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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 1  |  Issue : 4  |  Page : 212-216

Study of patient safety mandatory infrastructure in Isfahan Hospitals


1 Health Information Management, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Health Services Management, School of Management and Medical Information, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Chief Executive Officer of Al-Zahra Medical Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 PhD Educational Administration, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
5 Health Services Management, Student Research Committee, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication16-Apr-2014

Correspondence Address:
Vahideh Rostami
M.Sc Student, Health Services Managem ent, Student Research Committee, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.130736

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  Abstract 

Context: Patient safety is a critical component of health care quality. In addition to human suffering, unsafe health care exerts a heavy economic cost on the healthcare system. Aims: The aim of this study was to assess the patient safety infrastructure standards in selected hospitals of Isfahan. Subjects and Methods: The present descriptive-analytic study was carried out cross-sectional in spring of 2013. Data were collected using mandatory standards checklist, used by World Health Organization to assess patient safety in hospital, through observation, interviews, and reviewing documents in selected hospitals in Isfahan. The data were analyzed using SPSS 21 and descriptive-inferential statistical methods. Hospitals were classified into three levels of low (lower than 50%), average (5o-70%), and high (higher than 70%) based on the compliance level with infrastructure standards of patient safety. Results: The overall compliance level of patient safety infrastructure standards mean 57.6 ± 14.92 was evaluated average in the studied hospital. Leadership and management with the highest mean (69.5%) were evaluated as average and the patient and public involvement domain with the lowest mean (37.5%) were evaluated low. Conclusions: In total, the overall compliance level of patient safety infrastructure was evaluated average in the studied hospital. Given that acquiring 100% of critical standards in the four domains are essential to be considered at the basic level of patient safety friendly hospital; necessary investments in strategic and operational planning should be considered in order to achieve 100% standards in the four domains.

Keywords: Critical standard, patient safety culture, patient safety friendly hospital, patient safety


How to cite this article:
Raeisi A, Jabbari A, Ganji H, Bahrami S, Rostami V. Study of patient safety mandatory infrastructure in Isfahan Hospitals. Int J Health Syst Disaster Manage 2013;1:212-6

How to cite this URL:
Raeisi A, Jabbari A, Ganji H, Bahrami S, Rostami V. Study of patient safety mandatory infrastructure in Isfahan Hospitals. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2021 Jun 21];1:212-6. Available from: https://www.ijhsdm.org/text.asp?2013/1/4/212/130736


  Introduction Top


Patient safety is a critical component of health care quality [1] and must be considered in health care delivery. [2] Given that hospital is the most important health care organization and because of its special hazard it is extremely important to observe principles of safety in it. [3] Research studies in the Eastern Mediterranean Region have shown that up to 18% of inpatient admissions were associated with adverse events. A total of 2.8% of all admissions were found to be associated with death or permanent disability, while up to 83% of these adverse events were judged to be preventable. [4] In addition to human suffering, unsafe health care exerts a heavy economic cost. [5] There are no systematic activities in progress in these countries in order to reduce these hazards. [6] Patient safety is a new healthcare approach that emphasizes reporting, analysis, and prevention of medical errors that often lead to adverse healthcare events. [7]

In response to the pressing need for the development of patient safety-related interventions, the World Health Organization (WHO) Regional Office for the Eastern Mediterranean started a comprehensive program that includes all patient safety elements and activities called the Patient Safety Friendly Hospital Initiative (PSFHI) since 2006. [8],[9],[10] This intervention complements the efforts of accreditation and quality improvement in hospitals and health care organizations. [10] It involves the implementation of a set of patient safety standards in hospitals. Conformance with standards ensures that patient safety obtains the necessary priority and the hospitals and the staff implement best patient safety practice. [9]

Patient safety friendly hospital assessment is a mechanism developed to assess patient safety in hospitals in order to create a more accountable, responsible, fair, and transparent frame work for patient safety. [4],[9],[10] This assessment will help the hospital to recognize areas of weakness and encourages improvement to reach standard levels. Finally, it provides motivation for staff to participate in improving patient safety. The ultimate goal of the initiative is to improve the level of patient safety in hospitals by creating conditions that lead to safer care, protecting the community from avoidable harm and reducing adverse events in hospital settings. [9] Thus, it offers a starting point to build a safe national health system. [10]

