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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 22-27

Perception of patient safety culture amongst healthcare personnel in a tertiary care hospital


PediatricNursing,CollegeofNursing,AllIndiaInstituteofMedicalSciences,Bhubaneswar,Odisha,, India

Date of Submission26-Mar-2021
Date of Decision10-Aug-2021
Date of Acceptance11-Aug-2021
Date of Web Publication24-Sep-2021

Correspondence Address:
Dr. Asha P Shetty
CollegeofNursing,AllIndiaInstituteofMedicalSciences,Bhubaneswar,Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_8_21

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  Abstract 


Background: Patient safety in healthcare includes the safety of both patients (clients) and healthcare providers. It emphasizes reporting, analysis and prevention of medical errors that often lead to adverse health events and thus it becomes one of the most important aspects needed in a hospital setting.
Purpose: The study aimed to assess the perception of patient safety culture amongst healthcare personnel in a tertiary care hospital.
Methodology: A descriptive research design was selected as an appropriate method; 380 participants were selected through convenience sampling technique, including physicians, nursing officers and other technical staff. The setting for the study was all departments of a tertiary care hospital, All India Institute of Medical Sciences, Bhubaneswar. The Hospital Survey on Patient Safety Culture, a self-administered questionnaire, was used to assess the perception of patient safety culture.
Results: The data were entered into SPSS version 20. The overall response rate in the present study was 84%. The average composite response rate was 57.37%. The dimension of 'teamwork within the unit', 'organisational learning' and 'feedback and communication error' showed the maximum positive responses 81.25%, 79.91% and 70.61%, respectively.
Conclusion: Professional practice is a priority to promote patient safety culture amongst healthcare personnel. To have homogeneous patient safety culture amongst all healthcare professional, it is essential to increase awareness about patient safety amongst healthcare personnel and motivate them to participate in the service.

Keywords: Healthcare personnel, patient safety, patient safety culture


How to cite this article:
Meena KS, Shetty AP. Perception of patient safety culture amongst healthcare personnel in a tertiary care hospital. J Patient Saf Infect Control 2021;9:22-7

How to cite this URL:
Meena KS, Shetty AP. Perception of patient safety culture amongst healthcare personnel in a tertiary care hospital. J Patient Saf Infect Control [serial online] 2021 [cited 2021 Dec 5];9:22-7. Available from: https://www.jpsiconline.com/text.asp?2021/9/1/22/326624




  Introduction Top


Patient safety in healthcare includes the safety of both patients (clients) and healthcare providers (HCPs). Patient safety emphasizes reporting, analysis and prevention of medical errors that often lead to adverse health events.[1]

Patient safety is important for a healthcare institution to assess the status of their living culture of patient safety and control areas of weakness to target for improvement. The concept of patient safety emerged from research focused on safety and accident prevention in high reliability errors such as navigation, synthetic and nuclear power plants and assembling.[2]

Providing safe care helps to reduce mortality, morbidity, length of hospital stay and cost. Patient safety as the prevention of harm caused by errors of commission is highly linked to attitudes of HCPs, where those with more positive attitudes achieve higher degrees of patient safety. In order to ensure patient safety, healthcare systems should provide an environment that is free from accidental injury through establishing operational systems and procedures that minimise the chance for errors and maximise the probability of stopping them before they occur.[3]

Different studies in various countries have shown that 2.9%–16.6% of patients in acute care hospitals experience one or more conflicts. Roughly 50% of the conflicts are considered to be preventable. If hospitals want to improve patient safety, it is important to know more about the culture regarding patient safety, where different tools are available to make an assessment of the safety culture in hospitals.[4]

Patient safety requires knowledge and skills in multiple areas, including human factor and system management, as most common errors, which are preventable, are related to these areas including investigation errors, medication errors and nosocomial infections.[5] Patient safety culture is one of the most important aspects needed in a hospital setting. Safety culture can be defined as the reduction of unnecessary damage risk during healthcare to a minimum acceptable. Safety culture differs significantly not only between hospitals but also within the institutions.[6]

