The relationship between patient safety culture and the establishment of national accreditation management standards in a teaching hospital in Ardabil, Iran

Citation: Sitterding, M., (September 30, 2011) and Summary: Creating a Culture of Safety: The Next Steps OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 3, Overview and Summary. DOI: 10.3912/OJIN.Voll6No03ManOS Patient care errors continue to threaten patient safety and erode trust among the public we are privileged to serve. Recent studies have suggested the number and the percentage of adverse events has actually been grossly underestimated. Classen and colleagues (Claussen et al., 2011: Resar, Simmonds, & Haraden, 20061 found that estimates of adverse events among critical care patients indicate 11.3 adverse events/100 Intensive Care Unit days and 2.04 adverse events/patient; these estimates may be as much as ten times greater than previously measured and reported. Sharek and colleagues (2006) discovered an incidence of 74 adverse events/100 admissions in a neonatal critical care unit, and suggested that 56% of all adverse events are preventable. These recent statistics are a call to action for nurses to better understand the culture of patient safety and to identify with greater clarity the unique contribution nurses can make in decreasing adverse events, regardless of whether we work in practice, academe, or policy arenas. Radical change is essential. We need change that dives deeper, away from the tip of the iceberg and toward the core. The articles in this OJIN topic address ways in which nursing can dive deeper into the core of the iceberg/ As a collection these articles describe how the Magnet® nursing excellence framework enables a culture of patient safety; present a new model that describes nursing practice within a culture of safety; explain how nurses can practice within a culture of safety; provide insight about essential roles needed to support a culture of safety; and offer considerations for preparing the next generation of nurses to serve within a culture of safety. The relationship between nursing excellence and a culture of patient safety is illustrated by Swanson and Tidwell as they detail their Magnet Journey. These authors describe each Magnet Component (ANCC, 2008) and provide explicit examples of structures, processes, and outcomes in alignment with a culture of patient safety. Approaches that enhance effective communication through intentional nurse-physician collaborates are described and cited as factors contributing to both Magnet status and a culture of patient safety. The authors clearly illustrate how the Magnet Recognition Program provides an exemplary framework for nursing excellence, one that is in direct alignment with a culture of patient and workplace safety. Morath introduces readers to the Dynamic Systems Model (DSM), a model that describes the interaction between individual benefit and system benefit and illustrates the impact of this interaction on the culture of patient safety. One underlying assumption of the DSM is that as individual benefit increases, the system benefit decreases. Morath explains how the individual nurse and the system work within an envelope of boundaries that include operations/workload, financial, and safety factors. The model is used to describe the potential for migration into unsafe practices, for example through work-arounds that decrease task time yet increase the potential for error, and to suggest reasons for failure to recognize subtle warning signs. Sammer and James present the nursing unit leader role through a fictional lens describing what happened in a hospital lacking a culture of patient safety and what an optimal culture of safety environment could look like in an exemplary culture of patient safety. The authors masterfully narrate the story of a fictional patient within a fictional facility with a fictional team to illustrate the link between elements of the story and the subcultures of patient safety, as descried by Sammer, Lykens, Singh, Mains, and Lackan (2010). Paramount to the practice setting is academic preparation for the next generation of nurses to recognize and to practice within a culture of safety. …

Background and importancePharmacists play an essential role in patient safety culture and medication safety, coordinating and implementing patient safety initiatives and preventing medication errors; however, there is limited literature on...

