Measuring the Current Patient Safety Culture in Public General Hospitals of Southern Nations Nationalities and Peoples Region (SNNPR), Ethiopia: Perspective of Health Care Workers

  

    
Variables
    
Category
    
Unstandardized
      
Coefficients
    
p
    
95%
      
Confidence
      
Interval for β
  
  

    
β
    
Std.
      
Error
  
  

    
Lower
      
Bound
    
Upper
      
Bound
  
  

    
(Constant)
    

    
0.84
    
0.143
    
0
    
0.558
    
1.122
  
  

    
Hospitals
    
QEMH*
    

    

    

    

    

  
  

    
Yirgalem
    
0.47
    
0.043
    
0.028
    
0.27
    
0.917
  
  

    
Butajira
    
0.63
    
0.03
    
0.034
    
0.451
    
1.12
  
  

    
Sex
    
Male*
    

    

    

    

    

  
  

    
Female
    
0.14
    
0.0361
    
0.031**
    
0.012
    
0.37
  
  

    
Duration of experience
      
in work hospital
    
1-5 year*
    

    

    

    

    

  
  

    
6-10 year
    
0.302
    
0.017
    
0.02**
    
0.114
    
0.523
  
  

    
Staff position
    
Nurse*
    

    

    

    

    

  
  

    
Pharmacy
    
0.564
    
0.013
    
0.01**
    
0.34
    
0.902
  
  

    
Primary� work� area�    or
      
unit
    
Many different units
    
-0.312
    
0.065
    
0.031***
    
-0.583
    
-0.204
  
  

    
Emergency
    
-0.384
    
0.025
    
0.001***
    
-0.407
    
-0.108
  
  

    
Surgical*
    

    

    

    

    

  
  

    
Components/composite
    
Overall� perceptions
      
of
      
safety
    
0.92
    
0.018
    
0.01
    
0.995
    
1.32
  
  

    
Organizational learning
      
And continuous
      
improvement
    
0.75
    
0.066
    
0.002
    
0.61
    
0.934
  
  

    
Non-punitive�    response
      
to error
    
0.11
    
0.01
    
0.012
    
0.024
    
0.413
  
  

    
Management
      
expectation and support
      
to patient safety
    
-0.502
    
0.05
    
0.038
    
-0.814
    
-0.378
  
  

    
Communication
      
openness and feedback
      
about error
    
0.607
    
0.024
    
0.012
    
0.71
    
0.911
  
  

    
Teamwork across and
      
within hospital unit
    
0.12
    
0.06
    
0.027
    
0.03
    
0.304
  

Table 6: Multiple regression results showing the relationship between all variables and frequency of events reported score at SNNPR Public general hospitals,
February 16 to March 16, 2015.

Discussion

The incidence of medical errors during healthcare procedures is 7.5%, and majorities of the adverse events has identified as preventable [3]. For instance, a Harvard Medical Study of an acute care hospital in 1984 found an adverse event rate of 3.8%. Similarly, in 1992, a study on quality in Australian acute care hospitals found the rate to be 16.6%. Furthermore, studies conducted in acute care hospitals in UK (1999-2000), Denmark (1998), New Zealand (1998) and Canada (2001 ) found the adverse event rates to be 11.7%, 9.0%, 12.9%, and 7.5% respectively [4]. Our study indicated that health workers in the respective hospitals rated their hospital as acceptable/ medium grade (58.4%) and event reported rate no event reported (34.4%) and 1 to 2 event reported (62.8%) in 12 months. There is similarity with above findings, as our study result the patient safety culture is in risk, because this trend may leads to high adverse events and medical errors.

In this study with regard to the grading of hospitals patient safety culture, very few of the respondents, either grades their hospitals excellent or very good, 2.1% and 16.9% respectively. It is much fewer when compared with benchmark data of AHRQ 2012, 30% and 45% respectively [10]. On the other hand, with respect to the number of events reported over the past 12 months, more than half of the respondents indicated 1 to 2 events reported. Indicated in the similar study; Health care workers are less likely to grade excellent/very good and report events, especially physicians and nurses more likely grade poor/failing and no events reported [11,12]. This had attributed to many reasons including blame, shame and lack of proper reporting system in place. Encouraging health professionals, specifically nurses, to report events in a non-punitive environment is crucial for improving patient safety. Frequency of events reported had found to increase with increasing how often staff reports all types of mistakes, such as latent errors, accidents, and near misses. Reporting errors improves the quality of care for future patients [11,13]. In our study, the analysis of results identified those patient safety culture predictors such as sex, duration of experience, staff position and primary work area in accordance with characteristics of respondents were associated with the patient safety culture as measured by frequency of events reported.

The overall perceptions to safety score for this study was 27.3%, lower than the AHRQ (2012) score of 63% (10). This result indicates that healthcare workers are not highly positive about patient safety culture in SNNPR public general hospitals. There is also the same study in Taiwan had 53% score, it is higher than our finding and indicates there is room for improvement in our hospitals [14].

In the SNNPR, we found that the majority of dimensional-level scores were lower than the AHRQ (2012) benchmark report. The dimensions „Teamwork across and within hospital unit received the highest positive response rate. Similar results had found in studies conducted in Taiwan [15]. Teamwork is an essential part of the development of patient safety culture, and staff should be encouraged and supported in their efforts to establish good relationships with people working in the same unit and other units [3]. We believe that teamwork in the SNNPR public general hospitals is a strength that has used to create an enabling environment to develop a patient safety culture.

