Hospital Management Support Research Articles

The Enabling, Enacting, and Elaborating Factors of Safety Culture Associated With Patient Safety: A Multilevel Analysis.

Worldwide, 1 in 10 hospital patients is harmed while receiving care. Despite evidence that a culture of safety is associated with greater patient safety, these effects and the processes by which safety culture impacts patient safety are not yet clearly understood. Therefore, the purpose of this study was to examine the effects of various safety culture factors on nurses' perceptions of patient safety using an innovative theoretical model. This descriptive, correlational study drew on deidentified, publicly available data from the 2018 Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. The study sample included 34,514 nurses who provided direct care to patients in medical and surgical units in 535 hospitals in the United States. Multilevel linear regression was used to examine the effects of 11 safety culture factors on nurses' overall perceptions of patient safety. The 11 safety culture factors were grouped as enabling, enacting, and elaborating processes, and entered in separate blocks. All 11 safety culture factors were associated with nurse-perceived patient safety, and all but two of the 11 factors uniquely predicted nurse-perceived patient safety. Staffing adequacy was the strongest predictor of nurse-perceived patient safety, followed by hospital management support for patient safety (both enabling processes), and continuous organizational learning and improvement (an elaborating process). Hospital administrators and managers play a key role in promoting a safety culture and patient safety in healthcare organizations through enabling and elaborating processes. Organizational efforts should be made to provide sufficient staffing and hospital-wide support for patient safety. However, all staff, administrators, and managers have a role to play in patient safety.

Current Status and Predictors of Patient Safety Culture in Hospitals of Qassim Region, Saudi Arabia

Background and ObjectivesThe emerging concept of safety culture has been increasingly recognized as an issue of global importance. Measuring the Patient Safety Culture (PSC) of healthcare facilities helps in highlighting areas requiring improvement as well as tracking changes over time. Our study aimed to describe the current status and predictors of PSC in hospitals of Qassim Region, Saudi Arabia.MethodsIn 2016–2017, data on PSC were collected from 1460 staff members in five hospitals using the Hospital Survey on Patient Safety Culture instrument. The data were analyzed using descriptive statistics, Chi-square test (χ2), analysis of variance, and linear regression analysis.ResultsTeamwork within units received the highest score (mean score = 3.95/5), whereas nonpunitive response to errors received the lowest score (mean score = 2.25/5). The study has identified four PSC dimensions requiring improvement: teamwork across units, staffing, handoffs and transitions, and nonpunitive response to errors. In general, the categories of new hires and pharmacists were more likely to negatively perceive PSC dimensions. Furthermore, approximately half of the variance in PSC perception scores was explained by teamwork within units, organizational learning, hospital management support, teamwork across units, and nonpunitive response to errors.ConclusionPatient safety culture of any healthcare setting is not a simple paradigm, applying system changes to the healthcare systems remains vital to improve safety. It is essential to build an environment that support staff to speak up freely about their concerns regarding any safety issues.

A cross-sectional study of patient safety culture in acute-care hospitals in Greece

Background The development of a culture of safety can bring about an improvement in patient safety and quality of care. We aimed to investigate patient safety culture within an acute-care hospital setting in Greece. Methods A cross-sectional quantitative study was conducted using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire in two large acute-care hospitals in Greece. We examined questionnaire’s factorial structure using confirmatory and exploratory factor analysis. We assessed scales’ internal consistency, test–retest reliability and construct validity. To assess changes in patient safety culture, we conducted surveys at two points in time (2009 and 2014). Regression analysis examined whether any changes in scale scores could have been due to quality programs implementation or participants’ professional characteristics. Results Six scales with satisfactory psychometric properties emerged, namely ‘Teamwork Across Hospital Units’, ‘Teamwork Within Hospital Units’, ‘Feedback and Communication About Error’, ‘Frequency of Event Reporting’, ‘Supervisor/Manager Expectations and ‘Actions Promoting Safety’, ‘Hospital Management Support for Patient Safety’. Overall ratings of patient safety did not change over time. However, one of the two institutions experienced an increase in reported events. Conclusions The HSOPSC is a valuable tool for assessing patient safety culture in Greece. Moreover, despite the radical reduction in the financing of the Greek National Health System reported between 2009 and 2014, patient safety culture did not deteriorate. A worldwide trend towards increasing patient safety awareness, along with the increasing effort of hospitals’ administration to support patient safety might explain this lack of differences between the two points in time.

