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

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.

Implementation of the Comprehensive Unit-Based Safety Program to Improve Infection Prevention and Control Practices in Four Neonatal Intensive Care Units in Pune, India

Objective: To implement the Comprehensive Unit-based Safety Program (CUSP) in four neonatal intensive care units (NICUs) in Pune, India, to improve infection prevention and control (IPC) practices.Design: In this quasi-experimental study, we implemented CUSP in four NICUs in Pune, India, to improve IPC practices in three focus areas: hand hygiene, aseptic technique for invasive procedures, and medication and intravenous fluid preparation and administration. Sites received training in CUSP methodology, formed multidisciplinary teams, and selected interventions for each focus area. Process measures included fidelity to CUSP, hand hygiene compliance, and central line insertion checklist completion. Outcome measures included the rate of healthcare-associated bloodstream infection (HA-BSI), all-cause mortality, patient safety culture, and workload.Results: A total of 144 healthcare workers and administrators completed CUSP training. All sites conducted at least 75% of monthly meetings. Hand hygiene compliance odds increased 6% per month [odds ratio (OR) 1.06 (95% CI 1.03–1.10)]. Providers completed insertion checklists for 68% of neonates with a central line; 83% of checklists were fully completed. All-cause mortality and HA-BSI rate did not change significantly after CUSP implementation. Patient safety culture domains with greatest improvement were management support for patient safety (+7.6%), teamwork within units (+5.3%), and organizational learning—continuous improvement (+4.7%). Overall workload increased from a mean score of 46.28 ± 16.97 at baseline to 65.07 ± 19.05 at follow-up (p < 0.0001).Conclusion: CUSP implementation increased hand hygiene compliance, successful implementation of a central line insertion checklist, and improvements in safety culture in four Indian NICUs. This multimodal strategy is a promising framework for low- and middle-income country healthcare facilities to reduce HAI risk in neonates.

Awareness and understanding among patients about patient safety in India: A cross-sectional questionnaire-based study

Background There is a dearth of studies from India evaluating the awareness of patient safety. This study was performed to gain insight into the Indian patients’ awareness about patient safety and evaluate their willingness in promoting the same. Methods In this cross-sectional study, online interactive sessions pertaining to patient safety and patient safety culture were arranged by clinical pharmacologists for 800 urban patients post-discharge from a tertiary care hospital in India. A validated questionnaire was used, and the responses were analysed using descriptive statistics. Results A total of 635 patients [mean age, 43.2 ± 10.3 years; 385 (60.6%) males] responded. A total of 93.4% of the patients were aware of the term “patient safety” and 35.3% faced situations where they felt that patient safety was compromised. Of these patients, 64.3% reported to higher authorities when faced with such situations, while the remaining either ignored the issue or had no idea about how to deal with the same. A total of 99.2% of the patients never participated in any patient safety program; nevertheless, 94.5% of them were willing to participate in the same. Accessibility to information about patient care was deemed essential by 58.3% of the patients. Conclusions Although the overall awareness about patient safety among urban Indian patients is high, there is a lack of awareness about ways of dealing with patient safety issues. Given the high level of interest in participating in patient safety programs, such programs should routinely include patients for optimizing the chances for safer provision of health care.

Avaliação do trabalho em equipe na Unidade de Terapia Intensiva Materna com relação a Cultura de Segurança do Paciente

O objetivo deste estudo foi avaliar o trabalho em equipe de uma unidade de terapia intensiva materna, na perspectiva da equipe multiprofissional de saúde com relação a cultura de segurança do paciente. Estudo transversal, realizado entre fevereiro e março de 2021, que utilizou para a coleta de dados o questionário Hospital Survey on Patient Safety Culture, que avalia 12 dimensões da Cultura de Segurança do Paciente sendo para fins deste estudo, avaliado os itens que compõem as dimensões “Trabalho em equipe dentro da unidade” e “Trabalho em equipe entre as unidades”, constituindo assim, 8 itens. Participaram do estudo 40 profissionais. Ao analisar os itens avaliados, observou-se que 3 foram considerados áreas de força para a CSP, 1 como área neutra e 4 classificados como frágeis. Pode-se afirmar que na perspectiva da equipe multiprofissional da UTIM, o trabalho em equipe dentro da unidade é forte para a CSP, pois eles se tratam com respeito, apoiando uns aos outros, além de trabalharem como equipe quando há muito trabalho a ser realizado. No que se refere ao trabalho em equipe entre as unidades, os profissionais acreditam que os setores das maternidades não estão bem coordenadas entre si e que não existe uma boa cooperação entre as unidades que precisam trabalhar em conjunto.

