of patient safety culture and associated factors among health-care providers at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia, 2020.

Methods

A cross-sectional study design supported by the qualitative approach was conducted from March 15 to May 15/2020. A stratified simple sampling technique was used to select 575 study participants. The standardized tool, which measures 12 safety culture dimensions, was used for data collection. Bivariate and multivariable linear regression analyses performed using SPSS version 23. The significance level was obtained at 95% CI and p-value <0.05. For the qualitative part, a semi-structured interview guide with probing was used. Data were analyzed thematically using open code software version 4.02.

Results

The overall level of positive patient safety culture was 45.3% (95% CI: 44.7, 45.9) with a response rate of 92.2%. Factor analysis indicated that female, masters, participation in patient safety program, adverse event report, hospital management encourage reporting event and resource were positively associated with the patient safety culture. Whereas divorced/widowed, midwives, anesthetist, medicine, pediatrics, emergency, outpatient, pharmacy, direct contact with patients, and hospital management blame when medical errors happened were negatively associated. The in-depth interview revealed that teamwork, health-care professionals’ attitude toward patient safety and patient involvement as important factors that influence patient safety culture.

Conclusions and Recommendations

The overall level of positive patient safety culture was low. All variables except age, training, working hour, and working experience were factors significantly associated with the patient safety culture. Health-care policy-makers and managers should consider patient safety culture a top priority, and also create a blame-free environment that promotes event reporting.

Effect of the organizational culture for patient safety in the hospital setting: A systematic review

Objective: To identify the effect of the organizational culture on patient safety in the hospital context. Materials and methods: A systematic review, without meta-analysis, registered in PROSPERO with number CRD42020162981. Cross-sectional and observational studies were selected that assessed the safety environment and safety culture published between 2014 and 2020 in journals indexed in the EMBASE, Latin American and Caribbean Literature in Health Sciences (Literatura Latinoamericana e do Caribe em Ciências da Saúde, LILACS) via the Virtual Health Library (Biblioteca Virtual em Saúde, BVS), Medline (International Literature in Health Sciences) via PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Results: The findings show that a positive safety environment exerts a beneficial effect on the safety culture, favors the notification of events, and enables improvements in the quality of health care. Conclusions: The effective interaction between safety culture and organizational culture is still scarce in the literature. Most of the studies carried out investigate the situational diagnosis and little progress is made in terms of deepening the implications for the professional practice and the repercussions for the safety of hospitalized patients.

Assessment of Patient Safety Culture Among Doctors, Nurses, and Midwives in a Public Hospital in Afghanistan

INTRODUCTION

The first step to improve the safety of patients in hospitals is to evaluate safety culture. Therefore, the patient safety culture in doctors, nurses and midwives should be reviewed regularly. The aim of the study was to determine the current state of patient safety culture among physicians, nurses and midwives at the Estiqlal Hospital in Kabul to promote an effective safety culture.

METHODS

This cross-sectional descriptive study was conducted from January to March 2020 among doctors, nurses, and midwives at the Esteqlal Specialized Hospital in Kabul. In that study, the data were collected through a survey of hospital. Among the 267 employees invited to participate, 267 (100%) completed the surveys. Descriptive statistics have been used to adjust frequency distribution tables and inferential statistics to identify differences in variable relationships. The independent sample T-test and one-way 'ANOVA ' were used to check variations between groups, and SPSS version 25 was used for data analysis.

RESULTS

The findings of this study have shown that organizational learning and non-punitive response to errors have had the highest and lowest scores. Eight out of 12 dimensions of patient safety culture scored lower. Four dimensions of patient safety culture scored the highest. Overall, patient safety culture dimensions were low and poor (44%). This means the patient safety culture at the hospital was poor.

CONCLUSION

The safety culture of the patients at the hospital was inappropriate, particularly in the eight dimensions of the patient safety culture, immediate intervention was necessary. The study emphasizes the creation of a desirable organizational climate, the need for staff involvement in various levels of decision-making, the creation of a culture of error reporting and recognizing the causing factors, and promoting a patient safety culture.

