Dataset Information

Staying ahead of the curve: avigating changes and maintaining gains in patient safety culture - a mixed-methods study.

ABSTRACT:

Objectives

This study examines how the results of the Hospital Survey on Patient Safety Culture changed between 2012 and 2019 and identifies organisational factors affecting these changes.

Design

The study combined the use of quantitative surveys of staff and qualitative interviews with hospital leadership. Secondary data analysis was performed for previous surveys.

Setting

This study was conducted in a tertiary care teaching multisite hospital in Riyadh, Saudi Arabia.

Participants

One thousand hospital staff participated in the survey. Thirty-one executive board members and directors and four focus groups of frontliners were qualitatively interviewed.

Primary and secondary outcome measures

Twelve safety culture dimensions were assessed to study the patient safety culture as perceived by the healthcare professionals. An additional semi-structured interview was conducted to identify organisational factors, changes, and barriers affecting the patient safety culture. Furthermore, suggestions to improve patient safety were proposed.

Results

Comparing the results revealed a general positive trend in scores from 2012 to 2019. The areas of strength included teamwork within and across units, organisational learning, managerial support, overall perception of safety and feedback and communication about error. Non-punitive response to error, staffing and communication and openness consistently remain the lowest-scoring composites. Interview results revealed that organisational changes may have influenced the answers of the participants on some survey composites.

Conclusions

Patient safety is a moving target with areas for improvement that are continuously identified. Effective quality improvement initiatives can lead to visible changes in the patient safety culture in a hospital, and consistent leadership commitment and support can maintain these improvements.

SUBMITTER: Titi MA

PROVIDER: S-EPMC7934776 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Publications

Staying ahead of the curve: avigating changes and maintaining gains in patient safety culture - a mixed-methods study.

Titi Maher Abdelraheim MA Baksh Maram Mohammed MM Zubairi Beena B Abdalla Rawia Ahmad Mustafa RAM Alsaif Faisal Abdullah FA Amer Yasser S YS Jamal Diana D El-Jardali Fadi F

BMJ open 20210304 3

<h4>Objectives</h4>This study examines how the results of the Hospital Survey on Patient Safety Culture changed between 2012 and 2019 and identifies organisational factors affecting these changes.<h4>Design</h4>The study combined the use of quantitative surveys of staff and qualitative interviews with hospital leadership. Secondary data analysis was performed for previous surveys.<h4>Setting</h4>This study was conducted in a tertiary care teaching multisite hospital in Riyadh, Saudi Arabia.<h4>P ...[more]

PMID: 33664079

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Project description:BackgroundRoutine assessments of patient safety culture within hospitals have been widely recommended to improve patient safety. Experts suggested that mixed-methods studies can help gain a deeper understanding of the concept. However, studies combining quantitative and qualitative approaches exploring patient safety culture are still lacking. This study aimed to explore patient safety culture as perceived by operating room professionals of two university hospitals in Sousse, Tunisia.MethodsBased on a mixed-methods approach, a cross-sectional survey followed by semi-structured interviews were conducted over a period of two months (December 2019 to January 2020). This study took place in all the operating rooms of two public university hospitals in the district of Sousse, Tunisia. To collect data for this survey, the French version of the Hospital Survey On Patient Safety Culture was used. For interviews, 13 participants were selected purposively using a critical case sampling approach and a topic guide was prepared. Anonymity and confidentiality were respected.ResultsOverall, twelve operating rooms, with different surgical specialties, were included in the study. Survey feedback was provided by 297 professionals representing a response rate of 85.6%. Concerning patient safety culture, the 10 dimensions had low scores (below 50%) and were considered "to be improved". The highest score was found in 'teamwork within units' (45%). Whereas, the lowest scores were allocated to 'non-punitive response to error' (22.9%), followed by "frequency of adverse event reported" (25.6%) and "communication openness" (26.3%). Per qualitative data, participants provided a more detailed picture of patient safety issues such as underreporting, absence of an effective reporting system, lack of freedom of expression, and an existing blame culture in operating rooms.ConclusionsThe findings of this study showed a concerning perception held by participants about the lack of a patient safety culture in their operating rooms. It seems essential to design, implement and evaluate strategies that promote a positive patient safety culture and obliterate punitive climate in operating rooms.

