|Year : 2022 | Volume
| Issue : 2 | Page : 50-54
Assessing patient safety culture among healthcare providers at a tertiary care hospital: Bangalore
Sneha Mukherjee, J Aileen
Department of Allied Health Sciences, Faculty of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
|Date of Submission||16-Dec-2022|
|Date of Acceptance||26-Dec-2022|
|Date of Web Publication||13-Feb-2023|
Prof. J Aileen
Department of Allied Health Sciences, Ramaiah University of Applied Sciences, Bengaluru - 560 054, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Patient safety is significant to improve the quality care in health-care organisations; hence, assessment of patient safety culture is the paramount need of the h. However, in middle- and low-income countries, the burden of patient safety is vital as the healthcare-related injuries and deaths are increasing, this is global health concern. The awareness of measuring patient safety culture needs to be improved in low- and middle-income countries and this can help in evaluating the culture and formulating interventions and also achieving the accreditation standards. National Accreditation Board for Hospitals (NABH) with a focus of patient safety has contributed largely in the quality of health care in Indian hospitals and witnessed progress and improvement. However, the challenges in a country like India are large and complex and need to be addressed systematically beyond the meeting accreditation standards. Aim: The aim of this study was to assess the level of perception among the healthcare providers at a tertiary care hospital. Methods: Cross-sectional study was conducted using The Hospital Survey on Patient Safety culture (HSOPSC v−1) tool to assess the level of perception of patient safety culture among healthcare providers. The survey was conducted among 400 respondents of tertiary care hospital, Bangalore, Karnataka (India) through a structured, open- and close-ended questionnaire. Participants were selected through nonprobability random sampling. Collected data were analyzed through composite scores, Chi-square, and Man–Whitney U-test for test. Results: The present study showed a highest positive response in teamwork within the units and the least in nonpunitive response to error. The domain hands off and transitions which requires cooperation from other departments also showed low positive responses in many studies including the present study (41.13%). For the data analyzed above regarding the perception of patient safety culture dimensions among the healthcare professionals, it was seen that there was a statistically significant association (0.0026) between the two variables that perception and safety culture existing in the hospital. Conclusion: After comparing between experience and level of perception among healthcare providers, it was concluded that the Chi-square value is 0.04 which is statistically significant and there is a significant association between positions and level of perception. Therefore, our study indicates that there is a high need to develop strategies related to certain safety domains that urgently need improvement in this hospital.
Keywords: Health-care providers, patient safety, safety climate, safety culture, tertiary care hospital
|How to cite this article:|
Mukherjee S, Aileen J. Assessing patient safety culture among healthcare providers at a tertiary care hospital: Bangalore. QAI J Healthc Qual Patient Saf 2022;3:50-4
|How to cite this URL:|
Mukherjee S, Aileen J. Assessing patient safety culture among healthcare providers at a tertiary care hospital: Bangalore. QAI J Healthc Qual Patient Saf [serial online] 2022 [cited 2023 Mar 27];3:50-4. Available from: https://www.QAIJ.org/text.asp?2022/3/2/50/369616
| Introduction|| |
It has been described by Agency Health-care Research Quality (AHRQ) that culture is one of the critical components of health-care quality and safety. Culture is a combination that consists of the values, beliefs, and norms that are important in the organization. A culture of safety includes the attitudes and behaviors that are related to patient safety and that are expected and appropriate to promote patient safety. Assessing the organization's existing safety culture is the first stage of developing a safety culture. By doing patient safety culture assessments, it helps to evaluate and allow healthcare organizations to obtain a clear view of the patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture, help care giving units identify their existing patient safety problems, and benchmark their scores with other hospitals. Burnout is a result of long-haul pressure in the working environment. Vari4ous studies have reported that there is a connection between this which affects the patient safety when someone suffers from this pressure continuously.
