Patient Safety Culture in a Tertiary Referral Hospital: Evidence from a Main Criterion in Accreditation
-
Saeed Mohammadpou Mohammadpour
,
Alireza Rezazadeh
,
Maliheh Hemati
,
Zahra Ebrahimi
,
Tahere Sharifi
Abstract
Objectives: In Iran’s accreditation program, the patient safety dimension is one of the main dimensions, holding the highest weight among the accreditation criteria. The purpose of this study was to identify the patient safety culture (PSC) in a tertiary referral hospital.
Methods: The current study was conducted between March and April 2021 in a tertiary hospital in Iran. The sample size was 628 participants, selected through simple random sampling. The hospital survey on patient safety culture (HSOPSC) was used to assess provider and staff perceptions about patient safety issues, medical errors, and event reporting. The survey included 32 items that measure 10 dimensions of PSC. Normality tests, along with non-parametric Mann-Whitney and Kruskal-Wallis tests, were used to examine the relationship between PSC and demographic variables using SPSS 22 software.
Results: Based on current findings, among the 10 dimensions of PSC, teamwork and organizational learning-continuous improvement received the highest scores (83% positive response), which were higher than these variables in the Agency for Healthcare Research and Quality (AHRQ) data. Conversely, staffing and work pace, as well as hospital management support for patient safety, received the lowest positive scores (43% and 55% positive response, respectively), which were lower than these variables in the AHRQ data. There was a significant positive relationship between dimensions of PSC and older age, female gender, staff with longer working experience, and longer work hours per week (P < 0.05).
Conclusions: The majority of our participants felt that patient safety needs to be enhanced. Based on the findings of this study, it is recommended to emphasize the dimensions of “staffing and work pace” and “hospital management support for patient safety” more in the accreditation criteria to strengthen these dimensions in hospitals. Additionally, we have introduced a comprehensive guide for using an international tool to measure PSC, which hospitals can use to succeed in annual accreditation.
1. Okuyama JHH, Galvao TF, Silva MT. 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.
2. Fujita S, Wu Y, Iida S, Nagai Y, Shimamori Y, Hasegawa T. Patient safety management systems, activities and work environments related to hospital-level patient safety culture: A cross-sectional study. Med (Baltimore). 2019;98(50):e18352.
3. Alex Kim RJ, Chin ZH, Sharlyn P, Priscilla B, Josephine S. Hospital survey on patient safety culture in Sarawak General Hospital: A cross sectional study. The Medical journal of Malaysia.2019;74(5):385-8.
4. Ricklin ME, Hess F, Hautz WE. Patient safety culture in a university hospital emergency department in Switzerland - a survey study. GMS journal for medical education. 2019;36(2):Doc14.
5. Kwan MR, Seo HJ, Lee SJ. The association between experience of hospital accreditation and nurses’ perception of patient safety culture in South Korean general hospitals: a cross-sectional study. BMC Nurs. 2021;20(1):195.
6. Mosadeghrad AM, Jaafaripooyan E, Ghazanfari F. [Hospital accreditation methods in Iran: Challenges and solutions]. Health Monitor J Iran Institute Health Sci Res. 2021;20(6):655-70.
7. Aghaei Telikani ZA, Riahi L, Nastiripour AA. [The Effect of Accreditation Interventions on Patient Safety Measurement in Operating Rooms of one of Tehran Social Security Hospitals]. J Healthcare Managemnt 2022;13(1):71-83.
8. Waterson P, Carman EM, 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(9):e026896.
9. Hao HS, Gao H, Li T, Zhang D. Assessment and Comparison of Patient Safety Culture Among Health-Care Providers in Shenzhen Hospitals. Risk Manag Healthc Policy. 2020;13:1543-52.
10. Smith SA, Yount N, Sorra J. Exploring relationships between hospital patient safety culture and Consumer Reports safety scores. BMC Health Serv Res. 2017;17(1):143.
11. Reis CT, Paiva SG, 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(9):660-77.
12. Yousefian M, Eyni S, Amini K, Ershadifard S, Gheybati F, Asadi H. [The status of patient safety culture in Iranian hospitals: a sys-tematic review]. Health Monitor J Iran Institu Health Sci Res. 2023;22(2):129-38.