A patient safety culture can be an unsegregated pattern of individual and institutional bearing based on shared beliefs and values that constantly seek to reduce patient harm resulting from the processes of healthcare delivery.[6]

Patient safety culture has been measured by a range of instrument that analyses dimensions such as communication, teamwork and report to errors. For most of these tools, however, confirmation on validity and reliability properties is rather limited or even non-existent. One of the most applied instruments is the Hospital Survey on Patient Safety Culture (HSOPSC), an instrument developed by the Agency for Healthcare Research and Quality.[7]

The safety culture of an institution acts as a guide as to how personnel will behave in the cubicle. Of course, their behaviour will be affected by what behaviours are rewarded and acceptable within the cubicle.[8]

The characteristics of a strong and motivated safety culture include the commitment of the authority to discuss and learn from errors, to document and improve patient safety, to inspire and practice teamwork, to spot potential hazards, to use systems for reporting and analysing conflicts and to salute workers as heroes improving safety rather than as villains committing errors.[8] Prevention of harm could be attained through preventing errors and learning from these errors with emphasis on involving the healthcare personnel, institution and patients.[5]

The safety culture encompasses the product of individual and group values, attitudes, perceptions, capability, and patterns of behaviour that lead to commitment which reflects the style and expertise of an institution's health and safety management.[9]

A commitment to the constant improvement of patient care should be a top priority of healthcare organisation. The longstanding principle, 'First do no harm', should serve as a foundation of nursing and medical care, as most offences are preventable.[10]

Many trials have been proven the significance of patient safety culture to reduce conflicts and enhance patient safety. An assessment of patient safety culture in hospitals is only the first step in describing and clarifying a logical safety culture.[10]

India is still lacking a regulatory system for the control of medical errors and mandatory reporting. It is a common problem in all health centres, especially in a government health centre, where finance is limited, the patient safety is a critical issue in healthcare delivery.[10]

There are very limited studies in India related to patient safety culture. Investigators undertook the study to learn the patient safety culture in a tertiary care teaching institution and thus focus on improving the aspects relating to patient safety. The objective of the study was to assess the perception of patient safety culture amongst healthcare personnel in a tertiary care hospital.


  Methodology Top


The study adopted a descriptive research design. The setting for the study was a tertiary care hospital, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, a training and research institute, and this hospital is one of the referral centres in East India which handles the highest number of patient loads. These factors can make a different impact on patient safety culture compared to hospitals which are non-academic or facilities that handle the lesser patient load.

The participants for the present study consisted of representatives of healthcare personnel from various departments. Based on the calculated sample size and response rate of the previous study, a total of 380 participants were included in this study. Employees who are working in health care setting with a minimum of one year of work experience were included in the study. Those employees who are not directly involved in patient care were excluded.

Based on the availability of health personnel, they were categorised into three strata as physicians, nursing officers and other technical staff. In this study, convenience sampling technique was used.

Hence, it was decided to include 53% of the available population. As the technical staffs were available less in number, it was arbitrarily decided to increase physicians and decrease the technical staff.

In the present study, a standardised tool ''Hospital Survey of Patient Safety Culture' [HSOPSC] was used.

HSOPSC includes 12 dimensions. Responses were scored on a five-point Likert scale (1 – strongly disagree, 2 – disagree, 3 – neither agree nor disagree, 4 – agree and 5 – strongly agree). The responses were categorised as a negative, neutral, positive response and non-responsive.

The negatively framed questions were reverse coded. The test–retest reliability by using Brown split-half formula[11] was 0.86 and the tool was found to be reliable.

The technique used for data collection was a self-administered questionnaire. The data were collected (from October 1, 2019, to October 31, 2019) after the approval from the Institute Ethical Committee (IEC/AIIMS BBSR/Nursing/2018-19/14) and hospital authorities. Participants from different departments including paediatric, obstetrics and gynaecology, psychiatric, orthopaedic, neurology, nephrology, gastrology, ear-nose-throat, dermatology, ophthalmology, cardiology, oncology and other private wards were selected.

The data were analysed by descriptive statistics, such as frequency and percentage.