Assessing Patient Safety Culture in Hospital Settings

The current knowledge about patient safety culture (PSC) in the healthcare industry, as well as the research tools that have been used to evaluate PSC in hospitals, is limited. Such a limitation may hamper current efforts to improve patient safety worldwide. This study provides a systematic review of published research on the perception of PSC in hospitals. The research methods used to survey and evaluate PSC in healthcare settings are also explored. A list of academic databases was searched from 2006 to 2020 to form a comprehensive view of PSC's current applications. The following research instruments have been applied in the past to assess PSC: the Hospital Survey on Patient Safety Culture (HSPSC), the Safety Attitudes Questionnaire (SAQ), the Patient Safety Climate in Health Care Organizations (PSCHO), the Modified Stanford Instrument (MSI-2006), and the Scottish Hospital Safety Questionnaire (SHSQ). Some of the most critical factors that impact the PSC are teamwork and organizational and behavioral learning. Reporting errors and safety awareness, gender and demographics, work experience, and staffing levels have also been identified as essential factors. Therefore, these factors will need to be considered in future work to improve PSC. Finally, the results reveal strong evidence of growing interest among individuals in the healthcare industry to assess hospitals' general patient safety culture.

Patient safety culture in Oman: A national study

RATIONAL, AIM, AND OBJECTIVES

A positive patient safety culture in maternity units is linked to higher quality of care and better outcomes for mothers. However, safety culture varies across maternity units. Analyses of variation in safety culture using statistical process control (SPC) methods may help provider units to learn from each other's performance. This study aims to measure patient safety culture across maternity units in Oman using SPC methods.

METHODS

The 36-item Safety Attitude Questionnaire (SAQ) was distributed to all doctors, nurses, and midwifes working in ten maternity care units in Oman's hospitals and analysed using SPC methods. The SAQ considers six domains: job satisfaction, perception of management, safety climate, stress recognition, teamwork, and work condition.

RESULTS

Of the 892 targeted participants, 735 (82%) questionnaires were returned. The overall percentage of positive safety responses in all hospitals ranged from 53% to 66%, but no hospital had the targeted response of above 75%. Job satisfaction had the highest safety score (4.10) while stress recognition was the lowest (3.17). SPC charts showed that the overall percentage of positive responses in three maternity units (H1, H7, and H10) was above and one (H4) was below the control limits that represent special cause variation that merits further investigation.

CONCLUSION

Generally, the safety culture in maternity units in Oman is below target and suggests that considerable work is required to enhance safety culture. Several maternity units showed evidence of high/low special cause variation that may offer a useful starting point for understanding and enhancing safety culture.

Cultura de la seguridad del paciente en seis centros quirúrgicos de Antioquia

Introducción: Colombia, como otros países promueve políticas de seguridad al paciente con el fin de evitar situaciones que afecten su bienestar y su salud, asimismo, reducir y, de ser posible, eliminar la ocurrencia de eventos adversos.  Objetivo: Caracterizar la cultura de seguridad del paciente referido por el personal de seis centros quirúrgicos de Antioquia. Materiales y métodos: Estudio multicéntrico transversal descriptivo. Se aplicó el instrumento Hospital Survey on Patient Safety Culture propuesto por la Agency for Healthcare Research and Quality (AHRQ) a 514 trabajadores del área de la salud. Por recomendación de AHRQ, se recodificó la escala de Likert de la encuesta. Resultados: En una escala de cero a diez, el promedio del clima de seguridad en los servicios de cirugía es 8. El 62% de las respuestas sobre la percepción de la cultura de la seguridad fue positiva en aprendizaje organizacional/mejora continua en 81.70% de los trabajadores; en el trabajo en equipo en el servicio, 81.54%. Se encontraron oportunidades de mejora en dotación de personal (49.98%); respuesta no punitiva a errores (45.98%); y franqueza en comunicación (44.28%). Discusión: las dimensiones que son fortalezas y debilidades reportadas en la investigación son comparables con las reportadas en otros estudios y requiere atención del sistema de salud y de las direcciones de las instituciones. Conclusión: Se detectaron fortalezas y debilidades en la cultura de seguridad de los pacientes. En cuanto a las Fortalezas: el Aprendizaje organizacional/mejora continua y el Trabajo en equipo en la Unidad/Servicio; el resto son oportunidades de mejora. Como citar este artículo: Salazar Maya Ángela María, Restrepo Marín Diana Marcela. Cultura de la seguridad del paciente en seis centros quirúrgicos de Antioquia. Revista Cuidarte. 2020; 11(2): e1040. http://dx.doi.org/10.15649/cuidarte.1040

A comparative study on patient safety culture among emergency nurses in the public and private hospitals of Tabriz, Iran

Aim

To appraise patient safety culture in emergency departments of Iranian public and private hospitals.

