Hospital Management Support Research Articles

Culture of safety in an adult and paediatric emergency department before and after the COVID-19 pandemic

BackgroundThe WHO recognises patient safety as a serious public health problem. The COVID-19 pandemic affected adult EDs (AEDs) and paediatric EDs (PEDs) differently. We compared the culture of safety in...

The Influence of Hospital Physician Integration on Culture of Patient Safety.

Medical errors are responsible for a large number of deaths every year in the Unites States. Hospitals use various strategies including leadership, staffing, and structural changes to deal with this concerning issue. Hospital physician integration is a structural strategy to possibly improve patient safety. Using the conceptual lens of Donabedian's Structure Process Outcome model, this study aims to investigate how hospital physician integration affects organizational, management, and communication attributes of patient safety culture. A pooled cross sectional study design using the Hospital Survey on Patient Safety Culture, the American Hospital Association data, and Area Health Resource File was used to analyze the relationship between hospital physician integration and organizational and management patient safety culture attributes. The dataset comprised of hospital level data from 2021 and 2022 for patient safety culture and hospital characteristics and contained a final sample of 205 observations. The independent variable was levels of integration across five levels. Three attributes of safety culture were chosen-positive perceptions of communication openness, organizational learning, and hospital management support for patient safety. The control variables were organizational characteristics. Multivariable linear regression was used as the analytic method. Findings demonstrated a statistically significant correlation between higher level of hospital physician integration and positive perceptions of hospital management support for patient safety. There are 0.063 higher positive perceptions of hospital management support for patient safety for higher levels of integration compared with lower levels of integration (P < 0.05). Perceptions of communication openness and organizational learning did not demonstrate a statistically significant correlation with any level of hospital physician integration. Hospital physician integration and hospital management support for patient safety were moderately but significantly related. Hospital physician integration allows resources to become available for physician. As physicians take on management roles management of resources and eventually performance can improve, there is a need for future research in this area to examine if integration is a step in the right direction to overcome the challenges of patient safety and if investments in resources and training can be beneficial to safety culture.

Patient Safety Culture in a Tertiary Referral Hospital: Evidence from a Main Criterion in Accreditation

Objectives: In Iran’s accreditation program, the patient safety dimension is one of the main dimensions, holding the highest weight among the accreditation criteria. The purpose of this study was to identify the patient safety culture (PSC) in a tertiary referral hospital. Methods: The current study was conducted between March and April 2021 in a tertiary hospital in Iran. The sample size was 628 participants, selected through simple random sampling. The hospital survey on patient safety culture (HSOPSC) was used to assess provider and staff perceptions about patient safety issues, medical errors, and event reporting. The survey included 32 items that measure 10 dimensions of PSC. Normality tests, along with non-parametric Mann-Whitney and Kruskal-Wallis tests, were used to examine the relationship between PSC and demographic variables using SPSS 22 software. Results: Based on current findings, among the 10 dimensions of PSC, teamwork and organizational learning-continuous improvement received the highest scores (83% positive response), which were higher than these variables in the Agency for Healthcare Research and Quality (AHRQ) data. Conversely, staffing and work pace, as well as hospital management support for patient safety, received the lowest positive scores (43% and 55% positive response, respectively), which were lower than these variables in the AHRQ data. There was a significant positive relationship between dimensions of PSC and older age, female gender, staff with longer working experience, and longer work hours per week (P &lt; 0.05). Conclusions: The majority of our participants felt that patient safety needs to be enhanced. Based on the findings of this study, it is recommended to emphasize the dimensions of “staffing and work pace” and “hospital management support for patient safety” more in the accreditation criteria to strengthen these dimensions in hospitals. Additionally, we have introduced a comprehensive guide for using an international tool to measure PSC, which hospitals can use to succeed in annual accreditation.

PATIENT SAFETY CULTURE ANALYSIS IN THE STAFF OF A SPECIALTY HOSPITAL IN ECUADOR: A CROSS SECTIONAL STUDY.