13. Al Ma’mari Q, Sharour LA, Al Omari O. Fatigue, burnout, work environment, workload and perceived patient safety culture among critical care nurses. Br J Nurs. 2020;29(1):28-34.
14. Asadi H, Habibi Soola A, Davari M, Ershadifard S. [The status of patient safety culture in nurses of Imam Khomeini Hospital in Ardabil, Iran during the outbreak of COVID-19, in 2020]. J Military Med. 2020;22(11):1162-70.
15. Salarvand S, Kazemi A, Bahri N, Dalvand P, Moghimian M, Mahmoudi G, et al. [Assessing medical staff’s view of patient safety culture]. Nurs Management. 2015;4:54-64.
16. Rabiei N, Gholami Fesharaki M, Maleki S, Mohamadian M. [Relationship between burnout, job satisfaction and demographic factors with the level of patient safety culture in military healthcare staff]. J Mil Med. 2018;19(6):571-8.
17. Nekoei-Moghadam M, Raadabadi M, Heidarijamebozorgi M. Patient safety culture in university hospital’s emergency departments: A case study. Int J Health Plann Manage. 2020;35(4):852-8.
18. Kolankiewicz ACB, Schmidt CR, Carvalho R, Spies J, Dal Pai S, Lorenzini E. Patient safety culture from the perspective
of all the workers of a general hospital. Rev Gaucha Enferm. 2020;41:e20190177.
19. Bell A, Gallacher N. Succeeding in Sustained Reduction in the use of Restraint using the Improvement Model. BMJ Qual Improv Rep. 2016;5(1).
20. Habibzadeh P, Stoneman EK. The Novel Coronavirus: A Bird’s Eye View. Int J Occup Environ Med. 2020;11(2):65-71.
21. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. The New England journal of medicine. 2020;382(8):727-33.
22. Brborovic O, Brborovic H, Hrain L. The COVID-19 Pandemic Crisis and Patient Safety Culture: A Mixed-Method Study. Int J Environ Res Public Health. 2022;19(4).
23. Chen HY, Lu L, Ko YM, Chueh JW, Hsiao SY, Wang PC, et al. PostPandemic Patient Safety Culture: A Case from a Large Metropolitan Hospital Group in Taiwan. Int J Environ Res Public Health. 2021;18(9).
24. Asefzadeh S, Kalhor R, Tir M. Patient safety culture and job stress among nurses in Mazandaran, Iran. Electron Physician. 2017;9(12):6010-6.
25. Azami-Aghdash S, Ebadifard Azar F, Rezapour A, Azami A, Rasi V, Klvany K. Patient safety culture in hospitals of Iran: a systematic review and meta-analysis. Medical journal of the Islamic Republic of Iran. 2015;29:251.
26. Davoodi R, Mohammadzadeh Shabestari M, Takbiri A, Soltanifar A, Sabouri G, Rahmani S, et al. Patient Safety Culture Based on Medical Staff Attitudes in Khorasan Razavi Hospitals, Northeastern Iran. Iranian journal of public health. 2013;42(11):1292-8.
27. Sorra JS, Dyer N. Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture. BMC Health Serv Res. 2010;10:199.
28. Amiri M, Chaman R, Bagheri H, Sadeghian F, Khosravi A. [Cost analysis and per capita performance of the staff working in hygiene sectors of shahroud university of medical sciences]. Int Med Today. 2012;18(1):75-81.
29. Chen IC, Li HH. Measuring patient safety culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMC Health Serv Res. 2010;10:152.
30. Zebrak K, Yount N, Sorra J, Famolaro T, Gray L, Carpenter D, et al. Development, Pilot Study, and Psychometric Analysis of the AHRQ Surveys on Patient Safety Culture (SOPS((R))) Workplace
Safety Supplemental Items for Hospitals. Int J Environ Res Public Health. 2022;19(11).
31. Zwijnenberg NC, Hendriks M, Hoogervorst-Schilp J, Wagner C. Healthcare professionals’ views on feedback of a patient safety culture assessment. BMC Health Serv Res. 2016;16:199.
32. Nie Y, Mao X, Cui H, He S, Li J, Zhang M. Hospital survey on patient safety culture in China. BMC Health Serv Res. 2013;13:228.
33. El-Jardali F, Sheikh F, Garcia NA, Jamal D, Abdo A. Patient safety culture in a large teaching hospital in Riyadh: baseline assessment, comparative analysis and opportunities for improvement. BMC Health Serv Res. 2014;14:122.