Psychometric Properties of the Latin American Spanish Version of the Hospital Survey on Patient Safety Culture Questionnaire in the Surgical Setting.

The Hospital Survey on Patient Safety Culture (HSPSC) was designed to assess staff views on patient safety and has been translated and validated into several languages and settings. This study developed a Latin American Spanish version of the HSPSC for use in perioperative settings and examines its psychometric properties. After translation and adjustments, a web-based questionnaire was administered to all health care personnel at operating room in a public university-affiliated hospital in Popayán, Colombia. Descriptive statistics, internal reliability, confirmatory and exploratory factor analysis, and intercorrelations among survey composites were calculated. Confirmatory factor analysis showed inadequate model fit for the original 12-factor structure of the HSPSC. Rather, a 9-factor, 36-item instrument showed acceptable factor loadings, internal consistency, and psychometric properties. Five factors were formed with minor changes. Adjusted factors emerged, like "staffing and work pressure" and "supervisor/manager expectations and actions promoting patient safety," "organizational learning-continuous improvement," and "hospital management support for safety," as well as "repeated errors and perception of safety." Internal consistency for each remaining composite met or exceeded a Cronbach α value of 0.60. Psychometric analyses provided overall support for 9 of the 12 initial factors of patient safety culture. Our findings suggest that more validation studies need to be conducted before applying safety dimensions from the original HSPSC to perioperative settings only. By providing this initial tool, we hope to stimulate further studies and the patient safety research agenda in this part of the world.

Saudi Nurses Perception regarding Patient Safety in a Major Tertiary Hospital

Background: The absence of patient safety culture among nurses has been linked to increased errors and higher level of mortality and morbidity among patients. Higher culture of patient safety has been shown to be associated with better patient outcomes, and the implementation of improvements in organizational and safety culture enhances quality in healthcare. Aim: The main aim of this study is to assess the perception of nurses regarding patient safety among nurses at prince sultan military medical city in Saudi Arabia. Materials and Methods: Cross-sectional design was applied in this study among nurses who are working at prince sultan military medical city in Riyadh, Saudi Arabia. Sample was 215 nurses, selected by convenience sampling method. The Hospital Survey on Patient Safety Culture (HSOPS) survey was used in the current study to collect data. Data have been collected within seven weeks. Statistical package for social sciences has been used to analyze data using descriptive statistics and inferential statistics such as Independent sample t test and One-Way ANOVA. Results and Conclusion: The results can only be useful if data analysis is described. The highest domain of their perception was illustrated in “Hospital management support for patient safety” with a mean of 3.68 out of 5.0, while, the lowest mean for their perception was in the domain of “Teamwork across hospital units” with a mean 2.62. The total mean of nurses’ perception regarding patient safety was 3.19 out of 5.0. Also, there was a significant difference in the mean level of nurses’ perception of patient safety with regard to nurses’ gender. Encouraging patients’ safety culture among nurses is strongly recommended through effective communication and providing feedback.

Data Safety and Ethical Challenges in Teaching Institution: The AMDI Experience

The development of the internet and expansion of digital technology has played massive role in the innovation and utilization of Health Information System (HIS) which refers to a system designed to manage healthcare data. This includes systems that collect, store, manage and transmit a patient’s electronic medical record (EMR), hospital management or medical support services and healthcare policies. The rapidly evolving digital technology and internet speed might also increase the risk of cybersecurity threats, genuine risk of patient’s data breach, confidentiality related issues and numerous technical challenges. Both users and managers of the system must be aware and properly trained to minimize the risks. Teaching and training institutions have added risk of having multiple batches of students with full or limited access to HIS as part of teaching and training requirements. Rapid turnover of students and clinic a l trainees pose a significant challenge to the IT managers in controlling and monitoring access to HIS. Additionally, the access to database has become easier for research and audits but may subconsciously led to confidentiality breach and ethical misconduct. There are 4 main components of data safety in HIS namely, data management, data integration, responsibilit y and accessibility. The potential risks, solutions and future challenges related to data safety and ethical issues are discussed in this presentation as well as review of the Islamic medical ethics concept as true guidance in dealing with ethical misconduct.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 17