In Iranian hospitals, the poor quality of hospital services, medical errors, and adverse events are cases that have created problems for hospital management, reduced satisfaction, and increased public complaints. Solving these problems has been a serious concern of health system authorities and policy makers. In this respect, to improve accountability and responsibility, Ministry of Health and Medical Education of Iran has initiated PSFHI since 2010. [11],[12]

This program includes implementation of 140 standards in total. Five domains under which the standards are organized are leadership and management, patient and public involvement, safe evidence-based clinical practice, safe environment, and life-long learning. A set of critical, coral, and developmental standards is distributed among the five domains. As the first phase, the main objective of the "patient safety" initiative in Iran was to implementing critical standards. These are compulsory standards which are absolutely essential for any hospital to be considered at the basic level of patient safety.

In this study, we evaluated the current condition of mandatory standards compliance level in selected hospitals of Isfahan to meet the requirements for entering patient safety friendly hospital initiative.


  Subjects and Methods Top


The present descriptive-analytic study was carried out cross-sectional in spring of 2013. The study populations were Hospitals of Isfahan. We selected hospital that are general, private; governmental or social security; and were willing to participate in the study. Therefore, this study was conducted in four governmental hospitals, two private hospitals, and two social security hospitals.

The research tool in this study is mandatory standards checklist that is used by WHO to assess patient safety in hospitals. The checklist is consisted of four domains: leadership and management, patient and public involvement, safe evidence-based clinical practice, and safe environment. There are nine standards in leadership and management, seven standards in patient and public involvement, two standards in safe evidence-based clinical practice, and two standards in safe environment. The checklist is validated through the Iranian Ministry of Health and Medical Education. Data were collected through observation and reviewing of 28 different criteria, having interviews with the patient safety officers; patient safety coordinators; hospital managers; infection prevention and control nurses; laboratory staff; blood bank managers; chief pharmacists; head nurses; medical waste management officers and selected doctors; patients and nurses. Different document and measures were assessed and observed in departments such as inpatient wards, pharmacy, blood bank, laboratories, central sterilization unit, endoscopy unit, and medical record archive.

Research data were scored according to scoring guideline provided by WHO safety program; if the patient safety standard was met for structure, process, and output (the given score was equal to 1). If it was not met for structure, process, and output (the given score was equal to 0) and when standard was met for structure and process (the given score was equal to 0.5). Data were analyzed using SPSS statistical software and descriptive statistical methods and one-way analysis of variance (ANOVA). If the mean score associated with each domain was less than 50%, the status of hospital was low in that domain, if it was between 50% and 70% the status of hospital was average in that domain and if it was more than 70%. The status of hospital was high in that domain. Also, if the hospital total means score in four domain was less than 50% it was considered low, if it was between 50% and 70% the status of hospital was considered average, and if it was more than 70% the status of hospital was considered high.


  Results Top


Patient safety in the eight hospitals was assessed according to mandatory infrastructure standards that a hospital has to act in accordance with in order to be considered for patient safety friendly hospital initiative. From eight studied hospitals, 50% were public hospitals, 25% social security, and 25% private hospital. According to the [Table 1], the leadership and management domain with a mean compliance score of %66.7 ± 11.85 was evaluated average in the studied hospital. The highest and lowest level of compliance belong to hospital numbers 3 and 7 (83.3%) and hospital number 5 (50%), respectively. In leadership and management domain the standards, designated person coordinates patient safety and risk management activities and Qualified clinical staff, both permanent and temporary had the highest score compliance (100%). The standard hospital ensures availability of essential equipment received the lowest score (18.8%).
Table 1: Percentage of compliance level with infrastructure standards of patient safety in studied hospitals

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The patient and public involvement domain with a mean compliance score of %40.6 ± 1 2.93 was evaluated low in the studied hospital. The highest level of compliance belonged to hospital numbers 3, 5, 6, and 7 (50%). In this domain the standard, consent signed by the patient before any invasive procedures had the highest score of compliance (100%) and the standard, patient identification with 37.5% received the lowest score.

The safe evidence-based clinical practice domain with a mean compliance score of 51 ± 25.37 was evaluated average in the studied hospital. The highest and lowest mean level of compliance were hospital numbers 3 and 8 (83.3) and hospital number 2 (8.3%), respectively. In this domain the standard, hospital maintains clear channels of communication had the highest score (81.3%) and the standard, the hospital ensures availability of life-saving medications at all times received the lowest score (12.5%).