  Results Top


All participants had 1-5 year of working experience in this hospital and worked in current units. Maximum 315 (82.89%) of them worked 59 h a week. Thirty-two (8.42%) worked 99 h a week, and 278 (73.16%) had 1–5 years of working experience in the current specialty. Based on staff position, 68.42% were nursing officers, 26.32% were physicians and only 5.26% were other technical staff.

It was observed that 16.84% of the participants belong to the paediatric department, 15.79% were working in general medicine and the rest of them are from other different departments of the hospital.

The final response rate was 84% amongst healthcare personnel in a tertiary care hospital, AIIMS, Bhubaneswar.

The responses based on composites were calculated as per the frequency of response for each survey item. For easier understanding, the responses in terms of frequency and percentage are combined representing the number of items for a single dimension. The combination of responses ranged from the lowest response category (e.g., strongly disagree/disagree and never/rarely) and to highest response category (e.g., strongly agree/agree and most of the time/always). The midpoint of the scale is reported as a separate category (neither or sometimes).

[Table 1] depicts the dimension of patient safety culture based on items. Response rate for 'teamwork within the unit' which found 1235 (81.25%) positive response, 70 (4.60%) was negative and 215 (14.14%) was neutral.
Table 1: Dimensions of patient safety culture based on items

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Overall, the study findings revealed that the response rate in the dimension of 'teamwork within the unit', 'organisational learning' and 'feedback and communication error' showed the maximum positive responses 81.25%, 79.91% and 70.61%, respectively. The dimensions of 'staffing about patient safety', 'handoffs and transitions' and 'non-punitive response error' received the least positive reponses 15.06 %,41.64%, and 18.77% respectively.

As shown in [Figure 1], the overall average positive response rate on 'patient safety culture' amongst various health personnel in all dimensions was 53.03%, negative was 24.16% and neither was 24.16%, respectively.
Figure 1: Overall response rate in all dimensions.

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[Figure 2] depicts the overall patient safety grade in all dimensions amongst healthcare personnel indicated 66.86% 'acceptable' ;7.89% and 20% as 'excellent' and 'very good' respectively.
Figure 2: Patient safety grade amongst all dimensions

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[Figure 3] depicts that 66.05% never reported any events and 19.47% reported 1–2 events, 8.95% reported 3–5 events, 3.42% reported 6–10 events and only 0.53% reported more than 21 events.
Figure 3: Number of events reported

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[Table 2] depicts the composite positive response for various dimensions. The dimension of 'teamwork within the unit', 'organisational learning' and 'feedback and communication error' showed the highest positive responses 81.25%, 79.91% and 70.61%, respectively. The dimension of 'handoff and transitions', 'teamwork across units' and 'non-punitive response to errors' had received the least positive response 41.64%, 53.02% and 18.77%, respectively.
Table 2: A composite positive response rate of patient safety culture in all dimensions (n=380)

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The between group comparison of patient safety culture in the dimensions of 'teamwork within group', 'frequency of event reported' and 'handoffs and transition', the median score was higher amongst nurses as compared to physicians and other technical staff, which was found statistically significant. (Ꭓ2[2] =32.24, P < 0.001, 2[2] =8.68, P < 0.001 and 2[2] =10.76, P < 0.001, respectively).

In the dimension of 'overall perception', 'staffing' and 'non-punitive response to error', there was no statistically significant difference between the groups about the patient safety culture (2[2] =2.85, P < 0.240, 2[2] =03.80, P < 0.149 and 2[2] =04.31, P < 0.116, respectively).

In the dimension of 'supervisor/manager', 'organisational learning', 'management support', 'feedback and communication error' and 'teamwork across unit', it was found that the median score was lesser amongst the physicians compared to nursing officer and other technical staff, which was found statistically significant (2[2] =16.03, P < 0.001, 2[2] =21.52, P < 0.001, 2[2] =12.97, P < 0.001, 2[2] =11.70, P < 0.001 and 2[2] =11.35, P < 0.001, respectively).