Incident reporting behaviors and associated factors among health care professionals working in public hospitals in Addis Ababa, Ethiopia 2017

Introduction: A systematic and inclusive approach to incident reporting help to learn from errors and to avoid preventable medical errors. Thus this study was aimed to assess incident reporting behavior and associated factors among health care professionals in public hospitals in Addis Ababa, Ethiopia 2017. Methods: A cross–sectional study was conducted at public hospitals in Addis Ababa, Ethiopia 2017. Multistage sampling technique was used to enroll 697 study participants. Data was analyzed using SPSS version 21. The patient safety culture tool developed by health research and quality agency was used for data collection. A multivariate linear regression model was used to identify factors associated with the outcome variable. Results: The mean age of the participants was 29.06(±4.893) years. The health care professionals who were reported incident always was 30.4percent. But, 20.4% of the participants never reported an incident. A multivariable logistic regression analysis revealed that;, hospital management support (p=0.001, 95%CI; 0.206, 0.389), non–punitive response to errors (p=0.001, 95%CI; 0.168, 0.292), communication openness (p=0.001, 95%CI; 0.062, 0.249), supervisors actions promoting safety (p=0.001, 95%CI; 0.211, 0.439) and feedback on errors reported(p=0.005, 95%CI; 0.041, 0.237) were significant predictors for incident reporting behaviors among health professionals. Conclusion: Incident reporting behavior among health care professionals was low. To increase the incident reporting behavior among health professionals, the priority should be given by all hospital managers on feedback mechanisms, non–punitive response to errors and communication systems and process.

Outpatient nursing care implementations in Indonesian regional public hospitals

This study aimed to describe the nursing care implementations in the outpatient installations of several hospitals. A descriptive study design was used with purposive random sampling. A total of 292 patients were included based on the following criteria: treated at the internal, neurological, ear, nose, and throat, pulmonary, surgical, skin, sex, and heart disease polyclinics, able to read and write, and attended more than one visit. This study was conducted in three central referral hospitals in the Bogor, Depok, and Jakarta areas of Indonesia. The outpatient care implementation was not optimal in the three regional public hospitals (56.8%). The nurses minimally performed the outpatient nursing processes, namely diagnosis enforcement (63.7%) and implementation (62%). The implementation of care that is not optimal can result in a decrease in patient satisfaction and safety. The support of hospital management is needed to facilitate the availability of adequate nursing resources (both quantity and quality) and to provide equipment, facilities, and logistics to optimize nursing care.

Reducing Three Infections Across Cardiac Surgery Programs: A Multisite Cross-Unit Collaboration

Using a pre-post design, this study examined the impact of a multifaceted program to simultaneously improve 3 health care-associated infections and patient safety culture throughout the cardiac surgery service line in 11 hospitals. Interventions included the Comprehensive Unit-based Safety Program to improve safety culture and evidence-based bundles to prevent central line-associated bloodstream infection (CLABSI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP). CLABSIs and SSIs showed a downward trend over 2 years, then the rates returned to levels similar to baseline in the third year. VAP rate changes were difficult to interpret because of the VAP definition change. Patient safety culture domain "hospital management support" showed significant improvement, but feedback and communication about errors and staffing declined. Simultaneous implementation of multiple interventions across units is challenging. The findings highlight the importance of sustainment efforts and suggest future work should anticipate both positive and negative change in safety culture dimensions.