The safe environment domain with a mean compliance score of 53.1 ± 50.77 was evaluated average in the studied hospital. The highest level of compliance belonged to hospital numbers 3, 4, 6, and 7 (100%). In this domain the standard. The hospital conforms guidelines on safe management of wastes had the highest score (56.3%) and for the standard. The hospital segregates waste according to hazard level the studied hospital received the lowest score (50%).

The overall, compliance level of patient safety infrastructure mean with 57.6 ± 14.92 was evaluated average in the studied hospitals, the highest scored belonged to leadership and management domain (66.7 ± 11.85) and the patient and public involvement domain received the lowest score (40. 6 ± 12.93).

In the overall level of compliance with patient safety infrastructure standards, hospital number 3 had the highest rating (81.6%) while the lowest rating was hospital number 2 (34.2%).

According to the [Figure 1] in governmental hospitals, total compliance level of patient safety infrastructure standards was evaluated average (55.3%). The leadership and management domain with the highest mean (69.5%) was evaluated average and the patient and public involvement domain with the lowest mean (37.5%) was evaluated low in governmental hospitals.
Figure 1: Level of patient safety infrastructure standards compliance in governmental, social security, and private hospitals

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In social security hospitals, total compliance level of patient safety infrastructure standards was average (67.1). The leadership and management domain with the highest mean (75%) was evaluated average and the patient and public involvement domain with the lowest mean (37.5%) was evaluated low.

In private hospitals, total compliance level of patient safety infrastructure was average with a mean of 52.6%. the safe environment domain with the highest mean (62.5%) was evaluated average and the patient and public involvement domain and safe evidence-based clinical practice with the lowest mean (50%) was evaluated low in private hospitals.

As the figure shows in the leadership and management, safe evidence-based clinical practice domain and total compliance level, social security hospitals had the highest score. In the patient and public involvement and safe environment domain, private hospitals had the highest score.

According to one-way ANOVA, the level of compliance with patient safety infrastructure standards among different hospitals (governmental, social security, and private) showed no significant differences (P > 0/05).


  Discussion Top


This study is the first of its kind to systematically investigate the current state of patient safety mandatory infrastructure standards in Isfahan hospitals. The findings of this study produced an opportunity for health system managers and providers of health services to improve their organizational safety and contribute to building mutual trust and transparency between patients and providers of healthcare services.

The results of study indicated that the overall compliance level of patient safety infrastructure standards with a mean of %57.6 ± 14.92 was evaluated average in studied hospitals. The shortcomings were consistently distributed across all domains, suggesting that any safety improvement initiative would need to be comprehensive and should address all mandatory standards. Norozi et al., [13] in their study evaluated, realization of safety requirements average level (%58) at Shiraz Educational hospitals which is consistent with our study results.

Our study results depicted that among all the patient safety dimensions, the leadership and management domain had the highest mean score (66.7 ± 11.85), which was evaluated average in the studied hospitals. These results were consistent with Rezapoor et al., [14] research. In their study, hospital management support of patient safety was also evaluated average. In El-Jardali et al., [15] studied teamwork within units and hospital management support for patient safety, also had the highest rating. Among the most important of the noncompliance related to leadership and management, we can refer to standards for medical equipment. Therefore, given the important role of medical equipment in the diagnosis, treatment and medical education, and also adverse consequences for inappropriate and insufficient use of medical equipment; the hospitals should have a planning system for supplying, repairing, maintaining, technical training, and equipment information systems in this area.

The patient and public involvement domain with a mean score of %40.6 ± 12.93, level of compliance was evaluated low in the studied hospitals. Our findings are consistent with study conducted by Abbasi et al., [16] which found that hospital status according to patient/family education standards in patient and public involvement domain was at a low level (49%). In order to achieve desired status in patient and public involvement domain, promotion of patient awareness and participation of patients and their caretakers in making decisions about appropriate treatment should be provided. Also given growing threat of patient misidentification for patient safety, a proper patient identification system should be established to improve problems related to miss identification. According to Christian et al., [17] problems in communication and information flow, patient misidentification and workload, and competing tasks were found to have measurable negative impact in team performance and patient safety which confirms our findings.

