|Year : 2015 | Volume
| Issue : 1 | Page : 36-40
Patient's safety culture form the viewpoint of nurses working at selected charity, private, and public hospitals of Isfahan
Saied Karimi1, Maryam Yaghoubi2, Fatemeh Rahi3, Mohammadkarim Bahadori2
1 Health Management and Economic Research Center, Isfahan University of Medical Sciences, Tehran, Iran
2 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
3 Isfahan University of Medical Sciences, Isfahan, Tehran, Iran
|Date of Web Publication||17-Dec-2014|
Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Context: Patient's safety is the core part of healthcare service providing process and hence improving safety culture in hygienic care system plays a critical role in eliminating or reducing mistakes and generally improving the hygienic care quality. Aims: This study aims at evaluating the viewpoint of nurses working at selected hospitals of Isfahan toward patient's safety culture in 2013. Subjects and Methods: This study is a descriptive-analytical research. Sample community consists of 50 nurses of three selected hospitals in Isfahan and sampling method was chosen to be of stratified kind. Data gathering Questionnaire has been the patient safety culture evaluation questionnaire of the Agency of Healthcare Research and Quality of America (AHRQ). This questionnaire consisted of 44 questions categorized into 14 dimension, 10 dimension of patient safety and 4 dimension of consequences of patient safety culture. Statistical Analysis Used: Analysis of data from descriptive statistics has been conducted using SPSS version 18 software. Results: The amount of positive scores in 10 dimensions of safety culture and 4 dimension of safety culture consequences and almost in every factor of them was at acceptable level. The average of positive scores in 10 dimension of patient safety culture have been 73%, 83%, and 78% for charity, private, and public hospital respectively (feedback and communication about the errors) and lowest (teamwork in part) has the most points won have. Conclusion: Each organization can indeed improve the patient safety by knowing its weaknesses and strengths. For example in this research, hospitals must attention to feedback and communication about error and hospital management support form patient safety.
Keywords: Hospital, nurse, patient safety culture
|How to cite this article:|
Karimi S, Yaghoubi M, Rahi F, Bahadori M. Patient's safety culture form the viewpoint of nurses working at selected charity, private, and public hospitals of Isfahan. Int J Health Syst Disaster Manage 2015;3:36-40
|How to cite this URL:|
Karimi S, Yaghoubi M, Rahi F, Bahadori M. Patient's safety culture form the viewpoint of nurses working at selected charity, private, and public hospitals of Isfahan. Int J Health Syst Disaster Manage [serial online] 2015 [cited 2022 Aug 12];3:36-40. Available from: https://www.ijhsdm.org/text.asp?2015/3/1/36/147149
| Introduction|| |
Todays, the structures of health and medical care have been very complicated. Medical care are done within environments full of stress and speed in which there are a wide range of technologies and personal and daily judgments of health and medical staff. , Improving safety culture in health care system plays a critical role in eliminating or reducing error  and generally improving the health care quality.  Developing the patients' safety culture in health care organizations is the necessary foreground for improving patients' safety. , Health organizations are continuously trying to improve and increase the significance of patient's safety culture. In achieving patient's safety culture, needs to have proper understanding of values and beliefs and important norms for the organization. Also, identifying the supported, appreciated, and expected attitudes and behaviors toward patients' safety is an importance matter. , England Safety and Health Commission has declared one the most common definition of safety culture as follow: Safety culture is a production of values, norms, understanding, capacity, and individual and group behavioral patterns, which identify the commitment, style, skill, and safety and wellness management of a system.  Measuring the safety culture effect on improvement and evaluation of patient's safety.  Evaluate existing cultures about patients' safety and identify some areas of priority for fulfilling the purpose of improvement in patients' safety is important for health care organizations.  In general, patient's safety culture evaluation can play multi-aspect role; it can define the present status of dominant safety culture and its weaknesses and strengths for managers and matrons. This evaluation also has the capacity of improving safety culture by increasing the personnel knowledge about it. Finally, managers can evaluate their interventions done for improving patient's safety.  Since nurses consist the largest group among health care staff, they should be legally and morally responsible for the quality of delivered actions of care. Nurses play a vital role in care duration and health improvement, and they are fundamental parts of care quality improvement process. Their performance is highly effective in the course of fulfilling healthcare goals. Performing safe tasks to maintain patient's safety is the heart of high-quality nursing car.  