Patient Safety Culture Research Articles

Patient Safety Culture Among Healthcare Settings in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

Patient Safety Culture Among Healthcare Settings in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

Factors Influencing Children’s Hospital Nurses’ Safety Accident Management Activities for Hospitalized Children

Background: We aimed to identify the factors influencing safety accident management activities for hospitalized children in children’s hospitals. Methods: In August 2022, data were collected from 170 nurses across seven children’s hospitals in Gwangju Metropolitan City, Korea. The collected data were analyzed using independent t-tests, analysis of variance, Pearson’s correlation analysis, and multiple regression analysis. Results: Safety accident management activities for hospitalized children differ significantly based on nurses’ experience in children’s hospitals (P=0.048). Safety accident management activities were positively correlated with patient safety culture (r=0.47, P<0.001), critical thinking (r=0.35, P<0.001), and nursing work environment (r=0.51, P<0.001). Furthermore, the most influential determinant of safety accident management activities for hospitalized children was the nursing work environment (β=0.42, P<0.001), followed by nurses’ experience in children’s hospitals (β=0.20, P=0.004), and patient safety culture (β=0.17, P=0.041). These variables had an explanatory power of 34.0 % (adjusted R2=0.34, P<0.001). Conclusion: A positive nursing work environment and strong patient safety culture are essential for increasing safety accident management activities among children’s hospital nurses. Additionally, children’s hospitals should provide support to the nursing staff and implement policies that encourage long-term retention of experienced nurses.

Identifying Critical Dimensions of the Patient Safety Culture Affecting Nurses’ Turnover

Background A lack of understanding of the causes of turnover among nurses is the main threat to patients, as it directly affects the care that staff provide based on the patient safety culture (PSC). Therefore, it is necessary to identify critical dimensions affecting nurses’ turnover. Methodology This study uses the internal data sets of the Chinese version of the safety attitudes questionnaire of a regional teaching hospital in Taiwan from 2015 to 2018 focusing on the turnover of nursing staff who left their jobs in the next coming year (from 2016 to 2019) by employing linear regression with forward selection. Results Perceptions of management are the first critical variable to be identified followed by safety climate and teamwork climate. These three dimensions positively influence the overall satisfaction of the PSC from the viewpoints of nurses’ turnover. In contrast, this study concludes that working conditions and job satisfaction might be the dimensions to influence nurses’ leave in this case hospital. Conclusion Improving working conditions and job satisfaction to result in a higher overall satisfaction of the PSC might be an approach to reduce nurses’ turnover.

Nurse Leader Perspectives and Experiences on Caregiver Support Following a Serious Medical Error

OBJECTIVE This study explored nurse leaders' perspectives and experiences in supporting nurses following a serious medical error. BACKGROUND Appropriate support is crucial for nurses following an error. Authentic leadership provides an environment of psychological safety and establishes a patient safety culture. METHODS A cross-sectional survey research design was conducted to determine nurse leader's (NLs') perspectives on supporting nurses following a medical error. RESULTS NL training on handling serious medical errors varied. NLs indicated experiencing a variety of formal support programs: peer support, education, error examination, employee assistance, and just culture. Following an error, NLs reported these interventions were helpful, including education/retraining, psychological safety, time off the unit, identifying system failures, nurse involvement in disclosure, and peer support. CONCLUSION This study illuminates how NLs support nurses following an error. It provides insight into the education of NLs on assisting nurses and the need to implement formal caregiver support programs.

Patient safety in a rural sub-Saharan Africa hospital: A 7-year experience at the AIC Kijabe Hospital, Kenya.