The safe evidence-based clinical practice domain with a mean score of %51 ± 25.37 level of compliance was evaluated average in the studied hospital. Among the most important of the noncompliance related to this domain was hospital medication system. Given that medication errors are among the most common medical errors and annually exert a heavy economic and life burden on health care system. A medication error reduction program must be established for an effective clinical management system.

The findings of the study conducted by Soozani et al., [18] showed that given the important role of medication errors and their impact on patient safety effective management, improving motivation of nurses, and increasing scientific and clinical skills of nurses to implement medication orders is very important.

Our findings in this domain are consistent with Gibbs. [19] These researchers have investigated factors influencing patient safety in the operating room. The results of their study considering the important role of evidence-based clinical practice indicated that application of therapeutic guidelines and procedures in the operating room increases patient safety.

The safe environment domain with a mean score of %53.1 ± 50.77 was evaluated as average in level of compliance in the studied hospitals. The safe environment domain included safe waste management system. Considering that hospital waste is one of the environmental dilemmas that neglect proper management, it would result in increasing incidence and prevalence of diseases in the community and may lead to an epidemic which can threat human health and is costly. Therefore, appropriate medical waste management is essential. According to national guidelines for waste management, proper application and staff training determine the precise policy for waste management; therefore, more observation and control on the collection and disposal of waste is recommended.

In a study conducted by Yaghobi [20] affiliated with medical waste management in selected hospitals in Isfahan and Gilan and Boyer-Ahmad in 1388, the hospital waste management status was relatively good in segregation, storage, collection, and maintenance, which is consistent with our result. In a study conducted by Mohamed et al., [21] in Bahrain, separation of waste in a health care facility was 86%, which is inconsistent with our results. The reason for this mismatch can be pointed to differences in data collection tool.

The level of compliance with patient safety infrastructure standards among different hospitals: governmental, social security, and private showed no significant differences. In Raeisi et al.,'s study, on the Safety Culture in Isfahan hospitals, also safety culture among different hospitals: governmental and nongovernmental showed no significant differences, [22] which is consistent with our result.

The overall compliance level of patient safety infrastructure was evaluated intermediate in the studied hospitals. Acquiring 100% of critical standards in the four domains are essential to be considered at the basic level of patient safety friendly hospital. At present, the policies and plans are not sufficient in this area. Therefore, necessary investments in strategic and operational planning should be considered in order to achieve 100% compliance with standards in the four domains. Also paying attention to safety culture and it's improvement, conduct regular patient safety executive walk-rounds, proper medical equipment management in the leadership and management domain, using proper patient identification systems, taking measures for informed participation of patients and caretakers, increasing communication level with patients/caregivers and medical staff in the patient and public involvement domain, attention to clinical error particularly medication error and topics related to blood and blood products in the safe evidence-based clinical practice domain and implementation of safe waste management system in the safe environment domain can improve patient safety and provide more effective and faster achievement of critical standards for patient safety. With regard to the items above and the need to create safe hospital, the following suggestions are offered: Creating patient safety culture, promoting error analysis and nonpunitive reporting system, building proper complication management system, increase pharmacological information doctors and nurses with a review of education materials, consultation with a clinical pharmacist and use it in clinical team. Education-specific communication skills (communication within the team, between team, and with patients) standardization processes, constant monitoring of patient safety indicators in various hospital units and plan to improve existing situation, establishing a center for patient safety, develop clinical practice guidelines at least for common diseases and treatment methods and improvement of working conditions.

 
  References Top

1.Sorra JS, Dyer N. Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture. BMC Health Serv Res 2010;10:199.  Back to cited text no. 1
    
2.Emanuel L, Berwick D, Conway J, Combes J, Hatlie M, Leape L, et al. What exactly is patient safety. Adv Patient Saf 2008;1:1-17.  Back to cited text no. 2
    
3.Mehrabadi Z. Assessment of safety status of selected Tehran University of Medical Sciences of coping with disasters. Homaye Salamat 2006;3:5-11.  Back to cited text no. 3
    
4.World Health Organization. Safer hospitals for safer patient care. 2010. Available from: http://www.emro.who.int [Last cited on 2012 Apr 25].  Back to cited text no. 4
    