34. Kiaei MZ, Ziaee A, Mohebbifar R, Khoshtarkib H, Ghanati E, Ahmadzadeh A, et al. Patient safety culture in teaching hospitals in Iran: assessment by the hospital survey on patient safety culture (HSOPSC). Health Management Inf Sci. 2016;3(2):51-6.
35. Alquwez N, Cruz JP, Almoghairi AM, Al-Otaibi RS, Almutairi KO, Alicante JG, et al. Nurses’ Perceptions of Patient Safety Culture in Three Hospitals in Saudi Arabia. J Nurs Scholarsh. 2018;50(4):422-31.
36. Wagner C, Smits M, Sorra J, Huang CC. Assessing patient safety culture in hospitals across countries. Int J Qual Health Care. 2013;25(3):213-21.
37. Akologo A, Abuosi AA, Anaba EA. A cross-sectional survey on patient safety culture among healthcare providers in the Upper East region of Ghana. PLoS One. 2019;14(8):e0221208.
38. Gil-Aucejo A, Martínez-Martín S, Flores-Sánchez P, MoyanoHernández C, Sánchez-Morales P, Andrés-Martínez M, et al. Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19. Enfermería Intensiva. 2022;33(4):185-96.
39. Reis CT, Laguardia J, Bruno de Araujo Andreoli P, Nogueira Junior C, Martins M. Cross-cultural adaptation and validation of the Hospital Survey on Patient Safety Culture 2.0 - Brazilian version. BMC Health Serv Res. 2023;23(1):32.
40. Rangachari P, J LW. Preserving Organizational Resilience, Patient Safety, and Staff Retention during COVID-19 Requires a Holistic Consideration of the Psychological Safety of Healthcare Workers. Int J Environ Res Public Health. 2020;17(12).
41. Oliveira RM, Leitao IM, Aguiar LL, Oliveira AC, Gazos DM, Silva LM, et al. Evaluating the intervening factors in patient safety: focusing on hospital nursing staff. Rev Esc Enferm USP. 2015;49(1):104-13.
42. Manthorpe J, Iliffe S, Gillen P, Moriarty J, Mallett J, Schroder H, etal. Clapping for carers in the Covid-19 crisis: Carers’ reflections in a UK survey. Health Soc Care Community. 2022;30(4):1442-9.
43. Motazedi Z, Beilankohi M, Taherinia J, Asghari E, Arshadi Bostanabad M, Alikhah H. [Assessment of patient safety culture from viewpoint of nurses working in Tabriz Sina educational and treatment center]. Med J Tabriz Univ Med Sci Health Serv. 2019;41(1):92-9.
44. Dehghani M, Hayavie Haghighi MH, Salimi J, Khorami F. [Culture of Patient Safety from Nurses’ Perspective]. Iran J Nurs. 2015;28(93):42-54.
2. Fujita S, Wu Y, Iida S, Nagai Y, Shimamori Y, Hasegawa T. Patient safety management systems, activities and work environments related to hospital-level patient safety culture: A cross-sectional study. Med (Baltimore). 2019;98(50):e18352.
3. Alex Kim RJ, Chin ZH, Sharlyn P, Priscilla B, Josephine S. Hospital survey on patient safety culture in Sarawak General Hospital: A cross sectional study. The Medical journal of Malaysia.2019;74(5):385-8.
4. Ricklin ME, Hess F, Hautz WE. Patient safety culture in a university hospital emergency department in Switzerland - a survey study. GMS journal for medical education. 2019;36(2):Doc14.
5. Kwan MR, Seo HJ, Lee SJ. The association between experience of hospital accreditation and nurses’ perception of patient safety culture in South Korean general hospitals: a cross-sectional study. BMC Nurs. 2021;20(1):195.
6. Mosadeghrad AM, Jaafaripooyan E, Ghazanfari F. [Hospital accreditation methods in Iran: Challenges and solutions]. Health Monitor J Iran Institute Health Sci Res. 2021;20(6):655-70.
7. Aghaei Telikani ZA, Riahi L, Nastiripour AA. [The Effect of Accreditation Interventions on Patient Safety Measurement in Operating Rooms of one of Tehran Social Security Hospitals]. J Healthcare Managemnt 2022;13(1):71-83.
