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Patient Safety Culture in Hospitals

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health-Related Quality of Life and Well-Being".

Deadline for manuscript submissions: closed (23 March 2023) | Viewed by 28724

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Special Issue Editors

Dr. Joann Sorra

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Guest Editor

Behavioral Health and Health Policy, Center for Healthcare Delivery Research and Evaluation at Westat in Rockville, MD 20850, USA
Interests: health services research; patient safety and patient safety culture; patient experience with healthcare; health care quality; organizational culture; implementation science; program evaluation; survey research and methodology

Prof. Dr. Cordula Wagner

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Guest Editor

1. Netherlands Institute of Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands
2. VU University/Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
Interests: quality improvement; patient safety; health services research; safety culture and resilience; health care process evaluation; implementation science; health care systems and governance

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on hospital patient safety culture under the section of Health Care Sciences & Services in the International Journal of Environmental Research and Public Health. The venue is an open-access, peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of health sciences and public health. For detailed information about the journal, we refer you to https://www.mdpi.com/journal/ijerph.

Healthcare delivery in hospitals around the world has changed dramatically since the onset of the COVID-19 pandemic in late 2019/early 2020. Health systems have had to quickly adapt to this crisis by developing new ways to deliver care to patients while maintaining the safety of healthcare professionals. This Special Issue invites recent research that focuses on patient safety culture and organizational culture in hospitals. Research conducted before the COVID-19 pandemic should include reflection on the impact of the findings in light of the current situation at the time of submission. We are interested in capturing insights and lessons learned during this unprecedented time in healthcare delivery, as well as comparisons to the time before the crisis. Potential areas of interest, among others, include hospital-based research focused on:

The adaption and/or implementation of processes, practices or initiatives before or during the pandemic that affect hospital patient safety culture/organizational culture and/or quality of care;
Whether system adaptations will only be effective during a pandemic or could result in lasting benefits to patient care;
Understanding and interpreting hospital patient safety culture/organizational culture during a pandemic compared to a non-pandemic time;
Relationships between hospital patient safety culture/organizational culture and healthcare professional safety and wellbeing;
How hospital leadership response to the pandemic affects patient safety culture/organizational culture;
Resilience in crisis situations and its relationship to quality of care and hospital patient safety culture/organizational culture;
Patient experience of care in crisis situations related to hospital patient safety culture/organizational culture;
Innovation and creativity in crisis situations related to hospital patient safety culture/organizational culture;
Teamwork and communication within hospitals during the pandemic.

This Special Issue of IJERPH, entitled “Patient Safety Culture in Hospitals” welcomes the submission of research involving quantitative, qualitative, or mixed methods, as well as practice-oriented research or reviews of relevant scientific literature.

Dr. Joann Sorra
Prof. Dr. Cordula Wagner
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Hospital
Patient safety culture
Organizational culture
Healthcare delivery
Healthcare quality
Healthcare safety
Workplace/workforce/healthcare professional safety
COVID-19 pandemic
Resilience
Healthcare professional burnout/stress
Healthcare management

Published Papers (8 papers)

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10 pages, 333 KiB

Open AccessArticle

Factors Relating to a Safety Culture in the University Perinatal Center: The Nurses’ and Midwives’ Perspective

by Janina Ribelienė, Jūratė Macijauskienė, Rasa Tamelienė, Aušrelė Kudrevičienė, Irena Nedzelskienė and Aurelija Blaževičienė

Int. J. Environ. Res. Public Health 2022, 19(16), 9845; https://doi.org/10.3390/ijerph19169845 - 10 Aug 2022