Creación y validación de una nueva escala para medir cultura de seguridad del paciente en el medio hispano hablante

ObjectiveCreation and validation of a new in-house synthetic scale to measure patient safety culture. Material and methodCross-sectional and descriptive study in which the results of the assessment of the level of safety culture in health and non-health professionals of a university hospital are collected using a new in-house synthetic scale as a measurement tool. It is called ‘Questionnaire on patient safety culture in a Spanish speaking environment’. The construction process was carried out in six phases: Bibliographic search; Validation of the structure and content of the questionnaire by a group of experts in patient safety using a nominal group technique; Assumptions verification and exploratory factor analysis; Pilot test to ensure its compression by a convenience sample of expert professionals; Modification of version 1.1 after the relevant analyses and analysis of the reliability of the questionnaire. ResultsThe final version of the questionnaire had nine items, grouped into three factors a priori: Hospital Management support in patient safety, Perception of Safety, and Expectations and actions of the Managers/Supervisors that favour safety. The items were structured using a 5-point Likert scale. A general assessment item on patient safety at the Centre was also included, as well as five open questions to identify actions on patient safety undertaken by the Centre. Finally, the possibility of making observations in a section of free text was included. The comprehension analysis did not recommend, in any case, the revision of the wording or modification of the items. The Spearman and Pearson indices were similar, which allowed us to assume the linearity in the relationships proposed. The Kolmogorov-Smirnov test was satisfactory in all cases, which guaranteed the normal distribution of the variables. The sample was adequate to perform the factorial analysis. Both the Bartlett’ sphericity test and the Kaiser-Meyer-Olkin (KMO) index showed sample quality to perform the analysis. The recommendation of the exploratory factor analysis that advised eliminating 1 item was followed. Specifically, item 9 was eliminated: ‘It is only a matter of luck that in my Centre no more errors occur that affect patients’. The analysis of our scale has shown that all the factorial loads were greater than 0.5, which indicates good explanatory capacity of the item for the Dimension. In total, the scale manages to explain more than 60% of the perception by professionals in patient safety, considering an acceptable loss of information. ConclusionsA new and validated in-house scale has been created to measure patient safety culture in the Spanish speaking healthcare environment.

Assessment of Patient Safety Culture in Iranian Academic Hospitals: Strengths and Weaknesses.

In the relevant literature, the establishment of a patient safety culture (PSC) is a vital step in providing quality service to patients. The goal of this study was to establish a baseline for PSC in Iranian academic hospitals and to determine its strength and weaknesses. A survey was distributed in 26 academic hospitals linked to the Iran and Tehran Universities of Medical Sciences, of which 18 participated. The questionnaire, the Hospital Survey on Patient Safety Culture (HSOPSC), was used to collect the data. The questionnaire contained 14 dimensions and 43 items, and the questions were scored using a 5-point Likert scale in which 1 = strongly disagree and 5 = strongly agree.The results were expressed in the percentage of positive responses (%), or the percentage of positive responses (e.g., agree, strongly agree) to positively worded items (e.g., "Hospital units work well together to provide the best care for patients") in relation to the percentage of negative responses (e.g., disagree, strongly disagree) to negatively worded items (e.g., "When an event is reported, it feels like the person is being written up, not the problem"). To score each item, the following formula was applied: % of Positive Responses = [(No. of Agree + No. of Totally Agree) / Total No. of Subjects Responding to the Question)] × 100). For the negatively worded items, the answers were reversed. To score each dimension, a composite mean score of positive responses were estimated. The same methodology was applied to the scoring of the PSC of each hospital. (i.e., the composite mean score of positive responses on 12 dimensions was obtained). Note that the data reported in the tables of this manuscript represent percentages, and for ease of communication, (%) are omitted from the stated tables. In the text, however, we have used percent wherever needed.To categorize the hospitals' safety culture from very weak to very strong, a range of 0.0% to 100% positive responses on the PSC questionnaire was divided by 5 ((100% - 0.0%) / 5 = 20%), and 5 equally spaced intervals were defined (i.e., 0.0%-20.0%, very weak; 21.0%-40.0%, weak; 41.0%-60.0%, intermediate; 61.0%-80.0%, strong; 81.0%-100.0%, very strong).The convenience sampling method was used to select the samples. For the purpose of this research, 35 questionnaires were randomly distributed in each hospital: 15 among nurses and assistant nurses (as the frontline personnel having the most direct contact with patients) and 20 among other clinical and paraclinical personnel as well as other groups (physicians, residents, interns, ward secretaries, laboratory personnel, radiology personnel, and managers). The questionnaires were distributed and collected by the hospitals' head nurses. The data were analyzed using a one-sample and independent t test. The mean score of the hospitals on the PSC ranged from 42.74 to 67.22, 12 of 18 hospitals obtained an "intermediate" ranking position, and 6 obtained a "strong" ranking position on the PSC. The overall mean (SD) score for the entire hospital for PSC was 56.74 (18.41). No significant difference was observed between the Iran and Tehran universities of medical sciences hospitals for the PSC. However, significant differences were observable at the dimension and item levels.A hospital's strengths lie in the "organizational learning-continuous improvement," "teamwork within hospital units," and "hospital management support for patient safety" dimensions. Dimensions including "feedback and communication concerning errors," "communication openness," "staffing," and "nonpunitive response to error" were shown to be weak points of all of the hospitals in this study. The PSC of the investigated hospitals is not at an ideal level and is in need of serious improvement, particularly in the dimensions of feedback and communication regarding errors, communication openness, staffing, and nonpunitive response to error. The same conditions hold true for other Iranian hospitals (i.e., the Afshar and Sadoughi hospitals in the city of Yazd, Iran), and American hospitals were used for comparison purposes in this paper.