Background There are millions of deaths attributable to low levels of quality and patient safety in healthcare. One of the first steps in the journey to high reliability is to establish a solid patient safety culture. This study sought to determine the level of patient safety culture in the personnel of a specialty Hospital in Ecuador. Methods A cross-sectional study was conducted with a descriptive phase comprising the presentation of results of the patient safety culture level in the staff, and an analytical phase to determine conditioning factors of this aspect. Results 344 hospital staff answers were included in the study. The most significant group of personnel who responded to the survey corresponded to medical staff (39.83%). An overall patient safety culture level of 63.86% was determined, with higher scores observed in leadership positions (73,55%) and among the medical staff (69,90%), followed by support positions (60,97%), Other staff positions (60,44%), and nursing (56,74%). The dimensions of patient safety culture identified as strengths were teamwork and hospital management support in patient safety, and as improvement areas figured response to error, and staffing and work pace. Significant differences were found between the results of the patient safety culture domains and: staff position, working time in the hospital, working time in the current area or unit, weekly working hours, and typical contact with patients during daily activities (p &lt; 0.05). Conclusions The patient safety culture level in the Ecuadorian context was determined, as well as its strengths and improvement areas. In this study, the support of hospital management support in patient safety stands out as a strength. Additionally, aspects of the staff were found to be significantly associated with the results of the patient safety culture dimensions indicating potential areas of focus for efforts to improve patient safety culture.

From Reporting to Improving: How Root Cause Analysis in Teams Shape Patient Safety Culture.

Given the increasing focus on patient safety in healthcare systems worldwide, understanding the impact of Continuous Quality Improvement Programs (QIPs) is crucial. QIPs, including Morbidity and Mortality Conferences (MMCs) and Experience Feedback Committees (EFCs), have been identified as effective strategies for enhancing patient safety culture. These programs engage healthcare professionals in the identification and analysis of adverse events to foster a culture of safety (ie the product of individual and group value, attitudes, and perceptions about quality and safety). This study aimed to determine whether patient safety culture differed regarding care provider participation in MMCs and EFCs activities. A cross-sectional web-only survey was conducted in 2022 using the Hospital Survey on Patient Safety Culture (HSOPS) among 4780 employees at an 1836-bed, university-affiliated hospital in France. We quantified the mean differences in the 12 HSOPS dimension scores according to MMCs and EFCs participation, using Cohen d effect size. We performed a multivariate analysis of variance to examine differences in dimension scores after adjusting for background characteristics. Of 4780 eligible employees, 1457 (30.5%) participated in the study. Among the respondents, 571 (39.2%) participated in MMCs or EFCs activities. Participants engaged in MMCs or EFCs reported significantly higher scores in six out of twelve HSOPS dimensions, particularly in "Nonpunitive response to error", "Feedback and communication about error", and "Organizational learning" (Overall effect size = 0.14, 95% confidence interval = 0.11 to 0.17, P<0.001). Notably, involvement in both MMCs and EFCs was associated with higher improvements in patient safety culture compared to non-participation or singular involvement in either program. However, certain dimensions such as "Staffing", "Hospital management support", and "Hospital handoffs and transition" showed no significant association with MMCs or EFCs participation, highlighting broader systemic challenges. The study confirms the positive association between participation in MMCs or EFCs and an enhanced culture of patient safety, emphasizing the importance of such programs in fostering an environment conducive to learning, communication, and nonpunitive responses to errors. While MMCs or EFCs are effective in promoting certain aspects of patient safety culture, addressing broader systemic challenges remains crucial for comprehensive improvements in patient safety.