Project description:BackgroundThe study of safety culture and its relationship to patient care have been challenged by variation in definition, dimensionality and methods of assessment. This systematic review aimed to map methods to assess safety culture in hospitals, analyse the prevalence of these methods in the published research literature and examine the dimensions of safety culture captured through these processes.MethodsWe included studies reporting on quantitative, qualitative and mixed methods to assess safety culture in hospitals. The review was conducted using four academic databases (PubMed, CINAHL, Scopus and Web of Science) with studies from January 2008 to May 2020. A formal quality appraisal was not conducted. Study purpose, type of method and safety culture dimensions were extracted from all studies, coded thematically, and summarised narratively and using descriptive statistics where appropriate.ResultsA total of 694 studies were included. A third (n=244, 35.2%) had a descriptive or exploratory purpose, 225 (32.4%) tested relationships among variables, 129 (18.6%) evaluated an intervention, while 13.8% (n=96) had a methodological focus. Most studies exclusively used surveys (n=663; 95.5%), with 88 different surveys identified. Only 31 studies (4.5%) used qualitative or mixed methods. Thematic analysis identified 11 themes related to safety culture dimensions across the methods, with 'Leadership' being the most common. Qualitative and mixed methods approaches were more likely to identify additional dimensions of safety culture not covered by the 11 themes, including improvisation and contextual pressures.DiscussionWe assessed the extent to which safety culture dimensions mapped to specific quantitative and qualitative tools and methods of assessing safety culture. No single method or tool appeared to measure all 11 themes of safety culture. Risk of publication bias was high in this review. Future attempts to assess safety culture in hospitals should consider incorporating qualitative methods into survey studies to evaluate this multi-faceted construct.

Project description:BackgroundPatient safety research has lagged within academic settings, including chiropractic teaching institutions. To develop a robust patient safety culture, the Institute of Medicine emphasized the need for employee's attitudes to be understanding and positive. To initiate the assessment of the current culture and future needs, this study evaluated patient safety attitudes among chiropractic teaching clinic stakeholders (supervising clinicians, student interns, and administrative staff) and compared their standardized survey scores to established medical survey databases.MethodsWe conducted a cross-sectional, mixed methods survey design with quantitative analytic priority. Chiropractic interns, clinical faculty, and clinic staff of 5 international chiropractic educational programs completed a modified version of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture for Medical Offices Survey with open-ended comment fields between 2014 and 2016. Composite means of positive responses were calculated and compared to patient safety, quality of care, and overall self-ratings benchmarks from Canadian providers and academic settings in the AHRQ database. Qualitative responses were thematically categorized for a convergent analysis of quantitative results for the chiropractic sample.ResultsChiropractic survey response rate was 45.3% (n = 645). Quantitative survey results indicated moderate scores and ranges (57-85%) on all patient safety dimensions for the chiropractic samples. Academic medicine and chiropractic providers' benchmarks scored higher positive responses than chiropractic teaching clinics on most quantitative dimensions, except for work pressure/pace. Teamwork, organizational learning, and patient tracking/follow-up were the most positively endorsed quantitative dimensions, with communication, staff training, office standardization, and leadership support considered areas for improvement in both settings. Qualitative responses for the chiropractic clinics identified a need for open communication; additional staff training and student involvement in creating safety cultures; standardization of office processes including information exchange, scheduling, and equipment maintenance; and leadership support that focused on decreasing work pressure/pace and setting safety priorities.ConclusionAs the first report of patient safety attitudes from stakeholders in chiropractic teaching clinics, specific areas of improvement were identified. Chiropractic teaching programs might consider incorporating these and related patient safety concepts into their formal curricula. Mixed methods approach offers teaching clinics opportunities to assess stakeholders' insights and enhance safe delivery of chiropractic care.

