The status of patient safety culture in Iranian hospitals: a systematic review

Purpose: Iran has initiated Patient Safety Friendly Initiatives (PSFHI) in 10 hospitals since 2010, and now aims to expand it to 50 more hospitals. The aim of this study was to systematically measure patient safety culture in Iranian hospitals as the first national baseline measure. Methods: A cross-sectional study, using Farsi version of the popular Hospital Survey on Patient Safety Culture (HSOPSC) was done in 11 public teaching general hospitals in three major province centers in Iran. About 1000 questionnaires were randomly distributed staff across four selected strata (physicians, nurses, laboratory and radiology staff). Finally, percent positive scores were calculated. Results: A total of 725 respondents had successfully completed the questionnaire (response rate: 75.44%). Overall patient safety culture percent positive scores was 47%. Teamwork within units and organizational learning -continuous improvement, got the highest scores, while non-punitive response to error and staffing had the lowest ratings. About 58% of study participants reported not completing any event reports during the previous 12 months and only 22.5% gave their hospitals an ‘excellent or very good’ patient safety grade. Conclusion: Study findings provided a good baseline data about the current status of patient safety culture in Iranian hospitals, their strengths and potentials for improvement in this field, as well as the status in each dimension of safety culture among other countries from different WHO regions.

BackgroundInternationally, patient safety is increasingly seen as a priority area, and improving patient safety highly depends on achieving a culture that supports and encourages health care staffs to report their errors or near misses without fear of punishment. In Ethiopia, however, patient safety culture is a relatively new focus, and little is known regarding the current status of patient safety culture in public hospitals. The purpose of the current study was thus, aimed to assess the views and perceptions of health care professionals about patient safety culture in public hospitals in Ethiopia.MethodsA cross-sectional study, utilizing the ‘Hospital Survey on Patient Safety Culture (HSOPSC)’ questionnaire was carried out in 2016 in the Amhara region. A self-administered questionnaire was distributed to the 480 health care staffs, including physicians, nurses, pharmacists, and other clinical and non-clinical staffs. Data were summarized as percentages, means, and standard deviations. ANOVA and chi-square tests were employed to examine statistical differences between health care worker’s characteristics and patient safety predictors. We also computed internal consistency coefficients, correlation analysis, and exploratory factor analysis.ResultsA total of 410 questionnaires were returned (response rate, 85.4%). The overall patient safety score (46%) and most of the scores related to dimensions were lower than the benchmark scores. The positive response rate of two dimensions (‘Teamwork within units’ and ‘Organizational learning–continuous improvement’) received the highest score (each 72%), and the lowest score was attributed to ‘Staffing’ (26%). Approximately, two thirds of staffs reported at least one event in the past 1 year. Nurses reported better in the overall patient safety score compared with other health care professionals (P = 0.03). The internal consistency of the total survey was fairly satisfied (Cronbach’s α = 0.77).ConclusionsThere is a severe deficit of patient safety culture in Ethiopian public hospitals. Creating a positive patient safety culture by implementing actions that support all dimensions of safety culture is inevitable. Further research is needed to confirm the applicability of the translated version of the HSOPSC in the Ethiopian hospital settings.

Purpose The study aims to investigate the status of patient safety culture in a tertiary hospital in Jordan during the COVID-19 pandemic. Design/methodology/approach This descriptive cross-sectional study used the validated Safety Attitude Questionnaire distributed to the staff working in a tertiary hospital in Jordan. Findings The highest scores of patient safety culture dimensions were reported for both “Stress recognition” (60.56%) and “safety climate” (58.75%) dimensions. However, the lowest scores were reported for “perception of management” (53.85%) and “working conditions” (55%). Originality/value This study highlighted serious concerns about the safety culture in hospitals during COVID-19. This study provides a baseline finding yielding a clearer vision of the areas of safety culture that need to be improved to safeguard patient safety during disasters.