Design

A comparative cross-sectional survey design was used.

Methods

This cross-sectional study was conducted from January-March 2019. For data collection, the Hospital Patient Safety Culture (HSOPSC) questionnaire was employed. The study sample comprised 256 participants. Independent t test and analysis of variance were performed to report the mean differences in total patient safety culture perception according to the participants' characteristics and according to hospital ownership.

Results

There was no significant difference in overall perceptions of patient safety culture in public and private sectors (2.94 vs. 2.84, p > .05). There are no solid areas regarding patient safety found neither in public nor in private sectors. Out of 12 dimensions of patient safety culture, different perceptions of nurses working in public and private hospitals belonged to "Organizational learning" (t = 2.13, p = .034) and "Handoffs and transitions" (t = 2.91, p = .004). Regarding the participants' characteristics, no significant difference was observed as to the perspectives of nurses on patient safety culture. However, there was a meaningful difference in the attitudes of nurses working in public hospitals according to their employment status (t = 2.07, p = .039).

Fatigue, burnout, work environment, workload and perceived patient safety culture among critical care nurses

A study was conducted to explore whether fatigue, workload, burnout and the work environment can predict the perceptions of patient safety among critical care nurses in Oman. A cross-sectional predictive design was used. A sample of 270 critical care nurses from the two main hospitals in the country's capital participated, with a response rate of 90%. The negative correlation between fatigue and patient safety culture (r= -0.240) indicates that fatigue has a detrimental effect on nurses' perceptions of safety. There was also a significant relationship between work environment, emotional exhaustion, depersonalisation, personal accomplishment and organisational patient safety culture. Regression analysis showed that fatigue, work environment, emotional exhaustion, depersonalisation and personal accomplishment were predictors for overall patient safety among critical care nurses (R²=0.322, F=6.117, P<0.0001). Working to correct these predictors and identifying other factors that affect the patient safety culture are important for improving and upgrading the patient safety culture in Omani hospitals.

Patient Safety Culture and Associated Factors Among Health Care Providers in Bale Zone Hospitals, Southeast Ethiopia: An Institutional Based Cross-Sectional Study

Introduction

Patient safety is a serious global public health issue and a critical component of health care quality. Unsafe patient care is associated with significant morbidity and mortality throughout the world. In Ethiopia health system delivery, there is little practical evidence of patient safety culture and associated factors. Therefore, this study aims to assess patient safety culture and associated factors among health care providers in Bale Zone hospitals.

Methods

A facility-based cross-sectional study was undertaken using the “Hospital Survey on Patient Safety Culture (HSOPSC)” questionnaire. A total of 518 health care providers were interviewed. Analysis of variance (ANOVA) was employed to examine statistical differences between hospitals and patient safety culture dimensions. We also computed internal consistency coefficients and exploratory factor analysis. Bivariate and multivariate linear regression analyses were performed using SPSS version 20. The level of significance was established using 95% confidence intervals and a p-value of <0.05.

Results

The overall level of patient safety culture was 44% (95% CI: 43.3–44.6) with a response rate of 93.2%. Factor analysis indicated that hours worked per week, participation in a patient safety program, reporting of adverse events, communication openness, teamwork within hospital, organizational learning and exchange of feedback about error were among factors that were significantly associated with the patient safety culture.

Conclusion

According to the Agency for Health Research and Quality, the overall classification of patient safety score and most of the scores related to dimensions were low. Hours worked per week, participation in a patient safety program, reporting of adverse events and most safety dimensions were found to be factors associated with patient safety culture. Well-designed patient safety interventions need to be integrated with organizational policies to address all dimensions of patient safety culture.

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

OBJECTIVE

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

DESIGN

Literature review and an analysis framework to review studies.