In the dimension of 'communication openness' with regard to patient safety culture, there was a significant difference in median score amongst other technical staff when compared to nursing officer and physicians (2[2] =13.16, P < 0.001).

The between group comparison of composite positive percentage of patient safety culture indicated in the dimension of 'supervisor/manager', 'organisational learning', 'feedback and communication error', 'communication openness', and 'teamwork across unit', found that the median composite positive percentage score is higher amongst nursing officers as compared to physicians and other technical staff, which was found statistically significant (2[[2] =12.66, P < 0.002, 2[2]=19.22, P < 0.001, 2[2] =14.48, P < 0.001, 2[2] =14.67, P < 0.001, and 2[2] =18.56, P < 0.001, respectively).

Whereas in the dimension of 'overall perception of patient safety culture', the median composite positive percentage score was least amongst the physicians when compared to nursing officer and other technical staff, which was found statistically significant (2[2] =13.41, P < 0.001).

In the dimension of 'management support', the median composite positive percentage score was higher for technical staff in comparison to physicians and nursing officers, which was statistically significant (2[2] =20.27, P < 0.001).

In the dimension of 'handoffs and transition', the median score composite positive percentage score for patient safety culture was lesser for physicians compared to nursing officer and other technical staff, which was found to be statistically significant (2[2] =14.88 P < 0.001).


  Discussion Top


This study was conducted amongst 380 health personnel with the objective of assessing the perception of patient safety culture amongst healthcare personnel.

In the present study, all subjects had 1–5 years' work experience in the hospital and were working in current unit. A study indicated that 80.30% were working for 40–49 h in per week and 72.40% of participants were working in current profession. Similar findings were reported.[10]

In the present study, the final response rate of participants was 84% comparatively lesser than reported[10] as 91.6%. However, it is higher than reported in similar study.[1]

The present study findings revealed that the response rate in dimension of 'teamwork within the unit', 'organisational learning' and 'feedback and communication error' showed the highest positive responses. The dimensions of 'communication openness', 'non-punitive response to errors' and 'handoff and transitions' had received the least positive responses. These findings are in congruence with the study [10] which in addition to it revealed that “supervisor or officer-in-charge expectations” also showed the highest positive responses.

The response rate for the dimension of “staffing about patient safety” was comparatively lesser than reported in a similar study [10] which indicated higher positive response rate for the same dimension. This finding emphasizes the need for adequate staffing for promotion of patient safety and to enhance the patient safety culture which may be detrimental to patient safety. The need for staffing as per the norm is remarkably prudent to deliver comprehensive safe care and achieve patient satisfaction.

In present study, finding revealed that majority 66.05 % never reported any events and only 0.53% reported more than 21 events. Studies have reported that the subscales of communication and perception of frequency of events reported positively influence patient safety management system.[12] The process of communication in an institution, the composition of decision-making, and reporting systems are leading factors that influence perceptions of safety and actions.

In the present study, overall patient safety grade in all dimensions amongst healthcare personnel indicated that 66.86% 'acceptable' These findings have similarity to the respondents of the study who gave “Excellent/Very Good” patient safety grades had significantly the maximum mean scores for patient safety composites.[13]

The between group comparison of composite positive percentage of patient safety culture indicated in the dimension of “teamwork within group”, “supervisor/manager”, “organizational learning”, “feedback and communication error”, “communication openness”, “frequency of event reported”, “teamwork across unit” found that median composite positive percentage score is higher amongst nursing officers as compared to physicians and other technical staff respectively. However, it was reported in a similar study the overall composite mean positive response rate on “Patient safety culture” varied among the different occupational groups of health care personnel.[10] Doctors scored the highest average positive response rate in the dimensions of 'teamwork within the unit', 'feedback and communication error' and 'organisational learning and continuous improvement' (78.4%, 71.2% and 67.6%, respectively). Nurses scored the highest average positive response rate in the dimensions of 'teamwork within the unit', 'organisational learning and continuous improvement', 'supervisor/officer-in-charge expectations' and 'feedback and communication error' (83.3%, 77.1%, 74.5% and 69.4%, respectively). Other technical staff scored higher positive response in the dimensions of 'organisational learning and continuous improvement', 'teamwork within the unit', 'supervisor/officer-in-charge expectations', 'supervisor/officer-in-charge expectations' and 'management support' (84.6%, 78.9%, 76.7% and 68.2%, respectively). Other technical staff obtained less score in the domains of 'handoffs and transitions' and 'frequency of events reported' (35.4% and 37.8%) compared to physicians and nurses, respectively.