ObjectivesThis study aims to investigate patient safety culture in secondary hospitals of Heilongjiang, Northeast China, and explore the implications of patient safety culture and practices through the perspectives of various healthcare workers.MethodsA cross-sectional survey using the Safety Attitude Questionnaire (SAQ) was conducted to ascertain the status of patient safety culture in nine secondary hospitals across the six dimensions of the SAQ. Among the 900 staff members who were invited to participate, 665 completed the questionnaire. Descriptive statistics were used to calculate the general means and standard deviations of the patient safety culture dimensions and other numerical variables, and F-test and a multivariate regression analysis were used to statistically analyze the differences in perceptions of safety culture considering the differences in demographic characteristics. All statistical analyses were performed using SPSS v. 22.0.ResultsThe respondents rated job satisfaction as the highest among all six dimensions of the SAQ, followed in order by teamwork climate, working conditions, and stress recognition (the lowest). There were significant differences among the dimensions of patient safety culture and other factors, such as gender, age, job position, and education. Compared with previous studies, teamwork climate and working conditions scores were quite high, while stress recognition score was very low. We also found differences in patient safety culture by demographic characteristics.ConclusionsThe findings revealed the patient safety culture attitudes of healthcare workers in secondary hospitals of Heilongjiang, and provided baseline data for related future research. This evidence may also help government health policymakers and hospital administrators understand related challenges and develop strategies to improve patient safety culture in secondary hospitals of China and perhaps also in other developing countries.

To assess the present patient safety culture of three general hospitals in Saudi Arabia, as perceived by nurses. This study utilized a descriptive, cross-sectional design. A convenience sample of 351 nurses working in three general hospitals in the central region of Saudi Arabia was surveyed in this study using the Hospital Survey of Patients' Safety Culture (HSOPSC) from October 2016 to April 2017. From the 12 composites of the HSOPSC, the nurses perceived only the following two patient safety areas as strengths: teamwork within units and organizational learning-continuous improvement. Six areas of patient safety were identified as weaknesses, namely overall perception of patient safety, handoffs and transitions, communication openness, staffing, frequency of events reported, and nonpunitive response to errors. Nationality, educational attainment, hospital, length of service in the hospital, work area or unit, length of service in the current work area or unit, current position, and direct patient contact or interaction were significant predictors of the nurses' perceived patient safety culture. The findings in this study clarify the current status of patient safety culture in three hospitals in the Kingdom of Saudi Arabia. The present findings should be considered by policymakers, hospital leaders, and nurse executives in creating interventions aimed at improving the patient safety culture in hospitals. A multidimensional network intervention targeting the different dimensions of patient safety culture and involving different organizational levels should be implemented to improve patient safety.

To assess the patient safety culture in Peruvian hospitals from the perspective of healthcare professionals, and to test for differences between the private and public healthcare sectors. Patient safety is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of healthcare delivery. A non-random cross-sectional study conducted online. An online survey was administered from July to August 2016, in Peru. This study reports results from Lima and Callao, which are the capital and the port region of Peru. A total of 1679 healthcare professionals completed the survey. Participants were physicians, medical residents and nurses working in healthcare facilities from the private sector and public sector. Assessment of the degree of patient safety and 12 dimensions of patient safety culture in hospital units as perceived by healthcare professionals. Only 18% of healthcare professionals assess the degree of patient safety in their unit of work as excellent or very good. Significant differences are observed between the patient safety grades in the private sector (37%) compared to the public sub-sectors (13-15%). Moreover, in all patient safety culture dimensions, healthcare professionals from the private sector give more favorable responses for patient safety, than those from the public sub-systems. The most significant difference in support comes from patient safety administrators through communication and information about errors. Overall, the degree of patient safety in Peru is low, with significant gaps that exist between the private and the public sectors.

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.