Cited by 5 | Viewed by 1533

Abstract

Background: According to The Joint Commission, a culture of safety is a key component for achieving sustainable and safe health care services, and hospitals must measure and monitor this achievement. Promoting a patient safety culture in health services optimally includes midwifery and nursing. The first aim of this study is to assess the University Perinatal Center’s staff members’ perceptions of safety culture. A second aim is to identify how the perceptions of safety culture actors are related to the socio-demographic characteristic of the respondents. Methods: A descriptive, cross-sectional, correlational design was applied in this study. Registered nurses and midwives were recruited from the University Perinatal Center in Lithuania (N = 233). Safety culture was measured by the Safety Attitudes Questionnaire (SAQ). Results: The mean scores of the responses on the 6 factors of the SAQ ranged from 3.18 (0.46) (teamwork climate) to 3.79 (0.55) (job satisfaction) points. The percentage of positive responses to the SAQ (4 or 5 points on the Likert scale) ranged from 43.2% to 69.0%. The lowest percentage of the respondents provided positive responses to the questions on perception of management and teamwork climate, while the highest percentage of the respondents provided positive responses to the questions on job satisfaction. Perception of management positively correlated with safety climate (r = 0.45, p < 0.01) and working conditions (r = 0.307, p < 0.01). Safety climate positively correlated with job satisfaction (r = 0.397, p < 0.01) and working conditions (r = 0.307, p < 0.01). Job satisfaction positively correlated with working conditions (r = 0.439, p < 0.01). Conclusion: Evaluating the opinions of the safety climate among nurses and midwives who work at the University Perinatal Center showed that teamwork climate and perception of management are weak factors. Therefore, stakeholders should organize more training about patient safety and factors that affect patient safety. Full article

(This article belongs to the Special Issue Patient Safety Culture in Hospitals)

16 pages, 664 KiB

Open AccessArticle

Development, Pilot Study, and Psychometric Analysis of the AHRQ Surveys on Patient Safety Culture™ (SOPS^®) Workplace Safety Supplemental Items for Hospitals

by Katarzyna Zebrak, Naomi Yount, Joann Sorra, Theresa Famolaro, Laura Gray, Deborah Carpenter and Andrew Caporaso

Int. J. Environ. Res. Public Health 2022, 19(11), 6815; https://doi.org/10.3390/ijerph19116815 - 02 Jun 2022

Cited by 3 | Viewed by 3234

Abstract

Workplace safety is critical for advancing patient safety and eliminating harm to both the healthcare workforce and patients. The purpose of this study was to develop and test survey items that can be used in conjunction with the Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™ (SOPS^®) Hospital Survey to assess how the organizational culture in hospitals supports workplace safety for providers and staff. After conducting a literature review and background interviews with workplace safety experts, we identified key areas of workplace safety culture (workplace hazards, moving/transferring/lifting patients, workplace aggression, supervisor/management support for workplace safety, workplace safety reporting, and work stress/burnout) and drafted survey items to assess these areas. Survey items were cognitively tested and pilot tested with the SOPS Hospital Survey 2.0 among providers and staff in 28 U.S. hospitals. We conducted psychometric analysis on data from 6684 respondents. Confirmatory factor analysis results (item factor loadings and model fit indices), internal consistency reliability, and site-level reliability were acceptable for the 16 survey items grouped into 6 composite measures. Most composite measures were significantly correlated with each other and with the overall rating on workplace safety, demonstrating conceptual convergence among survey measures. Hospitals and researchers can use the Workplace Safety Supplemental items to assess the dimensions of organizational culture that support provider and staff safety and to identify both strengths and areas for improvement. Full article

(This article belongs to the Special Issue Patient Safety Culture in Hospitals)

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14 pages, 2232 KiB

Open AccessArticle

The COVID-19 Pandemic Crisis and Patient Safety Culture: A Mixed-Method Study

by Ognjen Brborović, Hana Brborović and Leonarda Hrain

Int. J. Environ. Res. Public Health 2022, 19(4), 2237; https://doi.org/10.3390/ijerph19042237 - 16 Feb 2022

