Understanding Internal Medicine Residents' Rheumatology Knowledge Base.

Rheumatology is one of the internal medicine subspecialties that residents train to become proficient in during their internal medicine training. Our study sought to understand how residents across all postgraduate year levels felt in terms of comfortability and exposure to rheumatology. We focused on the subjective measurement of resident knowledge and exposure rather than objective data. A five-question survey was distributed to all 75 residents of Lenox Hill Hospital's Internal Medicine categorical residency program, from PGY1 to PGY3. When asked if they get enough exposure or feel confident treating patients with rheumatology diseases, 96% of residents responded no. When asked about their confidence in boards, the average response was a 3/10. The residents at our program voiced a strong concern for lack of exposure and education. Other studies and institutions have shown this to be a problem that has also been seen with poor test performance on the subject. We explore educational modalities to help improve this gap in education.

Psychometric properties and criterion related validity of the Norwegian version of hospital survey on patient safety culture 2.0.

BACKGROUND: Several studies have been conducted with the 1.0 version of the Hospital Survey on Patient Safety Culture (HSOPSC) in Norway and globally. The 2.0 version has not been translated and tested in Norwegian hospital settings. This study aims to 1) assess the psychometrics of the Norwegian version (N-HSOPSC 2.0), and 2) assess the criterion validity of the N-HSOPSC 2.0, adding two more outcomes, namely 'pleasure of work' and 'turnover intention'. METHODS: The HSOPSC 2.0 was translated using a sequential translation process. A convenience sample was used, inviting hospital staff from two hospitals (N = 1002) to participate in a cross-sectional questionnaire study. Data were analyzed using Mplus. The construct validity was tested with confirmatory factor analysis (CFA). Convergent validity was tested using Average Variance Explained (AVE), and internal consistency was tested with composite reliability (CR) and Cronbach's alpha. Criterion related validity was tested with multiple linear regression. RESULTS: The overall statistical results using the N-HSOPSC 2.0 indicate that the model fit based on CFA was acceptable. Five of the N-HSOPSC 2.0 dimensions had AVE scores below the 0.5 criterium. The CR criterium was meet on all dimensions except Teamwork (0.61). However, Teamwork was one of the most important and significant predictors of the outcomes. Regression models explained most variance related to patient safety rating (adjusted R2 = 0.38), followed by 'turnover intention' (adjusted R2 = 0.22), 'pleasure at work' (adjusted R2 = 0.14), and lastly, 'number of reported events' (adjusted R2=0.06). CONCLUSION: The N-HSOPSC 2.0 had acceptable construct validity and internal consistency when translated to Norwegian and tested among Norwegian staff in two hospitals. Hence, the instrument is appropriate for use in Norwegian hospital settings. The ten dimensions predicted most variance related to 'overall patient safety', and less related to 'number of reported events'. In addition, the safety culture dimensions predicted 'pleasure at work' and 'turnover intention', which is not part of the original instrument.

Practices Used to Improve Patient Safety Culture Among Healthcare Professionals in a Tertiary Care Hospital.

Introduction: A patient safety culture primarily refers to the values, beliefs, attitudes, and behaviors within a healthcare setup in a community that assists in prioritizing patient safety and encouraging the reporting of errors and near-misses in that facility. There is a direct impact of patient safety culture on how well patient safety and quality improvement programs work. The aim of this cross-sectional descriptive study was to investigate the practices to improve patient safety culture and adverse event reporting practices among healthcare professionals in a tertiary care hospital located in Mirpur Azad Jammu and Kashmir. Methods: In the non-probability convenience sampling of this cross-sectional study, Divisional Headquarters Teaching Hospital in Mirpur, Azad Kashmir used the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture Hospital Survey to collect data about the perceptions of healthcare professionals regarding patient safety culture within their hospital to assess the trends of patient safety culture by obtaining longitudinal data. A pre-validated questionnaire that has undergone a rigorous trial of testing to maximize the reliability and accuracy of the outcomes was distributed among clinical staff (healthcare professionals who interact with patients on a daily basis, such as nurses, doctors, pharmacists, and laboratory technicians) and administrative staff (medical superintendent, deputy medical superintendent, assistant medical superintendent, heads of departments). Results: A total of 312 questionnaires were returned (response rate, 76%). The study found that the dimension "supervisor/manager expectation and action promoting safety" had the highest positive response rate (65.16%), and "nonpunitive response" had the lowest (27.4%). Higher scores in "nonpunitive response to error" were associated with lower rates of medication errors, pressure ulcers, and surgical site infections, and higher scores in "frequency of event reporting" were associated with lower rates of medication errors, pressure ulcers, falls, hospital-acquired infections, and urinary tract infections. Conclusion: We suggest that in order for hospital staff to continue providing excellent, clinically safe treatment, a well-structured hospital culture promoting patient safety is necessary. Moreover, further study is needed to determine strategies to improve patient safety expertise and awareness, and lower the frequency of adverse occurrences.

