Patient Safety Culture in a Turkish Public Hospital: A Study of Nurses’ Perceptions About Patient Safety

Abstract

The objective of this study was to investigate nurses’ perceptions about the culture of patient safety in a Turkish public hospital. The study adopted a cross-sectional research design and utilized the hospital survey of patient safety culture. The population studied consisted of approximately 300 nurses from which 200 nurses were surveyed. The response rate was 66.6 % of the population. Nurses responded most positively to two dimensions, hospital management support for patient safety (80 %) and supervisor/manager expectations and actions promoting patient safety (79 %). Four dimensions with a positive response rate of <50 % (‘Frequency of events reported’, ‘Nonpunitive response to error’, ‘Communication openness’ and ‘Hospital handoffs and transitions’) were considered as potential targets for improvement in our study. This study revealed six significant predictors of Overall Perceptions of Safety: Organizational Learning-Continuous Improvement; Communication Openness; Teamwork within Units; Staffing; Frequency of Event Reporting; and the Patient Safety Grade (of the Hospital Unit). Additionally, four significant predictors of the Patient Safety Grade (of the Hospital Unit) emerged: Feedback and Communication about Error; Organizational Learning-Continuous Improvement; Hospital Management Support for Patient Safety; and Supervisor/Manager Expectations and Actions Promoting Safety. Interventions designed to improve the safety culture in Turkish hospitals should be focused on the concerns of staff nurses and the improvement of communication between these nurses and their managers. The determination and evaluation of the patient safety culture level in hospitals should be viewed as a continuous process in Turkey where a need for continuous improvements in the hospital patient safety culture exists. To improve the patient safety level, nurses’ perceptions about patient safety appear to be essential. Nurses are important for the improvement of the patient safety culture in health care organizations. Moreover, some hospitals have recognized that providing patients with safe, high-quality care is fundamental to protecting the financial assets of the institution and therefore, falls within risk management’s role. In this new landscape, risk management and patient safety professionals are engaged in a close working relationship.

Appendix 1

Hospital Survey on Patient Safety

An “ event ” is defined as any type of error, mistake, incident, accident, or deviation, regardless of whether or not it results in patient harm.

“ Patient safety ” is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of health care delivery.

Section A: Your Work Area/Unit

In this survey, think of your “unit” as the work area, department, or clinical area of the hospital where you spend most of your work time or provide most of your clinical services.

Please indicate your agreement or disagreement with the following statements about your work area/unit.

1—Strongly Disagree, 2—Disagree, 3—Neither, 4—Agree, 5—Strongly Agree

Think about your hospital work area/unit…

• 1. People support one another in this unit.

• 2. We have enough staff to handle the workload.

• 3. When a lot of work needs to be done quickly, we work together as a team to get the work done.

• 4. In this unit, people treat each other with respect.

• 5. Staff in this unit work longer hours than is best for patient care.

• 6. We are actively doing things to improve patient safety.

• 7. We use more agency/temporary staff than is best for patient care.

• 8. Staff feel like their mistakes are held against them.

• 9. Mistakes have led to positive changes here.

• 10. It is just by chance that more serious mistakes don’t happen around here.

• 11. When one area in this unit gets really busy, others help out.

• 12. When an event is reported, it feels like the person is being written up, not the problem.

• 13. After we make changes to improve patient safety, we evaluate their effectiveness.

• 14. We work in “crisis mode” trying to do too much, too quickly.

• 15. Patient safety is never sacrificed to get more work done.

• 16. Staff worry that mistakes they make are kept in their personnel file.

• 17. We have patient safety problems in this unit.

• 18. Our procedures and systems are good at preventing errors from happening.

Section B: Your Supervisor/Manager

Please indicate your agreement or disagreement with the following statements about your immediate supervisor/manager or person to whom you directly report.

1—Strongly Disagree, 2—Disagree, 3—Neither, 4—Agree, 5—Strongly Agree

• 1. My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures.

• 2. My supervisor/manager seriously considers staff suggestions for improving patient safety.

• 3. Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts.

• 4. My supervisor/manager overlooks patient safety problems that happen over and over.

Section C: Communications

How often do the following things happen in your work area/unit?

1—Never, 2—Rarely, 3—Sometimes, 4—Most of the time, 5—Always

Think about your hospital work area/unit…

• 1. We are given feedback about changes put into place based on event reports.

• 2. Staff will freely speak up if they see something that may negatively affect patient care.

• 3. We are informed about errors that happen in this unit.

• 4. Staff feel free to question the decisions or actions of those with more authority.

• 5. In this unit, we discuss ways to prevent errors from happening again.

• 6. Staff are afraid to ask questions when something does not seem right.

Section D: Frequency of Events Reported

In your hospital work area/unit, when the following mistakes happen, how often are they reported?

1—Never, 2—Rarely, 3—Sometimes, 4—Most of the time, 5—Always

• 1. When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported?

• 2. When a mistake is made, but has no potential to harm the patient, how often is this reported?

• 3. When a mistake is made that could harm the patient, but does not, how often is this reported?

Section E: Patient Safety Grade

Please give your work area/unit in this hospital an overall grade on patient safety.

Section F: Your Hospital

Please indicate your agreement or disagreement with the following statements about your hospital.

1—Strongly Disagree, 2—Disagree, 3—Neither, 4—Agree, 5—Strongly Agree

Think about your hospital…

• 1. Hospital management provides a work climate that promotes patient safety.

• 2. Hospital units do not coordinate well with each other.

• 3. Things “fall between the cracks” when transferring patients from one unit to another.

• 4. There is good cooperation among hospital units that need to work together.

• 5. Important patient care information is often lost during shift changes.

• 6. It is often unpleasant to work with staff from other hospital units.

• 7. Problems often occur in the exchange of information across hospital units.

• 8. The actions of hospital management show that patient safety is a top priority.

• 9. Hospital management seems interested in patient safety only after an adverse event happens.

• 10. Hospital units work well together to provide the best care for patients.

• 11. Shift changes are problematic for patients in this hospital.

Section G: Number of Events Reported

In the past 12 months , how many event reports have you filled out and submitted?

Section H: Background Information

Source: http://www.ahrq.gov/legacy/qual/patientsafetyculture/hospscanform.pdf