Hospital Management Support Research Articles

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.

Examining the factors affecting the adoption of e-health innovative technology

In today's world, many modern health facilities have started using e-health with the aim of improving health services by managing its costs, patient waiting time, and other services. Nevertheless, there are numerous studies exploring the barriers to e-health adoption. Concentrating on innovation in the healthcare industry, the present study explores the external factors that predict patients' behavioural intention to use a personal health record (PHR) as an important part of the electronic patient-physician relationship. Empirical research is used to identify a conceptual framework illustrating the relation between patients' behavioural intention and the proposed factors: governmental incentives, physician support and hospital management support. The framework is tested by using data collected from Canada as a case study through a well-designed survey. The results of multiple regression analysis indicate that the proposed factors were significantly predicted as the perceived ease of use and perceived usefulness of PHR innovative technology. The perceived usefulness factor was significantly predicted in the behavioural intention to use PHR. Some procedures and actions should be considered by government and healthcare policy makers to manage the adoption and support the usage of PHR application.

Examining the factors affecting the adoption of e-health innovative technology

In today's world, many modern health facilities have started using e-health with the aim of improving health services by managing its costs, patient waiting time, and other services. Nevertheless, there are numerous studies exploring the barriers to e-health adoption. Concentrating on innovation in the healthcare industry, the present study explores the external factors that predict patients' behavioural intention to use a personal health record (PHR) as an important part of the electronic patient-physician relationship. Empirical research is used to identify a conceptual framework illustrating the relation between patients' behavioural intention and the proposed factors: governmental incentives, physician support and hospital management support. The framework is tested by using data collected from Canada as a case study through a well-designed survey. The results of multiple regression analysis indicate that the proposed factors were significantly predicted as the perceived ease of use and perceived usefulness of PHR innovative technology. The perceived usefulness factor was significantly predicted in the behavioural intention to use PHR. Some procedures and actions should be considered by government and healthcare policy makers to manage the adoption and support the usage of PHR application.

Nurses′ perceptions of patient safety culture in emergency departments of tertiary hospitals in Sichuan province

Objective To explore nurses′ perceptions of patient safety culture in emergency departments at tertiary hospitals in Sichuan province. Methods By convenient sampling method, a total of 210 emergency nurses from 6 tertiary hospitals in Sichuan province were investigated with a general data questionnaire and a hospital survey on patient safety scale. Results 68.10% of the emergency nurses had positive perceptions of patient safety culture, as evidenced by the following indicators. The organization learning and continuous improvement (74.27%), hospital management support for patient safety (72.70%), supervisor/manager expectations and actions promoting safety (78.10%), were the safety culture areas with higher percentage of positive response. Areas of non-punitive response to errors (19.67%), staffing (41.08%) had the lowest percentage of positive response. There were significant differences between such groups as years of working, education background and job title. Conclusions Patient safety culture should be improved in the emergency departments of the tertiary hospitals in Sichuan province, especially in the adverse events reporting system and staffing problem. Safety training deserves greater attention in nurses with less working experience, education background or job title in emergency departments. Key words: Sichuan province; Emergency department; Nurse; Patient safety culture; Survey

How Does Patient Safety Culture in the Surgical Departments Compare to the Rest of the County Hospitals in Xiaogan City of China?

Objectives: Patient safety culture affects patient safety and the performance of hospitals. The Hospital Survey on Patient Safety Culture (HSOPSC) is generally used to assess the safety culture in hospitals and unit levels. However, only a few studies in China have measured surgical settings compared with other units in county hospitals using the HSOPSC. This study aims to assess the strengths and weaknesses of surgical departments compared with all other departments in county hospitals in China with HSOPSC. Design: This research is a cross-sectional study. Methods: In 2015, a Chinese translation of HSOPSC was administered to 1379 staff from sampled departments from 19 county hospitals in Xiaogan City (Hubei Province, China) using a simple random and cluster sampling method. Outcome Measures: The HSOPSC was completed by 1379 participants. The percent positive ratings (PPRs) of 12 dimensions (i.e., teamwork within units, organizational learning and continuous improvement, staffing, non-punitive response to errors, supervisor/ manager expectations and actions promoting patient safety, feedback and communication about errors, communication openness, hospital handoffs and transitions, teamwork across hospital units, hospital management support for patient safety, overall perception of safety, as well as frequency of events reported) and the positive proportion of outcome variables (patient safety grade and number of events reported) between surgical departments and other departments were compared with t-tests and X2 tests, respectively. A multiple regression analysis was conducted, with the outcome dimensions serving as dependent variables and basic characteristics and other dimensions serving as independent variables. Similarly, ordinal logistic regression was used to explore the influencing factors of two categorical outcomes. Results: A total of 56.49% of respondents were from surgical departments. The PPRs for “teamwork within units” and “organizational learning and continuous improvement” were ≥75%, which denoted strengths, and the PPRs for “staffing” and “non-punitive response to errors” were ≤50%, which denoted weaknesses in surgical units and other units. Three dimensions for surgical departments were weaker than those for other departments (p < 0.05). The staff from surgical units reported more events compared with the other units, but only a few respondents in surgical settings evaluated patient safety grade as good/excellent. Four dimensions influenced patient safety grade, and three dimensions influenced event reporting in surgical units. Conclusions: Strategies including recruiting workers, using the reporting system, and building a non-punitive culture should be adopted in the surgical units of county hospitals in China to improve safety culture. Supervisors should also prioritise patient safety.

