Patient Safety Culture of Hospitals in Southern Laos: A Cross-Sectional Study Using the Hospital Survey on Patient Safety Culture
Abstract
1. Introduction
2. Methods
2.1. Study Design
2.2. Participants and Sampling
2.3. Questionnaire
2.4. Data Collection
2.5. Analysis
2.6. Ethical Considerations
3. Results
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
DH | District hospital |
HSOPSC | Hospital Survey on Patient Safety Culture |
PH | Provincial hospital |
PSC | Patient safety culture |
PRR | Positive response rate |
References
- Kohn, L.T.; Corrigan, J.M.; Donaldson, M.S. (Eds.) To Err is Human: Building a Safer Health System; National Academies Press: Washington, DC, USA, 2000. [Google Scholar]
- Sorra, J.; Gray, L.; Streagle, S.; Famolaro, T.; Yount, N.; Behm, J. Hospital Survey on Patient Safety Culture: User’s Guide; Agency for Healthcare Research and Quality: Rockville, MD, USA, 2018. [Google Scholar]
- Aspden, P.; Costigan, J.M.; Wolcott, J.; Erickson, S.M. (Eds.) Patient Safety: Achieving a New Standard for Care; National Academies Press: Washington, DC, USA, 2004. [Google Scholar]
- Azyabi, A.; Karwowski, W.; Hancock, P.; Wan, T.T.H.; Elshennawy, A. Assessing patient safety culture in United States hospitals. Int. J. Environ. Res. Public Health 2022, 19, 2353. [Google Scholar] [CrossRef]
- Mistri, I.U.; Badge, A.; Shabu, S. Enhancing the patient safety culture in hospitals. Cureus 2023, 15, e51159. [Google Scholar] [CrossRef]
- Singer, S.J.; Vogus, T.J. Reducing hospital errors: Interventions that build safety culture. Annu. Rev. Public Health 2013, 34, 373–396. [Google Scholar] [CrossRef]
- Weaver, S.J.; Lubomksi, L.H.; Wilson, R.F.; Pfoh, E.R.; Martinez, K.A.; Dy, S.M. Promoting a culture of safety as a patient safety strategy: A systematic review. Ann. Intern. Med. 2013, 158, 369–374. [Google Scholar] [CrossRef]
- Pereira, S.C.A.; Ribeiro, O.; Fassarella, C.S.; Santos, E.L.F. The impact of nursing practice environments on patient safety culture in primary health care: A scoping review protocol. BJGP Open 2023, 7, BIGPO.2023.0032. [Google Scholar] [CrossRef]
- Astier-Pena, M.P.; Martinez-Bianchi, V.; Torijano-Casalengua, M.L.; Ares-Blanco, S.; Bueno-Ortiz, J.M.; Fernandez-Garcia, M. The global patient safety action plan 2021–2030: Identifying actions for safer primary health care. Aten. Primaria 2021, 53, 102224. [Google Scholar] [CrossRef]
- Agency for Healthcare Research and Quality. Available online: https://www.ahrq.gov/sops/international/index.html (accessed on 26 December 2024).
- Waterson, P.; Carman, E.M.; Manser, T.; Hammer, A. Hospital Survey on Patient Safety Culture (HSPSC): A systematic review of the psychometric properties of 62 international studies. BMJ Open 2019, 9, e026896. [Google Scholar] [CrossRef]
- Harrison, R.; Cohen, A.W.; Walton, M. Patient safety and quality of care in developing countries in Southeast Asia: A systematic literature review. Int. J. Qual. Health Care 2015, 27, 240–254. [Google Scholar] [CrossRef]
- Juliasih, N.N.; Dhamanti, I.; Semita, I.N.; Wartiningsih, M.; Mahmudah, M.; Yakub, F. Patient safety culture, infection prevention, and patient safety in the operating room: Health workers’ perspective. Risk Manag. Healthc. Policy 2023, 16, 1731–1738. [Google Scholar] [CrossRef]
- Tran, L.H.; Pham, Q.T.; Nguyen, D.H.; Tran, T.N.H.; Bui, T.T.H. Assessment of patient safety culture in public general hospital in capital city of Vietnam. Health Serv. Insights 2021, 14, 11786329211036313. [Google Scholar] [CrossRef]
- Nonaka, D.; Inthavong, N.; Takahashi, K.; Chanthakoumane, K.; Toyama, Y.; Luangphaxay, C.; Pongvongsa, T.; Kounnavong, S. Primary health care situations in remote rural villages of the Savannakhet province, Lao People’s Democratic Republic. Trop. Med. Health 2022, 50, 90. [Google Scholar] [CrossRef]
- Qian, Y.; Yan, F.; Wang, W.; Clancy, S.; Akkhavong, K.; Vonglokham, M.; Outhensackda, S.; Østbye, T. Challenges for strengthening the health workforce in the Lao People’s Democratic Republic: Perspectives from key stakeholders. Hum. Resour. Health 2016, 14, 72. [Google Scholar] [CrossRef]
- World Health Organization, Regional Office for the Western Pacific. The Lao People’s Democratic Republic Health System Review; World Health Organization: Manila, Philippines, 2014. [Google Scholar]
- Ministry of Health, Department of Healthcare and Rehabilitation. Implementing Continuous Quality Improvement (CQI): Practical Applications and Outcomes in Four Southern Provinces; Ministry of Health: Vientiane, Laos, 2025. [Google Scholar]
- Japan International Cooperation Agency. Project for Improvement of Services at Health Centers in Lao PDR. Available online: https://www.jica.go.jp/Resource/project/english/laos/027/outline/index.html (accessed on 8 May 2025).