Studies confirmed that affected person safety cultures were low to common in all the affected person safety dimensions. Supervisor expectancies and movements selling patient protection and teamwork within units acquired the best ratings in three hospitals studies, whilst non punitive response to mistakes attained the least rating in studies hospitals. Zohar's research of Israeli ICUs drove him to describe hospital treatment surroundings as a “compound broaden” whose additives of stage and energy cooperate. Inability to understand this can make us leave out full-size connections that exist. Hospital survey on patient safety culture (HSOPSC) has been considered as a safety environment look at as self-file evaluations think about assessing an affiliation safety surroundings, even as, safety culture may be gotten to thru distinct way like conferences or perceptions. Studies have showed that the health-care workers surveyed in China had a positive attitude toward the patient safety culture within their organizations, but there were differences between China and the US in patient safety culture which suggested that cultural uniqueness should be taken into consideration whenever safety culture measurement tools are applied in different culture settings. As per the WHO, the main causes of injury and avoidable harm taking place in the health-care organization with the cost estimated for medication errors can be approximated around 42 billion annually, nosocomial infections can be seen in 7 out of 10 in every 100 hospitalized patients for both high-low and middle-income countries, whereas unsafe surgical procedures are another main cause for death following a surgery which is estimated around 7 million people will develop severe complications postoperatively and unsafe injection practices in health-care organization accounts for nearly 9.2 million years of life lost to disability and death worldwide (DALY).,
Thus, the key goal of medical error monitoring programs is to figure out how to change the health-care delivery process to avoid mistakes. Medical error reporting must be culturally recognized in the health-care system and voluntary medical error reporting should be put into practice to improve efficiency and increase patient safety. To promote health outcomes, regulatory and technical bodies have made it compulsory that health-care professionals should receive patient safety training. The measurement of safety climate can identify the areas of organizational failures or weaknesses at all levels and provide useful information for the purposes of patient safety.
| Methods|| |
This prospective cross-sectional analysis was performed using a HSOPSC that was developed by AHRQ among the healthcare providers which was a structured and consisted of both open- and closed-ended questions. The questionnaire included 31 questions which were grouped into 12 dimensions which are supervisor/manager expectations and actions promoting safety, organizational learning, and continuous improvement and teamwork within hospital. The hospital selected for conducting this study was a tertiary care hospital situated in Bangalore which contains a total of 1782 health-care professionals (nurses, physicians, patient care assistants, pharmacists, administrators, and others). The questionnaire was classified into (a) sociodemographic and (b) patient safety issues-based questions. A total of 31 questions were comprised within the questionnaire. The inclusion criteria for the study were (a) those in active full-time employment at the time data were gathered and exclusion criteria: (b) Non willingness or refusal to voluntarily participate in the study.
The sampling technique used was nonprobability convenient sampling. A pilot study was conducted for checking the reliability by using Cronbach's alpha test using the SPSS Statistical tool. The sample size calculated was 50 for the pilot study. A Cronbach alpha value of 0.734 was obtained thus, indicating the validity of the study. Informed consent was being taken from all the participants before the questionnaire was administered. The questionnaire was verified by two experts from the existing health-care organization which was self-administered to randomly selected participants. Responses were collected on a five point Likert scale (1-strongly disagree, 2-disagree, 3-neither agree nor disagree, 4-agree, and 5-strongly agree). Sociodemographic data on age, gender, occupational status, year of experience, and training on patient safety were also collected. After obtaining required data, Chi-square test/goodness of fit) test was used for determining the statistical significance of qualitative variables, whereas Chi-square test and Mann–Whitney test were used for inter-group comparisons in responses received for perception among health-care providers and a P < 0.01 was kept as statistically significant.
| Results|| |
This study was a questionnaire-based survey for assessing the perception of 400 study (healthcare providers) participants. Following statistical analysis, following observations were made.