Patient safety is a critical global concern, with millions of adverse events occurring annually. Nurses' attitudes towards patient safety culture are pivotal in its successful implementation. This study aimed to assess the risk factors related to nurses' attitudes towards patient safety culture and its relationship with the implementation of patient safety culture in a public hospital dr. H. Moch. Ansari Saleh in Banjarmasin, Indonesia. A cross-sectional study was conducted among nurses working in a public hospital dr. H. Moch. Ansari Saleh in Banjarmasin, Indonesia. Data were collected using a questionnaire adapted from the National Patient Safety Guidelines and the AHRQ Hospital Survey on Patient Safety. The questionnaire assessed nurses' attitudes towards patient safety, the implementation of patient safety culture, and potential risk factors such as age, gender, years of experience, and workload. Data were analyzed using descriptive statistics, Spearman's rank correlation coefficient, and multivariate logistic regression. A total of 85 nurses participated in the study. The majority of nurses (81.2%) exhibited a moderate attitude towards patient safety, while 83.5% reported a moderate level of patient safety culture implementation. Spearman's rank correlation analysis revealed a weak positive correlation (rho = 0.417, p = 0.01) between nurses' attitudes and the implementation of patient safety culture. Multivariate logistic regression analysis identified age (OR = 1.12, 95% CI = 1.01-1.24) and workload (OR = 1.18, 95% CI = 1.05-1.33) as significant risk factors associated with a less positive attitude towards patient safety culture. In conclusion, while there is a positive relationship between nurses' attitudes and patient safety culture implementation, the relationship is weak. Age and workload were identified as significant risk factors for a less positive attitude towards patient safety culture. These findings highlight the need for targeted interventions to address these risk factors and enhance nurses' attitudes, thereby strengthening patient safety culture in the hospital.

ObjectiveUsing the Hospital Survey on Patient Culture, our aim was to investigate the patient safety culture in all Swedish hospitals and to compare the culture among managers, physicians, registered nurses, and enrolled nurses and to identify factors associated with high overall patient safety.MethodsThe study used a correlational design based on cross-sectional surveys from health care practitioners in Swedish health care (N = 23,781). We analyzed the associations between overall patient safety (outcome variable) and 12 culture dimensions and 5 background characteristics (explanatory variables). Simple logistic regression analyses were conducted to determine the bivariate association between each explanatory variable and the outcome variable. The explanatory variables were entered to determine the multivariate associations between the variables and the outcome variable.ResultsThe highest rated culture dimensions were “teamwork within units” and “nonpunitive response to error,” and the lowest rated dimensions were “management support for patient safety” and “staffing.” The multivariate analysis showed that long professional experience (>15 years) was associated with increased probability for high overall patient safety. Compared with general wards, the probability for high overall patient safety was higher for emergency care but lower for psychiatric care. The probability for high overall patient safety was higher for both enrolled nurses and physicians compared with managers.ConclusionsThe safety culture dimensions of the Hospital Survey on Patient Culture contributed far more to overall patient safety than the background characteristics, suggesting that these dimensions are very important in efforts to improve the overall patient safety culture.

Objective To conduct a questionnaire survey on the current status of patient safety culture among the medical personnel of a certain hospital by using a self-made questionnaire form, so as to provide evidence for further improvement of patient safety culture and medical quality of the hospital. Methods A total of 1 583 questionnaires were issued to various departments of the hospital. The subjects of the survey were doctors, nurses, pharmacists and technicians. Epidata 3.1, SPSS 13.0 and Excel 2010 software were used for the feeding, analysis and statistics of the data. Positive response rate was applied to analyze the level of patient safety culture in the medical personnel. Results The level of patient safety culture in the medical personnel of the hospital was on the whole quite good with a total score of 4.08±0.42 and consent rate of 79.37%. Age, profession, staff category, length of work, education, professional titles were important factors affecting the level of patient safety culture. Conclusions In accordance with the results of the survey, correct and effective policies could be developed and sustaining progress be improved concerning patient safety. Key words: Questionnaire; Patient safety culture; Assessment

Background: Today, patient safety is an important issue in providing hospital services. Any failure in this area can cause undesirable consequences. Objective: The present study evaluated the status of patient safety culture in Educational Hospitals of Tehran, Iran. Methods: This cross-sectional study surveyed 205 therapeutic and diagnostic personnel of three Tehran hospitals selected using the clustered method; samples were collected in a randomized manner. To examine patient safety culture, the standard questionnaire of patient safety culture with 12 dimensions was used. Data was analyzed using SPSS software. Results: In the 12 dimensions of patient safety culture, exchange of data, expectations, and organization management had the lowest means of 3.28 (±0.87), and 3.32 (±0.74) among the various aspects of patient safety culture. Additionally, the two dimensions of teamwork within the organization’s units and frequency of reporting events with means of 3.71 (±0.79) and 3.73 (±0.7) had the highest means among the studied 12 dimensions of patient safety culture. The total mean of patient safety culture in the studied hospitals was 3.5 (±0.5). Conclusion: Increasing the attention paid to patient safety culture will lead to the development and progress of hospitals in the country and will guide them toward becoming patient-friendly hospitals. Those dimensions which had low mean values in this study should be paid more attention so as to promote and protect them.