- Ministry of Health, Department of Healthcare and Rehabilitation. Patient Safety Situational Report in Health Facilities; Ministry of Health: Vientiane, Laos, 2025. [Google Scholar]
- Reis, C.T.; Paiva, S.G.; Sousa, P. The patient safety culture: A systematic review by characteristics of Hospital Survey on Patient Safety Culture dimensions. Int. J. Qual. Health Care 2018, 30, 660–677. [Google Scholar] [CrossRef]
- Waterson, P.; Griffiths, P.; Stride, C.; Murphy, J.; Hignett, S. Psychometric properties of the Hospital Survey on Patient Safety Culture: Findings from the UK. Qual. Saf. Health Care 2010, 19, e2. [Google Scholar] [CrossRef]
- Copeland, D. Targeting the fear of safety reporting on a unit level. J. Nurs. Adm. 2019, 49, 121–124. [Google Scholar] [CrossRef]
- Waring, J.J. Beyond blame: Cultural barriers to medical incident reporting. Soc. Sci. Med. 2005, 60, 1927–1935. [Google Scholar] [CrossRef]
- Naome, T.; James, M.; Christine, A.; Mugisha, T.I. Practice, perceived barriers and motivating factors to medical-incident reporting: A cross-section survey of healthcare providers at Mbarara regional referral hospital, southwestern Uganda. BMC Health Serv. Res. 2020, 20, 276. [Google Scholar] [CrossRef]
- Brborovic, O.; Brborovic, H.; Nola, I.A.; Milosevic, M. Culture of blame—An ongoing burden for doctors and patient safety. Int. J. Environ. Res. Public Health 2019, 16, 4826. [Google Scholar] [CrossRef]
- Okuyama, J.H.H.; Galvao, T.F.; Silva, M.T. Healthcare professional’s perception of patient safety measured by the hospital survey on patient safety culture: A systematic review and meta-analysis. Sci. World J. 2018, 2018, 9156301. [Google Scholar] [CrossRef]
- Chen, I.C.; Li, H.H. Measuring patient safety culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMC Health Serv. Res. 2010, 10, 152. [Google Scholar] [CrossRef]
- Famolaro, T.Y.; Yount, N.D.; Hare, R.; Thornton, S.; Meadows, K.; Fan, L.; Birch, R.; Sorra, J. Hospital Survey on Patient Safety Culture: 2018 User Database Report; Agency for Healthcare Research and Quality: Rockville, MD, USA, 2018. [Google Scholar]
- Fujita, S.; Seto, K.; Ito, S.; Wu, Y.; Huang, C.C.; Hasegawa, T. The characteristics of patient safety culture in Japan, Taiwan and the United States. BMC Health Serv. Res. 2013, 13, 20. [Google Scholar] [CrossRef]
- Hao, H.S.; Gao, H.; Li, T.; Zhang, D. Assessment and comparison of patient safety culture among healthcare providers in Shenzhen hospitals. Risk Manag. Healthc. Policy 2020, 13, 1543–1552. [Google Scholar] [CrossRef]
- 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, 386–395. [Google Scholar] [CrossRef]
- Mekonnen, A.B.; McLachlan, A.J.; Brien, J.A.E.; Mekonnen, D.; Abay, Z. Hospital survey on patient safety culture in Ethiopian public hospitals: A cross-sectional study. Saf. Health 2017, 3, 11. [Google Scholar] [CrossRef]
- Ayisa, A.; Getahun, Y.; Yesuf, N. Patient safety culture and associated factors among healthcare providers in the University of Gondar comprehensive specialized hospital, Northwest Ethiopia. Drug Healthc. Patient Saf. 2021, 13, 141–150. [Google Scholar] [CrossRef]
- Abuosi, A.A.; Anaba, E.A.; Attafuah, P.Y.A.; Tenza, I.S.; Abor, P.A.; Setordji, A.; Nketiah-Amponsah, E. Comparing patient safety culture in primary, secondary and tertiary hospitals in Ghana. Ghana Med. J. 2023, 57, 141–147. [Google Scholar] [CrossRef]
- International Monetary Fund. Asia and Pacific Dept. Lao People’s Democratic Republic: 2023 Article IV Consultation—Press release; Staff report; and statement by the Executive Director for Lao PDR. IMF Staff Country Rep. 2023, 2023, A001. Available online: https://www.elibrary.imf.org/view/journals/002/2023/171/article-A001-en.xml (accessed on 8 May 2025).