8. Waterson P, Carman EM, 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(9):e026896.
9. Hao HS, Gao H, Li T, Zhang D. Assessment and Comparison of Patient Safety Culture Among Health-Care Providers in Shenzhen Hospitals. Risk Manag Healthc Policy. 2020;13:1543-52.
10. Smith SA, Yount N, Sorra J. Exploring relationships between hospital patient safety culture and Consumer Reports safety scores. BMC Health Serv Res. 2017;17(1):143.
11. Reis CT, Paiva SG, 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(9):660-77.
12. Yousefian M, Eyni S, Amini K, Ershadifard S, Gheybati F, Asadi H. [The status of patient safety culture in Iranian hospitals: a sys-tematic review]. Health Monitor J Iran Institu Health Sci Res. 2023;22(2):129-38.
13. Al Ma’mari Q, Sharour LA, Al Omari O. Fatigue, burnout, work environment, workload and perceived patient safety culture among critical care nurses. Br J Nurs. 2020;29(1):28-34.
14. Asadi H, Habibi Soola A, Davari M, Ershadifard S. [The status of patient safety culture in nurses of Imam Khomeini Hospital in Ardabil, Iran during the outbreak of COVID-19, in 2020]. J Military Med. 2020;22(11):1162-70.
15. Salarvand S, Kazemi A, Bahri N, Dalvand P, Moghimian M, Mahmoudi G, et al. [Assessing medical staff’s view of patient safety culture]. Nurs Management. 2015;4:54-64.
16. Rabiei N, Gholami Fesharaki M, Maleki S, Mohamadian M. [Relationship between burnout, job satisfaction and demographic factors with the level of patient safety culture in military healthcare staff]. J Mil Med. 2018;19(6):571-8.
17. Nekoei-Moghadam M, Raadabadi M, Heidarijamebozorgi M. Patient safety culture in university hospital’s emergency departments: A case study. Int J Health Plann Manage. 2020;35(4):852-8.
18. Kolankiewicz ACB, Schmidt CR, Carvalho R, Spies J, Dal Pai S, Lorenzini E. Patient safety culture from the perspective
of all the workers of a general hospital. Rev Gaucha Enferm. 2020;41:e20190177.
19. Bell A, Gallacher N. Succeeding in Sustained Reduction in the use of Restraint using the Improvement Model. BMJ Qual Improv Rep. 2016;5(1).
20. Habibzadeh P, Stoneman EK. The Novel Coronavirus: A Bird’s Eye View. Int J Occup Environ Med. 2020;11(2):65-71.
21. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. The New England journal of medicine. 2020;382(8):727-33.
22. Brborovic O, Brborovic H, Hrain L. The COVID-19 Pandemic Crisis and Patient Safety Culture: A Mixed-Method Study. Int J Environ Res Public Health. 2022;19(4).
23. Chen HY, Lu L, Ko YM, Chueh JW, Hsiao SY, Wang PC, et al. PostPandemic Patient Safety Culture: A Case from a Large Metropolitan Hospital Group in Taiwan. Int J Environ Res Public Health. 2021;18(9).
24. Asefzadeh S, Kalhor R, Tir M. Patient safety culture and job stress among nurses in Mazandaran, Iran. Electron Physician. 2017;9(12):6010-6.
25. Azami-Aghdash S, Ebadifard Azar F, Rezapour A, Azami A, Rasi V, Klvany K. Patient safety culture in hospitals of Iran: a systematic review and meta-analysis. Medical journal of the Islamic Republic of Iran. 2015;29:251.
26. Davoodi R, Mohammadzadeh Shabestari M, Takbiri A, Soltanifar A, Sabouri G, Rahmani S, et al. Patient Safety Culture Based on Medical Staff Attitudes in Khorasan Razavi Hospitals, Northeastern Iran. Iranian journal of public health. 2013;42(11):1292-8.
27. Sorra JS, Dyer N. Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture. BMC Health Serv Res. 2010;10:199.
28. Amiri M, Chaman R, Bagheri H, Sadeghian F, Khosravi A. [Cost analysis and per capita performance of the staff working in hygiene sectors of shahroud university of medical sciences]. Int Med Today. 2012;18(1):75-81.
29. Chen IC, Li HH. Measuring patient safety culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMC Health Serv Res. 2010;10:152.
