Patient Safety Culture: Effects on Errors, Incident Reporting, and Patient Safety Grade.

OBJECTIVES: This study mainly examines the effects of patient safety culture dimensions on 4 outcomes (self-reported errors, witnessing errors, incident reporting, and patient safety grade). METHODS: The data were collected using the Turkish version of the Safety Attitudes Questionnaire, which consists of 6 dimensions (teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions). Of 1679 personnel working in 6 hospitals in Ankara, 860 were randomly selected. The data were analyzed using descriptive statistics, the Spearman correlation coefficient, and binary logistic regression analyses. RESULTS: The response rate was 62.7%. When the overall patient safety culture score increased by 1 point; the probability of witnessing an error was 2 times lower (P < 0.001), the probability of incident reporting was 4.22 times higher (P < 0.001), and the probability of assessing the patient safety grade as excellent was 29.86 times higher (P < 0.001). The teamwork climate was negatively related to making errors and witnessing errors (P < 0.001). The safety climate and working conditions were positively related to incident reporting and patient safety grade (P < 0.001). Job satisfaction was negatively related to incident reporting (P < 0.001). Perceptions of management were positively related to making errors and patient safety grade (P < 0.001). CONCLUSIONS: The patient safety culture scores were positively correlated with incident reporting and patient safety grade but negatively correlated with the occurrence of errors. Each dimension of the patient safety culture, except stress recognition, affected different outcomes. Therefore, managers should focus on different dimensions of patient safety culture to improve different outcomes.

Relationship between authentic leadership, transformational leadership and innovative work behavior: mediating role of innovation climate.

Objectives. This study aimed to demonstrate the effect of transformational and authentic leadership characteristics of healthcare managers on employees' innovative work behavior and the mediating role of innovation climate. Methods. The study was conducted in 19 hospitals in Turkey and 263 managers participated. The data were collected using the transformational leadership questionnaire, the authentic leadership questionnaire, the innovative climate assessment tool and the innovative work behavior scale. Path analysis was performed to demonstrate the relationship between the variables. Results. When transformational and authentic leadership were put into the model separately through innovation climate, transformational leadership had an effect of 0.39 units (0.22 units direct, 0.17 units indirect) and authentic leadership had a 0.44-unit effect (0.29 units direct, 0.15 units indirect) on innovative work behavior. When transformational and authentic leadership were put together in the model, the total (direct and indirect) effect of them increased to 0.52 units. In this case, the effect of authentic leadership characteristics of health managers on innovative work behavior of their followers (0.42 units) was greater than the effect of transformational leadership characteristics (0.10 units). Conclusions. Although both types of leadership affect innovative work behavior, authentic leadership was more effective than transformational leadership.

Health literacy of cardiology patients: determinants and effects on patient outcomes.

Health literacy is important for the management of chronic cardiovascular diseases. Comprehensive studies related to health literacy of cardiac patients are limited. The aims of this study were to determine the determinants of health literacy and its effects on patient outcomes in cardiology patients. The European Health Literacy Survey Questionnaire (HLS-EU-Q- 47 items) was applied to 530 patients who presented to cardiology polyclinics of a university hospital in Ankara. Correlation coefficients, univariate and multi-linear regression analyses were used in the study. Determinants of health literacy were sex, education level, place of residence and perception of social status (p < .05). Although adjustments were made based on relevant control variables in multivariate analyses, health literacy was found to affect 14 of 26 patient outcomes within the scope of the study (p < .05). Higher education level and perception of social status, residing in the city center and being female were among the determinants of high health literacy. Higher health literacy was associated with more positive patient outcomes. Health literacy affected health behaviors and risks, drug use habits, health status, use of preventive health services and patient satisfaction.

The effect of nurses' empowerment perceptions on job safety behaviours: a research study in Turkey.