Barriers and Challenges in Implementing Clinical Pathway of Sectio Caesarea for Health Workers in a Private Hospital

Clinical pathway (CP) is one of the requirements required in hospital accreditation standards. It has an important role in controlling quality, and costs and supporting patient safety, especially in cases that have the potential to consume large amounts of resources, one of which is a sectio cesarean (SC). Apart from being able to reduce maternal mortality due to normal childbirth, SC procedures can also cause post-operative injuries. This research explores the barriers and challenges to implementing the sectio caesarean clinical pathway among health workers in hospitals. This qualitative case study research recruited 10 informants consisting of 3 obstetricians, 2 executive nurses, the head of the inpatient room, the head of the operating room, the deputy director of medical services, and 2 patients who had undergone SC at the hospital purposively. In-depth interviews were conducted in March 2024 at a private hospital in Bandar Lampung, Indonesia. Thematic analysis was used for data analysis. Several themes emerged as obstacles to the implementation of CP SC in this research, namely: 1) individuals, 2) patients, 3) infrastructure, and 4) hospital management support. Apart from that, the challenges faced include the need to carry out socialization, monitoring, and evaluation activities, as well as collaborative activities between health workers and hospitals to share experiences to increase compliance in implementing CP SC. Hospital management is expected to provide regular outreach, training, and personal approaches to health workers regarding the implementation of CP SC. Collaboration between professionals and hospitals is also needed to share experiences regarding the implementation of sectio caesarean clinical pathways in hospitals.

Exploring the perception of safety culture among nurses in Saudi Arabia

BackgroundMedical errors and adverse events pose a serious challenge to the global healthcare industry. Nurses are at the frontline in implementing safety measures and protecting patients. This study aimed to investigate nurses’ perceptions of the patient safety culture in Saudi Arabia.MethodsThis cross-sectional descriptive study used convenience sampling to survey 402 nurses from various hospitals in Jazan, Saudi Arabia. The Hospital Survey on Patient Safety Culture was used for the data collection.ResultsNurses reported a moderate perception of safety culture, with 60% positive responses. Teamwork had the highest safety culture rating at 77.8%, while responses to error and staffing were the lowest at 39.75% and 46.17%, respectively. Qualifications significantly predicts nurses’ safety culture rating (B = -0442, t = -4.279, p < 0.01). Positive correlations were found between event reporting frequency and communication openness (r = 0.142, p < 0.01), and patient safety grades with communication about errors (r = 0.424, p < 0.01) and hospital management support (r = 0.231, p < 0.01).ConclusionsNurses in Saudi Arabia demonstrated a strong sense of teamwork and commitment to organizational learning. However, critical areas such as staffing and error response require attention to improve patient safety.

THE HIDDEN IMPACTS OF OCCUPATIONAL STRESS ON PATIENT SAFETY CULTURE

Introduction: Previous studies have shown that over 45% of healthcare workers exhibit symptoms of stress, but the impacts of occupational stress on patient safety culture (PSC) are not well understood. Objectives: This study was to determine the relationship between occupational stress and PSC at Pham Ngoc Thach Hospital in 2022. Methods: A cross-sectional study was conducted on 390 healthcare workers at Pham Ngoc Thach Hospital in November 2022. Data was collected using the Vietnamese version of the HSOPSC 2.0 tool (Cronbach’s alpha 0.68-0.93) and the DASS-21-S. Results: The results showed that 15% of healthcare workers had mild to severe stress. The average PSC score was 3.13 with a standard deviation of 0.36 (5-point Likert scale). Higher occupational stress was associated with lower overall PSC. Specifically, occupational stress negatively impacted three domains of patient safety: teamwork, error communication, and hospital management support for patient safety. Conclusion: This study demonstrates that reducing healthcare worker stress could be an intervention to improve PSC. Hospitals should consider implementing workplace stress relief initiatives as an important factor in promoting PSC in healthcare, which can directly impact patient health and satisfaction.