Tabibi et al. has compared different attitudes of service providing teams such as doctors and nurses from six point of views of teamwork environment, safety environment, job satisfaction, stress detecting, management understanding, and job states.  Abdi et al. in a study titled as "personnel understanding of patient safety culture at selected training hospitals of the University of Medical Science of Tehran" shows that the score of patient safety culture in 10 aspects of safety culture and two aspects of presence of safety culture are at average - low level, and the aspects of nonpunitive response to errors and teamwork received the lowest score and the aspect of teamwork within units received the highest score. Foruzan et al. in a research on 413 nurses of training hospitals of Shiraz showed that the aspect of organizational training about patient safety and transferring patients among wards are the most proper and improper aspects respectively.  Haugen et al. evaluated patient safety in surgical environments at hospitals of the Norway and compared their findings with the results gained in the US.  Filiz and Bodur studied the patient safety from the viewpoint of nurses and doctors at public hospitals of the Turkey and showed that teamwork within units and frequency of events reported received the highest and the lowest score respectively; they also showed that more than three-fourth of doctors' and nurses' errors is not reported.  In 2007, Agency of Healthcare Research and Quality of America (AHRQ) conducted a study at 382 hospitals of US to evaluate patient safety culture from viewpoint of healthcare service providers such as doctors and nurses;  in another research in 2008, is studied from 419 hospitals around the US about patient safety culture.  Castle and Sonon conducted a study about safety culture at nursing homes and 32% of staff claimed that only one or two error had been reported.  Hellings et al. performed a research to study patient safety culture at five hospitals of the Belgium and found that the teamwork within units has gained the highest rank among other aspects of safety culture by receiving 71 positive points.  Scherer and Fitzpatrick conducted a study to evaluate operating room staff viewpoints about patient safety culture and concluded that teamwork within units received the highest positive score.  According to literatures cited above, nurses as individuals who have the most contacts with patients should have appropriate culture related to patient safety. The research conducted in Iran about patient safety culture were measured only in university hospitals. Since part of health care is provided in private and charities hospitals. Hence, this study aimed to compare the condition of the patient safety culture among patient in public, private, and charities hospitals from view point nurses.
| Subjects and Methods|| |
This is of descriptive-study. The present research has been conducted in 2012 and at three selected hospitals of Isfahan.
In this study, the participants were nurses who were working in the hospital ward, had direct contact with patients and had experience more than 6 months. To complete the questionnaire researcher were referred to hospitals in different shifts and then explain the benefits and use of the questionnaire to the nurses and explain how to complete the questionnaire. Sampling was done with stratified method and the sample number was 50.
Data gathering questionnaire has been the patient safety culture evaluation questionnaire of the AHRQ of America. This questionnaire consisted of 44 questions categorized into 14 dimension, 10 dimension of patient safety as (teamwork within units, supervisor/manager expectations and actions promoting patient safety, continuous improvement and organizational learning, communications clearance, feedback and communication about error, nonpunitive response to errors, handoffs and transitions, hospital management support from patient safety, staffing, and teamwork across units) and 4 dimension of consequences of patient safety culture presence (frequency of events reported, overall perceptions of patient safety, patient safety grade, and the number of events reported).
For 12 dimension of patient safety culture, five-option Likret scale was using. The dimension that receive at least 50% of positive scores are acceptable, and the aspects with less than this percentage are not in the proper state. For patient safety grade (excellent, very good, acceptable, poor, failing) score was used. And for the number of events reported, six position was considered (no event reports, 1 to 2 event reports, 3 to 5 event reports, 6 to 10 event reports, 11 to 20 event reports, 21 event reports or more).
| Results|| |
Among the selected sample, the highest frequency distribution belonged to operation section, since 42/6% of nurses under research were working at that ward and the lowest frequency was determined to be of children and intensive care unit wards. For work experience at three selected hospitals, the highest frequency distribution of work experience of nurses belongs to "1-5 year (s)"option and it is 42%; the lowest of frequency distribution also belongs to "21 years or more" option and it is 2%. For working hours among whole sample community, the highest working hour frequency distribution belongs to "40-59 h a week" option frequency of which is 64% and lowest frequency belongs to "79-90 h a week" option frequency of which is 6% [Table 1].