Focused group discussion with health care staff improves breastfeeding rates in hospitalized infants

Background Improving breastfeeding in sick infants is essential. During the neonatal care, health care staff play an important role in promoting breastfeeding. Therefore, it is important to study in depth how healthcare staff can improve breastfeeding practice in sick neonates.Objective To compare breastfeeding rates in sick infants before and after a focused group discussion (FGD) of health care staff on how to improve breastfeeding.Methods This study was an operational study using FGD and in-depth interviews as an intervention. A fish bone diagram was used to assess problems that may prevent mothers from breastfeeding their sick infants. Breastfeeding achievement was compared before and after the FGD.Results Of 257 sick infants, 177 subjects were in the before FGD group and 80 subjects were in the after FGD group. Significantly more after FGD subjects were breastfed during hospitalization than before FGD subjects [97.5% vs. 82.9%, respectively; (x2 =9.43; P=0.002)]. Breastfeeding initiation within 0-4 hours of birth was also significantly higher in the after FGD group [10 (12.5%) vs. 6 (3.5%), respectively; (x2 = 52.5; P&lt;0.001)]. The solutions for breastfeeding problems were: 1) support of hospital management, 2) support of healthcare workers for breastfeeding mothers, 3) support of husbands and families for breastfeeding mothers, 4) financial support, 5) other factors such as level of care and consistent FGD events, and 6) a prospective cohort study.Conclusion The FGD with health care staff significantly increases breastfeeding achievement during infant hospitalization, and accelerated breastfeeding initiation. A fish bone diagram is used to effectively assess the problems with breastfeeding programs for sick babies.

Focused group discussion with health care staff improves breastfeeding rates in hospitalized infants

Background Improving breastfeeding in sick infants is essential. During the neonatal care, health care staff play an important role in promoting breastfeeding. Therefore, it is important to study in depth how healthcare staff can improve breastfeeding practice in sick neonates.Objective To compare breastfeeding rates in sick infants before and after a focused group discussion (FGD) of health care staff on how to improve breastfeeding.Methods This study was an operational study using FGD and in-depth interviews as an intervention. A fish bone diagram was used to assess problems that may prevent mothers from breastfeeding their sick infants. Breastfeeding achievement was compared before and after the FGD.Results Of 257 sick infants, 177 subjects were in the before FGD group and 80 subjects were in the after FGD group. Significantly more after FGD subjects were breastfed during hospitalization than before FGD subjects [97.5% vs. 82.9%, respectively; (x2 =9.43; P=0.002)]. Breastfeeding initiation within 0-4 hours of birth was also significantly higher in the after FGD group [10 (12.5%) vs. 6 (3.5%), respectively; (x2 = 52.5; P&lt;0.001)]. The solutions for breastfeeding problems were: 1) support of hospital management, 2) support of healthcare workers for breastfeeding mothers, 3) support of husbands and families for breastfeeding mothers, 4) financial support, 5) other factors such as level of care and consistent FGD events, and 6) a prospective cohort study.Conclusion The FGD with health care staff significantly increases breastfeeding achievement during infant hospitalization, and accelerated breastfeeding initiation. A fish bone diagram is used to effectively assess the problems with breastfeeding programs for sick babies.