Associations between patient safety culture and workplace safety culture in hospital settings

BackgroundStrong cultures of workplace safety and patient safety are both critical for advancing safety in healthcare and eliminating harm to both the healthcare workforce and patients. However, there is currently minimal published empirical evidence about the relationship between the perceptions of providers and staff on workplace safety culture and patient safety culture.MethodsThis study examined cross-sectional relationships between the core Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey 2.0 patient safety culture measures and supplemental workplace safety culture measures. We used data from a pilot test in 2021 of the Workplace Safety Supplemental Item Set, which consisted of 6,684 respondents from 28 hospitals in 16 states. We performed multiple regressions to examine the relationships between the 11 patient safety culture measures and the 10 workplace safety culture measures.ResultsSixty-nine (69) of 110 associations were statistically significant (mean standardized β = 0.5; 0.58 < standardized β < 0.95). The largest number of associations for the workplace safety culture measures with the patient safety culture measures were: (1) overall support from hospital leaders to ensure workplace safety; (2) being able to report workplace safety problems without negative consequences; and, (3) overall rating on workplace safety. The two associations with the strongest magnitude were between the overall rating on workplace safety and hospital management support for patient safety (standardized β = 0.95) and hospital management support for workplace safety and hospital management support for patient safety (standardized β = 0.93).ConclusionsStudy results provide evidence that workplace safety culture and patient safety culture are fundamentally linked and both are vital to a strong and healthy culture of safety.

Acceptance and adoption of tele-rehabilitation by physiotherapists from Nigeria, a low resource setting: a mixed-method study

BackgroundAdoption of tele-rehabilitation among physiotherapists in developed countries has risen exponentially to complement conventional physical contact physiotherapy. However, many low- and middle-income countries like Nigeria where barriers to utilization of tele-physiotherapy were earlier identified still demonstrates limited evidence on its acceptance and adoption till date.MethodThis was a mixed-method design of quantitative and qualitative study, aimed at investigating acceptance and adoption of tele-rehabilitation among physiotherapists in Nigeria. Respondents comprised 331 physiotherapists practising in Nigeria and registered with the Medical Rehabilitation Therapists (Registration) Board of Nigeria (MRTB). Quantitative approach involved completion of a 33-item structured questionnaire shared as Google Forms to respondents’ WhatsApp and emails. Qualitative aspect involved in-depth interview with 12 physiotherapists at the clinics, using a 10-item semi-structured interview guide, and recorded with a voice recorder. Quantitative data was analysed using descriptive and inferential statistics at p < 0.05 alpha level. Qualitative data was analysed using thematic content analysis.ResultsRespondents comprised 172 males and 159 females. Their mean age and years of experience were 33.42 ± 8.95 and 8.86 ± 8.037 years, respectively. Pre-lockdown, only 62 (18.7%) respondents offered tele-physiotherapy. During the 35-day total lockdown, 114 (34.4%) offered tele-physiotherapy. Majority (155 (46.8%)) used smartphone apps. Fifty-seven (17.2%) respondents were confident that tele-rehabilitation can complement conventional physiotherapy, while 72 (21.8%) kept offering post-lockdown. Use of digital technology was highest for patient education (97 (29.3%)), especially for musculoskeletal conditions (85 (25.7%)). There were significant associations between pre-lockdown duties (p = 0.036), post-lockdown duties (p = 0.005) and use of digital health technology (p = 0.001) with respondents’ age. Significant associations also existed between respondents’ years of practice and each of post-lockdown duties (p = 0.017) and use of digital health technology (p = 0.001). Qualitative approach revealed that facilitators to adoption and acceptance of tele-rehabilitation included patient education, training of physiotherapists, availability of evidence-based guidelines and tele-health software and hardware systems. Barriers were lack of or limited technological infrastructures, finances, hospital management support, and knowledge of information and communication technology.ConclusionsPhysiotherapists in Nigeria demonstrated moderate acceptance but low adoption of tele-rehabilitation, in varied comparison with clinicians and physiotherapists in other climes. Training of physiotherapists in tele-rehabilitation and provision of enabling technological environment by regulatory bodies and policy makers are recommended.