The Integrative Therapy Nurse: A Valuable Player in Symptom Management.

With the support of colleagues and hospital management, the author, an RN with board certification in therapeutic massage and bodywork, developed and implemented the role of the integrative therapy nurse on the spinal cord injury and disorders unit at the Minneapolis Veterans Affairs Medical Center. The goal of this initiative was to provide patients with additional nonpharmacologic options for addressing their symptoms through the creation of an integrative therapy nurse role within the existing interdisciplinary team of physicians, NPs, psychologists, registered dieticians, physical therapists, occupational therapists, speech pathologists, and staff nurses. This article outlines the process of creating this role, discusses implications for practice, and reports the outcomes of three years of its implementation. The outcomes of decreased pain and increased relaxation among the veterans who participated in this initiative warrant its further expansion to additional clinical settings.

CULTURA DE SEGURANÇA DO PACIENTE: AVALIAÇÃO PELOS PROFISSIONAIS DE ENFERMAGEM

RESUMO Objetivo: avaliar a cultura de segurança do paciente das equipes de enfermagem no contexto hospitalar. Método: sob o ponto de vista da enfermagem foi realizado um estudo quantitativo, tipo survey, transversal. A coleta de dados ocorreu entre junho e julho de 2013. Foi utilizado o questionário Hospital Survey on Patient Safety Culture, respondido por 437 profissionais da equipe de enfermagem, com taxa de resposta de 100%. Resultados: entre as doze dimensões avaliadas, apenas seis apresentaram taxas de respostas positivas maiores que 50%, sendo frequência de relato de eventos (61,4%), aprendizado organizacional - melhoria contínua (60,5%), respostas não punitivas aos erros (58%), trabalho em equipe dentro da unidade (57,1%), passagem de plantão/turnos e transferências (53,1%) e retorno da informação e comunicação sobre erro (51,8%). Conclusão: para o alcance de cultura de segurança positiva são necessárias ações de melhoria que envolvam a gestão e as chefias no que se refere: percepção geral da segurança; expectativas sobre o supervisor/chefe e ações promotoras da segurança; abertura da comunicação; apoio da gestão hospitalar para a segurança do paciente e trabalho em equipe entre as unidades.

Similarities and differences in the associations between patient safety culture dimensions and self-reported outcomes in two different cultural settings: a national cross-sectional study in Palestinian and Belgian hospitals

ObjectivesTo investigate the relationships between patient safety culture (PSC) dimensions and PSC self-reported outcomes across different cultures and to gain insights in cultural differences regarding PSC.DesignObservational, cross-sectional study.SettingNinety Belgian hospitals...