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

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

Health staff perceptions of patient safety and associated factors in hospitals in Vietnam.

Introduction: Patient safety is a global challenge of preventing and mitigating medical errors which might harm patients during their course of treatment and care. This study was employed to contribute to the existing literature aimed to assess patient safety culture among health staff and to determine predictors of health staff perceptions of patient safety in hospitals in Vietnam. Methods: A cross-sectional study was conducted in three hospitals of Vietnam with a total of 763 participants. This study used the Hospital Patient Safety Scale developed by the American Health and Quality Research Organization. Results: In general, 8 of 12 patient safety dimensions in two hospital; and 10 of 12 dimensions in a third hospital had average scores of 60% and above positive responses. The communication openness and organizational learning dimensions were found to be significant different when comparing hospitals. Regarding sample characteristics, department (subclinical department) and health staff positions (nurses/technicians, pharmacists) were significant predictors in the total model including three hospitals (R2 = 0.07). Conclusion: This study reported that communication openness and organization learning are two aspects that need to be improved they are strongly related to patient safety culture and to knowledge exchange among health staff. It has been suggested that hospitals should deliver patient safety training courses and establish a supportive learning environment to improve these challenges.

Psychometric evaluation of the Persian version of the Hospital Survey on Patient Safety Culture Questionnaire (HSOPSC) in neonatal intensive care units: a methodological study.

BACKGROUND: A valid and reliable tool compatible with the culture is needed to evaluate the safety culture as one of the vital and promotional components in improving the quality of safety and health care. This study aimed to investigate the psychometric properties of the Persian version of the "Hospital Survey on Patient Safety Culture (HSOPSC)" in physicians and nurses working in Neonatal Intensive Care Units. METHODS: In this methodological research, the qualitative face, content validity, and construct validity were performed by Confirmatory Factor Analysis to the psychometric evaluation of the HSOPSC questionnaire. Based on convenience sampling and the inclusion criteria, 360 individuals completed the questionnaire. Internal consistency and stability were measured. Data analysis was performed using SPSS 21 and LISREL. RESULTS: In examining the construct validity, fit indices were not appropriate for the 12-dimension model of the Persian version. According to T-value, six heterogeneous items and a dimension were omitted. The 11-dimension model with 36 items showed an appropriate fit with the data. Cronbach's alpha was evaluated at 0.79, and the stability was 0.82 (p˂0.001). CONCLUSION: The Persian version of HSOPSC with 11 dimensions and 36 items has favorable validity and reliability and can be used in NICUs.

The impact of an educational program on knowledge and perception of patient safety culture among nurses in the two medical colleges of Manipur: A quasi-experimental study.