A Literature Review on the Korean Dental Hygienist Licensing Examination and Core Competencies

Objective: This study aimed to suggest methods to improve the korean dental hygienist licensing examination to review related literatures. Methods: This study is a literature review on the national dental hygienist examination and confirmed the dental hygienist national examination and core competencies, focusing on a total of 14 manuscripts and reports. Results: The research task of the national examination institute was conducted in the direction of evaluating the dental hygienist's job or core competency to perform in actual clinical practice. The dental hygienist’s core competencies include oral health education, treatment and clinical areas, occupational ethics, and hospital management support. Conclusions: The national examination continuously analyzed the duties and core competencies of dental hygienists to improve the national examination. In recent studies, the field was specialized according to the professional dental hygienist system.

Psychometric Analysis of the Indian Version of the Patient Safety Culture Tool (I-HSOPSC 2.0) Validation

Patient safety, which is both an overarching principle and a key factor in determining the quality of healthcare, continues to be a priority in healthcare systems on a global scale. A cross-sectional study in accredited Indian hospitals aimed to evaluate the HSOPSC V-2 (Hospital Survey on Patient Safety Culture). 1,603 healthcare professionals participated, assessing psychometric features using confirmatory factor analysis in SMART PLS 4. The average composite positive response rate was 64.8%. High positive responses (79%) were seen in ‘teamwork’, ‘communication about error’, and ‘hospital management support for patient safety’. However, ‘staffing and work pace’ (30%), ‘response to error’ (50%), ‘communication openness’, and ‘reporting patient safety events’ (both 59%) had lower positive responses, indicating room for improvement. Findings suggest I-HOSPSC 2.0’s content validity, reliability, and construct validity in measuring patient safety culture in Indian hospitals. It can aid administrators in assessing safety culture and improving patient safety and treatment efficacy. Notably, this is the inaugural HSOPSC V-2 validation research in the Indian healthcare context. Future research should explore the tool’s psychometric properties based on care setting levels due to substantial differences between public and private healthcare setups in India.

Patient safety culture predictors and outcomes for sustainable oncology nursing practice: A cross-sectional correlational study.

To examine the predictors and outcomes of patient safety culture (PSC) among oncology nurses working in public Saudi hospitals according to participant characteristics and evaluate the relationship between PSC domains. PSC is crucial in healthcare systems, particularly in oncology and chemotherapy units, and its assessment can enhance the standard service provided and cancer care quality. There is currently limited research on the status, predictors and outcomes of PSC in cancer care settings in developing countries, including Saudi Arabia. A cross-sectional correlational study. A convenience sample of 101 oncology nurses working in two large Saudi tertiary care hospitals participated in this study. The Hospital Survey on Patient Safety Culture validated instrument and demographic and work surveys were completed by the participants. The study methods were compliant with the STROBE checklist. Descriptive statistics and multiple linear regressions were used to analyse the data. The areas of PSC strength were related to organizational learning-constant improvement, feedback and communication about errors, and transitions and handoffs. Manager/supervisor actions and expectations, hospital management support, communication openness, experience in the current unit and oncology unit/area were the predictors of PSC. In terms of PSC outcomes, the oncology nurses reported either no or one to two adverse events and a substantially good patient safety rating. The level of PSC was lower than expected. Communication openness, experience in the current unit and oncology unit/area were the strongest predictors of PSC. Investing in oncology nursing practice that addresses these concerns and prioritizes patient safety is critical in Saudi cancer care settings to increase patient safety. The findings contribute to a better understanding of the predictors and outcomes of PSC, which should be considered when establishing effective nursing interventions or strategies for PSC in cancer care settings. No patient or public contribution.

Patient Safety Culture, Infection Prevention, and Patient Safety in the Operating Room: Health Workers' Perspective.