Hospital management support form patient safety has lowest positive answers percentage in Charity hospital, and teamwork within units (88%) and teamwork across units (90%) has the highest score.
In private hospital management support form, patient safety has the highest positive answers percentage (88%) and handoffs and transitions have the lowest (70%).
In public hospital continuous improvement and organizational learning has the highest positive answers (93%) percentage, and staffing has the lowest score (64%) [Table 1].
Most grade of patient safety in the charity hospital is 57% (very good), in private hospital is 70% (acceptable) and in the public hospital is 53% (acceptable) [Table 2]. 44% of wards have no event reports [Table 3]. There is a meaningful differences between hospitals over "overall perceptions of patient safety" supervisor/manager expectations and actions promoting patient safety and communications openness.
|Table 3: Frequency and percentage of number of events reported in hospital wards|
Click here to view
| Discussion|| |
Totally, the amount of positive scores in 10 dimension of safety culture and 4 dimension of safety culture consequences and almost in every factor of them was at acceptable level. The average of positive scores in 10 dimension of patient safety culture have been 73%, 83%, and 78% for charity, private, and public hospital respectively. That shows the status of safety culture in the private hospital is better than other hospitals. In present research, the aspect of "handoffs and transitions" with 69% and the aspect of "teamwork across units" with 88% have the lowest the highest positive scores respectively in three hospitals. It shows that the teamwork is strong in all three hospitals. It is similar to Scherer and Fitzpatrick  and Hellings et al.  studies. The results of this research are parallel with the findings of studies that have been conducted in US during 2007.  Today, in the education of health care professionals has a little important to patient safety, so the patient safety curriculum guide has developed by the World Health Organization. , Really research show that the training in patient safety played an important role.  In Forozan research  which deals with evaluating patient safety culture through hospitals of Shiraz, findings show that the aspect of transferring patients between wards and the continuous improvement and organizational learning have had the most proper and improper state respectively which is contrary to the findings of present study. Continuous improvement and organizational learning has a good average in the current study. Most grade of patient safety in the charity hospital is 57% (very good), in private hospital is 70% (acceptable) and in the public hospital is 53% (acceptable). In researches conducted in 2007 and 2008, 70% of hospitals received excellent and very good grade, 24% received acceptable grade, and 6% received poor and failing grade respectively. , These findings are contrary to those of the present study. Forty-four percentage of nurses claim that there have been no event reports during past 12 months, and 22% say that 3 to 5 event reports have been during past 12 months. In Castle and Sonon research conducted at nursing houses just 4% of staff claimed that there had been no event reports during past 12 months, and 32% of personnel said that 1 or 2 event reports had been observed by them during the given period.  In order to reduce the number of events, hospitals must have a more open culture and reflective attitude about patient safety. 
| Conclusion|| |
Patient safety as one of the fundamental factors of medial service quality has got increasing attention from researches of the health field around the world. The importance of a safety culture to maximize safety is no longer questioned. However, have a sustainable culture for improvements are less evident.  Patient safety culture significantly affects the existence of patient safety at hospitals and medical organizations and developing a culture of safety is a core element of many efforts to improve patient safety and care quality.  Each organization can indeed improve the patient safety by knowing its weaknesses and strengths. Issues such as type of responses to error made teamwork across and between units and lack of an error reporting system or having an inefficient system are some weaknesses.
| Acknowledgment|| |
Hereby, I appreciate from hospital staff for their cooperation.
| References|| |
Donalds S. World Alliance for Patient Safety: Forward Programme. Switzerland: World Health Organization; 2005. p. 1.
Tabibi J, Keikavoosi L, Nasiripur A, Reisi P. Hidden threats inducing medical errors in Tehran public hospitals. J Hormozgan Med Sci Iran 2011;10:154-62.
Building a Culture of Patient Safety. Report of the Commission on Patient Safety and Quality Assurance by the Stationary Office; July, 2008.