Objective: The aim of this study was to observe and describe the changes in the structures for patient safety (PS) and PS culture (PSC) at the level of health facilities, following the implementation of the National Patient Safety Program (NPSP). Methods: An observational, longitudinal, and descriptive study including follow-up of changes in structure and activities for PS and assessments of PSC before and 15 months after the NPSP enforcement. Three Brazilian hospitals with different management logistics participated in the study (federal public, state public, and private). PSC was measured using the AHRQ’s instrument, adapted and validated for the Brazilian context (Hospital Survey on Patient Safety Culture [HSOPSC]). Changes in structure and activities to improve PS were mapped against the NPSP objectives. Changes in PSC were assessed by the hospital and discussed considering a change theory based on the literature. Results: Structural changes occurred in all hospitals but at a different pace and extension. A PS unit, adoption of some PS protocols, and training on PS occurred in the three hospitals. PSC significantly improved in all facilities. Public hospitals had the worst baseline PSC but showed greater improvements. The state hospital presented few structural changes and soon had the lowest ratings of PSC. Conclusions: This study demonstrates that external regulatory initiatives can trigger, even if unevenly, actions promoting PS and relevant internal structural changes, which in turn seem to increase awareness and improvement in PSC.

Objectives: This article aims to systematically review and analyze the outcome of published literature on patient safety and safety culture related to dental schools. It also aims to observe implemented changes in dental school training and curriculum that have improved patient safety and safety culture within institutions. Methods: All studies concerning patient safety and safety culture from the period of January 2010 to May 2020 were included which were specific to dental educational institution settings. The assessment was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) checklist to ascertain that the included studies were specific to the objective of our systematic review. Results: The included studies were assessed for country-wise publication, type of study, and its outcome. Of the 10 studies that met the inclusion criteria, 5 articles were related to patient safety. 2 out of the 5 articles were from the United States of America (USA) 2 were from the United Kingdom (UK), followed by 1 from Mexico. For articles related to safety culture, 3 out of the 5 articles were from Saudi Arabia, and 2 were from the USA. Conclusion: The analysis of the selected review articles suggests that rigorous training should be implemented in inpatient record documentation, incident reporting, and infection control protocols. The authors suggested focused training on patient safety culture and the inclusion of safety culture awareness and training to the dental undergraduate curriculum.

IntroductionA positive patient safety culture is considered a main condition for patient safety. Several initiatives have been taken with the intention to improve this culture in healthcare. Because these were...

Patient participation and safety are pivotal in healthcare quality, internationally acknowledged for enhancing health services. This study examines the correlation between two assessment tools, the Patient Participation Culture Tool (PACT) and the Hospital Survey on Patient Safety Culture (HSPSC), using retrospective data from 2014 to 2021. METHOD: For the main analysis, dimensional scores of the HSPSC and domain scores of the PACT were aggregated according to hospital and specific wards. In a second step, we used aggregated scores by hospital and profession. Descriptive statistics outlined the sociodemographic characteristics of participants. Spearman's rank correlation coefficient was employed to evaluate relationships between continuous variables represented by PACT domain and HSPSC dimensional scores among study participants. Data from 17 hospitals were analysed. The participants were distributed across 43 wards, and a match based on staff positions resulted in 37 different groups, predominantly comprised of nurses (>89%). At ward level, five PACT domains correlated significantly with ten different HSPSC dimensions (p<0.05), while a significant correlation was found between four PACT domains and seven HSPSC dimensions based on function. The correlation graphs demonstrate strong internal coherence within safety and participation culture measurements, highlighting the distinctiveness and validity of each questionnaire in capturing intricacies within patient safety and participation culture, supporting their construct validity. This study compared the PACT and the HSPSC, revealing their connections and unique features. Using Spearman's correlation, it positively linked patient participation and safety culture, finding significant correlations, mainly moderate, between their specific aspects. It highlighted how patient involvement positively influences safety practices in healthcare, valuable for enhancing overall quality.