Simulation as a hospital management support tool

This study aims to demonstrate the use of the discrete event simulation technique as a hospital management support tool, as well as all complex processes existing in a health unit. There must be an analysis of the system as a whole from the perspective of service level provided to patients regarding waiting times. The role of this technique is to show the behavior of a given system. Data were collected from employees of a public Polyclinic, located in a city of the greater Sao Paulo, by means of interviews which questions were prepared to determine the time spent in the processes of the service system. Such data were inserted in the software Arena in flowchart format for analysis and identification of the problem. Since the person responsible for the screening process was overloaded, thus causing longer waiting times for patients submitted for screening, some changes were made in the model in order to propose an improvement, to balance the occupancy levels of the health unit’s staff and, at the same time, reach a shorter withdrawal period of patients throughout the system. Results showed a significant improvement in the performance of the Polyclinic’s system, as well as a subsequent improvement in the level of service provided to patients. Based on this study, one can note that simulation allows for evaluating scenarios and projecting changes that will impact the behavior of a certain system with no physical changes, thus preventing the lack of scientific basis when making management decisions and allowing for improvements.

Survey of Cancer Patient Safety Culture: A Comparison of Chemotherapy and Oncology Departments of Teaching Hospitals of Tehran

Background:Patient safety culture plays an important role in healthcare systems, especially in chemotherapy and oncology departments (CODs), and its assessment can help to improve quality of services and hospital care.Objective:This study aimed to evaluate and compare items and dimensions of patient safety culture in the CODs of selected teaching hospitals of Iran and Tehran University of Medical Sciences.Materials and Methods:This descriptive-analytical cross-sectional survey was conducted during a six-month period on 270 people from chemotherapy and oncology departments selected through a cluster sampling method. All participants answered the standard questionnaire for “Hospital Survey of Patient Safety Culture” (HSOPSC). Statistical analyses were performed using SPSS/18 software.Results:The average score for patient safety culture was three for the majority of the studied CODs. Statistically significant differences were observed for supervisor actions, teamwork within various units, feedback and communications about errors, and the level of hospital management support. (p<0.05). Relationships between studied hospitals and patient safety culture were not statistically significant (p>0.05).Conclusion:Our results showed that the overall status of patient safety culture is not good in the studied CODs. In particular, teamwork across different units and organizational learning with continuous improvement were the only two properly operating items among 12 dimensions of patient safety culture. Therefore, systematic interventions are strongly required to promote communication.

일개병원의 환자안전문화 인식도 조사결과

Objectives: This study measures the level of cognition of employee's patient safety culture and evaluates the current level through comparing the results to external levels. Ultimately it is performed to construct a strategic improvement plan through the basic database for patient's safety culture. Methods: A questionnaire survey of self reporting type was carried out using structured questionnaire of the patient's safety culture for employees currently employed in a hospital. Total responders was 1,129 and a response rate was 54.6%. The survey results were calculated with a percent positive response, and the current level was evaluated by comparing with the survey results of a hospital (2009 and 2014) and the survey result of The Agency for Healthcare Research and Quality(2014). Results: Sub-dimension of high percent positive response for each area were 'teamwork within hospital units' (80%), 'feedback & communication about error' (73%) and 'supervisor/manager expectations & actions promoting safety' (67%). Meanwhile, 'teamwork across hospital units' (31%), 'hospital management support for patient safety' (29%), 'staffing' (27%) and 'non-punitive response to error' (17%) were relatively low percent positive response. Compared to the survey results of AHRQ (2014) for each area, 'teamwork within hospital units' (80%), 'feedback & communication about error' (73%), 'frequency of event reporting' (66%) were at the top 50% percentile level and the remaining sub-dimensions showed a very low level in the lower 10% percentile area. Conclusion: In order to establish a system for patient safety culture within the hospital and evaluate the effect on this, it is necessary to periodically evaluate the patient's safety culture and establish regulations on hospital safety culture to comply with this.

Patient safety culture in surgical departments versus other departments in county hospitals of Hubei province, China: a cross-sectional survey