Assessment of patient safety culture in a rural tertiary health care hospital of Central India

Background: A safety culture assessment provides an organization with a basic understanding of the safety related perceptions and attitudes of its managers and staff. While patient safety has been a major area of research in industrialized nations for over a decade, data on the root causes of unsafe care in low-income settings is sparse. The objective of the study was to assess the patient safety culture in a rural tertiary health care hospital situated in Central India.Methods: A survey conducted during year 2015, in a rural tertiary health care teaching hospital, Maharashtra (India). The study participants were the 156 hospital staff working in various clinical work areas. The agency for healthcare research and quality hospital survey on patient safety culture, a validated instrument is used as an assessment tool.Results: Total 144 participants included in the study, 75 (52%) were females and rest were males 48%. Out of these 111 (77), maximum number of staff (57.05%) was belonging to different intensive care units. 57% of participants had worked in the hospital for 1 to 5 years. For the unit level safety culture dimension, the maximum composite score of positive responses was obtained for “Organizational learning- continuous improvement” (67%) followed by “Hospital management support for patient safety” (65%). On the other hand only 48% survey participants gave an affirmative opinion with respect to “Feedback and communication about error”. For the hospital wide dimensions response rate was obtained as 62% for the “Teamwork across Hospital Units” while for the dimension “Hospital Handoffs & Transitions”, the score came out as 55%.Conclusions: The perception of patient safety and standards of patient safety were fairly good in the present rural tertiary health care hospital, but there is an ample of prospect in improvement with regard to event reporting, feedback and non punitive error.

Patient Safety Culture Status and Its Predictors among Healthcare Workers

<p>Good patient safety culture of healthcare professionals brings about fine consequences for patients. This study, therefore, aimed in evaluating the current status and predictors of safety culture among healthcare workers in Mekelle Zone hospitals, Tigray, Northern Ethiopia. A cross-sectional survey was conducted among 325 healthcare workers in three hospitals of Mekelle city from February to May, 2017. Simple random sampling technique was employed to select study subjects. Data was analyzed using SPSS. Logistic regression was used to determine the predictors of patient safety culture among healthcare workers at 95% confidence level and 5% level of significance. Statistical significance was set at p <0.05. Of the 325 Healthcare workers, 21.6% rated the culture of patient safety as satisfactory and 78.4% rated as unsatisfactory. Old aged healthcare workers (AOR=21.9, 95% of CI: 2.51-61.69) and ‘hospital management support for patient safety’ (AOR=2.68, 95% CI=1.06-6.79) were strong predictor of satisfactory patient safety culture. Satisfactory patient safety culture grade obtained was only 21.6%, indicating that health care professionals are not delivering patient centered service and there is a lot of work to be done in the hospitals to improve culture of patient safety among healthcare workers. </p>

Patient safety culture as a quality indicator for a safe health system: Experience from Almadinah Almunawwarah, KSA.

ObjectivesSafety culture assessments allow healthcare organisations to get a clear understanding of those aspects of patient safety requiring urgent attention and highlight safety culture strengths and weaknesses. This study aimed to evaluate the extent to which the culture supports patient safety at a hospital in KSA.MethodsA cross-section analytical observational study was conducted at King Fahad Hospital in Almadinah Almunawwarah, KSA.ResultsAfter the survey, the staff felt less certain about the patient safety culture inside the institution. The greatest positive scores were obtained for teamwork within units, safety culture composites, feedback, communication about error, management expectations, actions promoting patient safety, organisational learning, and continuous improvement. However, none of these features achieved a positive score of 75% or more as an area of strength. The rest of the aspects were negatively ranked as areas for probable development, with the lowest scores obtained for non-punitive reaction to error, staffing, hospital handoff and transition, communication openness, and hospital management support for patient safety.ConclusionCommitment to quality care as an outcome is certainly correlated with patient safety. There is a strong need to improve and promote applicable policies to improve the culture of patient safety in hospitals. The development of strong management competence to promote an environment of open consultation and administrative wisdom will contribute to improving patient safety culture.