The development of a safety culture is challenging, primarily because it often disrupts institutional attitudes, norms and values. In the healthcare industry, most of the data on the results of unsafe care come from High-Income Countries. The Hospital Survey on Patient Safety Culture (HSOPS) is a tool for assessing, building, sustaining and comparing institutional safety cultures within healthcare organizations. We used the HSOPS over a 7-year period, and herein report our experience. The authors report their experience using the HSOPS tool in Kijabe Hospital, an institution with 650 employees, over a 7-year period. The HSOPS tool, with no local modifications, was distributed to all employees during each survey. The institutional HSOPS percent positive dimension scores for 2015, 2017 and 2019 were compared with baseline data from the 2013 survey. The average response rate during the study period was 84.5% (range 65.1% to 93.6%). In general, the mean percentage positive dimension scores of most domains improved in the 2019 survey (p<0.05), including reduced staff turnover and, improved hospital support for patient safety (p<0.0001), amongst other domains. The overall patient safety grade (excellent/very good), was 50% (range 43-64%). Although the dynamics of high staff turnover and hospital leadership change presented challenges in developing and measuring institutional patient safety culture, this study demonstrates that patient safety ideals can be developed and embraced in sub-Saharan Africa. Patient safety champions, a generative institutional leadership that is supportive of patient safety, are important for the development of an institutional safety culture. Creating an institutional just culture creates a patient safety culture.

Advancing Patient Safety Culture: A Systematic Review of Strategies and Best Practices in Riyadh, Saudi Arabia

This research study is an important contribution to that critical argument of how to develop patient safety culture in health care settings in Riyadh, Saudi Arabia. Having understood the pivotal role played by culture in the improvement of patient outcomes, very systematically lays down a literature review looking for the prevalent gaps and inefficiencies occurring in the present practices. That is to mean, the paper duly critically appraises different approaches and interventions that have greatly contributed to making a huge difference in the organizational climate, regarding the culture of safety through a systematic and rigorous manner. These findings, therefore, underline the need for full-fledged deployment of safety protocols, fostering a transparent atmosphere through which healthcare providers should learn from their mistakes, and demand quality enhancement programs. Presents a summary of such findings, and their general meanings with regards to health policy, leadership, and practice that suggest a way for healthcare institutions in Riyadh, to draw a more resilient and patient-centered safety culture. This research contributes to the academic void of discourse of patient safety by offering practical insights to the health leaders and policy-makers in Riyadh that, when implemented, will optimize the quality of care in health care and experience that patients have in it

An exploration of patient safety culture in NICUs: a convergent parallel mixed-method study

BackgroundSafety culture, as a component that improves the quality of safety and health care for neonates, serves as foundation for providing professional and high-quality care by creating positive insight among employees. This study aimed to explore the safety culture concept in neonatal intensive care units (NICUs).MethodsThis convergent parallel mixed-method study included Quantitative, Qualitative, and Integrated parts. In the Quantitative part, the psychometric properties of the Persian version of “Hospital Survey on Patient Safety Culture” were examined among physicians and nurses in NICUs. CFA was performed on the data obtained from 342 participants. The Qualitative section data were collected through in-depth and semi-structured interviews with 24 staff to understand the concept of safety culture. Data were analyzed through the Elo & Kyngäs approach. The interpretation of the results and the convergence of the data was done using the Onwuegbuzie and Teddlie method.ResultsThe initial CFA showed that the 12-dimensional model did not align well with indices. Subsequently, based on T-values, six heterogeneous items were eliminated. The revised 11-dimensional model consisting of 36 items showed an acceptable fit during the second CFA. In the qualitative part, five main categories of “Constructive interactions”, “Management’s commitment to neonatal safety”, “Organizational supportive climate”, “Professional development”, and “Planning and implementation of neonatal developmental care” were obtained. The comparison of the results showed that the dimensions of the quantitative part, except for “Overall perceptions of patient safety”, were also present in the qualitative part, but they were different in some aspects. New findings in the qualitative study such as “Striving for mutual empowerment”, “Constructive criticism in teamwork”, “Efficient supervision procedures”, “Inexperienced staff’ leading” and “Provision of care assistance equipment and facilities” were not found in the dimensions of the quantitative part. The main categories “Acquiring professional competence” and “Planning and implementation of neonatal developmental care” were not align with the dimensions identified in the quantitative study.ConclusionThe findings shed light on previously unexplored aspects of the safety culture concept within the nursing profession, leading to a better understanding and evolution of this concept in Iranian NICUs. The new definition obtained in this study can enhance nursing knowledge on safe care and improve patient safety culture in the NICUs in Iran and globally.