Background: Nurses' leaders are protracted as high-leverage players who would be instrumental in initiating or bettering the culture of safety in the hospital, with no previous intervention done for the same in Manipur. Objectives: The aim of this study was to assess the effectiveness of an educational intervention program on patient safety culture among nurses in Manipur. Materials and Methods: A quasi-experimental study was conducted from July 2019 to December 2021 among the 32 nurses of two tertiary-level hospitals in Manipur. A structured questionnaire and Hospital Survey on Patient Safety Culture version 2 were used (Hospital Survey on Patient Safety Culture (HSOPSC) version 2.O (AHRQ, Rockyville, Maryland, USA)). A 2-day intervention based on the WHO's Multi-Professional Patient Safety Curriculum Guide was used. Data were collected before, immediately, and 3 months after the intervention. Data were summarized using descriptive using IBM SPSS 26. Paired t-test, Chi-square test, and t-test were employed to check for differences within and between the groups, and P < 0.05 was taken as statistically significant. Results: The mean knowledge scores were comparable between the groups at baseline (7.13 ± 3.3, 8.44 ± 3.74; P = 0.142) but differed significantly at posttest and follow-up tests (P < 0.0001). The dimensions of "staffing and work pace" and "reporting patient safety events" had the lowest positive responses from both the groups at baseline. There is a significant increase in the total safety score from baseline to posttest and follow-up in the intervention group (P < 0.001). Conclusions: The study asseverated the effectiveness of an educational intervention in increasing the knowledge and perception of patient safety culture, but the results highlighted the need for training at regular intervals.

Healthcare Managers' Perception on Patient Safety Culture.

Introduction: This paper takes a detailed look at safety culture, different roles, and powers shared by managers, lessons from which can be applied in any form of management. It also focuses on the job of managers in enhancing safety standards in a health institution. The objective of this paper was to examine the managers' perception of patient safety culture. Methods: This study followed a quantitative cross-sectional design. The research procedure involved all middle-level managers in Aseer Central Hospital in Abha, Saudi Arabia (N = 52). To assess the status of patient safety culture and the role of healthcare managers in the field study, the researchers constructed a study questionnaire; it included questions adapted and modified from the Safety Attitudes Questionnaire, the Hospital Survey on Patient Safety Culture questionnaire, the 10 Mintzberg managerial roles and the six types of power for healthcare managers. Results: Most participants were Saudi nationals (73.1%) aged 31 to 40 years (44.2%). The managerial role practiced frequently was leadership (85%), but the least managerial role was the figurehead (23%). Mangers held positive attitudes toward patient safety culture with 100% positive replies. No significant association was found between sex, nationality, years of experience, and professions concerning patient safety. Additionally, the results indicated that most managers were willing to uphold a safe environment for their patients and ready to involve employees in decision-making strategies to motivate them. Conclusion: The managerial choices in Aseer Central Hospital are based on the culture and tradition of the community, which might negatively undermine the capability of other individuals handling the same office based on their educational backgrounds and competency. Such situations also may demoralize the employees, leading to poor employee performance Suboptimal achievement was exhibited primarily by middle-level healthcare managers of all six power types: resource allocator, negotiator, liaison, spokesperson, figurehead, and entrepreneur. Therefore, there is a pressing need to improve managers' attitudes toward patient safety and activate managerial roles to ensure patients' safety is practiced unequivocally.

An Evaluation of Healthcare Safety Culture Among Healthcare Professionals in Secondary and Tertiary Public Hospitals in the Middle East Region.