BackgroundPatient safety culture affects hospital safety and performance. The Hospital Survey on Patient Safety Culture (HSOPSC) is widely used to assess the safety culture in hospital and unit level. We aimed to assess strengths and weaknesses of surgical departments compared with others in county hospitals of China with HSOPSC. MethodsA cross-sectional study was conducted in 2015 with a Chinese translation of HSOPSC being administered to 1500 staff from 19 county hospitals in Xiaogan city of Hubei province China. We compared the percentage of positive ratings and outcome dimensions (patient safety grade and number of events) between surgical departments and other departments with t tests and χ2 tests. We explored factors affecting overall perceptions of safety, frequency of events reported, and outcome variables with multiple linear regression, two-level multiple regression, or two-level ordered logistic regression analyses. Findings1379 (92%) of participants completed the HSOPSC. 779 (56%) of respondents were from surgical departments. “Teamwork within units” and “organizational learning and continuous improvement” were strengths, and “staffing” and “non-punitive response to errors” were weaknesses in the surgical departments. The dimensions “non-punitive response to errors” (38·68% vs 40·61%, p=0·001), “supervisor/manager expectations and actions promoting patient safety” (69·42% vs 71·63%, p=0·013), and “hospital management support for patient safety” (61·83% vs 65·28%, p=0·027) in surgical units were lower than those in other units. Staff in surgical units reported more events than other units (mean 2·84 [SD 0·93] vs 1·72 [0·88], p=0·015); ratios of reported patient safety grades differed between surgical settings and others (p=0·010), with fewer respondents reporting patient safety grades as good or excellent in surgical units than in other departments. A clustering effect of hospital staff within hospitals existed for overall perceptions of safety, patient safety grade, and number of events reported. Four dimensions (“organizational learning and continuous improvement”, “supervisor/manager expectations and actions promoting patient safety”, “feedback and communication about errors”, and “hospital handoffs and transitions”) influenced patient safety grade and just “hospital handoff and transition” influenced events reporting in surgical units. InterpretationStrategies that include recruitment of more staff, improve use of reporting systems of adverse events, and build a non-punitive culture should be adopted in surgical units of county hospitals in China to improve the safety culture. Gaps remain in patient safety that need to be addressed. FundingChinese National Health and Family Planning Commission (grant 20131577).

The Effect of a Freely Available Flipped Classroom Course on Health Care Worker Patient Safety Culture: A Prospective Controlled Study

BackgroundPatient safety culture is an integral aspect of good standard of care. A good patient safety culture is believed to be a prerequisite for safe medical care. However, there is little evidence on whether general education can enhance patient safety culture.ObjectiveOur aim was to assess the impact of a standardized patient safety course on health care worker patient safety culture.MethodsHealth care workers from Intensive Care Units (ICU) at two hospitals (A and B) in Hong Kong were recruited to compare the changes in safety culture before and after a patient safety course. The BASIC Patient Safety course was administered only to staff from Hospital A ICU. Safety culture was assessed in both units at two time points, one before and one after the course, by using the Hospital Survey on Patient Safety Culture questionnaire. Responses were coded according to the Survey User’s Guide, and positive response percentages for each patient safety domain were compared to the 2012 Agency for Healthcare Research and Quality ICU sample of 36,120 respondents.ResultsWe distributed 127 questionnaires across the two hospitals with an overall response rate of 74.8% (95 respondents). After the safety course, ICU A significantly improved on teamwork within hospital units (P=.008) and hospital management support for patient safety (P<.001), but decreased in the frequency of reporting mistakes compared to the initial survey (P=.006). Overall, ICU A staff showed significantly greater enhancement in positive responses in five domains than staff from ICU B. Pooled data indicated that patient safety culture was poorer in the two ICUs than the average ICU in the Agency for Healthcare Research and Quality database, both overall and in every individual domain except hospital management support for patient safety and hospital handoffs and transitions.ConclusionsOur study demonstrates that a structured, reproducible short course on patient safety may be associated with an enhancement in several domains in ICU patient safety culture.

Qualitative Inquiry into Challenges Experienced by Registered General Nurses in the Emergency Department: A Study of Selected Hospitals in the Volta Region of Ghana.

Registered General Nurses (RGNs) play crucial roles in emergency departments (EDs). EDs in Ghana are primarily staffed by RGNs who have had no additional formal education in emergency care. Additionally, basic, master's, or doctoral level nursing education programs provide limited content on the complexities of emergency nursing. Nurses in EDs are affected by many challenges such as growing patient population, financial pressures, physical violence, verbal abuse, operational inefficiencies, overcrowding, and work overload. There is a paucity of research on challenges experienced by RGNs in EDs in the Volta Region of Ghana. In this qualitative study, twenty RGNs in EDs from three selected hospitals in the Volta Region of Ghana were interviewed. All recorded interviews were transcribed, reviewed several times by researchers and supervisors, and analyzed using content analysis. Five thematic categories were identified. These thematic categories of challenges were lack of preparation for ED role, verbal abuse from patients relatives, lack of resources in ED, stressful and time consuming nature of ED, and overcrowding in ED. Formal education of RGNs in the advanced role of emergency care, adequate supply of resources, increased hospital management support, and motivations for RGNs working in ED are necessary to improve the practice of emergency care.