Objective. This study aimed to investigate the effect of nurses' empowerment perceptions on job safety behaviours. Methods. A survey of 377 nurses working in five hospitals in Turkey was conducted using the conditions of work effectiveness questionnaire, psychological empowerment instrument, universal precautions compliance scale and occupational health and safety obligations compliance scale. Relations between variables were tested using Pearson's correlation and path analysis. Results. There was a moderate and statistically significant relationship between psychological and structural empowerment and complying with universal safety measures and meeting occupational health and safety obligations. Also, an increase of 1 unit on the level of psychological empowerment was found to correspond to an increase of 0.37 units on the level of universal precautions compliance and to an increase of 0.46 units on the level of occupational health and safety obligations compliance. As such, an increase of 1 unit in structural empowerment corresponds to an increase of 0.53 units on the level of universal precautions compliance and to an increase of 0.36 units (total effect) on the level of occupational health and safety obligations compliance. Conclusions. The findings reveal that empowerment is a valuable tool for nurses' positive job safety behaviours.

Staff perceptions of patient safety culture in general surgery departments in Turkey.

BACKGROUND: The first step towards establishing and improving patient safety culture in hospitals is measuring patient safety culture perceptions of staff. Few studies have examined the perception of patient safety culture in general surgery departments. OBJECTIVES: The objective of this study was to evaluate patient safety culture and patient safety grade in general surgery departments and to examine the relation between the patient safety culture and the patient safety grade. METHODS: This study examined patient safety culture and patient safety grades of 124 staff in seven surgery departments of a hospital in Turkey. The staff completed the hospital survey on patient safety culture and answered questions about their professional characteristics. One-way ANOVA, Independent-samples t test, corrected chi-square test, multiple correspondence analysis and Eta co-efficient were used in statistical analyses. RESULTS: The patient safety dimension of "teamwork within units" had the highest mean and percentage of positive responses. The "frequency of events reported" and "non-punitive response to errors" had the lowest means and percentages of positive responses. Participants with resident or nurse positions, < age 31 years, with < 6 years of professional experience, and 60 or more work hours/week, had significantly more negative perceptions of patient safety culture than other participants. Patient safety grades and the dimensions of "management support for patient safety" and "overall perceptions of patient safety" had significantly high Eta coefficients. CONCLUSION: Frequency of events reported and non-punitive responses to errors should be improved, and participants' characteristics should be considered at improvement efforts in general surgery departments. The dimesions with low means suggest opportunities for improvement.

Evaluation of Transition to Electronic Prescriptions in Turkey: Perspective of Family Physicians.

BACKGROUND: One of the most important steps of the health transformation program involves the application of electronic prescriptions (e-prescriptions) in health services. Information technologies are highly important in generating e-prescriptions, which can be described as a document produced by authorized personnel electronically, containing written information and instructions regarding a patient's medication and its usage. E-prescribing has become increasingly applied in recent years as a contributing application to prescribers and patients. The aim of this study was to determine the level of satisfaction of family physicians providing primary care in Turkey regarding the application of e-prescriptions, and reveal the related positive effects and problems encountered in the first months of implementation of e-prescribing. METHODS: A questionnaire with eight questions was sent to e-mails of all family physicians working in Turkey in May 2013. A total of 1564 family physicians filled in the questionnaire form and sent it back by e-mail. The responses to openended questions were evaluated by content analysis. RESULTS: It was observed that the most frequently indicated advantages of the application of e-prescriptions were speeding up the prescription process and saving time (36.6%). The most commonly reported problems regarding the application of e-prescriptions were found to be system-induced problems (26.5%) and internet problems (19.9%). In addition, the mean score of satisfaction of the family physicians who did not report problems with the application of e-prescriptions was higher than that of those who reported having problems with it. In the study, 77.8% of the family physicians were satisfied with the application of e-prescriptions. CONCLUSION: Although some problems were reported regarding the application of e-prescriptions in the first months of the application, family physicians participated in the study were found to be satisfied with the application of e-prescriptions, and identified positive effects on their work and processes.

Predictors of hospital readmissions in internal medicine patients: Application of Andersen's Model.

