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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 180-185

The study of safety management in the hospitals affiliated to Isfahan University of Medical Science in 2013


1 Department of Health Services Management, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
2 Health Services Management, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
4 Environmental Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication4-Oct-2014

Correspondence Address:
Noureddin Niknam
M.Sc. Student in Health Services Management, Health Management and Economics Research Center, Isfahan University of Medical Science, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.142207

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  Abstract 

Introduction: Hospital, as one of the most important departments providing health services needs to regard safety principles due to its especial conditions. This study was conducted to assess safety in the hospitals affiliated to Isfahan University of Medical Sciences. Materials and Methods: This Cross-sectional and descriptive study was conducted in four hospitals affiliated to Isfahan University of Medical Sciences. Data collection instruments consist of the checklist and questionnaire which were completed through observation, the monitoring of documents and interview with the officials of different sectors. These equipments were designed and used in according to Australia`s safety Management Standards. In addition, the amounts of Cronbach's alpha for the checklist and questionnaire were 0.74 and 0.77 respectively. Hospitals safety condition was classified to very appropriate, appropriate, moderate, weak and very weak categories, according to the levels achieved by safety management standards. The study's results were analyzed by SPSS through ANOVA statistical test. Results: The averages and standard deviations of safety management scores of A, B, C and D hospitals were 62.5 ± 7.09, 49.08 ± 9.15, 60.01 ± 9.46 and 60.3 ± 5.76, respectively. The highest levels achieved by safety management standards were found in management, leadership and organization standards with 68.87 average score and also the least ones could be seen in the standard of the plan assuring quality with 36.09 average score. Conclusions: The condition of safety management in studied hospitals was mostly at the average level and in some cases was evaluated lower than expected. Since regarding the safety principles in hospitals are very necessary and crucial, they must be reconstructed and considered in the hospitals' policies and management rules.

Keywords: Safety management, hospital, clinical unit, paraclinical unit


How to cite this article:
Shams AA, Jabbari A, Niknam N, Zadeh AH, Mengelizadeh N, Mostafaie S. The study of safety management in the hospitals affiliated to Isfahan University of Medical Science in 2013. Int J Health Syst Disaster Manage 2014;2:180-5

How to cite this URL:
Shams AA, Jabbari A, Niknam N, Zadeh AH, Mengelizadeh N, Mostafaie S. The study of safety management in the hospitals affiliated to Isfahan University of Medical Science in 2013. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2024 Mar 28];2:180-5. Available from: https://www.ijhsdm.org/text.asp?2014/2/3/180/142207


  Introduction Top


Hospitals are considered dangerous places for their staffs. According to the report of the United States' Labor Organization, they have higher level of occupational and non-fatal damages (7.5) rather than constructing industries (6.2), productive industries (5.6), business, transportation and civil services (5.6). [1] There are physical, chemical, biological, psychological and social hazards in hospitals which affect their staffs. In fact, they are regarded as permanent stressors of hospital-related occupations. [2] These dangers and threats can be eradicated or at least reduced by decreasing the potential risks, preventing from accidents and minimizing negative results made by occupational stressors. This means that comprehensive safety management system should be established to gain these goals. So, safety management as one of the main agents of health services quality has the significant role in enabling hospitals to promote the safety of patients, staffs, processes and policies. [3]

Safety management system is defined as organizational construct, responsibilities, processes, policies and resources applied for controlling, making trust and also promoting health and safety of health care. [4] The safety level of organization which is regarded as the least acceptable one should be qualified enough. But risky levels of safety in organization are fluctuated in various periods of time due to organizational affairs and the identity of duties. In other words, the organizations keep this level at the least assumed rates by conducting safety measures. [5] Consequently, traditional attitude towards safety management considers this concept as a reaction to occurrences. On the other hand, new approach to safety management focuses on this issue so that the level of risk, in organization, must be kept in appropriate rate. It actually depends on having a future-based view to this concept. [6] Therefore, the responsibility of providing safety in hospital is an important task of all managers in different ranks. They have to establish an efficient management team to achieve safety by qualified planning and bringing about the circumstances in which the probability of destructive events reduces as far as possible. [7],[8]

The study conducted in the U.S.A. showed that the average hospital costs increase due to disregarding safety principles, was 400 USD for every patient. Some research conducted in England by Hosper demonstrated that the costs of hospitals have reduced down to 7 million pounds by implementing a seven-year comprehensive safety program. He found that the average of safety expenses in those sectors decreased 30% by regarding safety program. [9] Yamaochi et al., [10] have done a project to seek how far hospitals were ready in handling any critical events. They found that written protocol to handle firing in more than two third of studied hospitals were available. They also believe that providing a written safety protocol for hospitals in order to prevent from happening dangerous events is very essential.