Nursing professionals and health care assistants' perception of patient safety culture in the operating room

To assess nursing professionals and health care assistants' perceptions, opinions and behaviours on patient safety culture in the operating room of a public hospital of the Spanish National Health Service. To describe strengths and weaknesses or opportunities for improvement according to the Agency for Healthcare Research and Quality criteria, as well as to determine the number of events reported. A descriptive, cross-sectional study was conducted using the Spanish version of the questionnaire Hospital Survey on Patient Safety Culture. The sample consisted of nursing professionals, who agreed to participate voluntarily in this study and met the selection criteria. A descriptive and inferential analysis was performed depending on the nature of the variables and the application conditions of statistical tests. Significance if p < .05. In total, 74 nursing professionals responded (63.2%). No strengths were found in the operating theatre, and improvements are needed concerning staffing (64.0%), and hospital management support for patient safety (52.9%). A total of 52.3% (n = 65) gave patient safety a score from 7 to 8.99 (on a 10 point scale); 79.7% (n = 72) reported no events last year. The total variance explained by the regression model was 0.56 for "Frequency of incident reporting" and 0.26 for "Overall perception of safety". There was a more positive perception of patient safety culture at unit level. Weaknesses have been identified, and they can be used to design specific intervention activities to improve patient safety culture in other nearby operating theatres.

Patient′s safety culture form the viewpoint of nurses working at selected charity, private, and public hospitals of Isfahan

Context: Patient's safety is the core part of healthcare service providing process and hence improving safety culture in hygienic care system plays a critical role in eliminating or reducing mistakes and generally improving the hygienic care quality. Aims: This study aims at evaluating the viewpoint of nurses working at selected hospitals of Isfahan toward patient's safety culture in 2013. Subjects and Methods: This study is a descriptive-analytical research. Sample community consists of 50 nurses of three selected hospitals in Isfahan and sampling method was chosen to be of stratified kind. Data gathering Questionnaire has been the patient safety culture evaluation questionnaire of the Agency of Healthcare Research and Quality of America (AHRQ). This questionnaire consisted of 44 questions categorized into 14 dimension, 10 dimension of patient safety and 4 dimension of consequences of patient safety culture. Statistical Analysis Used: Analysis of data from descriptive statistics has been conducted using SPSS version 18 software. Results: The amount of positive scores in 10 dimensions of safety culture and 4 dimension of safety culture consequences and almost in every factor of them was at acceptable level. The average of positive scores in 10 dimension of patient safety culture have been 73%, 83%, and 78% for charity, private, and public hospital respectively (feedback and communication about the errors) and lowest (teamwork in part) has the most points won have. Conclusion: Each organization can indeed improve the patient safety by knowing its weaknesses and strengths. For example in this research, hospitals must attention to feedback and communication about error and hospital management support form patient safety.

Patient safety culture among nurses.

Patient safety is considered to be crucial to healthcare quality and is one of the major parameters monitored by all healthcare organizations around the world. Nurses play a vital role in maintaining and promoting patient safety due to the nature of their work. The purpose of this study was to investigate nurses' perceptions about patient safety culture and to identify the factors that need to be emphasized in order to develop and maintain the culture of safety among nurses in Oman. A descriptive and cross-sectional design was used. Patient safety culture was assessed by using the Hospital Survey on Patient Safety Culture among 414 registered nurses working in four major governmental hospitals in Oman. Descriptive statistics and general linear regression were employed to assess the association between patient safety culture and demographic variables. Nurses who perceived more supervisor or manager expectations, feedback and communications about errors, teamwork across hospital units, and hospital handoffs and transitions had more overall perception of patient safety. Nurses who perceived more teamwork within units and more feedback and communications about errors had more frequency of events reported. Furthermore, nurses who had more years of experience and were working in teaching hospitals had more perception of patient safety culture. Learning and continuous improvement, hospital management support, supervisor/manager expectations, feedback and communications about error, teamwork, hospital handoffs and transitions were found to be major patient safety culture predictors. Investing in practices and systems that focus on improving these aspects is likely to enhance the culture of patient safety in Omani hospitals and others like them. Strategies to nurture patient safety culture in Omani hospitals should focus upon building leadership capacity that support open communication, blame free, team work and continuous organizational learning.

Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors.

Aim: To explore the mechanisms through which nurse practice environment dimensions, such as nurse–physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption.Background: Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging.Design: Cross-sectional survey.Method: Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium.Results: Nurse practice environment dimensions predicted nurses’ ratings of job outcome variables as well as quality of care. Features of nurses’ work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care.Conclusion: The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services.