OBJECTIVE: This study aimed to identify predictors of internal medicine patients' readmission to hospital, using Andersen's behavioral model. METHODS: This prospective cohort study included 2622 patients aged ≥18 years, who were admitted to internal medicine wards at a university hospital between 1 February 2015 and 31 January 2016. Independent variables were divided into four groups (predisposing, enabling, need, and utilization), based on Andersen's model, and included in stepwise logistic regression analysis. RESULTS: Younger age, male sex, a main diagnosis of neoplasm, longer length of stay, higher comorbidity scores, and weaker coping ability predicted all readmission. Predictors of unplanned readmission included having someone to help at home following discharge, comorbidity scores, and length of stay. Predictors of unplanned, related, and preventable readmissions included having someone to help at home following discharge, having a regular physician, and the main diagnosis at discharge. The most powerful predictors influencing readmission were need-related variables. CONCLUSION: Although some predictors of readmission were unalterable, they could be used to identify high-risk patients. Innovative approaches targeting discharge planning and postdischarge care for patients with high comorbidity scores and long length of stay could reduce internal medicine patients' unplanned readmission.

Ethical climate as a moderator between organizational trust and whistle-blowing among nurses and secretaries.

OBJECTIVES: To reveal the effect of perception of ethical climate by nurses and secretaries and their level of organizational trust on their whistleblowing intention. METHODS: Nurses and secretaries working in a University Hospital in Ankara, Turkey, were enrolled in the study conducted in 2016. Responses were received from 369 nurses and secretaries working at Clinics and Polyclinics. Path analysis, investigation of structural equation models used while multi-regression analysis was also applied. RESULTS: According to the regression model, ethical climate dimensions, profession, gender, and work place had significant impact on the whistleblowing intention. According to Path analysis, ethical climate had direct impact of 69% on whistleblowing intention. It was seen that organizational trust had an indirect impact of 27% on the whistleblowing score when ethical climate had a moderator role. CONCLUSION: In order to promote whistleblowing in organizations, it is important to keep the ethical climate perception of employees and the level of their organizational trust at high levels.

Patients' readiness for discharge: Predictors and effects on unplanned readmissions, emergency department visits and death.

AIM: To determine the variables that affect patients' perceptions about their readiness for discharge and to elucidate the effects of these perceptions on patient outcomes such as unplanned readmission to the hospital, emergency department visits and death within 30 days after discharge. BACKGROUND: In recent years, it has become even more important to assess patients' readiness for discharge as patients tend to be discharged more quickly. METHODS: For the determination of patients' self-assessment, the Readiness for Hospital Discharge Scale/Short Form was utilized. This 1-year prospective cohort study included 1,601 patients. Data were analysed using a chi-square test, Mann-Whitney U test, univariate logistic regression analysis and multiple logistic regression analysis. RESULTS: The results of multiple logistic regression analysis revealed that age, sex, marital status, educational status, presence of someone to help at home after discharge and length of stay were predictors of patients' readiness for hospital discharge. Furthermore, being unready for discharge increased the risk of 30 day unplanned readmission and 30 day death. CONCLUSIONS: Considering these predictors, patients' perceptions of readiness for discharge must be assessed before deciding to discharge them. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can consider the predictors of patients' readiness for discharge, thus the risk of unplanned readmission and death may be reduced.

A comprehensive framework identifying readmission risk factors using the CHAID algorithm: a prospective cohort study.