A hospital's patient safety culture affects surgical outcomes. Operating room safety culture has been overlooked despite the importance of patient safety. The AHRQ's Hospital Survey on Patient Safety Culture (HSOPSC) has been used worldwide to assess and enhance patient safety culture. This study examined how patient safety culture and infection prevention effect patient safety in the Operating Room (OR). This observational study used an online survey and included 143 OR workers. Descriptive statistics and multilinear regression were used to examine how patient safety culture and infection prevention affects level of patient safety. Most responders worked in excellent-accredited general hospitals. Most responders were male, aged between 26 to 40 years old, and had bachelor's degrees. Most were hospital-experienced nurses. Less than half had worked in units for over ten years. Organizational Learning - Continuous Improvement; Teamwork and Handoffs; and Information Exchange had the most positive responses in the OR. However, Staffing, Work Pace, and Patient Safety ranked lowest. Organizational Learning - Continuous Improvement and Hospital Management Support for Infection Prevention Efforts were found to affect OR patient safety level perceptions. According to the findings of our study, the overall patient safety culture in the operating room remains weak which highlights the importance of continuing efforts to improve patient safety in the OR. Further study could be directed to identify organizational learning in infection prevention to enhance the patient safety in the OR.

The Effect of Professional Autonomy and Nursing Work Environment on Nurses’ Patient Safety Activities: A Perspective on Magnet Hospitals

Aim. This study aimed to identify the effects of nurses’ professional autonomy and work environment on patient safety in general hospitals. By understanding this relationship, we sought to identify practical measures to improve patient safety in the healthcare context. Background. Professional autonomy and nursing work environments have positive effects on job performance, job satisfaction, and patient outcomes. Methods. Data were collected from 200 nurses working in general hospitals, using a cross-sectional survey design. The survey was conducted in 2021 using self-report questionnaires that included the Nursing Work Environment Scale and items on professional autonomy and patient safety activities. Results. The total professional autonomy score was 162.06 (range: 60–240). The mean scores of nursing work environment and nurses’ patient safety activities were 2.55 out of 4 and 4.22 out of 5, respectively. Multiple regression analysis revealed that professional autonomy (β = 0.234 and p = 0.001 ) and nursing work environment (β = 0.138 and p &lt; 0.05 ) were identified as variables that had significant effects on patient safety activities. Among the independent variables, professional autonomy had the greatest influence on patient safety. Conclusion. The findings confirm the need to improve and find ways to enhance nurses’ professional autonomy and nursing work environment. Implications for Nursing Management. The findings confirm the need to improve and find ways to enhance nurses’ professional autonomy and the nursing work environment. Based on these findings, medical institutions and nursing managers should continue to make efforts to improve the nursing work environment to enhance patient safety, especially system improvements, expand nurse autonomy within medical institutions, strengthen hospital management support to evaluate its effectiveness, and further improve government-level policies and systems.

Patient safety culture among healthcare professionals in Bhutan

Introduction: There is dearth of information regarding the status of patient safety culture in Bhutanese healthcare system. The aim of the study was to assess the baseline patient safety culture among the healthcare professionals working in different levels of hospitals in Bhutan. Methods: A cross-sectional study was conducted using the Hospital Survey on Patient Safety, version 2 (HSOPS2) questionnaire in 2021 in six District Hospitals (DHs), two Regional Referral Hospitals (RRHs), and one National Referral Hospital (NRH) in Bhutan. A total of 782 healthcare professionals were recruited into the study. EpiData version 3.0 and Statistical Package for Social Science (SPSS) version 28.0 were used to process data and conduct the statistical analysis on survey data including descriptive statistics and validity and reliability of survey. The internal consistency reliability of each composite measure was assessed by calculating Cronbach’s alpha score. Results: The overall level of patient safety culture was 61.28% (95% CI: 113.26, 115.27) and the percentage scores for the ten patient safety dimensions ranged from 45.13% to 82.65%. The dimension, “Teamwork within the hospital units” had the highest positive score while the dimensions, “Staffing and work pace” and “Reporting patient safety events” had the lowest positive scores. Conclusions: The healthcare professionals working in hospitals in Bhutan had average patient safety culture. To improve patient safety culture, more emphasis should be given on human resource management, patient safety event reporting system, hospital management support for patient safety and quality improvement initiatives and creating an environment that promote just and learning culture.