Patient safety culture in obstetrics and gynecology and neonatology units: the nurses’ and the midwives’ opinion

Background: Patients treated in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events. The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a health care institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety.Methods: We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses’ and midwives’ opinion about patient safety issues. The overall response rate in the survey was 100% (n = 233).Results: The analysis of the dimensions of safety on the unit level showed that the respondents’ most positive evaluations were in the Organizational Learning – Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error Dimensions.Conclusions: On the hospital level, the critical domains in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork Across Hospital Units, and on the unit level – Communication Openness, Teamwork Within Units, Non-punitive Response to Error, and Staffing. The remaining domains were seen as having a potential for improvement.

The contribution of open comments to understanding the results from the Hospital Survey on Patient Safety Culture (HSOPS): A qualitative study.

IntroductionTo develop high-quality and safe healthcare, a good safety culture is an important feature of healthcare-providing structures. The objective of this study was to analyze the qualitative data of the comments section of a Hospital Survey on Patient Safety (HSOPS) questionnaire to clarify the answers given to the closed questions.MethodUsing the original data from a cross-sectional survey of 5,064 employees at a single university hospital in France, we conducted a qualitative study by analyzing the comments of a HSOPS survey and conducting in-depth interviews with 19 healthcare providers. We submitted the comments and the interviews to a thematic analysis.ResultsA total of 3,978 questionnaires were returned, with 247 comments collected. The qualitative analysis identified several structural failures. The main categories of the open comments were concordant with the lowest dimension scores found in the quantitative analysis. The most frequently reported failures were related to the staffing and hospital management support dimensions. The healthcare professionals perceived the lack of resources, including understaffing, as the major barrier to the development of a patient safety culture. Concrete organizational issues related to hospital handoffs and risk coordination were identified, such as transfers from the emergency departments and the lack of feedback following self-reporting of incidents.ConclusionThe analysis of the open comments complemented the HSOPS scores, increasing the level of detail in the description of the hospital’s patient safety culture. Combined with a classical quantitative approach used in HSOPS-based surveys, the qualitative analysis of open comments is useful to identify organizational weaknesses within the hospital.

Improving patient safety in Palestinian hospitals: a cross-sectional and retrospective chart review study

BackgroundPatient safety is the central component of health-care quality. There is a lack of patient safety data in the occupied Palestinian territory. The aim of this study was to assess patient safety and explore relationships between patient safety culture and the prevalence of adverse events at the department level. MethodsBetween May 25, 2009, and June 1, 2010, the Arabic validated Hospital Survey on Patient Safety Culture was used to measure the norms and perceptions of health professionals regarding safety. The survey was used in eight medical departments in two hospitals (Al Makassed hospital and Al Ahli hospital in the West Bank; four departments per hospital). During the same period, a retrospective review of medical records was done to identify adverse events using the validated Palestinian version of the Global Trigger Tool. Descriptive statistics and Spearman's rho coefficient were used. Ethical approval was obtained from the participating hospital boards and the Palestinian health authorities, and written consent was obtained from participants. Findings640 randomly selected records (320 records per hospital) were reviewed, and 428 health-care workers participated in the safety culture assessment (response rate 74%). 213 (50%) participants were nurses, 163 (38%) were doctors, and 52 (12%) were other health-care professionals. Patients had a mean age of 44·2 years (SD 19·6; range 18–95) and a mean length of stay of 4·8 days (SD 5·6; range 1–70). 91 (14%) records included an adverse event. Adverse events were negatively associated with the aggregate safety culture (r=–0·905; p=0·0009), hospital management support (r=–0·881; p=0·0017), non-punitive response to errors (r=–0·731; p=0·019), communication and feedback on errors (r=–0·905; p=0·0009), teamwork (r=–0·886; p=0·0021), organisational learning (r=–0·778; p=0·011), and supervisor actions promoting patient safety (r=–0·857; p=0·0029), indicating that departments with a more positive patient safety culture had lower rates of adverse events. InterpretationsSafety must be improved for Palestinian patients. To promote patient safety, managers and policy makers should acknowledge and allocate resources for enhancing overall safety culture, hospital management support, non-punitive response, communication on errors, teamwork, organisational learning, and supervisor actions. FundingResearch and development, KU Leuven, Leuven, Belgium.