A total of 400 participants were selected from 1782 Health Care Providers (HCP's) (proportions: nurses − 139, physicians − 48, patient care assistants − 24, pharmacists − 24, administrators − 24, and others − 102) which includes other technical staffs. The responses received were 302. The overall composite mean positive response rate on patient safety culture varied among different occupational groups of HCPs; nurses, physicians, patient care assistants, pharmacists, administrators, and others. The highest response rate came from the nurses (38.5%) and from other technical staffs (28.25%). 30.47% had an overall experience of 6–10 years and 57.89% weekly working for 20–39 h, respectively. 28.53% does not have any particular work area allotted, which means they are on either rotational basis and other technical staffs [Table 1].
|Table 1: Sociodemographic characteristics of the study participants (n=302)|
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The present study showed a highest positive response in teamwork within the units and the least in nonpunitive response to error. The domain hands off and transitions which requires cooperation from other departments also showed low positive responses in many studies including the present study (41.13%). In the present study apart from the dimension of teamwork within unit, other dimensions such as organizational learning and continuous improvement (83.43%), frequency of events reported (81.56%), and feedback and communication error (68.74%) had more positive responses. The dimensions of overall general perception (18.1%) and nonpunitive response to errors (10.59%) received the least positive responses [Table 2].
|Table 2: Composite positive response rate of patient safety culture in all dimensions of hospital survey on patient safety culture among study participants|
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Perception (P) response
On comparing the perception difference between physicians and other healthcare providers and patient safety culture, the P values obtained among various hospital staff using the Mann–Whitney U test, extremely statistical difference was obtained. On comparing perception responses using Chi-square test, the result again was found to be significant which means that the variables perception patient safety dimensions and position, level of experience of healthcare professionals were associated with each other. Here, the alternate hypothesis which says perception and position, level of experience are related to each other is being accepted [Table 3].
|Table 3: The level of perception of hospital staff regarding patient safety culture: Comparison of proportions was done and Chi-square test was performed|
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| Discussion|| |
In the present study, on comparing perception of patient safety dimensions with the position, level of experience, significant statistical significance was obtained hence, indicating that the quantitative variable, position, and level of experience variables are independent of each other as well as patient safety dimensions in the studied population.
The present study showed the highest positive response was from teamwork within the units and the least was in nonpunitive response to error. The domain hands off and transitions which requires cooperation from other departments also showed low positive responses (41.13%) in many studies including the present study. In the present study apart from the dimension of teamwork within unit, other dimensions such as organizational learning and continuous improvement (83.43%), frequency of events reported (81.56%), feedback, and communication error (68.74%) had more positive responses. Similar studies revealed that 34.1% was the positive response rate for PSC and the dimensions of patient safety culture varied from 20.9% to 43.8%. However, other dimensions scored very low, and therefore, the study concluded that the manager should develop strategies to prevent errors and conduct regular training for their health-care workers. One of the study found that teamwork within departments scored the highest positive responses (91.50%) and nonpunitive response to error (17.65%) scored the lowest. The study concluded that nonpunitive response to error was the area that requires improvement and further strategies should be implemented. Studies showed that the overall patient safety score was 50.1% and most of the scores related to dimensions were lower than the benchmark scores (64.8%) and the mean positive response rate for all the dimensions were lower than composite data of AHRQ, except for “Organizational Learning-Continuous Improvement,” which is also the highest positive response rate (80%), higher than AHRQ data (73%).On the other hand, the lowest percentage of positive responses was “nonpunitive response to error” (18%), meaning that most of the staffs perceived that they will be punished for medical error.
The present study showed the average composite positive response among physicians (38.5%) and highest among the nurses and other technical staffs. Highest positive responses received from other technical staffs can be due to their nature of the work which directly relates to patient safety in their daily activities. The highest positive responses were reported among nursing staffs which could be due to the reporting systems which are under the control of nursing staffs. Similar studies were conducted to find the relationship between patient safety culture with factors influencing working environment such as working hours, the number of night shifts, and the number of days off among health-care workers in Japan. The result showed that long working hours, numerous night shifts, and few days off were associated with low patient safety culture but physicians had low composites of patient safety culture grades. The study concluded that there is an increase need in improving the patient safety culture by managing the working environment of healthcare workers. Patient safety climate in health-care organizations is measured in terms of safety climate and psychometric properties prevailing in the healthcare organization which showed that that three domains namely, organizational work, unit, and interpersonal showed variances among them and therefore adequate measures and strategies to be developed for a better organizational safety climate.
