KnE Life Sciences | The 2nd International Conference on Hospital Administration (The 2nd ICHA) | pages: 286–291

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1. Introduction

Patient safety is the indicator of healthcare service quality. Assessing the organization's existing safety culture is the first stage of developing a safety culture [1]. Patient safety culture assessments, required by international accreditation organizations, allow healthcare organizations to obtain a clear view of the patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture [2]. Jombang Islamic Hospital already established Patient Safety Team since 2011 but the patient safety culture is still low because only 3 incidents had been reported in 2015. This study aims to measure patient safety culture in hospital identify the factor that should be improved in hospital unit.

Table 1

Demographic characteristic of respondents.


n % n %
Work unit/department Time worked in their current unit
ER 13 11 Less than 1 year 27 27
Outpatient 8 8 1–5 41 41
Class 1 17 16 6–10 14 14
Class 2 9 9 11–15 11 11
Class 3 12 11 16–20 8 8
Obstetrics 9 9 21 years or more 0 0
Operating Room 12 11 Missing 4
Pharmacy 13 12
Laboratorium & Radiology 6 6 Typical hours worked per week
Nutrition 6 6 Less than 20 hours/week 0 0
20–39 18 18
Staff position 40–59 74 76
Physician assistant/Nurse practitioner 59 58 60–79 6 6
Pharmacist 2 2 80–11 0 0
Dietician 1 1 100 hours/week or more 0 0
Unit assistant 21 21 Missing 7
Other 18 18
Missing 4 Time worked in their current specialty
Less than 1 year 16 16
Time worked in the hospital 1–5 36 35
Less than 1 year 19 19 6–10 16 16
1–5 25 25 11–15 21 21
6–10 17 17 16–20 13 13
11–15 27 27 21 years or more 0 0
16–20 12 12 Missing 3
21 years or more 0 0
Missing 5
Table 2

Average positive response rate for the HSOPSC results for Jombang Islamic Hospital and AHRQ data.


Patient Safety Culture Composites Average % Positive Response ( n : 105) Average % Positive Response AHRQ ( n : 261.102)
1. Teamwork within units 94% 82%
2. Supervisor/manager expectations & actions promoting patient safety 71% 78%
3. Hospital management support for patient safety 92% 73%
4. Organizational learning-continuous improvement 81% 72%
5. Overall perception of safety 62% 66%
6. Feedback & communication about error 72% 68%
7. Communication openness 60% 64%
8. Frequency of event reporting 52% 67%
9. Teamwork across hospital units 80% 61%
10. Staffing 34% 54%
11. Hospital handoffs & transitions 68% 48%
12. Non-punitive response to error 50% 45%
Overall average positive response 68% 65%
Table 3

Average positive response rate for the HSOPSC results for units in Jombang Islamic Hospital.


Patient Safety Culture Composites ER ( n : 13) OUT PATI ENT ( n :8) CLASS 1 ( n :17) CLASS 2 ( n :9) CLASS 3 ( n :12) OBS GYN ( n :9) OK ( n :12) PHARM ACY ( n :13) LAB & RAD ( n :6) NUTRI TION ( n :6)
Teamwork within units 98 100 91 83 100 100 100 92 88 79
Supervisor or manager expectations & actions promoting patient safety 79 56 72 89 77 97 77 19 83 79
Hospital management support for patient safety 95 75 82 56 94 96 94 70 47 69
Organizational learning-continuous improvement 100 96 85 70 97 100 97 92 94 89
Overall perception of safety 57 53 48 47 61 94 71 68 75 58
Feedback & communication about error 66 63 81 78 86 70 89 50 67 56
Communication openness 62 46 57 44 81 74 81 28 61 61
Frequency of event reporting 21 29 56 48 50 33 83 77 67 50
Teamwork across hospital units 100 56 91 47 94 100 92 56 65 68
Staffing 37 34 32 44 25 42 48 20 17 46
Hospital handoffs & transitions 65 63 69 47 80 97 92 54 40 53
Non-punitive response to error 49 63 38 37 64 89 69 15 28 56
Average across composites 69 61 62 58 76 83 83 54 61 64

2. Materials and Methods

This was descriptive analytic study. Primary data was collected in 2016 used Indonesian-translated version of Hospital Survey on Patient Safety Culture (HSOPSC) paper-based questionnaire adopted from The Agency for Healthcare Research and Quality (AHRQ). The HSOPSC questionnaire measures 12 patient safety dimension. The respondents were 117 Jombang Islamic Hospital staffs who work in hospital unit that give direct medical service.