Background and aim The provision of quality healthcare is initiated by a culture of patient safety. Understanding the patient safety culture (PSC) is a critical concept for all healthcare workers. We conducted this study to evaluate the PSC understanding among the Hamad Medical Corporation (HMC) staff members. Furthermore, to establish a local (HMC) reference point for providing quality health care based on a culture of patient safety. Method A Hospital Patient Safety Culture Survey (HSOPSC) was presented to our health system employees to assess their perceptions and understandings of PSC. The survey was self-administered. STATA Package version 12.0 culture software was used to analyze these data in terms of descriptive, correlational, and multivariate ordinal regression. Results This study targeted to survey 6,538 employees in HMC facilities, but only 5,583 responded, resulting in a percentage response rate of 85.4%. Ten facilities achieved 100% participation, and other HMC facilities had response rates ranging from 71.2% to 97.5%. Approximately 88.0% of the responders had direct patient contact. The HSOPSC survey resulted in an overall positive response rate of 62.4%. The dimensions with the highest positive response score were "teamwork within the Unit" followed by "organizational learning/continuous improvement" and "management support for patient safety" with a mean percent positive response (PPR) of 83.1%, 82.0%, and 79.2%, respectively. Conversely, there are three dimensions with the lowest positive response score, including "communication openness," "staffing," and "nonpunitive response to errors," with a mean PPR of 46.6%, 40.1%, and 27.7%, respectively. ANOVA and the student t-test revealed that men (64.3% ± 8.1%), employees with 11-15 years of experience in their specialty (65.8% ± 6.5%), and general hospital type (64.4% ±7.2%), were all significantly associated with differences in the overall perceptions of PSC. According to the study results, there was a moderate correlation between perceptions of PSC at the hospital and the following: Teamwork Across Units (RS= 0.43; p < 0.05), and Frequency of Events Reported (RS= 0.40; p < 0.05.). A regression analysis found that men, workers under 40 years of age, professionals with no direct contact with patients, employees with 11-15 years of experience in their specialty, intensive care staff, and general hospital staff were all significant predictors of overall favorable perceptions of the PSC. Conclusion PSC's understanding of HMC staff is moderate. Furthermore, this is the first study conducted for PSC understanding by the HMC staff in Qatar State. It is eligible to be considered a backbone and reference for new research projects about PSC in Qatari health facilities, if not worldwide.

Safety perception in the operating environment: The nurses' perspective versus that of the surgeons.

Background: Adverse effects due to surgery occur in 25% of patients, and the patient safety perception seems to differ between nurses and surgeons in the operating room (OR). This difference can be attributed to lack of communication. However, our hospital has not conducted any studies on patient safety climate (PSC) in the OR. Aims: To determine if the perception of PSC of nurses and surgeons in the OR diverges and understand whether these differences could be explained by communication gap. Methods: A total of 42 perioperative nurses and 44 surgeons in the OR of a tertiary hospital answered the Spanish version of the US Hospital Survey on PSC. This was an observational, cross-sectional study with descriptive statistics and a non-parametric test. Results: Nurses had a worse perception of the dimensions of overall safety, leader expectations, teamwork within units, feedback, staffing, and hospital management (p < .05). Although no differences were found concerning organizational learning/continuous improvement, communication openness, nonpunitive responses, and teamwork across hospital unit dimensions, the findings suggest that the nurses' perception was worse than that of the surgeons. Conclusions: In general, OR nurses have worse PSC than surgeons, mainly in the areas where communication it's important. Our study has provided the data that will enable the hospital management team to make decisions to improve the PSC in the operating room area. We recommend a more active presence of nurses in directive teams.

The First Comprehensive Survey of the Practice of Postoperative Pain Management in Hungarian Hospitals: A Descriptive Study.

BACKGROUND: Pain management is a key issue in health care. Providers adopt promising technological developments, like Acute Pain Service, at differing speeds, with countries, such as the USA and Germany taking the lead. Where Hungary stands is unknown, as the practice of pain management has not yet been comprehensively reviewed in that country. AIM: To explore the practice of postoperative pain management in Hungarian hospitals by addressing the questions of who is responsible for it, who measures pain and how, what kind of pain relief technologies are used, and who takes care of patients during duty hours. METHODS: We carried out a survey covering Hungarian hospitals with operational license for surgery, traumatology, orthopedics and anesthesiology between December 2019 and March 2020. The response rate was 72%, and we analyzed 135 questionnaires. RESULTS: We identified only 2 hospitals with an Acute Pain Service. In the majority of hospitals, the attending physician orders pain relief therapy. During duty hours the surgeon on duty takes care of pain management in 52.1% of the cases. Among pain relief therapies, intravenous infusions (74.1%) and oral medication (67.4%) are the most frequent. Ward nurses measure postoperative pain (77.8%) with unidimensional scales. According to 59.7% of the respondents, pain is not measured and documented at rest. Written protocols are available in 34.4% of the departments. CONCLUSIONS: Compared with other countries, pain management in Hungary lags behind with significant room for improvement. Development and implementation of pain management protocols with appropriate education is the key intervention point.

Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis.

