Abstract

BackgroundThere is a lack of robust, rigorous mixed methods studies of patient safety culture generally and notably those which incorporate behavioural theories of change. The study aimed to quantify and explain key aspects of patient safety culture which were of most concern to healthcare professionals in Qatar.MethodsA sequential explanatory mixed methods design of a cross-sectional survey followed by focus groups in Hamad Medical Corporation, Qatar. All doctors, nurses and pharmacists were invited to complete the Hospital Survey on Patient Safety Culture (HSOPS). Respondents expressing interest in focus group participation were sampled purposively, and discussions based on survey findings using the Theoretical Domains Framework (TDF) to explain behavioural determinants.ResultsOne thousand, six hundred and four questionnaires were received (67.9% nurses, 13.3% doctors, 12.9% pharmacists). HSOPS composites with the lowest levels of positive responses were non-punitive response to errors (24.0% positive) and staffing (36.2%). Specific TDF determinants potentially associated with these composites were social/professional role and identity, emotions, and environmental context and resources. Thematic analysis identified issues of doctors relying on pharmacists to correct their errors and being reluctant to alter the prescribing of fellow doctors. There was a lack of recognition of nurses’ roles and frequent policy non-adherence. Stress, workload and lack of staff at key times were perceived to be major contributors to errors.ConclusionsThis study has quantified areas of concern relating to patient safety culture in Qatar and suggested important behavioural determinants. Rather than focusing on changing behaviour at the individual practitioner level, action may be required at the organisational strategic level to review policies, structures (including resource allocation and distribution) and processes which aim to promote patient safety culture.

Highlights

  • Promoting patient safety in healthcare settings is a global challenge, with an estimated one in ten patients being harmed whilst receiving care [1]

  • Hospital Survey on Patient Safety Culture (HSOPS) composites with the lowest levels of positive responses were non-punitive response to errors (24.0% positive) and staffing (36.2%)

  • Thematic analysis identified issues of doctors relying on pharmacists to correct their errors and being reluctant to alter the prescribing of fellow doctors

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Summary

Introduction

Promoting patient safety in healthcare settings is a global challenge, with an estimated one in ten patients being harmed whilst receiving care [1]. The challenge calls for action to reduce patient harm which occurs as a result of unsafe medication practices and medication errors [2,3]. Common to all systematic reviews is the relatively poor research methodologies reported in most of the primary literature, a lack of behavioural theory and organisational culture in study design. There is a lack of robust, rigorous mixed methods studies of patient safety culture generally and notably those which incorporate behavioural theories of change.

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