5.Moghri J, Ghanbarnezhad A, Moghri M, Rahimi Forooshani A, Akbari Sari A, Arab M. Validation of Farsi version of hospital survey on patient Safety culture questionnaire, using confirmatory factor analysis method. Hospital 2012;2:19-29.  Back to cited text no. 5
    
6.Ravaghi H. 7 step to patient safety. Available from: http://vct.qums.unv.behdasht.gov.ir/index.aspx [Last cited on 2013 Feb 15].  Back to cited text no. 6
    
7.NHS. South Central Strategic Health Authority Oxford Deanery Executive. Patient Safety Policy (including Whistle blowing Guidance). 2011; [Cited 2012 April 8]. Available from: www.oxforddeanery.nhs.uk.  Back to cited text no. 7
    
8.World Health Organization. Regional Office for the Eastern Mediterranean. Assessment of patient safety in hospitals a manual for evaluators. 2010; [Cited 2012 June 18]. Available from: www.jmu.ac.ir.  Back to cited text no. 8
    
9.World Health Organization Regional Office for the Eastern Mediterranean. Patient safety assessment manual. 2011; [Cited 2012 February 15]. Available from: www.emro.who.int/dsaf/emropub_2011_1243.pdf.  Back to cited text no. 9
    
10.Ali Abdullatif A. The patient safety friendly hospital initiative: An entry point to building a safer health system the Eastern Mediterranean region. Int Hosp Perspect Reference Book 2007/2008; [Cited 2012March15]. Available from: www.ihf-fih.org.  Back to cited text no. 10
    
11.Islamic Republic of Iran. Patient safety. Available from: http://www.emro.who.int/fr/patient safety/countries/country-activities-islamic-republic-of-iran.html [Last cited on 2012 Sep 5].  Back to cited text no. 11
    
12.Kermanchi J. Patient safety in Iran: Opportunities and challenges. Patient Safety. Urmia. 2012. p. 1-191.  Back to cited text no. 12
    
13.Norozi MA, Mahdi J, Parvin A, Forough ZD. Evaluation of the safety conditions of Shiraz university of medical sciences educational hospitals using safety audit technique. Payavard Salamat 2012;6:42-51.  Back to cited text no. 13
    
14.Rezapoor A, Ebadi Fard Azar F, Tanoomand KA, Bayat R, Arabloo J, Rezapoor Z. Study of patients′ safety culture in Selected training hospitals affiliated with Tehran University of medical sciences. Hospital 2012;41:56-64.  Back to cited text no. 14
    
15.El-Jardali F, Jaafar M, Dimassi H, Jamal D, Hamdan R. The current state of patient safety culture in Lebanese hospitals: A study at baseline. Int J Qual Health Care 2010;22:386-95.  Back to cited text no. 15
    
16.Abbasi Sh, Tavakoli N, Moslehi M. Readiness of hospitals with quality management systems based on joint commission on accreditation standards. Health Inf Manag 2012;9:502-12.  Back to cited text no. 16
    
17.Christian CK, Gustafson ML, Roth EM, Sheridan TB, Gandhi TK, Dwyer K, et al. A prospective study of patient safety in the operating room. Surgery 2006;139:159-73.  Back to cited text no. 17
    
18.Soozani A, Bagheri H, Poorheydari M. Survey nurses view about factors affects medication errors in different care units of Imam Hossein hospital in Shahroud. Knowl Health 2007;2:8-13.  Back to cited text no. 18
    
19.Gibbs VC. Patient safety practices in the operating room: Correct-site surgery and nothing left behind. Surg Clin North Am 2005;85:1307-19.  Back to cited text no. 19
[PUBMED]    
20.Yaghobi M. Study of medical waste management and waste associated with the selected hospitals in Isfahan, Gilan and Boyer Ahmad asserting in 1388. Dissertation. Esfahan: Isfahan University of Medical Sciences ; 2009.  Back to cited text no. 20
    
21.Mohamed LF, Ebrahim SA, Al-Thukair AA. Hazardous healthcare waste management in the Kingdom of Bahrain. Waste Manag 2009;29:2404-9.  Back to cited text no. 21
    
22.Raeisi AR, Nazari M, Bahmanziari N. Assessment of safety culture in Isfahan hospitals (2010). Mater Sociomed 2013;25:44-7.  Back to cited text no. 22
    


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