- World Health Organization. Lao People’s Democratic Republic: A Primary Health Care Case Study in the Context of the COVID-19 Pandemic; World Health Organization: Geneva, Switzerland, 2023; Available online: https://iris.who.int/bitstream/handle/10665/372688/9789240076709-eng.pdf (accessed on 8 May 2025).
Dimension | Number of Items | Example of Item in HSOPSC |
---|---|---|
Supervisor/Manager Expectations and Actions Promoting Patient Safety | 4 | My supervisor/manager seriously considers staff suggestions for improving patient safety. |
Organizational Learning–Continuous Improvement | 3 | Mistakes have led to positive changes here. |
Teamwork Within Units | 4 * | People support one another in this unit. |
Communication Openness | 3 | Staff will freely speak up if they see something that may negatively affect patient care. |
Feedback and Communication About Error | 3 | We are given feedback about changes put into place based on event reports |
Nonpunitive Response to Error | 3 | Staff feel like their mistakes are held against them. (negatively worded) |
Staffing | 4 | We use more agency/temporary staff than is best for patient care. (negatively worded) |
Management Support for Patient Safety | 3 | Hospital management provides a work climate that promotes patient safety. |
Teamwork Across Units | 4 | There is good cooperation among hospital units that need to work together. |
Handoffs and Transitions | 4 | Shift changes are problematic for patients in this hospital. (negatively worded) |
Overall Perceptions of Patient Safety | 4 | We have a patient safety problem in this unit. (negatively worded) |
Frequency of Events Reported | 3 | When a mistake is made that could harm the patient, but does not, how often is this reported? |
Characteristics | Number (n = 253) | Percentage |
---|---|---|
Age | ||
20–29 years | 47 | 18.6% |
30–39 years | 119 | 47.0% |
40–49 years | 52 | 20.6% |
50–59 years | 32 | 12.7% |
60 years or older | 3 | 1.2% |
Gender | ||
Men | 69 | 27.3% |
Women | 135 | 53.4% |
Unknown/Missing | 49 | 19.4% |
Profession | ||
Physician | 100 | 39.5% |
Nurse | 70 | 27.7% |
Pharmacist | 22 | 8.7% |
Midwife | 19 | 7.5% |
Dentist | 7 | 2.8% |
Others | 32 | 12.7% |
Unknown/Missing | 3 | 1.2% |
Patient Safety Training Experience | ||
Yes | 75 | 29.6% |
No | 169 | 66.8% |
Unknown/Missing | 9 | 3.6% |
Years of Experience at Current Hospital | ||
Less than 1 year | 9 | 3.6% |
1–5 years | 50 | 19.8% |
6–10 years | 79 | 31.2% |
11–15 years | 39 | 15.4% |
16–20 years | 28 | 9.9% |
21 years or more | 43 | 17.0% |
Unknown/Missing | 5 | 2.0% |
Type of Current Hospital | ||
Provincial hospital | 73 | 29.4% |
District hospital | 180 | 70.6% |
Dimension | Number of Items | Cronbach’s α |
---|---|---|
Supervisor/Manager Expectations and Actions Promoting Patient Safety | 4 | 0.51 |
Organizational Learning–Continuous Improvement | 3 | 0.64 |
Teamwork Within Units *1 | 3 | 0.43 |
Communication Openness | 3 | 0.41 |
Feedback and Communication About Error | 3 | 0.65 |
Nonpunitive Response to Error | 3 | 0.54 |
Staffing | 4 | 0.37 |
Management Support for Patient Safety | 3 | 0.33 |
Teamwork Across Units | 4 | 0.54 |
Handoffs and Transitions | 4 | 0.70 |
Overall Perceptions of Patient Safety | 4 | 0.39 |
Frequency of Events Reported | 3 | 0.68 |
Dimension | Physicians (n = 100) (%) | Nurses (n = 70) (%) | Pharmacists (n = 22) (%) | Midwifes (n = 19) (%) | p-Value |