OBJECTIVE: To identify frequency of readmission after discharge from internal-medicine wards, readmission risk factors, and reasons and costs of readmission. DESIGN: Prospective cohort study. SETTING: A tertiary-care hospital in Turkey. PARTICIPANTS: 2622 adult patients discharged from internal-medicine wards of the hospital between 1 February 2015 and 31 January 2016. MAIN OUTCOME MEASURES: Thirty day all-cause readmission rates, reasons and costs of readmission. To identify readmission risk factors Chi-square Automatic Interaction Detector (CHAID) analysis was conducted. RESULTS: The same hospital readmission rate was 17.9%, while the same hospital or different-hospital readmission rate was 21.3%. Receiver operating characteristic (ROC) curve analysis showed that the predictive performance of the CHAID algorithm was high. According to the CHAID algorithm, the most significant readmission risk factor was the main diagnosis of neoplasm at the index admission. In other diagnosis groups, higher Charlson comorbidity score, higher level of education, having a regular physician, and three dimensions of Readiness for Hospital Discharge Scale were significant risk factors for readmission. The most frequent reason for readmission was neoplasm, and the total cost of readmissions was ~$900 000. CONCLUSIONS: The CHAID algorithm for readmissions had a high predictive strength and provided details that aid physicians in decision-making. Measures must be taken from initial diagnosis to post-discharge follow-up, to minimize readmissions, especially in patients with neoplasm.

Validity and reliability of the Turkish version of the readiness for hospital discharge scale/short form.

AIM: The aim of this study is to test the validity and reliability of the Turkish version of the readiness for hospital discharge scale/short form. BACKGROUND: Assessment of readiness for discharge from the patient's perspective is becoming increasingly important for patient safety, satisfaction and various patient outcomes such as readmission, health service utilization and mortality. The readiness for hospital discharge scale/short form allows health care providers to determine patients' discharge readiness. METHODS: Participants were 1,579 inpatients from internal medicine departments. The readiness for hospital discharge scale/short form was translated into Turkish via back-translation. We analyzed its reliability and validity via item analyses, an expert panel (content validity) and exploratory and confirmatory factor analyses (construct validity). RESULTS: The Cronbach's alpha of the whole scale was .74 and those for the subscales ranged from .79 to .93. The Spearman-Brown reliability coefficient was .92. The confirmatory factor analysis revealed good fit indices (χ2 /df = 2.6; RMSEA = .03; CFI = 1; GFI and AGFI = .99). The mean total score was 7.27 ± 1.85, while the subscale means ranged from 6.62 ± 3.41 to 7.69 ± 2.24. CONCLUSION: The Turkish version of the readiness for hospital discharge scale/short form is a valid and reliable tool for assessing discharge readiness. The subscales with low means suggest opportunities for improvement. IMPLICATIONS FOR NURSING MANAGEMENT: If readiness for hospital discharge scale/short form is valid and reliable, patients who are unready for discharge can be determined with this scale. Thus, nurse managers can determine what kind of measures should be taken for patients who are not ready for discharge, can control nursing practices related to these patients and can provide cooperation between the nurses and other health professionals.

The relationship between burnout and mobbing among hospital managers.

BACKGROUND: Mobbing and burnout can cause serious consequences, especially for health workers and managers. Level of burnout and exposure to mobbing may trigger each other. There is a need to conduct additional and specific studies on the topic to develop some strategies. RESEARCH OBJECTIVES: The purpose of this study is to determine the relationship between level of burnout and exposure to mobbing of the managers (head physician, assistant head physician, head nurse, assistant head nurse, administrator, assistant administrator) at the Ministry of Health hospitals. RESEARCH DESIGN: The "Leymann Inventory of Psychological Terrorization" scale was used to measure the level of exposure to mobbing and the "Maslach Burnout Inventory" scale was used to measure the level of burnout of hospital managers. The relationship between level of burnout and exposure to mobbing was analyzed by Pearson's Correlation Analysis. Participants and research context: The population of this study included managers (454 managers) at the Ministry of Health hospitals in the metropolitan area of Ankara between September 2010 and May 2011. All the managers were tried to conduct, but some managers did not want to reply to the questionnaire and some managers were not found at their workplace. Consequently, using a convenience sampling, 54% of the managers replied to the questionnaire (244 managers). Ethical consideration: The approval of the study was granted by the Ministry of Health in Turkey. Furthermore, the study was evaluated and accepted by the Education, Planning and Coordination Council of one of the education and research hospitals in the study. FINDINGS: Positive relationships were found among each subdimension of the mobbing and emotional exhaustion and depersonalization. A negative relationship was found between each subdimension of the mobbing and personal accomplishment. DISCUSSION: In hospitals, by detecting mobbing actions, burnout may be prevented. CONCLUSION: Exposure to mobbing and burnout could be a serious problem for head nurses who are responsible for both the performance of the nurses and organization. Additionally, head nurses who are faced with mobbing and burnout are more likely to provide suboptimal services which could potentially result in negative outcomes. Therefore, this study draws attention to the importance of preventing these attitudes in the organization.