Similar studies suggested that the dimensions with the highest effective rankings were teamwork inside units, hospital management support, and organizational getting to know and nonstop improvement, whilst people with lowest rankings included staffing and nonpunitive reaction to error. Around 60% of respondents said now not finishing any events reports within past 12 months and over 70% gave their hospitals an “outstanding/excellent” patient safety grade. The best composite proportion of high-quality responses has been for: teamwork inside devices (80%), feedback and communication about error, organizational learning-nonstop development and supervisor/manager expectations and movements promoting patient safety (78%), and management support for affected person safety (75%). The lowest composites have been for: frequency of events reported (57%), nonpunitive response to errors (53%), communication openness (51%), and staffing (37%) [Table 3], [Table 4], [Table 5].
For the data analyzed above regarding the perception of patient safety culture dimensions among the health-care professionals, it was seen that there was statistically significant association (0.0026) between the two variables, i.e., the perception and safety culture existing in the hospital. Strong association was observed between level of agreement, neutrality, and strong disagreement (< 0.001). However, no statistical correlation was obtained between level of disagreement and perception levels (0.287). On comparing P values, using Mann − Whitney analysis, statistically significant difference (P < 0.001) was observed. Furthermore, on analyzing the perception difference of patient safety culture between physicians and other healthcare workers, it was found that the P values obtained among various hospital staff using the Mann–Whitney U test, extremely statistical difference was obtained. After comparing between position and level of perception, it was concluded that the Chi-square value is 0.02 which is statistically significant and there is a significant association between positions and level of perception for patient safety culture among the health-care professionals. One of the most significant impediments to establish a good safety culture is the belief that mistakes will be punished, which has been successfully introduced in the tertiary care hospitals. Nurse's perception regarding patient safety climate and quality of health care in general hospital concluded that there should be continuous improvement toward the perception of nurses with the aspect of reliability, assurance, responsiveness, and empathy in health care service quality. Similar studies suggested that there is a need to develop strategies that create a culture of safety and teamwork climate to improve nurse's satisfaction and retention as well as patient safety outcomes in the hospital.
There are very limited studies which classify the response based on hospital settings such as casualty, ICU, critical, and noncritical areas. The HSOPSC tool is a self-administered tool which avoids the chances of interviewer bias and confidentiality was maintained throughout the study and was ensured their responses will not be used for any other measures. Hence, the responses were highly reliable.
Front-line workforce's standpoint on affected person safety culture with the implementation of HSOPSC confirmed that collaboration inside units' scored the maximum PSC score (67.2%) and “noncorrectional reaction to blunder” scored the least score (40.4%). One of the study revealed that the reaction rates were 74.1% for doctors and 100% for paramedical staff and the least was (32.7%) for the management support for safety culture for patients. Therefore, the study concluded that there is a need to improve all dimensions of patients' safety culture among the healthcare professionals. Similar studies found that, half of the participants i.e., 44.8% indicated good safety culture. Good patient safety culture was positively associated with working in primary hospital (AOR = 2.56, 95% confidence interval = 1.56, 4.21). Negative association was found between patient safety culture and health professional's age between 25 and 34 and those working in pediatric ward and emergency ward.
| Conclusion|| |
Patient safety culture is a culmination of common beliefs, values, and standards that affect the activities and behaviors of healthcare professionals and other staffs in the organization. The present study revealed that average positive response rate among the 12 dimensions, more positive responses were reported in the dimensions of “teamwork within the units (84.65%)” Organizational learning and continuous improvement (83.43%), frequency of events reported (81.56%), and feedback and communication error (68.74%). For the data analyzed above regarding the perception of patient safety culture dimensions among the health-care providers, it was seen that there was statistically significant association (0.0026) between the two variables, i.e., the perception and safety culture existing in the hospital. Developing a culture of safety is a core element of many efforts to improve patient safety and care quality. Although much needs to be done on the road toward better hospital patient safety, however, there are certain limitations in this study such as (a) sample collection was based up on nonprobability convenient sampling because of COVID-19 pandemic which led to biased sampling; (b) the time frame was less for putting the framework into practice; (c) the study focused only on perception of healthcare professionals toward the patient safety dimensions; and (d) the study did not evaluate the posttest results after the implementation of patient safety framework.
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Conflicts of interest
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]