  Conclusions Top


Based on the study finding, the investigators conclude that HSOPSC is a reliable tool to assess the patient safety culture in a tertiary care hospital. It reflects all the relevant dimensions and is reliable tool to a setting like tertiary care teaching institute. Effective communication and adequate staffing enhances professional practice which is a priority to promote patient safety culture amongst healthcare personnel. Healthcare institutions need to nurture homogeneous patient safety culture amongst all healthcare professional and take necessary measures to increase awareness about patient safety amongst them. Enhancing the interprofessional communication and regular supervision of nursing care activities with constructive feedback will help in promoting patient safety culture.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Ali H, Ibrahem SZ, Al Mudaf B, Al Fadalah T, Jamal D, El-Jardali F. Baseline assessment of patient safety culture in public hospitals in Kuwait. BMC Health Serv Res 2018;18:158.  Back to cited text no. 1
    
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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. 2
    
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Abu-El-Noor NI, Abu-El-Noor MK, Abuowda YZ, Alfaqawi M, Böttcher B. Patient safety culture among nurses working in Palestinian governmental hospital: A pathway to a new policy. BMC Health Serv Res 2019;19:550.  Back to cited text no. 3
    
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Smits M, Christiaans-Dingelhoff I, Wagner C, Wal GV, Groenewegen PP. The psychometric properties of the 'Hospital Survey on Patient Safety Culture' in Dutch hospitals. BMC Health Serv Res 2008;8:230.  Back to cited text no. 4
    
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El-Sherbiny NA, Ibrahim EH, Abdel-Wahed WY. Assessment of patient safety culture among paramedical personnel at general and district hospitals, Fayoum governorate, Egypt. J Egypt Public Health Assoc 2020;95:4.  Back to cited text no. 5
    
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da Silva JK, de Lima Alves T, Dantas GD, Kelmer LM, Rios MA. Nursing perception of safety culture: Integrative review. J Nurs UFPE 2016;10(10):3890-7.  Back to cited text no. 6
    
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Najjar S, Hamdan M, Baillien E, Vleugels A, Euwema M, Sermeus W, et al. The Arabic version of the hospital survey on patient safety culture: A psychometric evaluation in a Palestinian sample. BMC Health Serv Res 2013;13:193.  Back to cited text no. 7
    
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Aboul-Fotouh AM, Ismail NA, EzElarab HS, Wassif GO. Assessment of patient safety culture among health-care providers at a teaching hospital in Cairo, Egypt. East Mediterr Health J 2012;18:372-7.  Back to cited text no. 8
    
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Wagner C, Smits M, Sorra J, Huang CC. Assessing patient safety culture in hospitals across countries. Int J Qual Health Care 2013;25:213-21.  Back to cited text no. 9
    
10.
Rajalatchumi A, Ravikumar TS, Muruganandham K, Thulasingam M, Selvaraj K, Reddy MM, et al. Perception of patient safety culture among health-care Providers in a tertiary care hospital, south India. J Nat Sci Biol Med 2018;9:14-8.  Back to cited text no. 10
    
11.
Jacob J. Reliability: How? When? What? Int J Adv Nurs Manag 2017;5:372-4.  Back to cited text no. 11
    
12.
Jang HE, Song Y, Kang HY. Nurses' perception of patient safety culture and safety control in patient safety management activities. J Korean Acad Nurs Adm 2017;23:450-9.  Back to cited text no. 12
    
13.
Kawamoto AM, Oliveira JL, Tonini NS, Nicola AL. Leadership and patient safety culture: Perceptions of professionals in a university hospital. Rev Pesqui Cuid Fundam 2016;8:4387-98.  Back to cited text no. 13
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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