Violence Against Doctors and Nurses in Hospitals in Turkey.

PURPOSE: This study shows the rates of violence experienced by doctors and nurses and their ensuing responses including reporting rates and any effects experienced because of the violence. METHOD: The Survey for Investigating the Violence on Medical Employees was administered to 254 doctors and nurses. Data were analyzed using chi-square and logistic regression analysis. RESULTS: Of the participants, 74.4% had been exposed to some form of violence. Most of the participants, 87.3%, experienced verbal violence; 12.2% experienced physical violence; and 0.5% experienced sexual violence. Logistic regression analysis indicated that married doctors and nurses are at risk of experiencing violence 0.5 times greater when compared with unmarried or widowed doctors and nurses (p = 0.026). The experience of violence differs by hospital type (p = 0.038) and years working in the healthcare industry (p = 0.042). Differences were also found regarding exposure to violence between doctors and nurses in terms of time of day (p = 0.031) and the work being performed (p < 0.001). The most cited cause of violence (50.8%) was the healthcare system. Verbal response was the most frequent reaction to violence (24.4%), with loss of occupational performance (58.2%) being the most cited negative outcome. Approximately 9.3% of the victims reported the violence to judicial authorities. A lengthy judicial proceeding was chosen as the most significant hindrance to reporting the violence (45.8%). DISCUSSION: This study reveals the effects of violence and reporting rates at two hospitals in Turkey, and it implies that underreporting of violence is an important issue. Therefore, hospital management should take measures to increase reporting and take necessary actions when violence is reported.

The Turkish version of the safety attitudes questionnaire: psychometric properties and baseline data.

OBJECTIVE: To test the psychometric soundness of the Safety Attitudes Questionnaire (SAQ) in Turkish hospitals, examine differences in perceptions of safety and provide baseline data. METHODS: The SAQ (inpatient version) was translated with the back-translation technique into Turkish. Ten out of 50 teaching hospitals belonging to the Ministry of Health in Turkey were selected randomly. The Turkish version of the SAQ was administered to a sample of 2000 care givers at 10 hospitals. The factor structure of the responses was tested by confirmatory factor analysis. Cronbach alphas were calculated, and the mean and percentage positive safety attitude scores were assessed. RESULTS: The response rate was 67.5%. Cronbach alphas of six factors (teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions) ranged from 0.66 to 0.77. Goodness-of-fit indices from the confirmatory factor analysis showed a reasonable model fit. There was a substantial variability among hospitals in terms of items and factors. Baseline data for the Turkish hospitals are presented. CONCLUSION: The Turkish translation of the SAQ showed satisfactory internal psychometric properties. Attitudes relevant to safety culture vary widely by hospital and indicate a need for improvement. Survey findings provide a baseline for future benchmarking.

Comparing patients' and physicians' opinions on quality outpatient care.

The objective of this study was to compare the opinions of patients and physicians on the importance of discrete elements of health care as determinants of the quality of outpatient care. A survey was conducted on patients and physicians of a military hospital in Ankara, Turkey. Participants rated 60 elements of care on its importance to high-quality care on a 5-point scale (not important [1] to essential [5]). These elements covered eight domains: physician clinical skill, physician interpersonal skill, outpatient clinic support staff, outpatient clinic environment, provision of health-related information, patient involvement in care, access to care, and coordination of care. Patients and physicians agreed that clinical skill and interpersonal skill of the physician are the most crucial elements of quality health care, but they disagreed about the relative importance of access to care, coordination of care, and provision of information. Patients placed greater value on these domains than did physicians.