SETTING

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

DATA SOURCES

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

PRIMARY AND SECONDARY OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

An exploration of patient safety culture in Kuwait hospitals: a qualitative study of healthcare professionals' perspectives

OBJECTIVE

Patient safety culture (PSC) represents a key component of the quality of care offered by healthcare professionals. Therefore, it is crucial to understand the factors that influence the implementation of a safe culture. This study explored the knowledge and attitudes of healthcare professionals in Kuwait towards the factors that might affect the PSC.

METHODS

A qualitative study using semi-structured interviews with healthcare professionals was conducted between February and June 2018 at two major hospitals in Kuwait. Both hospitals had been accredited and have been applying the safety programmes recommended by the Kuwaiti Ministry of Health. Participants were purposively selected where 20 healthcare professionals were interviewed. The interviewees comprised of six physicians, six clinical pharmacists, six nurses and two members of the patient safety committee. Inclusion criteria involved healthcare professionals who had more than 1-year clinical experience, have interest in patient safety and had a good level of English. Interviews were audio-recorded and transcribed verbatim. Thematic analysis of the interview transcripts was conducted to identify the emergent themes.

KEY FINDINGS

Thematic analysis of the interviews yielded three major themes related to 'management', 'regulations and policies' and 'healthcare professionals'. Management issues included managerial support, resources, safety environment and staff training. Regulations and policies highlighted issues related to policies and procedures and incident reporting system. Healthcare professionals' theme covered factors related to knowledge, communication and teamwork among healthcare professionals.

CONCLUSIONS

This study gave insight into how healthcare professionals perceive the current PSC in Kuwait. Despite their positive attitudes and knowledge towards patient safety, various barriers were reported that hinder optimal PSC. These barriers were related to support, staffing, resources and response to error.

Hospital Survey on Patient Safety Culture: psychometric evaluation in Kuwaiti public healthcare settings

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.

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

Purpose

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

Data sources

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

Study selection

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

Data extraction

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

Results

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

Conclusion

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

Assessment of patient safety culture in primary health care in Muscat, Oman: a questionnaire -based survey

BACKGROUND

Patient safety is a universal issue which affects countries at all stages of health system development. Patient safety research in primary care reveals that globally millions of people suffer disabilities, injuries, or death due to unsafe medical practices. This study aims to explore the understanding of frontline primary health care professionals regarding patient safety culture in health care facilities in Oman.

METHODS

A questionnaire-based survey was conducted using a validated Hospital Survey of Patient Safety Culture tool. Invitations were sent to all 198 health professionals from each occupational category from each primary care center in Muscat, Oman.

RESULTS

The total number of respondents was 186 participants out of 198 (response rate: 94%). Overall, the staff had a strong sense of teamwork within the units (85%), they reported organization learning for continuous improvement (84%) and teamwork across the units (82%). However, the four dimensions which received the lowest scores were related to communication problems between the staff (23%), non-punitive response to errors (27%), frequency of event reporting (40%), and errors occurring when transferring patients to higher levels of health care during handoffs and transitions (46%).

CONCLUSIONS

Overall, the participants rated patient safety in the primary health care setting as excellent or very good and the perception of patient safety was moderately positive. The core areas of strength were teamwork within the units with positivity and organization learning and continuous improvement. The weaknesses were non-punitive response to errors, inadequate staffing and hand offs and transition. The results of this study will provide policy makers and health care professionals with a detailed understanding of the current patient safety culture in primary care in Muscat, Oman. The results will be used by the Ministry of Health to inform policy and strategies to strengthen patient safety within primary health care in Oman.

Developing patient safety system using WHO tool in hospitals in Oman

Objective

Oman is progressively implementing the Patient Safety Friendly Hospital Initiative (PSFHI), a tool formulated by the World Health Organization (WHO) to achieve optimal patient safety in hospitals. This paper describes its implementation in selected government and private hospitals in Oman and analyses the performance of four hospitals whose implementations of PSFHI were assessed by WHO.

Design

The PSFHI initiative was launched in 11 hospitals in Oman during 2016. The enrolled hospitals implemented a 1-year plan composed of several steps such as formation of steering committees, working groups, full orientation about the standards, training of staff, documents development and community involvement. One year later, four hospitals which were the earliest to join the initiative were subjected to WHO assessment.

Setting

Secondary level government and private hospitals.