Association of Occupational Burnout and Nursing Errors With Patient Safety

During the daily nursing practice, dangerous situations might appear that, if not recognized and treated early, can lead to fatigue and professional burnout, causing detrimental consequences for the patient's safety and the adequacy of the healthcare quality of the provider. This article aims to synthesize existing research investigating the association between burnout in healthcare professionals with the safety of patient care in the last decade. The authors herein examined specific nurse surveys that involve burnout assessment and association with clinical errors throughout nurse provided care. Results from this search indicate that patient safety culture must be cultivated towards nursing errors and burnout reduction. The prompt recognition of burnout signs is the critical parameter for nursing errors prevention and patient safety, in the long term. Nursing error management is oriented towards investigation of the burnout symptoms and exists as an integral and essential issue for nursing administration to ensure excellent and qualitative patient care.

Organizational Supports as Moderation in Increasing the Effect of Professionalism on Patient Safety Culture

Patient safety is a fundamental concept in providing health services and it is critical that health care facilities consider it. Negligence in the application of patient safety will lead to patient safety incidents. The individual factors of medical staff have a significant influence on the implementation of patient safety. The attitude of medical staff can affect the culture of patient safety because being unprofessional will cause problems in providing quality care, encourage bad events and medical errors, and ultimately reduce patient satisfaction. Organizational support also has a role in the attitude and behavior of medical staff. There are already policies in the form of regulations from the Minister of Health, standard operating procedures, and training for medical staff. However, there are still many patient safety incidents that occurred. There is also medical staff who are not aware of the importance of reporting so that patient safety incidents are not recorded. The study was conducted in 12 Primary Health Care (PHC) in Kuningan Regency. The research method used is quantitative analysis with a cross-sectional design using a questionnaire. The research data was taken using proportional stratified random sampling to 200 medical staff in 12 PHC in Kuningan Regency. The questionnaire consists of 3 parts regarding professionalism, patient safety culture, and organizational support. The results showed that professionalism had a positive and significant impact on patient safety culture (p-value <0.001), and Organizational support is a quasi-moderating variable on the effect of professionalism on patient safety culture (p-value <0.001).

INTERNAL AND EXTERNAL FACTORS RELATED TO THE IMPLEMENTATION OF PATIENT SAFETY GOALS: A LITERATURE REVIEW

Background: Patient safety goals are important things that must be done by nurses to get a patient safety culture. Individual internal factors and external factors can influence nurses in carrying out patient safety goals. Objective: This literature review study aims to discuss further internal and external factors that correlated in implementing patient safety goals by nurses. Methods: The design used was literature review. The keywords are in two languages. The keywords for articles in Indonesian are “faktor yang mempengaruhi”, “sasaran keselamatan pasien”, “perawat”, “rumah sakit”. The keywords for English articles are "factor", "patient safety goals", "Nurse", “hospital”. There was conducted through three databases, including PubMed (13 articles), Google Scholar (482 articles in Bahasa), and Science Direct (110 articles). Articles limited from January 2015 to October 2021. Then the author re-sorted the articles according were free access and full text, in the form of original articles. Result: There are 8 articles that appropriate with the criteria. Six articles are quantitative studies with a cross sectional approach and 2 articles with the SEM method. The results of the review show that there are 2 factors. Internal factors that correlated are motivation, knowledge and length of work. External factors that correlate are supervision and organizational culture. Conclusion: Two factors correlated with patient safety goals implementation by Nurses. Further research that can be carried out as a follow-up study from this literature review is to determine interventions related to these two factors to achieve the maximum application of patient safety goals.