The studies which have been conducted in Iran for finding hospitals safety situation showed that there is a long way to reach the appropriate condition. [11],[12],[13] Fathi [14] came to this conclusion in his study that only one hospital owned acceptable safety condition and 20-30% of his studied hospitals had weak safety condition. The rest of them had average level of safety. He concluded that safety condition in hospitals is not appropriate at all. Jahani et al., [15] investigated some of hospitals safety indices. They found that, in 94% of studied cases, the pathways towards emergency exit were not shown by guiding signals. Only 33.2% of hospitals, in this study, established accidents, safety and crisis committee. Pourreza [16] in the study in which the safety condition in operation rooms were monitored, found that all fire extinction devices were manual. He concluded that the most important operation rooms' safety defects consisted of danger announcement system, staff training and the floor electricity conduction.

Ignoring safety management standards in hospitals leads to highly irrecoverable damages including financial losses. It may result in death of innocent victims. So, providing safe and qualified health services, as one of the main health system functions, has high priority among other affairs. Naturally, policy making, planning, implementing and appropriate control of this issue needs a great deal of attention. [17]

Establishing safety management and quality system in hospitals in order to provide safety for staffs and clients are very crucial. The systematic establishment of this system causes to instruct safety and professional health so that it can be used to create a safe and healthy environment. Applying safe principles and institutionalizing safety atmosphere among staffs prevents from risky behaviors, accidents and destructions. So, this study was done to monitor safety condition in the hospitals affiliated to Isfahan University of Medical Science and utilize the achieved results to make decision and plan for improving safety and reduce accidents among patients and staffs. Considering these results leads to progress patients', staffs' and hospitals' safety condition and improve the policies, and approaches being related to this issue.


  Materials and Methods Top


This is an analytical-descriptive and cross-sectional study conducted in 2012-2013. Four hospitals' units and wards which were affiliated to Isfahan University of Medical Sciences participated in this project. The names of these centers were not announced to regard confidentiality and moral principles. Instead, they were marked by alphabetic letters from A-D. Inclusion criteria consisted of being a general hospital which had safety and accidents committee and also the same sectors with similar numbers and services.

Studied sectors in every hospital comprised clinical and paraclinical units, the Safety and Accidents Committee of the hospital and general operation rooms. They were investigated through census method. Since hospital's units are the first lines of providing health services, they have significant roles in controlling accidents and improving safety in hospitals. So, this is the main reason to select them to study in present project.The high level of workload, existing expensive facilities and their close contact to clients and people seeking services are the other reasons to select hospitals' units for studying.

Checklist and questionnaire were two instruments being used to gather data in this project. The checklist which was based on Australia Society Standards [18] consisted of safety management assessing standards in clinical and paraclinical uints. The title of the applied questionnaire included the evaluation of safety management in operation rooms and Safety and Accident Committee. Since the condition of safety management in clinical and paraclinical units could be monitored by the researcher and also for increasing the preciseness of the study, the data were collected through direct observation and interviewing to the managers of the units. But the questionnaire was used to gather the data of operation rooms and Safety and Accident Committee because the documents of safety management were available to safety officials who assisted to conduct the present study.

The checklist being applied, had 10 safety standards comprising 79 questions. All these questions were made for evaluating clinical and paraclinical units. This study's questionnaire consisted of two parts. The first one included five standards of safety management evaluation in operation rooms. The second part consisted of 12 standards of safety management evaluation in Safety and Accident Committee. The number of questions were 34 and 75 ones in the first and second parts respectively.

This questionnaire was designed according to Lickert 5- option criteria containing very appropriate, appropriate, moderate, weak and very weak respectively. Zero to one hundred scores was considered for every standard. The spectrum of score for these five options were noted as followed; 80-100 (very appropriate), 60-80 (appropriate), 40-60 (moderate), 20-40 (weak) and 0-20 (very weak). [18]

The validity of the checklist and questionnaire was investigated through content validity and by using the viewpoints of psychiatric and behavioral sciences scholars. The reliability of these instruments was assessed by Cronbach's alpha. These rates were 0.74 and 0.77 for the checklist and questionnaire respectively. Cronbach's alpha measures affirmed their reliability. SPSS (Version 21) was used to analyze the data. Descriptive data were also measured by frequency, frequency percentage, average and standard deviation. The analysis of data was done by use of ANOVA statistical test.