Forozan F. Evaluate the Patient′s Safety Culture in Hospitals in Shiraz and Guidelines for Improving the Existing Situation, MS Thesis; 2010.
Gilmour JM. Adverse Events Analysis as an Educational tool to Improve Patient Safety Culture in Primary Care; May, 2006.
Schutz AL, Counte MA, Meurer S. Development of a patient safety culture measurement tool for ambulatory health care settings: Analysis of content validity. Health Care Manag Sci 2007;10:139-49.
Hospital Survey on Patient Safety Culture: Comparative Data Base Report. Agency for Health Care Research and Quality; 2008.
Joann S, Theresa F, Dawn N, Kabir KH. Hospital Survey on Patient Safety Culture: 2010 User Comparative Database Report. Agency for Healthcare Research and Quality; 2010.
Joann S, Noami D. Multilevel Psychometric Properties of the AHRQ Hospital Survey on Patient Safety Culture. BMC Health Services Research 2010;10:199.
Anees K, Singla MD, Barret T, Kitch MD, Eric G. Assessing patient safety culture: A review and synthesis of the measurement tools. J Patient Saf 2006;2:105-115.
Abdi GH, khosravi A, Maleki M. Staff perceptions of patient safety in Tehran University of medical sciences hospitals. J Payesh 2010;10:411-9.
Yahaya R, Samudi YM, Amran M. The impact of companies, age on safety culture in the metal products industry. Am J Eng Appl Sci 2009;2:735-42.
Foruzan F. Evaluation of patient safety culture from the perspective of nurses in teaching hospitals of Shiraz and provide solutions to improve the situation [Thesis in Persian]. Shiraz University of Medical Sciences; 2008-2009.
Haugen AS, Søfteland E, Eide GE, Nortvedt MW, Aase K, Harthug S. Patient safety in surgical environments: Cross-countries comparison of psychometric properties and results of the Norwegian version of the Hospital Survey on Patient Safety. BMC Health Serv Res 2010;10:279.
Said B. Validity and Reliability of Turkish Version of "Hospital Survey on Patient Safety Culture" and Perception of Patient Safety in Public Hospitals in Turkey [Dissertation]. Turkey: University Selcuk; 2011.
Castle NG, Sonon KE. A culture of patient safety in nursing homes. Qual Saf Health Care 2006;15:405-8.
Hellings J, Schrooten W, Klazinga N, Vleugels A. Challenging patient safety culture: Survey results. Int J Health Care Qual Assur 2007;20:620-32.
Scherer D, Fitzpatrick JJ. Perceptions of patient safety culture among physicians and RNs in the perioperative area. AORN J 2008;87:163-75.
Saadat M, Mostofian F. A review of studies relating to the history of the formation, management and development activities for patient safety monitoring systems in the world, with an emphasis on patient safety reporting systems. Iran: Ministry of Health and Medical Education, Patient Safety Unit; 2009. [Book in Persian].
Leotsakos A, Ardolino A, Cheung R, Zheng H, Barraclough B, Walton M. Educating future leaders in patient safety. J Multidiscip Healthc 2014;7:381-8.
Saura RM, Moreno P, Vallejo P, Oliva G, Alava F, Esquerra M, et al.
Design, implementation and evaluation of a management model of patient safety in hospitals in Catalonia, Spain. Med Clin (Barc) 2014;143:48-54.
Wagner C, Smits M, Sorra J, Huang CC. Making health care safer: A critical review of evidence supporting strategies to improve patient safety. Int J Qual Health Care 2013;158:213-21.
Simons PA, Houben R, Vlayen A, Hellings J, Pijls-Johannesma M, Marneffe W, et al.
Does lean management improve patient safety culture? An extensive evaluation of safety culture in a radiotherapy institute. Eur J Oncol Nurs 2014 pii: S1462-388900112-4.
Weaver SJ, Lubomksi LH, Wilson RF, Pfoh ER, Martinez KA, Dy SM. Promoting a culture of safety as a patient safety strategy: A systematic review. Ann Intern Med 2013;158:369-74.
[Table 1], [Table 2], [Table 3]
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