Cited by 21 | Viewed by 3469

Abstract

The COVID-19 pandemic has put inordinate pressure on frontline healthcare workers (HCWs) and hospitals. HCWs are under chronic emotional stress, affected by burnout, moral distress and interpersonal issues with peers or supervisors during the pandemic. All of these can lead to lower levels of patient safety. The goal of this study was to examine patient safety culture values in a COVID-19 frontline hospital. Patient safety represents action, while patient safety culture represents the beliefs, values and norms of an organization that support and promote patient safety. Patient safety culture is a prerequisite for patient safety. A cross-sectional study on healthcare workers (228, response rate of 81.43%) at a COVID-19 frontline hospital was conducted using the Hospital Survey on Patient Safety Culture (HOSPSC), which had PSC dimensions, single question dimensions and comments. Our research revealed that, during the COVID-19 pandemic, a number of patient safety issues have been identified: low communication openness and current punitive response to errors, which might have incapacitated HCWs in the reporting of adverse events. Although participants expressed high supervisor/management expectations, actual support from the supervisor/management tier was low. Poor teamwork across units was identified as another issue, as well as low staffing. The infrastructure was identified as a potential new PSC dimension. There was a lack of support from supervisors/managers, while HCWs need their supervisors to be available; to be visible on the front line and to create an environment of trust, psychological safety and empowerment. Full article

(This article belongs to the Special Issue Patient Safety Culture in Hospitals)

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19 pages, 773 KiB

Open AccessArticle

Patient Safety Culture in European Hospitals: A Comparative Mixed Methods Study

by Nina Granel-Giménez, Patrick Albert Palmieri, Carolina E. Watson-Badia, Rebeca Gómez-Ibáñez, Juan Manuel Leyva-Moral and María Dolors Bernabeu-Tamayo

Int. J. Environ. Res. Public Health 2022, 19(2), 939; https://doi.org/10.3390/ijerph19020939 - 14 Jan 2022

Cited by 17 | Viewed by 5081

Abstract

Background: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. Purpose: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. Design: A comparative mixed methods study with a convergent parallel design. Methods: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. Results: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. Conclusions: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy. Full article

(This article belongs to the Special Issue Patient Safety Culture in Hospitals)

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10 pages, 328 KiB

Open AccessArticle

Using Dominance Analysis to Identify the Most Important Dimensions of Safety Culture for Predicting Patient Safety

by Seung Eun Lee and V. Susan Dahinten

Int. J. Environ. Res. Public Health 2021, 18(15), 7746; https://doi.org/10.3390/ijerph18157746 - 21 Jul 2021

Cited by 7 | Viewed by 2689

Abstract

Studies have demonstrated associations between safety culture and patient safety based on the perceptions of healthcare professionals, but limited attention has been given to the perceptions of nurses. Moreover, most studies have used regression modeling, an approach that limits researchers’ ability to identify the most important predictors of patient safety due to intercorrelations among predictors in the model. Therefore, the purpose of this study was to examine the effects of seven dimensions of safety culture on nurse-rated patient safety and identify the relative importance of these dimensions for predicting patient safety. This correlational study used data from the Agency for Healthcare Research and Quality’s 2018 Hospital Survey on Patient Safety Culture. Data from 13,031 nurses working in surgical areas of 443 hospitals in the United States were examined using logistic regression and dominance analysis. Staffing adequacy was the strongest predictor of patient safety, followed by hospital management support for patient safety and organizational learning/continuous improvement. However, dominance analysis showed that hospital management support for patient safety was the most important predictor rather than staffing adequacy. Nurse managers and hospital administrators should role model a culture of safety and demonstrate their valuing of patient safety by providing sufficient resources, listening to and valuing staff suggestions regarding patient safety, and providing feedback about organizational changes to improve patient safety. Full article

(This article belongs to the Special Issue Patient Safety Culture in Hospitals)