  Results Top


The average and standard deviation of safety management average scores in all studied hospitals were 58.02 ± 8.8. The average and standard deviation of A, B, C and D hospitals scores were 62.5 ± 7.09, 49.08 ± 9.95, 60.01 ± 9.46 and 60.30 ± 5.76 respectively. Data analysis done by ANOVA test showed that there was not any significant difference in safety management standards among studied hospitals (P = 0.091) [Table 1].

The highest average score of regarding safety management standards were seen in management, leadership and organization items with average score 68.87 and evaluated appropriate. The lowest one was also found in the program of assuring quality with average score 36.09 and evaluated weak [Figure 1].

The total average score of safety management in studied hospitals were 61.04 and 65.1 in clinical units and paraclinical units respectively. The highest and lowest average scores of safety management in clinical units were seen, in turn, in hospitals A and C. The highest and lowest average scores in paraclinical units found hospitals A and B respectively [Figure 2].
Figure 1: Percentage of regarding safety management standards in studied hospitals

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Figure 2: The comparison of safety condition in clinical and paraclinical sectors among studied hospitals

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Table 1: The comparison of safety management standards average among studied hospitals

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After assessing the organization and management condition of safety in Safety and Accidents committee of the hospitals which were studied in this investigation and calculating the average of the scores of studied factors, the total average of safety management was achieved 63.18 and evaluated appropriate. The hospital A and D had appropriate level of safety condition with average scores of 72.53 and 66.2, respectively. Hospitals B and C owned average levels of safety condition as well. Their average scores were, in turn, 55.42 and 58.6. On the other hand, hospitals A and B had the highest and lowest levels of average of score respectively [Table 2].
Table 2: The Function of accident and safety committees about safety management among studied hospitals

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Since surgery ward is very critical and risky, the investigation of safety management was done in present study. The achieved results showed that the average score of safety management was 67.02. This level of safety management was evaluated appropriate. In addition, hospital A with average score of 82.16 had very appropriate condition. The hospitals B and C, with 59.42 and 58.28 average scores were in moderate condition. On the other hand, hospital D had appropriate level with average score of 68.24 [Table 3].
Table 3: The function of general operational rooms about safety management among studied hospitals

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  Discussion Top


Our study's results showed that the average score of safety management was 58.02 in studied hospitals. Moreover, they had moderate level of safety. The hospitals being monitored by Yamaochi et al., [10] achieved 92 average score of safety management principles in hospitals. It might be due to regarding safety instructions by staffs. The assessment of the same principles in Noruzi et al., [19] study in Shiraz city showed that the average score of safety management principles in hospitals were 58. The safety condition was evaluated at the moderate level in this study. As the researcher found, the main reason of this result was due to existing ambiguity in responsibilities and lacking of organizational construct in the affairs related to safety management. In the same study being conducted by Raeisi et al., [20] to find the main necessities of patient's safety, the average score of 57.6 was achieved. The results of these two studies are compatible with the present one's results. Since considering safety and health principles in hospitals can lead to increase activities efficiency and productivity, they need to be taken into especial account.

High ranking leadership and management of the organization is one of the significant agents of hospital's safety management and supports other agents as well. The major role of safety in hospital is played by management and leadership. As a result, safety should be the basic priority for the manager of the organization. [20] This study's results showed that the standard of management, organizing and leadership of safety achieved the highest average score (68.87 scores) among other standards of safety management. Rezapour et al., [21] and Raeisi et al., [20] studies' conclusions achieved 67 and 66.7 scores average of the standard of management, organizing and leadership respectively. So, their results were compatible with the present study's ones. The project was conducted in Lebanon by El-Jerdali et al., [22] about the culture of patient's safety, revealed the same results showing the importance of management and leadership agent. The score average of standard of the program of assuring quality, in the present study, was achieved 36.09 and evaluated weak. This was found 100 in Zaboli et al's., [18] investigation and evaluated very appropriate.