IntroductionRecognizing the values and norms significant to healthcare organizations (Safety Culture) are the prerequisites for safety and quality care. Understanding the safety culture is essential for improving undesirable workforce attitudes and behaviours such as lack of adverse event reporting. The study assessed the frequency of adverse event reporting, the patient safety culture determinants of the adverse event reporting, and the implications for Ghanaian healthcare facilities.MethodsThe study employed a multi-centre cross-sectional survey on 1651 health professionals in 13 healthcare facilities in Ghana using the Survey on Patient Safety (SOPS) Culture, Hospital Survey questionnaire. Analyses included descriptive, Spearman Rho correlation, one-way ANOVA, and a Binary logistic regression model.ResultsThe majority of health professionals had at least reported adverse events in the past 12 months across all 13 healthcare facilities. Teamwork (Mean: 4.18, SD: 0.566) and response to errors (Mean: 3.40, SD: 0.742) were the satisfactory patient safety culture. The patient safety culture dimensions were statistically significant (χ2 (9, N = 1642) = 69.28, p < .001) in distinguishing between participants who frequently reported adverse events and otherwise.ConclusionPromoting an effective patient safety culture is the ultimate way to overcome the challenges of adverse event reporting, and this can effectively be dealt with by developing policies to regulate the incidence and reporting of adverse events. The quality of healthcare and patient safety can also be enhanced when healthcare managers dedicate adequate support and resources to ensure teamwork, effective communication, and blame-free culture.

Objective This study examined the current patient safety culture from the perspective of healthcare workers in a teaching hospital in Ghana and drew comparison with the Agency for Healthcare Research and Quality 2018 Patient Safety Culture Comparative Database Report. Methods A cross-sectional survey was conducted using the Hospital Survey on Patient Safety Culture developed by the Agency for Healthcare Research and Quality. A total of 435 questionnaires were distributed and 322 valid responses were received (a response rate of 74%). The study sample included 178 nurses, 59 doctors, 19 pharmacists, 35 technicians ((laboratory and radiology), and 31 management staff. The Hospital Survey Excel Tool 1.6 and the Statistical Package for the Social Sciences (SPSS) version 20 were used to analyze the data. Results The overall average score for the 12 dimensions of patient safety culture was 53% which is 12% lower than the Agency for Healthcare Research and Quality 2018 benchmark report of 65%. The dimension with the highest positive mean score was “Teamwork within Hospital Units” (77%) while the one with the lowest score was “Frequency of Event Reporting” (33%). All 12 domains except for Frequency of Event Reporting ( p = 0.414), Management Support for Patient Safety ( p = 0.823), and Teamwork within Units ( p = 0.070) have significant relationship with patient safety culture. Conclusions Generally, the patient safety culture dimension in the teaching hospital was low. Training of healthcare workers on patient safety and a broad based research including all categories of healthcare staff is highly needed in other to fully understand and change the patient safety culture in Ghanaian Hospitals.

Good leadership plays a role in implementing patient safety efforts within an established patient safety culture. This study aims to determine the influence of transformational leadership on patient safety efforts, with patient safety culture as the intervening variable. This quantitative research design is cross-sectional, with a sample size of 100 medical personnel, nurses, and medical support staff, selected using random cluster sampling. Data were collected using questionnaires, and the analysis was conducted using path analysis. The results showed that transformational leadership directly affects patient safety culture, with a t statistic measurement of 2.80 (&gt;1.96). Transformational leadership also directly affects patient safety efforts, with a t statistic measurement of 2.26 (&gt;1.96). Patient safety culture also directly affects patient safety efforts, with a t statistic measurement of 20.404 (&gt;1.96). The indirect effect was measured through the indirect impact of transformational leadership on patient safety efforts through a patient safety culture, which had a t statistic measurement of 3.101. The study concludes that transformational leadership can improve patient safety efforts and culture.

The lack of the leadership function in monitoring and evaluation, the limited training on patient safety is suspected to have resulted in a low safety culture and clinical risk management. This study aims to determine the influence of transformational leadership, patient safety knowledge and culture on clinical risk management at PMI Hospital. Design of a cross-sectional study, 138 nurses in August 2024. Simple random sampling technique, the independent variable is knowledge about patient safety goals and transformational leadership; the dependent variable of clinical risk management, and the intervening variable of patient safety culture. Descriptive analysis shows that PMI Hospital has nurses who have high knowledge of patient safety targets, with a charismatic leadership style, and a communicative patient safety culture. The results show that knowledge of patient safety goals, transformational leadership, and patient safety culture simultaneously and partially have a significanteffect on clinical risk management so that high knowledge, charismatic leadership, and communicative patient safety culture are proven to encourage improvements in clinical risk management at PMI Hospital.