3. Results

Questionnaire final response rate was 91%. The overall average positive response in Jombang Islamic Hospital was 68%, slightly higher than the average positive response for the AHRQ database report in 2016 (65%). From Table 1, it can be seen that most of the respondents was work in Class 1 Inpatient Unit (16%), assigned as physician assistant (58%), had been working in the hospital for 11–15 years (27%) and work in their current unit for 1–5 years (41%). In addition, 76% respondents worked 40–59 hours/week and 35% of them already work in their current specialty for 1–5 years.

Table 2 shows the dimension that received the highest percentage of positive response was `Teamwork within units' that reached 94% and the lowest was `Staffing' with only 34%. The composites which got higher positive response than AHRQ database report was `Teamwork within units', `Hospital management support for patient', `Organizational learning-continuous improvement', `Feedback & communication about error', `Teamwork across hospital units', `Hospital handoffs & transitions', and `Non-punitive response to error'. In contrary, `Supervisor/manager expectations & actions', `Overall perception of safety', `Communication openness', `Frequency of event reporting', and `Staffing' need to be improved. In Table 3, it is clear that Pharmacy had the lowest positive response (54%) while Obstetric and Operation Room had the highest positive response (83%).

4. Discussion

This is the first study to report on the status of patient safety culture in Jombang Islamic Hospital. Since the publication of the Institute of Medicine (IOM) report `To err is human', [3] patient safety culture has become a core element in improving patient safety. The HSOPSC survey results in this study suggest that Jombang Islamic Hospital should have imperatives to calculate how many staffs that needed and recruit if the hospital is lacked because most of the respondents stated that there were not enough staff to do the job.

Hospital also needs to develop a non-punitive culture and an atmosphere which helps staffs to report any incident without being punished. This appear to be the same with previous study in Lebanon where non-punitive response to error composite received one of the lowest scores which reveal that Lebanese hospital employees are also not at ease when it comes to reporting errors [4]. Build an open communication environment particularly between staffs and top–middle hospital manager to alleviate the communication gap is important. Thus, employees should be encouraged to report any adverse events, errors, incidents or near misses so that lessons can be learnt [5]. In addition, Jombang Islamic Hospital also have to focus on patient transfer or transition through the different units or different shifts because there is high possibility of miscommunication that will endanger patient safety through the process.

Jombang Islamic Hospital has a strong teamwork within units and determination to learn and improve their patient safety culture. Previous study in Ethiopia also found that the dimension with the highest average percentage positive responses was teamwork within department [6]. This could be the organizational strength to improve their perception on safety and increase the frequency of event reporting. Specific consideration should be made to manage Pharmacy because the staffs need more support from hospital management in implementing patient safety culture as communication openness, non-punitive response to error and supervisor expectations and actions promoting patient safety got the lowest positive response among other units.

5. Conclusions

This study conclude that the staffs feel positively toward patient safety culture. It is important to give an intervention to hospital unit and dimension which received low percentage of positive response in order to achieve better healthcare service quality.

References

1 

Hellings, J., Schrooten, W., Klazinga, N., et al. (2007). Challenging patient safety culture: Survey results. International Journal of Health Care Quality Assurance, vol. 20, pp. 620–632.

2 

Smits, M., Wagner, C., Spreeuwenberg, P., et al. (2009). Measuring patient safety culture: An assessment of the clustering of responses at unit level and hospital level. Quality and Safety in Health Care, vol. 18, pp. 292–296.

3 

Kohn, L., Corrigan, J., and Donaldson, M. (2000). To Err is Human: Building a Safer Health System. Washington D.C.: National Academies Press.

4 

El-Jardali, F., Dimassi, H., Jamal, D., et al. (2011). Predictors and outcomes of patient safety culture in hospitals. BMC Health Services Research, vol. 11, no. 1, p. 45.

5 

Elmontsri, M., Almashrafi, A., Banarsee, R., et al. (2017). Status of patient safety culture in Arab countries: A systematic review. BMJ Open, vol. 7, no. 2.

6 

Wami, S., Demssie, A., Wassie, M., et al. (2016). Patient safety culture and associated factors: A quantitative and qualitative study of healthcare workers' view in Jimma zone Hospitals, Southwest Ethiopia. BMC Health Services Research, vol. 16, no. 1, p. 495.

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ISSN: 2413-0877