INTRODUCTION: Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America. PURPOSE: Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC). METHODS: This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated. RESULTS: In total, 30 studies from five countries-Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)-were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were "organizational learning: continuous improvement" and "teamwork within units", while the least positive were "nonpunitive response to error" and "staffing". Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53-51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02-63.66). CONCLUSIONS: Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives.

[Patient safety culture in neonatal intensive care units as seen by nurses]. / La culture de sécurité des patients dans les unités de soins intensifsnéonatals vue par les équipes.

Neonatal intensive care units (NICUs) are critical environments in terms of safety of care, with a high risk of adverse events. Measuring the patient safety culture of the professionals working there should help to improve the care offered. A descriptive cross-sectional study, conducted among 141 nurses and childcare workers in 2020 in 5 Tunisian hospitals, examined this question.

Healthcare Workers' Perceptions and Medically Approved COVID-19 Infection Risk: Understanding the Mental Health Dimension of the Pandemic. A German Hospital Case Study.

Introduction: This study analyses how healthcare workers (HCWs) perceived risks, protection and preventive measures during the COVID-19 pandemic in relation to medically approved risks and organizational measures. The aim is to explore "blind spots" of pandemic protection and make mental health needs of HCWs visible. Methods: We have chosen an "optimal-case" scenario of a high-income country with a well-resourced hospital sector and low HCW infection rate at the organizational level to explore governance gaps in HCW protection. A German multi-method hospital study at Hannover Medical School served as empirical case; document analysis, expert information and survey data (n = 1,163) were collected as part of a clinical study into SARS-CoV-2 serology testing during the second wave of the pandemic (November 2020-February 2021). Selected survey items included perceptions of risks, protection and preventive measures. Descriptive statistical analysis and regression were undertaken for gender, profession and COVID-19 patient care. Results: The results reveal a low risk of 1% medically approved infections among participants, but a much higher mean personal risk estimate of 15%. The majority (68.4%) expressed "some" to "very strong" fear of acquiring infection at the workplace. Individual protective behavior and compliance with protective workplace measures were estimated as very high. Yet only about half of the respondents felt strongly protected by the employer; 12% even perceived "no" or "little" protection. Gender and contact with COVID-19 patients had no significant effect on the estimations of infection risks and protective workplace behavior, but nursing was correlated with higher levels of personal risk estimations and fear of infection. Conclusions: A strong mismatch between low medically approved risk and personal risk perceptions of HCWs brings stressors and threats into view, that may be preventable through better information, training/education and risk communication and through investment in mental health and inclusion in pandemic preparedness plans.

Healthcare professionals' perceptions of patient safety culture and teamwork in intrapartum care: a cross-sectional study.

BACKGROUND: In complex healthcare organizations, such as intrapartum care, both patient safety culture and teamwork are important aspects of patient safety. Patient safety culture is important for the values and norms shared by interprofessional teams in an organization, and such values are principles that guide team members' behavior. The aim of this study was 1) to investigate differences in perceptions of patient safety culture and teamwork between professions (midwives, physicians, nursing assistants) and between labor wards in intrapartum care and 2) to explore the potential associations between teamwork and overall perceptions of patient safety and frequency of events reported.  METHODS: The design was cross-sectional, using the Swedish version of the Hospital Survey on Patient Safety Culture (14 dimensions) and the TeamSTEPPS® Teamwork Perceptions Questionnaire (5 dimensions). Midwives, physicians, and nursing assistants in three labor wards in Sweden in 2018 were included. Descriptive statistics, the Kruskal-Wallis H test, two-way ANOVA, and standard multiple regression analysis were used. RESULTS: The questionnaires were completed by 184 of the 365 healthcare professionals, giving a response rate of 50.4%. Two-way ANOVA showed a significant main effect of profession on two patient safety culture dimensions and one teamwork dimension and a significant main effect of labor ward on four patient safety culture dimensions and four teamwork dimensions. A significant interaction effect of profession and labor ward was found on four patient safety culture dimensions and four teamwork dimensions. The regression analysis revealed that four out of the five teamwork dimensions explained 40% of the variance in the outcome dimension ´Overall perceptions of patient safety´. CONCLUSIONS: The results of the study indicate that profession and labor ward are important for healthcare professionals' perceptions of patient safety culture and teamwork in intrapartum care. Teamwork perceptions are significant for overall patient safety.