Implementation of a High-Reliability Organization Framework in a Large Integrated Health Care System: A Pre-Post Quasi-Experimental Quality Improvement Project.

The purpose of this quality improvement (QI) project was to evaluate outcomes across Veterans Health Administration (VHA) hospital facilities engaged in an enterprise-wide implementation of a high-reliability organization (HRO) framework. This QI project relied on primary data drawn from 139 facilities nationwide from 2019 to 2023. Data sources included the All Employee Survey Patient Safety Culture (PSC) Module and patient safety reporting data derived from the Joint Patient Safety Reporting system. The project design applied a pre-post quasi-experimental design that examined within-cohort changes at pre-intervention, intervention, and 2 post-intervention follow-up timepoints. HRO interventions included a combination of training, leadership coaching, site assessments, and experiential learning. HRO interventions were initiated at 18 facilities beginning in 2019 (Cohort 1), 54 facilities in 2020 (Cohort 2), and 67 facilities in 2021 (Cohort 3). For between-cohort analyses, the relative degree of change within Cohort 1 sites was compared with all other sites. There were broad positive within-group trends for PSC scores across all sites, and domain-specific between-group differences in PSC Dimension 2-Risk Identification and Just Culture-and Dimension 4-Error Transparency and Risk Mitigation. For patient safety reporting, total events reported, and close calls increased for Cohort 1. The ratio of close calls to adverse events also increased for both Cohort 1 and all other VHA sites at post-intervention year 2. The results of this QI project will inform further refinements to VHA's efforts to implement HRO principles and practices in the nation's largest integrated health system. In addition, the implementation practices may inform other large-scale, multi-level efforts to improve quality and patient safety.

Patient Safety Culture Among Nurses: Comparison Between Public and Private Hospital in Indonesia

Aims: This study aimed to describe the patient safety culture among nurses working in both public and private hospitals in Karawang, Indonesia. By examining the perceptions and practices of nurses regarding patient safety, the research sought to identify strengths and areas for improvement within the healthcare system. The findings are intended to inform strategies for enhancing patient safety practices, thereby contributing to better healthcare outcomes for patients in the region. Methods This study employed a cross-sectional methodology to investigate the patient safety culture in the intensive care units of two private and two public hospitals in Karawang, Indonesia. The researchers utilized the Hospital Survey on Patient Safety Culture (HSPSC) to gather data on nurses' perceptions and practices regarding patient safety. To analyze the data and identify any significant differences in patient safety cultural practices between the various hospital groups, both chi-square tests and independent t-tests were conducted. This approach allowed for a comprehensive assessment of the patient safety culture within the selected hospitals, facilitating comparisons between public and private healthcare settings. Results The study included a total of 118 nurses, with 52 working in a public hospital and 66 in a private hospital. The average age of nurses in the public hospital was 36.11 years (SD: 4.78), while those in the private hospital had a lower average age of 32.45 years (SD: 3.67). The results indicated a significant difference in the scores related to patient safety culture between the two groups of nurses. Specifically, nurses in the private hospital reported a higher patient safety culture compared to their counterparts in the public hospital, highlighting the disparities in perceptions and practices regarding patient safety in these different healthcare settings. Conclusion Nurses employed in private hospitals reported a higher level of patient safety culture compared to those working in public hospitals. This finding underscores the importance of creating a comfortable work environment in healthcare settings, as it is essential for minimizing the risk of patient safety incidents. By fostering a supportive and safe atmosphere, healthcare facilities can enhance the overall quality of care provided to patients and promote better outcomes in both private and public hospitals.