Intervention(s)

The WHO-PSFHI standards.

Main Outcome Measure

Hospitals' adherence to the standards.

Results

Three of the four hospitals (one government and two private) scored level two. One government hospital scored level three, earning it the distinction of being the first hospital in the Eastern Mediterranean Region to reach level three in the very first assessment.

Conclusions

Implementation of PSFHI in selected hospitals of Oman had successful outcomes in improving patient's safety.

Healthcare Professional's Perception of Patient Safety Measured by the Hospital Survey on Patient Safety Culture: A Systematic Review and Meta-Analysis

Objective

To assess the culture of patient safety in studies that employed the hospital survey on patient safety culture (HSOPS) in hospitals around the world.

Method

We searched MEDLINE, EMBASE, SCOPUS, CINAHL, and SciELO. Two researchers selected studies and extracted the following data: year of publication, country, percentage of physicians and nurses, sample size, and results for the 12 HSOPS dimensions. For each dimension, a random effects meta-analysis with double-arcsine transformation was performed, as well as meta-regressions to investigate heterogeneity, and tests for publication bias.

Results

59 studies with 755,415 practitioners surveyed were included in the review. 29 studies were conducted in the Asian continent and 11 in the United States. On average studies scored 9 out of 10 methodological quality score. Of the 12 HSOPS dimensions, six scored under 50% of positivity, with “nonpunitive response to errors” the lowest one. In the meta-regression, three dimensions were shown to be influenced by the proportion of physicians and five by the continent where survey was held.

Conclusions

The HSOPS is widely used in several countries to assess the culture of patient safety in hospital settings. The culture of culpability is the main weakness across studies. Encouraging event reporting and learning from errors should be priorities in hospitals worldwide.

Patient safety and safety culture in primary health care: a systematic review

BACKGROUND

Patient safety in primary care is an emerging field of research with a growing evidence base in western countries but little has been explored in the Gulf Cooperation Council Countries (GCC) including the Sultanate of Oman. This study aimed to review the literature on the safety culture and patient safety measures used globally to inform the development of safety culture among health care workers in primary care with a particular focus on the Middle East.

METHODS

A systematic review of the literature. Searches were undertaken using Medline, EMBASE, CINAHL and Scopus from the year 2000 to 2014. Terms defining safety culture were combined with terms identifying patient safety and primary care.

RESULTS

The database searches identified 3072 papers that were screened for inclusion in the review. After the screening and verification, data were extracted from 28 papers that described safety culture in primary care. The global distribution of the articles is as follows: the Netherlands (7), the United States (5), Germany (4), the United Kingdom (1), Australia, Canada and Brazil (two for each country), and with one each from Turkey, Iran, Saudi Arabia and Kuwait. The characteristics of the included studies were grouped under the following themes: safety culture in primary care, incident reporting, safety climate and adverse events. The most common theme from 2011 onwards was the assessment of safety culture in primary care (13 studies, 46%). The most commonly used safety culture assessment tool is the Hospital survey on patient safety culture (HSOPSC) which has been used in developing countries in the Middle East.

CONCLUSIONS

This systematic review reveals that the most important first step is the assessment of safety culture in primary care which will provide a basic understanding to safety-related perceptions of health care providers. The HSOPSC has been commonly used in Kuwait, Turkey, and Iran.

Exploring Safety Culture in Jordanian Hospitals: A Baseline Study

Medical error is a serious issue in hospitals in Jordan. This study explored Jordanian nurses' perceptions of the culture of safety in their hospitals. The Hospital Survey of Patient Safety Culture translated into Arabic was administered to a convenience sample of 391 nurses from 7 hospitals in Jordan. The positive responses to the 12 dimensions of safety culture ranged from 20.0% to 74.6%. These are lower than the benchmarks of the Agency for Healthcare Research and Quality. Jordanian nurses perceive their hospitals as places that need more effort to improve the safety culture.

Status of patient safety culture in Arab countries: a systematic review

OBJECTIVES

To explore the status of patient safety culture in Arab countries based on the findings of the Hospital Survey on Patient Safety Culture (HSPSC).

DESIGN

Systematic review.