Patient Safety Culture in Primary Healthcare Centers in the Eastern Province of Saudi Arabia.

PURPOSE: This study aimed to explore health-care workers' perceptions of patient safety culture (PSC) at primary health-care centers (PHCs) in the Eastern Province of Saudi Arabia and the factors that influence them. An additional aim was to identify the challenges of adopting PSCs in the PHCs of this region. METHODS: This is a cross-sectional study that adopted a PSC questionnaire from the Agency for Healthcare Research and Quality (AHRQ). The questionnaire was administered online and onsite targeted health-care workers at private, governmental, and quasi-governmental PHCs in the Eastern Province of Saudi Arabia, with 310 participants completing the survey. RESULTS: The overall positive response rate of participants to the survey areas was 43.5% which is lower than the average for the AHRQ data in general. Teamwork scored the highest positive response (68.8%) while Number of Events and non-punitive Response to Error scored the lowest at 10.6% and 30.7%, respectively. In addition, ANOVA and t-tests were used to determine the bivariate associations for the parametric variables. The study reveals statistically significant differences between all demographic variables and overall PSC score, except by age. CONCLUSION: The findings highlight a number of areas for improvement, particularly in relation to event reporting, non-punitive responses, and openness in communication. Consequently, establishing a safety culture in health-care organizations necessitates the elimination of three crucial elements regarding errors: blame, fear, and silence. Error reporting should not just be considered a means of learning from mistakes; it should also be considered the first step towards preventing injury and improving patient safety.

Cultura de seguridad del paciente en diferentes ámbitos asistenciales: fortalezas y oportunidades de mejora / Patient safety culture in different healthcare settings: strengths and improvement opportunities

Objetivo: identificar fortalezas y oportunidades de mejora respecto a la cultura de seguridad (CdS) del paciente de profesionales sanitarios en diferentes niveles asistenciales y analizar su asociación con factores sociales y profesionales. Método: estudio descriptivo transversal realizado en el Parc Sanitari Sant Joan de Déu de Sant Boi de Llobregat (Barcelona, España). Se incluyeron profesionales asistenciales excluyendo a los que llevaran <1 año trabajando o estudiantes (N= 1.976). Se administró la versión española del cuestionario Hospital Survey on Patient Safety Culture. Se consideraron fortalezas un ≥ 75% de respuestas positivas y oportunidades de mejora ≥ 50% de respuestas negativas. Se realizó un análisis descriptivo, un análisis bivariante mediante Chi cuadrado, U de Mann-Whitney y Kruskal-Wallis considerando significancia estadística a valores p< 0,05. Resultados: participaron 205 profesionales (10,4%) de los cuales el 56,1% fue mujer, el 25,4% enfermero/a, el 54,6% trabajaba en Salud Mental, el 76,1% tenía turno diurno y el 71,7% llevaba > 5 años trabajando. La dimensión “Trabajo en equipo dentro de las unidades/servicios” fue la única de las 12 analizadas que resultó una fortaleza (75,31% respuestas positivas). No se identificaron oportunidades de mejora, pero la “Dotación de personal” fue la dimensión peor valorada (44,26% respuestas negativas). Los auxiliares de Enfermería mostraron mayor CdS, igual que los del turno nocturno, los que llevaban > 5 años trabajando y los de ámbito hospitalario. El ámbito con menos CdS fue el de Salud Mental. Conclusiones: el trabajo en equipo es un pilar fundamental en la CdS. Es imprescindible diseñar estrategias que generen un impacto positivo en la seguridad del paciente, como reforzar la dotación de personal.(AU)