30. Zebrak K, Yount N, Sorra J, Famolaro T, Gray L, Carpenter D, et al. Development, Pilot Study, and Psychometric Analysis of the AHRQ Surveys on Patient Safety Culture (SOPS((R))) Workplace
Safety Supplemental Items for Hospitals. Int J Environ Res Public Health. 2022;19(11).
31. Zwijnenberg NC, Hendriks M, Hoogervorst-Schilp J, Wagner C. Healthcare professionals’ views on feedback of a patient safety culture assessment. BMC Health Serv Res. 2016;16:199.
32. Nie Y, Mao X, Cui H, He S, Li J, Zhang M. Hospital survey on patient safety culture in China. BMC Health Serv Res. 2013;13:228.
33. El-Jardali F, Sheikh F, Garcia NA, Jamal D, Abdo A. Patient safety culture in a large teaching hospital in Riyadh: baseline assessment, comparative analysis and opportunities for improvement. BMC Health Serv Res. 2014;14:122.
34. Kiaei MZ, Ziaee A, Mohebbifar R, Khoshtarkib H, Ghanati E, Ahmadzadeh A, et al. Patient safety culture in teaching hospitals in Iran: assessment by the hospital survey on patient safety culture (HSOPSC). Health Management Inf Sci. 2016;3(2):51-6.
35. Alquwez N, Cruz JP, Almoghairi AM, Al-Otaibi RS, Almutairi KO, Alicante JG, et al. Nurses’ Perceptions of Patient Safety Culture in Three Hospitals in Saudi Arabia. J Nurs Scholarsh. 2018;50(4):422-31.
36. Wagner C, Smits M, Sorra J, Huang CC. Assessing patient safety culture in hospitals across countries. Int J Qual Health Care. 2013;25(3):213-21.
37. Akologo A, Abuosi AA, Anaba EA. A cross-sectional survey on patient safety culture among healthcare providers in the Upper East region of Ghana. PLoS One. 2019;14(8):e0221208.
38. Gil-Aucejo A, Martínez-Martín S, Flores-Sánchez P, MoyanoHernández C, Sánchez-Morales P, Andrés-Martínez M, et al. Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19. Enfermería Intensiva. 2022;33(4):185-96.
39. Reis CT, Laguardia J, Bruno de Araujo Andreoli P, Nogueira Junior C, Martins M. Cross-cultural adaptation and validation of the Hospital Survey on Patient Safety Culture 2.0 - Brazilian version. BMC Health Serv Res. 2023;23(1):32.
40. Rangachari P, J LW. Preserving Organizational Resilience, Patient Safety, and Staff Retention during COVID-19 Requires a Holistic Consideration of the Psychological Safety of Healthcare Workers. Int J Environ Res Public Health. 2020;17(12).
41. Oliveira RM, Leitao IM, Aguiar LL, Oliveira AC, Gazos DM, Silva LM, et al. Evaluating the intervening factors in patient safety: focusing on hospital nursing staff. Rev Esc Enferm USP. 2015;49(1):104-13.
42. Manthorpe J, Iliffe S, Gillen P, Moriarty J, Mallett J, Schroder H, etal. Clapping for carers in the Covid-19 crisis: Carers’ reflections in a UK survey. Health Soc Care Community. 2022;30(4):1442-9.
43. Motazedi Z, Beilankohi M, Taherinia J, Asghari E, Arshadi Bostanabad M, Alikhah H. [Assessment of patient safety culture from viewpoint of nurses working in Tabriz Sina educational and treatment center]. Med J Tabriz Univ Med Sci Health Serv. 2019;41(1):92-9.
44. Dehghani M, Hayavie Haghighi MH, Salimi J, Khorami F. [Culture of Patient Safety from Nurses’ Perspective]. Iran J Nurs. 2015;28(93):42-54.
| Files | ||
| Issue | Vol 8 No 3 (2024): Special Issue on Accreditation | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/htaa.v8i3.16402 | |
| Keywords | ||
| Patient Safety HSOPSC Accreditation Iran | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mohammadpour SM, Rezazadeh A, Hemati M, Ebrahimi Z, Sharifi T. Patient Safety Culture in a Tertiary Referral Hospital: Evidence from a Main Criterion in Accreditation. Health Tech Ass Act. 2024;8(3).