Effects of Grit, Patient Safety Competence, and Patient Safety Culture on the Patient Safety Nursing Activities of Nurses in Comprehensive Nursing Service Wards

Purpose : In this study, we aimed to assess the impacts of grit, patient safety competence, and patient safety culture on the patient safety nursing activities of nurses in comprehensive nursing service wards. Methods : Here, a self-reported survey of 179 nurses from three tertiary hospitals was performed. Data from 171 valid responses were analyzed using descriptive statistics, independent &lt;i&gt;t&lt;/i&gt;-test, one-way analysis of variance, Pearson’s correlation, and stepwise multiple regression analyses.Results : The key sub-factors influencing the patient safety nursing activities were attitude (&lt;i&gt;β&lt;/i&gt;=.30, &lt;i&gt;p&lt;/i&gt; ＜.001) and skill (&lt;i&gt;β&lt;/i&gt;=.26, &lt;i&gt;p&lt;/i&gt; ＜.001) in the patient safety competence factor and safety environment (&lt;i&gt;β&lt;/i&gt;=.26, &lt;i&gt;p&lt;/i&gt; ＜.001) in the patient safety culture factor. The regression model explained 42.7% of the variance in patient safety nursing activities (F=43.29, &lt;i&gt;p&lt;/i&gt; ＜.001). Conclusion : Overall, these findings highlight the importance of improving the nurse attitude and skills related to patient safety as well as the safety environment in hospitals to enhance the patient safety nursing activities in comprehensive nursing service wards. Targeted educational and training programs should be provided along with organizational support to establish a safe and supportive nursing environment in comprehensive nursing service wards.

The influencing factors of pediatric nurses' perception of patient safety culture and partnership with patients' parents on patient safety nursing activities in South Korea: a descriptive study.

This study aimed to identify the effects of pediatric nurses' perception of patient safety culture and their partnership with patients' parents on pediatric patient safety nursing activities. This descriptive study was conducted over a two-month period, from October to November 2022, utilizing self-reported questionnaires. The study included 165 nurses, each having at least 6 months of working experience in wards where children were admitted. These nurses were selected from 13 pediatric specialty hospitals, general hospitals, and university hospitals across seven regions. The data analysis was performed using the SPSS/WIN 26.0 program (IBM Corp.) for descriptive statistics, t-test, One-way ANOVA, Scheffé test, Pearson correlation coefficients, and multiple regression analysis. The average scores for awareness of patient safety culture, partnership with patients' parents, and pediatric patient safety nursing activities were 3.37±0.41, 3.94±0.41, and 4.50±0.38, out of 5 points respectively. The factors influencing pediatric patient safety nursing activities were identified as a partnership with patients' parents (β=.41, p<.001). Among hospital-related characteristics, safety management committee (β=.16, p=.029) and safety management regulations (β=.17, p=.016) were also analyzed as factors influencing patient safety nursing activities. These factors accounted for 29.2% of the explanatory power for pediatric patient safety nursing activities. Based on the above study results, we found that to promote safe nursing activities for pediatric patients, developing and implementing training programs that enhance partnerships with patient's parents was imperative, and establishing work regulations and a safety management committee to systematically manage safety management tasks was deemed important.

Patient Safety Competence Among Diploma III Nursing Student In Jakarta, Indonesia; A Cross-Sectional Survey

Nursing students frequently made errors or near-misses due to non-compliance with patient safety protocols, including authenticating medication administration rights, verifying patient identification, and reviewing allergy status. This study was conducted using cross-sectional design at nursing Academy in Jakarta. The inclusion criteria were nursing diploma student at grade 3, nursing students who had not passed any patient safety training courses, those who passed the credit of “Fundamentals of Nursing and Management Patient Safety”, and those who started learning in the clinical setting. The Health Professional Education in Patient Safety Survey (H-PEPSS) was designed by Agency for Healthcare Research and Quality to evaluate recently students' levels of clinical safety. A descriptive statistic was used to analyze data using mean, standard deviation. A simple linear regression was done to determine the relationship between gender, age, and religion with patient safety competence. About 55% student have moderate level of competence, 28% good, and 20% excellent. There was no significant difference on patient safety competence among nursing students in 8 nursing colleges in Jakarta (p&gt;0.05). Gender was associated contributed significantly to the variance in patient safety competence with R square was 28.8%. The study suggests nursing institutions should develop new approaches to improve patient safety competence and culture among students, preparing them for advanced technology education in healthcare institutions.