Project description:PurposePatient safety in eye health care is an underdeveloped field of research. A patient safety incident occurs when an unintended incident happens that could have (or did) lead to harm. To enable learning from patient safety incidents in optometry, a characterisation of commonly experienced safety incidents is needed to identify options to improve the quality of care. This study aimed to characterise eye health-related patient safety incidents from the perspective of eye care practitioners.MethodsAt a national conference in Wales, 56 eye care practitioners participated in a stakeholder workshop on eye care-related patient safety incidents. Participants were asked to suggest patient safety incidents that have occurred, or based on their experience, could occur in optometric practice. Using the nominal group technique, participants voted on the incident they perceived could cause the most harm and the incident observed most frequently in practice. Framework analysis supported identification of themes about the nature and outcomes of incidents in eye care.ResultsDiagnostic incidents were perceived to be the most severe (highest number of 'severity votes', n = 38), whilst administration-related incidents were most frequent (highest number of 'frequency votes' n = 39). Four themes were identified which are as follows: inappropriate clinical decision-making; delayed or missed referral of patients to general medical practitioners or ophthalmologists; compromised communication with other practitioners or patients and delays in receiving eye care. The results suggest that incidents relating to inappropriate clinical decision-making could result in the most severe harm to patients but may not occur frequently.ConclusionsDiagnostic- and administrative-related incidents pose clear challenges for improvement in quality and safety of care. The breadth of themes reflecting the nature and outcomes from unsafe eye care highlights the complexity underpinning incidents and the burden to patients. This work has informed the content of an all-Wales incident report form for primary eye care practitioners.

Project description:BackgroundPatient safety is an essential component of healthcare quality. Despite enormous advances in medical knowledge, many adverse events continue to endanger patient safety. Although mixed-method studies are necessary to gain a deeper understanding of safety culture, few studies provide practical evidence of patient safety culture and associated factors in Ethiopia. This study aimed to assess patient safety culture and associated factors among healthcare professionals in public hospitals in Bahir Dar City, Northwest Ethiopia.MethodsA cross-sectional study design was employed, in triangulation with qualitative methodologies, from March 10 to April 10, 2022. A stratified sampling technique was used to select 420 study participants from three public hospitals. A standardized tool measuring 12 patient safety culture composites was used for data collection. Purposive sampling was employed in the qualitative study. Bi-variable and multivariable linear regression analyses were performed using SPSS version 23, with significance set at a 95% confidence interval and a p-value of <0.05. Content analysis was utilized in the qualitative study.ResultsThe overall patient safety culture score was 47.6% (95% CI: 42.7, 52.5). Age (β = 1.196, 95% CI: (0.968, 1.322), patient safety training (β = 0.168, 95% CI: 0.040, 0.297), working in pediatric wards (β = 0.236, 95% CI: 0.099, 0.370), and resource availability (β = 0.346, 95% CI: 0.220, 0.473) were significantly associated with patient safety culture. The in-depth interviews identified infrastructure, communication barriers, lack of management support, poor governance, healthcare professionals' knowledge, skills, and attitudes, and patient involvement during treatment as factors affecting patient safety.ConclusionsThis study concludes that the patient safety culture in the studied hospitals is suboptimal, falling below the acceptable threshold. Enhancing resource availability, providing continuous patient safety training, improving communication systems, and fostering a supportive management environment are essential steps towards building a safer healthcare system.

Dataset Information

Staying ahead of the curve: avigating changes and maintaining gains in patient safety culture - a mixed-methods study.

Objectives

Design

Setting

Participants

Primary and secondary outcome measures

Results

Conclusions

Publications

Staying ahead of the curve: avigating changes and maintaining gains in patient safety culture - a mixed-methods study.

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