Patient Safety Perception Within Hospitals: An Examination of Job Type, Handoffs and Information Exchange, and Hospital Management Support.

The study has 3 aims: (1) to assess to what extent a person's job role relates to their evaluation of patient safety in the hospital setting; 2) to identify the relationship from hospital management aspects, including level of organizational learning-continuous improvement, level of management support, and level of leader support to patient safety perception in the hospital setting; and 3) to examine the relationship between the rating of the ease of information exchange and clinical handoffs and perceived patient safety in the hospital setting. This study used a publicly available, deidentified cross-sectional data set from the 2021 Agency for Healthcare Research and Quality's Survey on Patient Safety Culture Hospital Survey 2.0. Welch's analysis of variance and multiple linear regression were used to examine each factor's impact on patient safety rating. Supervisors had a higher ( P < 0.001) patient safety perception than people in other job types, whereas nurses had a lower ( P < 0.001) patient safety perception than other job types. Level of organizational learning-continuous improvement ( P < 0.001), level of hospital management ( P < 0.001), level of leader support ( P < 0.001), and ease of handoffs and information exchange ( P < 0.001) were positively related to perceived patient safety. This study highlights the importance of identifying the unique issues affecting nurses and supervisors, different from other job types, that may explain their lower patient safety ratings. Findings from this study suggest that it is critical for organizations to focus on initiatives and policies that promote leadership, management, ease in information exchange and handoffs, and continuous learning.

Testing the association between the enabling and enacting factors of patient safety culture and patient safety: structural equation modelling

BackgroundDespite evidence linking a safety culture with patient safety, the processes by which aspect of safety culture influences patient safety are not yet well understood. Thus, this study aimed to test a theoretical model of the relationships between three enabling factors (supervisor/clinical leader support for patient safety, hospital management support for patient safety, and psychological safety), and four enacting factors of patient safety culture (handoffs and information exchange, teamwork, error reporting intention, and withholding voice) with nurse assessments of patient safety.MethodsA cross-sectional, descriptive correlational study design was used. Between May and June 2020, 526 nurses who provided direct care to patients in medical surgical units in three Korean hospitals completed an online survey that included four standardized scales or subscales. Structural equation modelling was used to test the hypothesized model.ResultsAmong the three enabling factors, psychological safety was associated with all four enacting factors, and all enacting factors were associated with overall patient safety. Hospital management support was associated with all enacting factors except teamwork, but supervisor/clinical leader support was associated with only handoffs and information exchange, and withholding voice. Thus, teamwork was influenced only by psychological safety. Findings demonstrate overall support for the theoretical model of safety culture wherein enabling factors influence enacting factors which, in turn, lead to patient safety outcomes, but emphasize the critical nature of psychological safety among nursing staff.ConclusionThis study provides further insight into the importance of support from hospital management and unit supervisors/clinical leaders for patient safety to motivate and enable hospital nurses to enact behaviours necessary for patient safety. However, such support must also take the form of enhancing psychological safety for nursing staff.

Impact of workplace bullying and burnout on job satisfaction among Bangladeshi nurses: A cross-sectional study