9 pages, 291 KiB

Open AccessArticle

The Organizational Atmosphere in Israeli Hospital during COVID-19: Concerns, Perceptions, and Burnout

by Osnat Bashkin, Nadav Davidovitch, Noam Asna, Doron Schwartz and Keren Dopelt

Int. J. Environ. Res. Public Health 2021, 18(11), 5544; https://doi.org/10.3390/ijerph18115544 - 22 May 2021

Cited by 8 | Viewed by 2682

Abstract

The COVID-19 crisis poses challenges to healthcare systems and requires micro- and macro-organizational adaptations. This study examined the organizational atmosphere in Israeli hospitals by evaluating workers’ perceptions and concerns about the COVID-19 crisis and its management. At the end of the pandemic’s first wave in Israel, 547 healthcare workers responded to an online survey, which inquired about COVID-19 concerns at the individual and family level, perceptions at the national and organizational level, perceptions of the way the crisis was managed, self-assessment of coping with the crisis and burnout, and demographics. Findings showed that healthcare workers expressed deep concerns for family members and apprehension at a national level. Respondents noted that they were coping well with the crisis while expressing negative perceptions of how the crisis was managed. A regression model showed that the low self-assessment of medical staff of coping with the crisis, deep concerns at the organizational level, negative perceptions of crisis management, and providing care for COVID-19 patients were predictors of burnout. The findings emphasize the importance of developing a supportive organizational culture for hospital workers. Awareness of their concerns and perceptions is essential to improve organizational culture and healthcare systems’ ability to continue fighting the virus and confront future health crises. Full article

(This article belongs to the Special Issue Patient Safety Culture in Hospitals)

11 pages, 356 KiB

Open AccessArticle

Perceptions of Patient Safety Culture and Medication Error Reporting among Early- and Mid-Career Female Nurses in South Korea

by Sun-Joo Jang, Haeyoung Lee and Youn-Jung Son

Int. J. Environ. Res. Public Health 2021, 18(9), 4853; https://doi.org/10.3390/ijerph18094853 - 01 May 2021

Cited by 10 | Viewed by 3913

Abstract

Reporting medication errors is crucial for improving quality of care and patient safety in acute care settings. To date, little is known about how reporting varies between early and mid-career nurses. Thus, this study used a cross-sectional, secondary data analysis design to investigate the differences between early (under the age of 35) and mid-career (ages 35–54) female nurses by examining their perceptions of patient safety culture using the Korean Hospital Survey on Patient Safety Culture (HSPSC) and single-item self-report measure of medication error reporting. A total of 311 hospital nurses (260 early-career and 51 mid-career nurses) completed questionnaires on perceived patient safety culture and medication error reporting. Early-career nurses had lower levels of perception regarding patient safety culture (p = 0.034) compared to mid-career nurses. A multiple logistic regression analysis showed that relatively short clinical experience (<3 years) and a higher level of perceived patient safety culture increased the rate of appropriate medication error reporting among early-career nurses. However, there was no significant association between perception of patient safety culture and medication error reporting among mid-career nurses. Future studies should investigate the role of positive perception of patient safety culture on reporting errors considering multidimensional aspects, and include hospital contextual factors among early-, mid-, and late-career nurses. Full article

(This article belongs to the Special Issue Patient Safety Culture in Hospitals)

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23 pages, 1305 KiB

Open AccessSystematic Review

Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis

by Doriam E. Camacho-Rodríguez, Deibys A. Carrasquilla-Baza, Karen A. Dominguez-Cancino and Patrick A. Palmieri

Int. J. Environ. Res. Public Health 2022, 19(21), 14380; https://doi.org/10.3390/ijerph192114380 - 03 Nov 2022

Cited by 11 | Viewed by 4533

Abstract

Introduction: Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America. Purpose: Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC). Methods: This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated. Results: In total, 30 studies from five countries—Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)—were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were “organizational learning: continuous improvement” and “teamwork within units”, while the least positive were “nonpunitive response to error” and “staffing”. Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53–51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02–63.66). Conclusions: Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives. Full article

(This article belongs to the Special Issue Patient Safety Culture in Hospitals)

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