Measuring safety culture: Application of the Hospital Survey on Patient Safety Culture to radiation therapy departments worldwide

doi:10.1016/j.prro.2017.08.005

Practical Radiation Oncology

Volume 8, Issue 1, January–February 2018, Pages e17-e26

https://doi.org/10.1016/j.prro.2017.08.005 Get rights and content

Abstract

Background

Minimizing errors and improving patient safety has gained prominence worldwide in high-risk disciplines such as radiation therapy. Patient safety culture has been identified as an important factor in reducing the incidence of adverse events and improving patient safety in the health care setting.

Purpose

The aim of distributing the Hospital Survey on Patient Safety Culture (HSPSC) to radiation therapy departments worldwide was to assess the current status of safety culture, identify areas for improvement and areas that excel, examine factors that influence safety culture, and raise staff awareness.

Methods and materials

The safety culture in radiation therapy departments worldwide was evaluated by distributing the HSPSC. A total of 266 participants were recruited from radiation therapy departments and included radiation oncologists, radiation therapists, physicists, and dosimetrists.

Results

The positive percent scores for the 12 dimensions of the HSPSC varied from 50% to 79%. The highest composite score among the 12 dimensions was teamwork within units; the lowest composite score was handoffs and transitions.

Conclusions

The results indicated that health care professionals in radiation therapy departments felt positively toward patient safety. The HSPSC was successfully applied to radiation therapy departments and provided valuable insight into areas of potential improvement such as teamwork across units, staffing, and handoffs and transitions. Managers and policy makers in radiation therapy may use this assessment tool for focused improvement efforts toward patient safety culture.

Section snippets

Background

Approximately one-half of all cancer patients require radiation therapy (RT) at some point in their illness.[1], [2] RT is a highly complex treatment modality requiring the input of many individuals in its planning and delivery. Its delivery is facilitated by collaboration and clear communication among radiation oncologists, radiation therapists, physicists, and dosimetrists. It is a highly regulated medical practice with historically low incident and error rates. The true rate of injury in

Research design and materials

This study was undertaken in the form of a cross-sectional survey using the HSPSC developed by the AHRQ.¹⁷ There was no identifiable material in the survey that could result in participant identification, thus ensuring complete confidentiality. The participants were informed that completing the survey indicated consent to participate in the study.

In participating departments, a person working in an administrative role acted as a gatekeeper and distributed the study information to staff working

Characteristics of respondents

A total of 266 HCPs responded to the survey from various RT departments worldwide. Each returned survey was examined, and 44 were excluded from the study following AHRQ guidelines.³⁰ Excluded responses were either blank or contained responses for the demographic section only. A total of 222 evaluable responses from radiation oncologists, radiation therapists, physicists, and dosimetrists were thus included in the study (n = 222). These responses represented 40 countries worldwide. As shown in

Discussion

This study explored the 12 dimensions measured by the HSPSC in RT departments worldwide. The study provided a detailed insight into the patient safety culture attitudes and behaviors of radiation oncologists, radiation therapists, physicists, and dosimetrists. The HSPSC has been used in 44 studies in 20 countries in Europe and in America.[18], [31], [32], [33], [34], [35] Despite its extensive use in the health care setting, the literature indicates that this is the first study to use the HSPSC

Conclusion

Safety culture is a critical component of patient safety. Although errors in the delivery of RT are uncommon, it remains vital that HCPs in RT departments work with awareness and continually strive to improve patient safety. This study suggests that the presence of management and policy makers committed to patient safety who encourage increased reporting of near misses, who aim to improve staffing and communication, and who aim to eliminate a punitive culture would serve to enhance the safety

References (52)

EC Ford et al.
How safe is safe? Risk in radiotherapy
Int J Radiat Oncol Biol Phys
(2010)
FW Guldenmund
The nature of safety culture: A review of theory and research
Saf Sci
(2000)
Y Pfeiffer et al.
Development of the German version of the Hospital Survey on Patient Safety Culture: Dimensionality and psychometric properties
Saf Sci
(2010)
GK Gill et al.
Perceptions of safety management and safety culture in the aviation industry in New Zealand
J Air Transp Manag
(2004)
R Botney
Improving patient safety in anesthesia: A success story?
Int J Radiat Oncol Biol Phys
(2008)
E Olsen
Exploring the possibility of a common structural model measuring associations between safety climate factors and safety behaviour in health care and the petroleum sectors
Accid Anal Prevent
(2010)
ÜY Güneş et al.
A survey of the patient safety culture of hospital nurses in Turkey
Collegian
(2016)
E Dayton et al.
Communication failure: Basic components, contributing factors, and the call for structure
Jt Comm J Qual Patient Saf
(2007)
KM Haig et al.
SBAR: A shared mental model for improving communication between clinicians
Jt Comm J Qual Patient Saf
(2006)
PA Gluck
Medical error theory
Obstet Gynecol Clin N Am
(2008)

Y Lievens et al.