Revised Hospital Survey on Patient Safety Culture (HSOPSC 2.0): cultural adaptation, validity and reliability of the Malay version

BackgroundSurveys on Patient Safety Culture™ Hospital Survey (HSOPSC) developed by the U.S. Agency for Healthcare Research and Quality (AHRQ) has been adopted worldwide. The Hospital Survey on Patient Safety Culture (HSOPSC) version 2.0 was released in 2019, but there have been no publications to date of its translation and validation for use in Malaysia. This study aimed to translate and cross-culturally adapt the revised HSOPSC 2.0 into the Malay language and determine its psychometric properties including the content, face, and construct validity, and reliability analyses.MethodsThis study was conducted from April – June 2023 and divided into three stages: translation and cultural adaptation; content and face validation; and construct validation using confirmatory factor analysis and reliability testing among 319 healthcare personnel from a public university hospital in Malaysia.ResultsThe translated instrument demonstrated excellent content validity (I-CVI = 0.80 ~ 1.0, SCVI-average = 0.96) and face validity (I-FVI = 0.80 ~ 1.0, SFVI-average = 0.98). Reliability testing was acceptable (Cronbach’s α = 0.60 ~ 0.80) but indicated that reverse-coded items were poorly perceived. Confirmatory factor analysis showed a satisfactory model fit for the translated instrument (RMSEA = 0.08, GFI = 0.80, CFI = 0.80, and χ2/df = 2.96). Six items had very low factor loadings (< 0.40), with two constructs “Staffing and Work Pace” and “Response to Error” having AVE < 0.4, but acceptable CR ≥ 0.6. No items were removed from the questionnaire despite low factor loadings following a consensus from an expert panel.ConclusionThe Malay version of the HSOPSC 2.0 containing ten domains and 32 items demonstrated satisfactory psychometric properties following expert consensus, with acceptable reliability and construct validity for measuring patient safety culture. Given factor loadings smaller than 0.40 in six items, broader validation is suggested to support the use of the translated instrument in the Malaysian healthcare setting.

Leadership opportunities to mitigate challenges and barriers of precision health

Abstract Background Precision health, encompassing personalized and proactive health solutions, aims to address this gap by integrating genetic, behavioral, and environmental factors. However, challenges persist in its integration, necessitating new healthcare competencies, particularly in leadership, to expedite the transition. Our goal is to identify barriers and solutions for the implementation of precision health and build a core curriculum of leadership competencies to mitigate challenges and barriers for the implementation of precision health. Methods A systematic literature review of qualitative primary studies on barriers and facilitators to precision health implementation was conducted. Data extracted from included articles were analyzed thematically, adapting leadership competencies outlined in the CanMEDS Physician Competency Framework. This approach identified key leadership traits crucial for precision health implementation. Results 51 articles meeting inclusion criteria yielded 985 barriers and facilitators. Thematic analysis identified 9 primary leadership competencies essential for precision health implementation: application of quality improvement science (30%); fostering a culture of patient safety in data use (10%); advocacy for innovative data management (4%); resource allocation advocacy (9%); evidence-based cost management (4%); driving practice change (8%); prioritization and time management (11%); and optimization of healthcare workforce practices (14%). Discussion The synthesized leadership competencies provide a useful framework for addressing barriers and fostering precision health implementation among healthcare professionals. The high representation of competency related to quality improvement science is emblematic of how cultural elements specific to leadership and management in medicine could represent a strategic asset to foster the implementation of innovative solutions, like precision health, in healthcare. Key messages • Leadership skills are a crucial element in the curriculum of health professionals to support the implementation of precision health in clinical practice. • Incorporating elements of ‘quality improvement science’ in the healthcare professionals education emerged as essential to foster precision health implementation.

Exploring Collaboration and Social Dynamics in the Paediatric Morbidity and Mortality Meeting, A Qualitative Case Study.