BackgroundPatient safety culture is an essential factor in determining the ability of hospitals to treat and reduce patient risks. Healthcare professionals, especially nurses, play an important role in patient safety because they are responsible for direct and ongoing patient care. Few studies in Iran examine the patient safety culture in Iranian teaching hospitals, particularly from the perspective of nursing staff. This research assessed patient safety culture in teaching hospitals in Iran from the nurses’ point of view and compared the outcomes with similar regional and global studies. Furthermore, the study identified the factors influencing patient safety culture and its association with outcomes.MethodsA cross-sectional study was accomplished in thirty-two teaching hospitals in five provinces of Iran. A total of 2295 nurses were chosen through convenience sampling. Collection data were done using the Hospital Survey of Patient Safety Culture (HOPSC) from October 2018 and September 2019. We analyzed the data using descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis.ResultsThe results demonstrated the overall percentage of positive response rate for the HOPSC tool (36.4%). The average percentage of positive responses among all dimensions ranged from 27.1% in “Staffing” to 53.8% in “Teamwork across Hospital Units”. Benchmarking analysis shows that Iranian hospitals are equal or better performance than the benchmark on several composites compared to regional and global findings. The results of multiple linear regression analysis showed that the age, gender, total years of experience in nursing, work area or unit, work hours, and size of the hospital were significant predictors of the perceptions patient safety culture of nurses (p < 0.05).ConclusionsThis is one of few studies that examine nurses’ perceptions of patient safety culture in public hospitals in Iran. Although the results of the present study showed that the results of Iran were at or better than the many composites in Jordan, Turkey, KSA, and the Philippines. The findings confirmed that all 12 dimensions can be considered as areas requiring improvement, and these results demonstrated that there was a severe shortage in patient safety culture among the included hospitals.

To develop a patient safety culture instrument for use in Chinese hospitals, we assessed the appropriateness of existing safety culture questionnaires used in the USA and Japan for Chinese respondents and identified new items and domains suitable to Chinese hospitals. Focus group study. Twenty-four physicians, nurses and other health-care workers from 11 hospitals in three Chinese cities. Three focus groups were conducted in 2010 to elicit information from hospital workers about their perceptions of the appropriateness and importance of each of 97 questionnaire items, derived from a literature review and an expert panel, characterizing hospital safety culture. understood the concepts of patient safety and safety culture and identified features associated with safe care. They judged that numerous questions from existing surveys were inappropriate, including 39 items that were dropped because they were judged unimportant, semantically redundant, confusing, ambiguous or inapplicable in Chinese settings. Participants endorsed eight new items and three additional dimensions addressing staff training, mentoring of new hires, compliance with rules and procedures, equipment availability and leadership walk-rounds they judged appropriate to assessing safety culture in Chinese hospitals. This process resulted in a 66-item instrument for testing in cognitive interviews, the next stage of survey development. Focus group participants provided important insights into the refinement of existing items and the construction of new items for measuring patient safety culture in Chinese hospitals. This is a necessary first step in producing a culturally appropriate instrument applicable to specific local contexts.