Since clinical and paraclinical units have modern equipments, they are considered so risky in hospital so that safety management is very significant for them. [23] The score average of safety management in clinical wards, in the hospitals being studied in the present investigation, was 61.04 and evaluated appropriate. The score average of safety management in clinical wards, in the hospitals being studied in Khalui's [23] investigation, in Kerman city, was 64.1and compatible with this project. On the other side, Zaboli et al's [18] achieved the score average of 87.51 of safety management in clinical wards. This is higher than the present study. They concluded that the main reasons of achieving high score of safety management standards include to have expert medical and supportive staffs, their awareness to safety matters and also implementation of educational programs related to safety. [18]

The results achieved in present study showed that average score of the condition of safety management in paraclinical units in studied hospitals was 65.1 and evaluated appropriate. The average score of the condition of safety management in the same units of Pourebrahim et al., [24] study was 20 which is lower than present investigation. This average score in Fathi's [14] study, was 60 in their studied paraclinical units which is similar to our study and evaluated appropriate. Debra storm [25] found that permanent training of staffs in addition to regarding safety precautions is necessary to develop safety in paraclinical units. His project was done to find the development of safety in hospitals' paraclinical units, especially, against radiation rays.

Since existing comprehensive safety policies and guidelines is a significant issue, Accident and Safety Committee should establish them seriously. This committee must be determined to observe the implementation of these policies as well. It also has some other tasks such as training, supervising and managing the affairs and employees being related to safety issue in any ways. [26] The results of present study showed that the average score of safety management in Accident and Safety Committees of studied hospitals was 63.18.This was higher than Kavari et al., [27] study in which the average score of safety management of their Accident and Safety Committees was 33 and 11.1 percent of their hospitals had this committee. Since the average score of safety management of Accident and Safety Committee was 62.97 in Zaboli et al., [18] project, their findings is compatible with present study's results. This committee, in general, should have enough knowledge to implement safety principles. It must also provide and develop the programs for urgent situations. [28]

Operation rooms as the central part of doing therapeutical measures have high capacity for happening risky events due to have different electrical instruments and medical gases.So, they need to be paid special attention for performing safety principles. [16] The results of present study showed that the score average of safety management standards in operation rooms was 67.02. This rate was 84.9 in Musavi et al. [29] in the hospitals affiliated to Tehran University of Medical Science and is higher than our study. The implementation of safety management standards in hospitals affiliated to Shiraz University of Medical Sciences showed that the score average of these standards was up to 60 in all operation rooms of studied hospitals. The mentioned project was conducted by Mohabati et al. [30] This rate was 71 in Jonghorbani et al., [31] study which was conducted to find safety management condition in Beheshti hospital's operation rooms. Both of these studies' results are the same as present study. Neale [32],[33] investigated hospitals accidents rate in National Health Service (NHS) in the Great Britain. He came to this conclusion that around 20% of accidents in hospitals were happened in operation rooms. Applying safety management is an alternative to prevent from these accidents or at least reduce them according to his final conclusions. Christian et al., [34] conducted a future-based study to find patients' safety condition in operation rooms. They recognized various potential dangers threatening patients' safety. Their results showed that staffs communication style, existing a lot of electrical instruments, high load of work and not recognizing the patients are the most important threats for their safety in operation rooms.

Safety management condition was assessed on the basis of standards and evaluation criteria of safety management system, in this study. Some other factors which are suggested for studying in next projects are as followed; the effectiveness of revised measures in safety management system, the impact of hospitals' safety management systems on events and accidents, staffs' occupational satisfaction in different units, decrease or increase of hospitals' efficiency, staffs mental and physical health and also institutionalizing the culture of safety as a real attitude among staffs.


  Results Top


This study's results proved that safety condition of studied hospitals were at the moderate down to vulnerable levels. This needs to reconstruct mainly the hospitals' policies, management systems and constructs. This necessity is seen more these days because of high number of patients and staffs, existing modern instruments and process variations. So, it is recommended to reestablish safety and accident committees in hospitals consisting of the members who are supposed to participate seriously. Putting aside a major part of scores in hospitals assessment for regarding safety principles and providing general educational programs for all hospitals and also individually specific plans for every hospital according to their unique conditions are the other suggestions which can be lead to promote safety condition in these centers.


  Acknowledgement Top


We thank Isfahan University of Medical Sciences for supporting us financially. We also appreciate the staffs of studied hospitals for their mutual cooperation to conduct this study. This project was submitted to conduct in this university by number 392580.

 
  References Top

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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