In our study variables included in the final model explain 69% of the variance in the frequency of events reported score (R square = 0.69). The finding implies that system/PSC dimension factors are the most important factors in patient safety culture and causes of medical errors in the hospital and poor frequency of events reported. Overall perceptions of safety, Non-punitive response to error, Organizational learning and continuous improvement, Management expectation and support to patient safety, Communication openness and feedback about error and Teamwork across and within hospital unit explained frequency of events reported.

Likewise, as experiential evidences have revealed the root causes of medical errors are primarily the system factors include poor communication, unclear lines of authority between care providers, disconnected reporting systems within hospitals, and inadequate reporting frequency systems of events to share information about errors [16].

In our finding system/PSC dimension related factors such as management expectation and support to patient safety, overall perceptions to safety, non-punitive response to error, organizational learning and continuous improvement, communication openness and feedback about error and teamwork across and within units were associated with the patient safety culture as measured by frequency of events reported. In the same study communication openness and feedback about errors, teamwork across hospital units and non-punitive response to error was significantly associated with frequency of event reporting at (p<0.05) [17]. Teamwork within and across hospital units is critical in a healthcare environment as the patient is usually treated by several healthcare practitioners and specialists in multiple settings [11]. In the other study our finding was strengthen that teamwork across and within hospital unit were directly influencing patient safety outcome (p<0.05) [9].

Proper communication within and across healthcare teams is essential to remove any threats to safety of patients and essential to increase frequency of events reported. Communication problems have identified as major contributing factors to adverse events [18]. An analysis of 2,455 sentinel events reported to the Joint Commission on the Accreditation of Healthcare Organizations showed that 70% of the cases were a result of failure in communication [18]. We found that communication openness was directly associated with frequency of events reported.

In order for a patient safety program to be, successful, strong leadership needed. When leadership and management is committed to a culture of safety, the whole organization will follow and thus disclosing an events and finding their root causes will become an organizational process [19].

This finding also answered the final objectives of this study “To identify the factors related to patient safety culture in SNNPR public general hospitals.” Using regression analysis most of the dimensions was significant (P<0.001), which means each dimensions has an influence on the patient safety culture [15]. However, using multiple regression analysis, found all dimensions to be associated with patient safety culture as measured by frequency of events reported except hospital handoffs and transition. The slight variation in our results compared other finding could be due to the differences in the study settings and time.

Limitations of the Study

This study was limited to only public general hospitals in SNNPR; therefore, the result cannot apply to other categories of health care organizations.

In addition, the sample included only health workers. That perception of other administrative body was not included.

Conclusions and Recommendations

The majority of the respondents considers to the present patient safety culture in our hospitals just acceptable/medium and more than half of the respondents indicated that 1 to 2 events reported in the past 12 months. The realization of an acceptable environment of patient safety depends on the changing the perceptions of the healthcare workers towards positive patient safety culture. As indicated in the result section PSC is poor and need special attentions.

The strong relationships between independent and dependent variable (patient safety culture) as measured by frequency of events reported in this study also revealed in the result of multiple linear regression analysis. These result indicated that most of the independent variables have influence on the patient safety culture in the SNNPR public general hospitals.

However, our result shown that all factors (patient safety dimensions) except hospital handoffs and transition pertaining to patient safety culture had found to significant relationship with patient safety culture as measure by frequency of events reported in respective studied hospitals. There as a result great effort has needed to improve frequency of event reporting.

Recommendations

There is a need for concrete interventions to implement the concept of patient safety culture. The strengthening and further integration of the patient safety concept especially event reporting into the continuous professional training curriculum for health care professionals is highly recommended. In order to achieve that, patient safety should have prioritized on the agenda of the SNNPR health bureau and all stakeholders to improve patient safety in the region.

They should establish and strong follow up patient safety committee to assess every aspect of activities related to patient safety culture in the SNNPR general hospitals.

On the contrary, health care workers should be encouraged to report errors for the purpose of learning and improvement. This would require formulation of policies that promote the establishment of non-punitive environments. There is need for broadly based research in to patient safety culture, which should include all categories of health care organizations in the region. That our study was only focused general hospitals.

Our study finding suggested that an effective event reporting frequency should initiated, supported, and maintained in the SNNPR general hospitals. Generally, patient safety can best achieved by paying close attention to patient safety culture. Health care organizations should implement patient safety culture and give strong support for safety activities to improve patient safety.

Therefore, in an effort to implement patient safety culture all these patient safety system related factors should be considered, without disregarding any single dimension especially those with strong associations/significant differences with frequency of events reported.

Finally, SNNPR public general hospitals should focus on each of these dimensions in order to improve frequency of events reported that improve patient safety culture.

Acknowledgments

The authors would like to thank the respondents participated in the study. They are also grateful to Jimma University for funding the study.

Author Contributions

TE conceived, designed the study, participated in the data collection, analyzed the data, interpretation of data, and drafted the manuscript. BB and AA participated in designing the study, data analysis, interpretation of data, revised, and edited the manuscript. All authors read and approved the final version of the manuscript.

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