To explore collaboration and social dynamics within paediatric Morbidity and Mortality meetings. Qualitative Exploratory Case Study Methodology incorporating semi-structured interviews and qualitative observations. Data were collected in a large quaternary paediatric hospital in Melbourne, Australia. Semi-structured interviews with meeting attendees were conducted after observing and documenting meeting conduct. Reflexive thematic analysis was used to interpret data and generate a thematic map of findings. Forty-four interviews and 32 meeting observations were conducted between July 2019 and January 2020. Participants valued collaboration between attendees in Morbidity and Mortality meetings, however there were barriers to this. They included differing views about roles and negative impacts of hierarchies and authority. Senior doctors dominated discussion, and participants described this occasionally signalling reverence and respect, but sometimes signified intimidation and feeling unsure about how to contribute. Because of this complexity, successfully achieving positive social dynamics in a meeting required active promotion and management. Morbidity and Mortality meetings mirror the complexity and richness of the clinical environment. Descriptions of how meeting conduct can shape positive workplace culture and address hierarchical obstructions to safe clinical care highlight their far-reaching potential. Effective collaboration is an intrinsic part of realising this value. This paper addresses a paucity in the literature in understanding how social dynamics and collaboration in Morbidity and Mortality meetings are interpreted and experienced. These findings illuminate challenges and obstacles to achieving a productive and equitable social dynamic in meetings. They also illustrate positive discrimination strategies that may improve participation and widespread engagement of nurses, junior doctors, and allied health professionals. Importantly, fostering constructive social dynamics in the Morbidity and Mortality meeting could positively impact patient safety culture and therefore patient care. No patient or public contribution.

Developing an NHS patient safety culture: swings and roundabouts.

John Tingle, Associate Professor, Birmingham Law School, University of Birmingham, discusses a new report and consultation on NHS patient safety culture development.

Safety Culture in Focus: Review of Patient Safety Culture Survey Results in Primary Health Care Corporation Qatar

Abstract Background Patient Safety is a crucial aspect of every healthcare organization and understanding the safety culture is essential for improving patient health outcomes. Evaluating the patient safety culture enables the health care organizations to gain insights into how their internal system’s structure and processes impact the patient’s overall well-being. In this paper, the hospital survey on patient safety culture that is adopted from AHRQ was used to examine the patient safety culture in the primary health centers in Qatar (PHCC), allowing for a better understanding of areas of strength and areas that require improvements Method The study aimed at comparing the organization’s safety culture in 2021 and its improvement in 2023. The survey was disseminated into 28 primary health centers with different sizes and patient volumes. The survey was sent electronically to all PHCC staff, allowing for better convenience and higher response rate Findings The results of this survey revealed numerous areas of strength, including teamwork across departments, error reporting, management support, communication error, non-punitive response to errors and staffing. On the other side, survey composites such as continuous learning and teamwork within department were identified as areas for improvement Conclusion By allowing for better insights into the culture of safety and identifying areas of strength and weaknesses, PHCC can make informed decisions and implement effective interventions. This will support in enhancing the health and wellbeing of Qatar’s population that aligns with the national health strategies which improves the overall healthcare in the region.

Cultivating a Culture of Patient Safety in Healthcare Settings: A Systematic Review of Evidence-Based Interventions

Background and purpose: Establishing a robust culture of safety is essential for enhancing health outcomes and minimizing risks to patients. This systematic review aims to synthesize interventions designed to enhance safety culture in healthcare settings. Methods: A comprehensive literature search was performed across multiple databases, including PubMed, CINAHL, and Scopus. The initial search yielded a total of 250 articles. After applying inclusion and exclusion criteria, which considered study design, population, and intervention type, 35 articles were shortlisted for full-text review. Ultimately, 21 studies met the final inclusion criteria, focusing on various interventions aimed at promoting safety culture. Results: The analysis revealed notable variation in the types of safety culture interventions implemented across the studies, with educational programs emerging as the most frequently adopted approach. The effectiveness of these interventions was found to be significantly influenced by both individual and systemic factors, highlighting the importance of contextual elements in promoting safety culture. Additionally, many interventions faced challenges related to sustainability and maintaining long-term impact, suggesting that ongoing support and resources are necessary for success. The review also indicated that the participation of nursing professionals in safety culture initiatives was often limited, despite their critical role in patient care, underscoring the need for strategies that engage this key group more effectively. Conclusion: The review underscores the necessity for targeted strategies that actively engage nursing professionals in safety culture initiatives to foster a safer healthcare environment. The findings serve as a valuable resource for policymakers and healthcare managers aiming to implement best practices for enhancing safety culture.

