Abstract
Covid-19 has placed an unprecedented demand on healthcare systems worldwide. A positive safety culture is associated with improved patient safety and, in turn, with patient outcomes. To date, no study has evaluated the impact of Covid-19 on safety culture. The Safety Attitudes Questionnaire (SAQ) was used to investigate safety culture at a large UK healthcare trust during Covid-19. Findings were compared with baseline data from 2017. Incident reporting from the year preceding the pandemic was also examined. SAQ scores of doctors and “other clinical staff”, were relatively higher than the nursing group. During Covid-19, on univariate regression analysis, female gender, age 40–49 years, non-White ethnicity, and nursing job role were all associated with lower SAQ scores. Training and support for redeployment were associated with higher SAQ scores. On multivariate analysis, non-disclosed gender (−0.13), non-disclosed ethnicity (−0.11), nursing role (−0.15), and support (0.29) persisted to a level of significance. A significant decrease (p < 0.003) was seen in error reporting after the onset of the Covid-19 pandemic. This is the first study to investigate SAQ during Covid-19. Differences in SAQ scores were observed during Covid-19 between professional groups when compared to baseline. Reductions in incident reporting were also seen. These changes may reflect perception of risk, changes in volume or nature of work. High-quality support for redeployed staff may be associated with improved safety perception during future pandemics.
Highlights
The provision of safe, high-quality care should always be an essential aim of a healthcare system, even during crises such as natural disasters, conflicts, or pandemics
Study participants were invited to complete a self-administered questionnaire during the Covid-19 pandemic, with available historical data collected the same way as baseline
Using a cross-sectional survey-based design alongside incident reporting data, we have identified significant differences in safety attitudes between professional healthcare worker groups, factors affecting safety attitudes, as well as changes in incident reporting before and during the Covid-19 pandemic
Summary
The provision of safe, high-quality care should always be an essential aim of a healthcare system, even during crises such as natural disasters, conflicts, or pandemics. Rapid changes in models of care delivery were seen during the Covid-19 pandemic including increased workload, redeployment of staff to unfamiliar clinical environments, cancellation of routine services, and the requirement to treat patients suffering from a novel disease about which little was known. Working in these challenging conditions may impact on the ability of staff to deliver safe and effective care. Previous work has identified organisational breakdown, inadequate staffing, increased production pressures and provider fatigue as contributors to poor patient safety [1]. A way of obtaining insight into the state of patient safety is via assessing safety culture and incident reporting
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