---|---|---|---|---|---|
Nonpunitive Response to Error | 16.0 | 18.0 | 9.1 | 18.5 | 0.96 |
Frequency of Events Reported | 19.4 | 15.4 | 22.7 | 11.8 | 0.58 |
Overall Perceptions of Patient Safety | 35.0 | 30.4 | 36.9 | 30.9 | 0.53 |
Staffing | 34.3 | 38.7 | 39.8 | 38.9 | 0.90 |
Handoffs and Transitions | 38.0 | 44.1 | 39.3 | 34.7 | 0.74 |
Feedback and Communication About Error | 45.9 | 42.1 | 58.3 | 35.1 | 0.62 |
Management Support for Patient Safety | 43.6 | 47.3 | 65.1 | 44.4 | 0.04 * |
Communication Openness | 48.9 | 56.4 | 53.7 | 44.4 | 0.60 |
Supervisor/Manager Expectations and Actions Promoting Patient Safety | 64.0 | 67.8 | 61.9 | 55.9 | 0.24 |
Teamwork Across Units | 64.6 | 70.0 | 72.7 | 66.2 | 0.65 |
Teamwork Within Units | 76.0 | 74.1 | 77.3 | 75.4 | 0.78 |
Organizational Learning–Continuous Improvement | 76.4 | 86.9 | 86.4 | 83.3 | 0.18 |
Dimension | This Study | Taiwan (2010) [28] | Lebanon (2010) [32] | Japan (2013) [30] | Ethiopia (2017) [33] | USA (2018) [29] | China (2020) [31] | Vietnam (2021) [14] |
---|---|---|---|---|---|---|---|---|
Nonpunitive Response to Error | 18% | 45% | 24% | 43% | 33% | 47% | 36% | 53% |
Frequency of Events Reported | 18% | 57% | 68% | 66% | 36% | 67% | 72% | 77% |
Overall Perceptions of Patient Safety | 33% | 65% | 73% | 53% | 26% | 66% | 64% | 75% |
Staffing | 37% | 39% | 37% | 40% | 26% | 53% | 38% | 49% |
Handoffs and Transitions | 40% | 48% | 50% | 36% | 33% | 48% | 57% | 63% |
Feedback and Communication About Error | 43% | 59% | 68% | 53% | 46% | 69% | 87% | 83% |
Management Support for Patient Safety | 47% | 62% | 78% | 51% | 47% | 72% | 36% | 85% |
Communication Openness | 50% | 58% | 57% | 49% | 42% | 66% | 64% | 66% |
Supervisor/Manager Expectations and Actions Promoting Patient Safety | 64% | 83% | 66% | 61% | 46% | 80% | 78% | 86% |
Teamwork Across Units | 67% | 72% | 56% | 44% | 57% | 62% | 64% | 73% |
Teamwork Within Units | 75% * | 94% | 56% | 70% | 72% | 82% | 87% | 91% |
Organizational Learning–Continuous Improvement | 80% | 84% | 78% | 51% | 72% | 72% | 87% | 88% |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Sodeno, M.; Thandar, M.M.; Thounsavath, S.; Phouthavong, O.; Hachiya, M.; Ichimura, Y. Patient Safety Culture of Hospitals in Southern Laos: A Cross-Sectional Study Using the Hospital Survey on Patient Safety Culture. Healthcare 2025, 13, 1934. https://doi.org/10.3390/healthcare13151934
Sodeno M, Thandar MM, Thounsavath S, Phouthavong O, Hachiya M, Ichimura Y. Patient Safety Culture of Hospitals in Southern Laos: A Cross-Sectional Study Using the Hospital Survey on Patient Safety Culture. Healthcare. 2025; 13(15):1934. https://doi.org/10.3390/healthcare13151934
Chicago/Turabian StyleSodeno, Miho, Moe Moe Thandar, Somchanh Thounsavath, Olaphim Phouthavong, Masahiko Hachiya, and Yasunori Ichimura. 2025. "Patient Safety Culture of Hospitals in Southern Laos: A Cross-Sectional Study Using the Hospital Survey on Patient Safety Culture" Healthcare 13, no. 15: 1934. https://doi.org/10.3390/healthcare13151934
APA StyleSodeno, M., Thandar, M. M., Thounsavath, S., Phouthavong, O., Hachiya, M., & Ichimura, Y. (2025). Patient Safety Culture of Hospitals in Southern Laos: A Cross-Sectional Study Using the Hospital Survey on Patient Safety Culture. Healthcare, 13(15), 1934. https://doi.org/10.3390/healthcare13151934