METHODS

We performed electronic searches of the MEDLINE, EMBASE, CINAHL, ProQuest and PsychINFO, Google Scholar and PubMed databases, with manual searches of bibliographies of included articles and key journals. We included studies that were conducted in the Arab countries that were focused on patient safety culture. 2 reviewers independently verified that the studies met the inclusion criteria and critically assessed the quality of the studies.

RESULTS

18 studies met our inclusion criteria. The review identified that non-punitive response to error is seen as a serious issue which needs to be improved. Healthcare professionals in the Arab countries tend to think that a 'culture of blame' still exists that prevents them from reporting incidents. We found an overall similarity between the reported composite score for dimension of teamwork within units in all of the reviewed studies. Teamwork within units was found to be better than teamwork across hospital units. All of the reviewed studies reported that organisational learning and continuous improvement was satisfactory as the average score of this dimension for all studies was 73.2%. Moreover, the review found that communication openness seems to be a concerning issue for healthcare professionals in the Arab countries.

CONCLUSIONS

There is a need to promote patient safety culture as a strategy for improving the patient safety in the Arab world. Improving patient safety culture should include all stakeholders, like policymakers, healthcare providers and those responsible for medical education. This review was limited only to English language publications. The varied settings in which the HSPSC was used may have influenced the areas of strengths and weaknesses as healthcare workers' perception of safety culture may differ.

Awareness and implementation of nine World Health Organization's patient safety solutions among three groups of healthcare workers in Oman

Background

The pressing need to reduce burgeoning poor safety measures affecting millions worldwide has alerted World Health Assembly to set-up mechanisms to increase patient safety. In response to such needs, World Health Organization (WHO) formulated nine life-saving patient safety solutions that would be essential to lower reduce healthcare-related harm. There is a paucity of research examining awareness of such nine patient safety solutions. This study has been designed and conducted to compare self-estimated awareness and practice of the World Health Organization’s nine “Life-saving Patient Safety Solutions” aide memoirs among different groups of healthcare workers in Oman.

Methods

All nationwide healthcare workers (nurses, physicians and allied health professionals) in hospitals and primary healthcare under the auspice of Ministry of Health were the target population of this survey. Participants were selected by a simple, systematic random sampling from the list of staff in each representative institution. The study was conducted from November 2012 to February 2013. A total of 800 participants (590 from health centers and 210 from hospitals) were invited to participate in this study.

Results

A total number of 763 healthcare professionals consented to participate. The overall response rate was 95 % with the majority being nurses, female staff and who had an average of more than 4 years of experience. Overall, 85 % of the participants self-estimated awareness of the nine life-saving patient safety solutions showed the nurses being the most aware, followed by physicians with the allied health professionals showing suboptimal awareness. The primary healthcare center staff demonstrated higher awareness compared to hospital staff. There was a complex relationship between health professional’s age, place of work and awareness and practice.

Conclusion

This study lays the foundation for international comparisons of self-estimated awareness and practice towards nine patient safety solutions. The data from Oman indicates the need for more attention to be directed towards heightening awareness and practice of the nine patient safety solutions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1771-1) contains supplementary material, which is available to authorized users.

The perception of safety culture among nurses in a tertiary hospital in Central Saudi Arabia

Developing a patient safety culture was one of the recommendations made by the Institute of Medicine (IOM) to assist hospitals in improving patient safety. Nurses are the key to safety improvements in hospitals. It is necessary to know their awareness and perception regarding institutional safety climate. The aim of this study is to explore perceptions of patient safety among nursing staff in a tertiary hospital in Central Saudi Arabia in different discipline units. The current study was conducted at Prince Sultan Military Medical City (PSMMC), a tertiary center in Riyadh, Central Saudi Arabia. In November 2014, five hundred nurses were randomly selected to participate in this study. A survey questionnaire with Likert scale was adopted covering characteristics of participants together with their views on patient safety issues. Two hundred and twenty-four participants filled the questionnaire with a response rate of 44.8%. The overall perception of patient safety among participants was (57.9%). The majority (74.1%) thought that the existing system is good at preventing errors and only one third indicated that they have patient safety problems. Most of the participants were happy with the existing patient safety culture including organizational learning/continuous improvement (95.5%), and errors feedback and communication (76.64%). In conclusion, this study showed that perception of patient safety was sub-optimal among nurses and there are several areas for improvement regarding safety culture.