To determine the relationships among nurses' fatigue, nurses' performance and patient safety culture. Cross-sectional study. A multicentre study was conducted with 308 nurses working in 14 medical and surgical wards from four teaching hospitals in Iran. The sampling method was stratified with a proportional allocation. Data were collected via a demographic form, the Occupational Fatigue/Exhaustion Recovery (OFER-15), the Nurse Performance Instrument (NPI) and the Hospital Survey on Patient Safety Culture (HSOPSC). The data were analysed via structural equation modelling (SEM). Nurse fatigue was significantly inversely related to performance and patient safety culture (p < 0.001). Path analysis revealed that each unit of reducing nurses' fatigue improved patients' safety culture by 0.286 units and that each unit of improved nurse performance improved patients' safety culture by 0.360 units. Additionally, each one-unit increase in a nurse's fatigue could decrease his or her performance by 0.860 units. SEM analysis confirmed the mediating effect of nurses' performance on the relationship between their level of fatigue and patient safety culture. The proposed model can assist nursing managers and healthcare policymakers in developing practical strategies to mitigate and reduce nurses' fatigue and, consequently, improve nurses' performance and patient safety. All participants contributed to this research by completing self-reported scales.

This article examined the association between workplace incivility experiences of nurses and patient safety (PS) culture in hospitals. Workplace incivility, which is characterised by low-intensity behaviours with unclear intention to harm and disruption of workplace ambiance of mutual respect, may threaten the work environment, resulting in an unhealthy and unsafe workplace. Cross-sectional study. This study surveyed 261 nurses in Saudi Arabia from June 2019 to August 2019 using the 'Hospital Survey of Patients' Safety Culture' and the 'Nurse Incivility Scale'. A multiple linear regression was performed with unit- and hospital-level PS culture as the dependent variables. 'Organizational learning-continuous improvement' and 'Teamwork within units' were recognised as PS culture strengths. The nurses reported workplace incivility from patient/visitor as the most frequently experienced (mean=2.27, standard deviation=0.88). Working in Hospital B (ß=0.24, p<.001, 95%CI=0.15, 0.33) and having a baccalaureate degree in nursing (ß=0.13, p=.014, 95%CI=0.03, 0.23) were associated with better perceptions of unit-level PS, whereas working in medical-surgical wards (ß=-0.16, p=.002, 95%CI=-0.26, -0.06) and in intensive care units (ß=-0.19, p=.002, 95%CI=-0.32, -0.07) and experiencing patient/visitor incivility (ß=-0.09, p=.004, 95%CI=-0.15, -0.03) were associated with poor unit-level PS culture perceptions. Experiences of general incivility (ß=-0.24, p<.001, 95%CI=-0.35, -0.13) and supervisor incivility (ß=-0.26, p=.011, 95%CI=-0.46, -0.06) were associated with poor hospital-level PS culture perceptions. Workplace incivility from patients/visitors had a negative association with unit-level PS culture perceptions, whereas experiences on general and supervisor incivilities had an adverse relationship with hospital-level PS culture perceptions. The study emphasises the call to eradicate any form of incivility in healthcare settings to guarantee a PS culture. Hospital and nursing managers should prioritise the creation and implementation of policies aimed at eliminating uncivil behaviours in clinical settings to ensure that unit- and hospital-level PS culture are above standards.

Purpose: Forming a patient safety culture is the first step in addressing patient safety issues. This study therefore examines the patient safety culture among healthcare professionals in South Korea. It also identifies the factors influencing patient safety culture and related activities. Methods: Among the survey studies conducted in South Korea, we reviewed those that measured patient safety culture using the Korean version of the Hospital Survey on Patient Safety Culture 1.0. We identified the level of patient safety culture, the relationship between patient safety culture and patient safety activities, and the factors affecting patient safety culture. Results: A total of 640 studies were identified through searches of seven domestic and international databases, with 58 included in the analysis. Studies targeting nurses accounted for 96.6%. The general characteristics of patient safety culture included length of service, age, working hours, department of work, hospital size, conflict occurrence, unreported incidents, and subjective safety management evaluations. A statistically significant correlation between patient safety culture and patient safety activities was confirmed in 84.5% of studies. Patient safety culture was the most frequently reported factor influencing patient safety activities. Conclusion: Strategies to enhance patient safety culture can promote patient safety activities in South Korean healthcare institutions. Considering organizational and organizational members characteristics when devising these strategies can enhance their effectiveness.