ObjectivesTo measure and establish a baseline assessment of the patient safety culture in the Palestinian hospitals.DesignA cross-sectional descriptive study using the Arabic version of the Safety Attitude Questionnaire (Short Form 2006).ParticipantsA total of 339 nurses and physicians returned the questionnaire out of 370 achieving a response rate of 91.6%.SettingFour public general hospitals in the Gaza Strip, Palestine.MethodsNurses and physicians were randomly selected using a proportionate random sampling. Data analysis performed using Statistical Package for the Social Sciences software version 20, and p value less than 0.05 was statistically significant.Main outcomes measuresCurrent status of patient safety culture among healthcare providers and percentage of positive attitudes.ResultsMale to female ratio was 2.16:1, and mean age was 36.5 ± 9.4 years. The mean score of Arabic Safety Attitude Questionnaire across the six dimensions on 100-point scale ranged between 68.5 for Job Satisfaction and 48.5 for Working Condition. The percentage of respondents holding a positive attitude was 34.5% for Teamwork Climate, 28.4% for Safety Climate, 40.7% for Stress Recognition, 48.8% for Job Satisfaction, 11.3% for Working Conditions and 42.8% for Perception of Management. Healthcare workers holding positive attitudes had better collaboration with co-workers than those without positive attitudes.ConclusionFindings are useful to formulate a policy on patient safety culture and targeted a specific safety culture dimension to improve the safety of patients and improve the clinical outcomes within healthcare organisations.

BackgroundPatient safety culture is one of the main components of the quality of health services and is one of the main priorities of health studies. Accordingly, this study aimed to determine and compare the views of healthcare staff on the patient safety culture and the impact of effective factors on patient safety culture in public and private hospitals in Tehran, Iran.MethodsThis cross-sectional study was carried out on a sample of 1203 health care workers employed in three public and three private hospitals in Tehran, Iran. Stratified random sampling was used in this study. Data were collected using the Maslach burnout inventory and patient safety culture questionnaire (HSOPSC). IBM SPSS v22 and Amos v23 were used to perform path analysis.ResultsEight hundred sixty-seven (72.57%) females and 747 (27.43%) males with a mean age of 33.88 ± 7.66 were included. The average percentage of positive responses to the safety culture questionnaire in public and private hospitals was 65.5 and 58.3%, respectively. The strengths of patient safety culture in public hospitals were in three dimensions including non-punitive response to errors (80%), organizational learning—continuous improvement (79.77%), and overall perceptions of patient safety (75.16%), and in private hospitals, were three dimensions including non-punitive responses to errors (71.41%), organizational learning & continuous improvement (69.24%), and teamwork within units (62.35%). The type of hospital and work-shift hours influenced the burnout and patient safety questionnaire scores (P-value < 0.05). The path analysis results indicate the fitness of the proposed model (RMSEA = 0.024). The results showed a negative impact of a work shift (β = − 0.791), occupational burnout (β = − 0.554) and hospital type (β = − 0.147) on the observance of patient safety culture.ConclusionProviding feedback on errors and requirements for the frequent incident reporting, and patient information exchange seem necessary to promote the patient safety culture. Also, considering the negative impact of the shift work and burnout on patient safety culture, by planning and managing these factors appropriately, correct actions could be designed to improve the safety culture.

BackgroundThe setting of this work is Andhra Pradesh (AP), the fourth largest state Indian state with 76 million people in which the AP patient safety alliance was recently launched. This...

ObjectivesTo explore the status of patient safety culture in Arab countries based on the findings of the Hospital Survey on Patient Safety Culture (HSPSC).DesignSystematic review.MethodsWe performed electronic searches of the...