Objective: to identify the strengths and improvement opportunities regarding Safety Culture (SC) for patients by healthcare professionals in different settings of care, and to analyse their association with social and professional factors. Method: a descriptive cross-sectional study conducted at the Parc Sanitari Sant Joan de Déu in Sant Boi de Llobregat, (Barcelona, Spain). The study included healthcare professionals; students or those who had been working for <1 year were excluded (N= 1,976). The Spanish version of the Hospital Survey on Patient Safety Culture questionnaire was administered. Strengths were considered at ≥ 75% of positive answers, and improvement opportunities at ≥ 50% of negative answers. Descriptive analysis was conducted, and bivariate analysis through Square Chi, Mann-Whitney’s U and Kruskal-Wallis; statistical significance was considered at p< 0.05 values. Results: the study involved 205 professionals (10.4%); 56.1% were female, 25.4% were nurses, 54.6% worked in Mental Health, 76.1% worked in the day shift, and 71.7% had been working for > 5 years. The dimension “teamwork within the units/ departments” was the only one out of the 12 analysed which represented a strength (75.31% of positive answers). No improvement opportunities were identified, but “staffing” was the dimension with the worst rating (44.26% of negative answers). Nursing assistants showed higher SC, as well as those in the night shift, those who had been working >5 years and those in the hospital setting. The setting with the lowest SC was Mental Health. Conclusions: teamwork is a key element in SC. It is essential to design strategies that will generate a positive impact on patient safety, such as reinforcing the staff.(AU)

Patient Safety Culture in European Hospitals: A Comparative Mixed Methods Study.

BACKGROUND: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. PURPOSE: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. DESIGN: A comparative mixed methods study with a convergent parallel design. METHODS: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. RESULTS: The overall perception of safety culture for most dimensions was 'adequate' in Sweden and 'adequate' to 'poor' in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. CONCLUSIONS: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy.

Patient Safety Culture in a Teaching Hospital in Eastern Province of Saudi Arabia: Assessment and Opportunities for Improvement.

PURPOSE: The objective of the present study is to explore the perceptions of patient safety culture (PSC) among King Fahd University Hospital's (KFUH) employees and to develop recommendations to overcome the factors that impede the integration of PSC in the study setting. METHODS: This is a cross-sectional study that assessed the level of PSC at KFUH. This study used the Hospital Survey on Patient Safety Culture tool from all KFUH healthcare workers (n=900) in 2018. FINDINGS: The response rate of the study was 67%. Findings show that KFUH excelled in three PSC composites: continuous organizational learning, feedback and communication about error, and frequency of events reported. In contrast, staffing, teamwork within units, and non-punitive response to error yielded low composite scores. ORIGINALITY/VALUE: The strength of the present study was the use of a valid questionnaire that has been used widely in the literature with a large sample size, which yielded valid results. It is, to our knowledge, the first research study that analyzes health workers' perceptions on patient safety culture in a teaching hospital in Eastern Province in KSA and compares it with Agency for Healthcare Research and Quality (AHRQ) and Saudi Hospital Survey on Patient Safety Culture (HSPSC). Results from the study highlight the need to employ an adequate number of workers, implement continuous patient safety training programs, and adopt safety programs and policies.

Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work.

BACKGROUND: Safety culture can be described and understood through its manifestations in the organization as artefacts, espoused values and basic underlying assumptions and is strongly related to leadership-yet it remains elusive as a concept. Even if the literature points to leadership as an important factor for creating and sustaining a mature safety culture, little is known about how the safety work of first line managers' is done and how they balance the different and often conflicting organizational goals in everyday practice. The purpose of this study was to explore how health care first line managers perceive their role and how they promote patient safety and patient safety culture in their units. METHODS: Interview study with first line managers in intensive care units in eight different hospitals located in the middle of Sweden. An inductive qualitative content analysis approach was used, this was then followed by a deductive analysis of the strategies informed by constructs from High reliability organizations. RESULTS: We present how first line managers view their role in patient safety and exemplify concrete strategies by which managers promote patient safety in everyday work. CONCLUSIONS: Our study shows the central role of front-line managers in organizing for safe care and creating a culture for patient safety. Although promoted widely in Swedish healthcare at the time for the interviews, the HSOPSC was not mentioned by the managers as a central source of information on the unit's safety culture.