The Predictors of Patient Safety Culture in Hospital Setting: A Systematic Review.

Patient safety (PS) is a global public health concern. It is estimated that 10% of patients experience preventable harm while hospitalized. Patient safety culture (PSC) has been recognized as essential to improving PS, drawing inspiration from other high-risk industries. In PS research, however, PSC poses conceptual challenges, with inconsistent terminology, a lack of definitions, and limited use of substantiating theory. Despite these challenges, PSC remains widely used in PS research and practice, as it is seen as a potential gateway to understanding sociotechnical complex aspects of the healthcare system and improving safe patient treatment and care. This review explores the concept of PSC in a hospital setting. How PSC is used as an outcome, thus exploring the theoretical position underpinning PSC, which predictors impact PSC, and how these predictors are related to PSC. Using a search of 3 electronic databases, 23 studies that met the inclusion criteria were selected for review. The review identified 81 predictors of PSC. Study population, unit of analysis and method varied widely. PSC as an outcome was assessed based on one of 4 surveys. Thus, the underpinning position of the PSC construct is dominated by an organizational/managerial approach. The large number of predictors explored and the range in outcome measures, units of analysis, and methods make it hard to establish any causal relationship. We argue that studies closer to actual practices in the messy conditions of clinical practice are needed.

Caring in crisis: Addressing patient safety, burnout, and long hours in healthcare.

Madam, The World Health Organization defines patient safety as preventing errors and adverse effects to patients associated with health care and “to do no harm to patients”. Specifically, in low and middle-income countries (LMICs), about 134 million adverse events occur each year due to unsafe care in hospitals, resulting in 2.6 million deaths annually. [1] Along with other determining factors, professional well-being, long hours, and burnout syndromes also influence patient care. [2] Burnout is a condition directly linked to workplace environment, stemming from occupational stress and extended working hours. Garcia, C.L. et al., through meta-analysis, found a relationship between the development of burnout and patient safety actions, with a probability of superiority of 66.4%. High levels of burnout and worsening patient safety are related to external factors such as high workload, long working hours, lack of a secure environment, and interpersonal relationships. [3] These findings raise concerns, particularly in a country like Pakistan, where the extent of understaffing and high workload can be inferred from the following statistics: The doctor-to-population ratio in Pakistan was 1:1000 in 2018 [4]. In contrast, the doctor-to-population ratio in Malaysia was 2.2:1000 in 2018 [5]. As a result of this shortage, the current workforce in Pakistan is negatively affected. In a study by Kasi PM et al. on postgraduate trainees in Pakistan, individuals under stress were more likely to report longer working hours. This increased workload made them prone to medical errors, which ultimately undermines the patient safety culture. A study conducted at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC) compared the benchmarks from hospitals in the USA and discovered that high staff workload is a significant concern among staff [6] In Pakistan, where healthcare resources are limited, fostering a culture of effective work-hour management and breaks is essential for creating a healthier and safer environment for health professionals and patients. Ensuring adequate staffing levels to distribute the workload and prevent overburdening is essential. Providing designated areas for relaxation, offering mental health resources and mindfulness programmes like yoga or meditation can help doctors to cope with stress. Furthermore, promoting a culture of multidisciplinary teamwork, a mentorship program, and effective handover protocols during shift changes can ensure continuity of care. Medical institutes should invest in technology that can streamline administrative tasks and reduce paperwork burden. ---Continue