Health economics in radiation oncology: Introducing the ESTRO HERO project

Radiother Oncol

(2012)

G Delaney et al.

The role of radiotherapy in cancer treatment

Cancer

(2005)

Department of Health National Radiotherapy Advisory Group

Radiotherapy: Developing a world class service for England

(2007)

International Atomic Energy Agency

Accidental overexposure of radiotherapy patients in Bialystok

(2004)

International Atomic Energy Agency

Investigation of an accidental exposure of radiotherapy patients in Panama

(2001)

G Wack et al.

Summary of ASN report no. 2006 ENSTR 019 - IGAS n° RM 2007-015P on the Epinal radiotherapy accident

W Bogdanich

Radiation offers new cures, and ways to do harm

(2010)

W Bogdanich

As technology surges, radiation safeguards lag

(2010)

W Bogdanich et al.

A pinpoint beam strays invisibly, harming instead of healing

(2010)

W Bogdanich et al.

Radiation errors reported in Missouri

(2010)

V Nieva et al.

Safety culture assessment: A tool for improving patient safety in healthcare organizations

Qual Saf Health Care

(2003)

J Reason

Managing the risks of organizational accidents

(2016)

J Krumberger

Building a culture of safety

RN

(2001)

RE Mardon et al.

Exploring relationships between hospital patient safety culture and adverse events

J Patient Saf

(2010)

R Francis

Report of the Mid Staffordshire NHS Foundation Trust public inquiry: executive summary

(2013)

J Sorra et al.

Hospital survey on patient safety culture

(2004)

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The survey response rate was ≥68% each year (range, 68%-80%). High-volume event reporting was sustained (4673 reports; average of 0.9 ILS entries per treatment course). ILS engagement increased, with 43% of respondents submitting reports during the 12 months pre-ILS compared with 64% with ILS in use (P < .001). Significant improvements (pre- vs. with-ILS) were observed in the cultural domains of patient safety perceptions (25% vs 39%; P < .03), and responsibility and self-efficacy (43% vs 60%; P < .01). The overall patient safety grade of very good or excellent significantly increased (69% vs 85%; P < .01). Significant reductions were seen in the following barriers to error reporting: embarrassment in front of colleagues, getting colleagues into trouble, and effect on department reputation.
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: Conflicts of interest: None.

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Basic Original ReportMeasuring safety culture: Application of the Hospital Survey on Patient Safety Culture to radiation therapy departments worldwide

Abstract

Background

Purpose

Methods and materials

Results

Conclusions

Section snippets

Background

Research design and materials

Characteristics of respondents

Discussion

Conclusion

Int J Radiat Oncol Biol Phys

Saf Sci

Saf Sci

J Air Transp Manag

Int J Radiat Oncol Biol Phys

Accid Anal Prevent

Collegian

Jt Comm J Qual Patient Saf

Jt Comm J Qual Patient Saf

Obstet Gynecol Clin N Am

Radiother Oncol

The role of radiotherapy in cancer treatment

Cancer

Radiotherapy: Developing a world class service for England

Accidental overexposure of radiotherapy patients in Bialystok

Investigation of an accidental exposure of radiotherapy patients in Panama

Summary of ASN report no. 2006 ENSTR 019 - IGAS n° RM 2007-015P on the Epinal radiotherapy accident

Radiation offers new cures, and ways to do harm

As technology surges, radiation safeguards lag

A pinpoint beam strays invisibly, harming instead of healing

Radiation errors reported in Missouri

Safety culture assessment: A tool for improving patient safety in healthcare organizations

Qual Saf Health Care

Managing the risks of organizational accidents

Building a culture of safety

RN

Exploring relationships between hospital patient safety culture and adverse events

J Patient Saf

Report of the Mid Staffordshire NHS Foundation Trust public inquiry: executive summary

Hospital survey on patient safety culture

Basic Original Report
Measuring safety culture: Application of the Hospital Survey on Patient Safety Culture to radiation therapy departments worldwide