Abstract
BackgroundAssessments of the culture surrounding patient safety can inform healthcare settings on how their structures and processes impact patient outcomes. This study investigated patient safety culture in Primary Health Care Centres in Kuwait, and benchmarked the findings against regional and international results. This study also examined the association between predictors and outcomes of patient safety culture in these settings.MethodsThis cross-sectional quantitative study used the Medical Office Survey on Patient Safety Culture. The study was targeted at staff of all the Primary Health Care Centres in Kuwait with at least one year of experience. Data were analysed using SPSS 23 at a significance level of ≤ .05. Univariate (means, standard deviations, frequencies, percentages) and bivariate (chi-squared tests, student t-tests, ANOVA F-tests, Kruskal–Wallis tests, Spearman’s correlation) analyses provided an overview of participant socio-demographics and the association between patient safety culture composites and outcomes. We undertook a multivariate regression analysis to predict the determinants of patient safety culture. Results were benchmarked against similar local (Kuwait, 2014), regional (Yemen, 2015) and international (US, 2018) studies.ResultsThe responses of 6602 employees from 94 centres were included in the study, with an overall response rate of 78.7%. The survey revealed Teamwork (87.8% positive ratings) and Organisational Learning (78.8%) as perceived areas of strength. Communication about Error (57.7%), Overall Perceptions of Patient Safety and Quality (57.4%), Communication Openness (54.4%), Owner/Managing Partner/Leadership Support for Patient Safety (53.8%) and Work Pressure and Pace (28.4%) were identified as areas requiring improvement. Benchmarking analysis revealed that Kuwait centres are performing at benchmark levels or better on four and six composites when compared to international and regional findings, respectively. Regression modelling highlighted significant predictions regarding patient safety outcomes and composites.ConclusionsThis is the first major study addressing the culture of patient safety in public Primary Health Care Centres regionally. Improving patient safety culture is critical for these centres to improve the quality and safety of the healthcare services they provide. The findings of this study can guide country-level strategies to develop the systems that govern patient safety practices.
Highlights
Assessments of the culture surrounding patient safety can inform healthcare settings on how their structures and processes impact patient outcomes
Of the 8389 questionnaires distributed at the 100 Primary Healthcare Centre (PHC), 7392 (88.1%) were returned from 94
The returned questionnaires were screened for their eligibility, which resulted in the exclusion of a further 790, yielding a final response rate of 78.7% (n = 6602)
Summary
Assessments of the culture surrounding patient safety can inform healthcare settings on how their structures and processes impact patient outcomes. Based on that general understanding, safety culture is defined as the product of those attributes in regards to daily safety issues that interact with an organisation’s structure and determine that organisation’s health and safety management [1, 7, 12, 13] In their quest to study safety culture, researchers have used quantitative, qualitative and mixed approaches to understand the challenges facing healthcare organisations in providing safe care [14,15,16]. They identified leadership support, teamwork, communication and feedback, and workload and burnout as common themes that impact safety culture [16,17,18]. Systematic reviews have revealed that participants from primary or secondary care settings rate teamwork among the highest positive dimensions and non-punitive response to errors as an area of concern [1, 19]
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