Developing family-friendly signage in a South African paediatric healthcare setting.

Multiple renovations and changing flow in a tertiary children's hospital in Cape Town resulted in numerous signs being posted in the corridors and units, making wayfinding extremely complex. A request from nursing management prompted the formation of a learning collaborative of nurses from all departments to improve wayfinding signage. The project aimed to contribute to a family-friendly environment by reviewing the current situation and developing signage to improve wayfinding and convey essential information to parents, caregivers and patients. A participative action research method followed a four-stage process to facilitate the development of family-friendly signage. Nurse participants reviewed existing signage and collaboratively developed new signage templates and posted signs. The signage was then evaluated using a rapid appraisal questionnaire involving 50 parents and nurse respondents. At each stage of data collection, thematic content analysis was used to analyse data gathered in process meetings and the reflections of participating nurses. A design template and then 44 new signs were developed and used to replace old signage. Respondents reported that the new signs were noticeable, looked attractive and were easily understandable. Intentional and active participation of nurses in clinical paediatric settings ensured collaborative data gathering and analysis. An inclusive research design allowed for insights into the words and tone of posted signs that nurse participants had not noticed previously. The participative redesign of signage resulted in a sense of ownership of the signs.The support and involvement of hospital management throughout ensured that the resulting signage received wide acceptance.

Patient Safety Culture in a Turkish Public Hospital: A Study of Nurses’ Perceptions About Patient Safety

The objective of this study was to investigate nurses’ perceptions about the culture of patient safety in a Turkish public hospital. The study adopted a cross-sectional research design and utilized the hospital survey of patient safety culture. The population studied consisted of approximately 300 nurses from which 200 nurses were surveyed. The response rate was 66.6 % of the population. Nurses responded most positively to two dimensions, hospital management support for patient safety (80 %) and supervisor/manager expectations and actions promoting patient safety (79 %). Four dimensions with a positive response rate of <50 % (‘Frequency of events reported’, ‘Nonpunitive response to error’, ‘Communication openness’ and ‘Hospital handoffs and transitions’) were considered as potential targets for improvement in our study. This study revealed six significant predictors of Overall Perceptions of Safety: Organizational Learning-Continuous Improvement; Communication Openness; Teamwork within Units; Staffing; Frequency of Event Reporting; and the Patient Safety Grade (of the Hospital Unit). Additionally, four significant predictors of the Patient Safety Grade (of the Hospital Unit) emerged: Feedback and Communication about Error; Organizational Learning-Continuous Improvement; Hospital Management Support for Patient Safety; and Supervisor/Manager Expectations and Actions Promoting Safety. Interventions designed to improve the safety culture in Turkish hospitals should be focused on the concerns of staff nurses and the improvement of communication between these nurses and their managers. The determination and evaluation of the patient safety culture level in hospitals should be viewed as a continuous process in Turkey where a need for continuous improvements in the hospital patient safety culture exists. To improve the patient safety level, nurses’ perceptions about patient safety appear to be essential. Nurses are important for the improvement of the patient safety culture in health care organizations. Moreover, some hospitals have recognized that providing patients with safe, high-quality care is fundamental to protecting the financial assets of the institution and therefore, falls within risk management’s role. In this new landscape, risk management and patient safety professionals are engaged in a close working relationship.

An exploration of Australian hospital pharmacists' attitudes to patient safety.

To explore the attitudes of Australian hospital pharmacists towards patient safety in their work settings. A safety climate questionnaire was administered to all 2347 active members of the Society of Hospital Pharmacists of Australia in 2010. Part of the survey elicited free-text comments about patient safety, error and incident reporting. The comments were subjected to thematic analysis to determine the attitudes held by respondents in relation to patient safety and its quality management in their work settings. Two hundred and ten (210) of 643 survey respondents provided comments on safety and quality issues related to their work settings. The responses contained a number of dominant themes including issues of workforce and working conditions, incident reporting systems, the response when errors occur, the presence or absence of a blame culture, hospital management support for safety initiatives, openness about errors and the value of teamwork. A number of pharmacists described the development of a mature patient-safety culture - one that is open about reporting errors and active in reducing their occurrence. Others described work settings in which a culture of blame persists, stifling error reporting and ultimately compromising patient safety. Australian hospital pharmacists hold a variety of attitudes that reflect diverse workplace cultures towards patient safety, error and incident reporting. This study has provided an insight into these attitudes and the actions that are needed to improve the patient-safety culture within Australian hospital pharmacy work settings.