BackgroundJob satisfaction is one of the most important but least researched issues in the nursing profession in Bangladesh. This study aimed to investigate how workplace bullying and burnout are related to job satisfaction, as well as determine the factors that are associated with job satisfaction among Bangladeshi nurses. MethodsData were collected from Bangladeshi registered nurses between February 26, 2021, and July 10, 2021, in this cross-sectional study. Bullying, burnout, and job satisfaction were measured with the Short Negative Acts Questionnaire [S-NAQ], the Burnout Measure-Short version (BMS), and the Short Index of Job Satisfaction (SIJS-5), respectively. The correlations between age, bullying, burnout, and job satisfaction were assessed using a Pearson's correlation test. In order to investigate the adjusted association of demographic characteristics, occupational variables, bullying, and burnout with job satisfaction, multiple linear regression models were fitted. ResultsThe study included 1,264 nurses (70.02% were female) with a mean age of 28.41 (±5.54) years. Job satisfaction was significantly negatively correlated with bullying and burnout (p < 0.001). According to the multiple linear regression models, the private-employed nurses had lower job satisfaction than the government-employed nurses (β = −0.901, CI: −1.640 to −0.162). Compared to the nurses in the Dhaka division, the nurses in the Chattogram division (β = 0.854, CI: 0.099 to 1.609) and other divisions (β = 0.993, CI: 0.273 to 1.713) had higher job satisfaction. Nurses without sufficient equipment to manage patients (β = −1.230, CI: −1.696 to −0.763), and nurses not paid on time (β = −1.475, CI: −2.221 to −0.729) were predicted to have significantly lower job satisfaction. Nurses’ job satisfaction levels were decreased with higher levels of workplace bullying (β = −0.086, CI: −0.120 to −0.053), and burnout (β = −1.040, CI: −1.242 to −0.838). ConclusionsNurses' job satisfaction was correlated with workplace bullying and burnout. Moreover, insufficient professional support from the authorities predicted nurses' job satisfaction. Reducing the instances of bullying and burnout among nurses, as well as improving their working environment, are essential to increase job satisfaction. This is possible with the support of hospital management, policymakers, and government authorities.

Determination of the Enablers and Challenges in the Implementation of Pharmacy-based Antimicrobial Stewardship (AMS) Program in a Level 3 Hospital in Manila.

Antimicrobial resistance (AMR) is a global public health threat that results from misuse and overuse of antimicrobials. The Department of Health (DOH) institutionalized the Antimicrobial Stewardship (AMS) Program in hospitals, based on the core elements (1) Leadership, (2) Policies, Guidelines, and Pathways, (3) Surveillance Antimicrobial Use (AMU) & AMR, (4) Action, (5) Education, and (6) Performance Evaluation to ensure rational use of antimicrobials and improve patient outcomes. The program implementation will require the involvement of the AMS clinical pharmacist to positively influence the success of the program's implementation. This study aims to identify the enablers and challenges as perceived by AMS clinical pharmacists in the implementation of an AMS program in a level 3 hospital in Manila. A quantitative descriptive study design was employed by administering an online 50-item survey questionnaire to AMS pharmacists, who have at least six (6) months of experience as an AMS pharmacist in the hospital. The survey questionnaire was validated by an expert consultant and underwent pre-testing (Cronbach α = 0.983) for acceptable internal consistency. Responses were collated, coded, and analyzed using median values and frequency distributions for each questionnaire item per Department of Health (DOH) Core Element. Items garnering a median of >3.50 up to 5 were considered as perceived enablers, while those ≤3.50 were identified as perceived challenges. Some perceived enablers by the AMS pharmacists include presence of a leader and/or clinician in the AMS team, Information Technology (IT) resource availability, clear roles of AMS pharmacists, readily available hospital AMS guidelines, engagement in AMR and AMU surveillance activities, regular performance of AMS interventions (e.g., IV-to-PO conversion, dose optimization, de-escalation of broad spectrum), regular monitoring and evaluating of prescriptions and prescribing behavior, and continuous education on infection, prevention, and control (IPC) and hygiene. On the other hand, some perceived challenges include insufficient funding, inadequate knowledge in interpreting antibiograms, lack of adequate and specialized training sessions, lack of coordination with medical and nursing staff to ensure timely drug administration and automatic stop order, prescribing of non-Philippine National Formulary (PNF) antimicrobials, lack of time to perform AMS activities, lack of qualified personnel, and lack of hospital management and information technology (IT) support. Empowering AMS clinical pharmacists is vital to addressing the perceived challenges and maximizing the perceived enablers to ensure the successful implementation of the AMS program in the hospital.