Patient safety culture at the unit level of a tertiary hospital in South Africa: a survey study
Accepted: 3 July 2022
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Background. Patient safety research is scarce in developing countries. Estimates of patient harm due to healthcare processes in resource-poor settings are thought to be greater than those in developed countries. Ideally, errors in healthcare should be seen as opportunities to improve the future quality of care.
Objective. This study aimed to investigate patient safety culture within high-risk units of a tertiary hospital in South Africa.
Methods. A quantitative, descriptive, cross-sectional methodology, using a survey questionnaire that measured 10 safety dimensions and one outcome measure among clinical and nursing staff, was employed.
Results. Two hundred participants completed the survey questionnaire. Areas of strength identified by the participants included organizational learning (91.09%), staff attitudes (88.83%), and perceptions of patient safety (76.65%). Dimensions that have potential for improvement included awareness and training (74.04%), litigation (73.53%), feedback and communication about errors (70.77%), non-punitive response to error reporting (51.01%), size and tertiary level of the hospital (53.76%), and infrastructure and resources (58.07%). The only dimension identified as weak was teamwork and staffing (43.72%). In terms of the patient safety grade, respondents graded their own units highly but graded the hospital as a whole as having a poor patient safety grade.
Conclusion. There are still significant gaps in the quality of care provided at this tertiary hospital. The current patient safety culture is perceived as punitive in nature with regard to reporting adverse events. It is advised that targeted patient safety improvements be made, followed by further investigation.
Institute of Medicine. To Err Is Human: Building a Safer Health System [Internet]. Washington DC: National Academies Press; 2000. 312 p. Available from: https://www.ncbi.nlm.nih.gov/books/NBK225182/
Wilson RM, Michel P, Olsen S, Gibberd RW, Vincent C, El-Assady R, et al. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital. BMJ. 2012 Mar 13;344:e832. DOI: https://doi.org/10.1136/bmj.e832
Jha AK, World Health Organization, World Alliance for Patient Safety, Research Priority Setting Working Group. Summary of the evidence on patient safety: implications for research. Geneva, Switzerland: World Health Organization; 2008.
Mayeng LM, Wolvaardt JE. Patient safety culture in a district hospital in South Africa: An issue of quality [Internet]. [cited 2021 Jun 18]. Available from: http://www.scielo.org.za/scielo.php?pid=S2223-62792015000100038&script=sci_arttext&tlng=es
Skosana PP, Schellack N, Godman B, Kurdi A, Bennie M, Kruger D, et al. A point prevalence survey of antimicrobial utilisation patterns and quality indices amongst hospitals in South Africa; findings and implications. Expert Rev Anti Infect Ther. 2021 Oct;19:1353–66. DOI: https://doi.org/10.1080/14787210.2021.1898946
Kyu HH, Maddison ER, Henry NJ, Ledesma JR, Wiens KE, Reiner R, et al. Global, regional, and national burden of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study. Lancet Infect Dis. 2018 Dec 1;18:1329–49.
Mashaba TP, Matlala M, Godman B, Meyer JC. Implementation and monitoring of decisions by pharmacy and therapeutics committees in South African public sector hospitals. Expert Rev Clin Pharmacol. 2019 Feb;12:159–68. DOI: https://doi.org/10.1080/17512433.2018.1545572
Liu C, Liu W, Wang Y, Zhang Z, Wang P. Patient safety culture in China: a case study in an outpatient setting in Beijing. BMJ Qual Saf. 2014 Jul;23:556–64. DOI: https://doi.org/10.1136/bmjqs-2013-002172
Colla JB, Bracken AC, Kinney LM, Weeks WB. Measuring patient safety climate: a review of surveys. Qual Saf Health Care. 2005 Oct;14:364–6. DOI: https://doi.org/10.1136/qshc.2005.014217
Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Health Care. 2003 Dec 1;12:17ii–23. DOI: https://doi.org/10.1136/qhc.12.suppl_2.ii17
El-Jardali F, Dimassi H, Jamal D, Jaafar M, Hemadeh N. Predictors and outcomes of patient safety culture in hospitals. BMC Health Serv Res. 2011 Dec;11:45. DOI: https://doi.org/10.1186/1472-6963-11-45
National Department of Health. National Department of Health. National Core Standards for Health Establishments in South Africa [Internet]. COHSASA. 2011 [cited 2021 Jun 24]. Available from: http://cohsasa.co.za/content-national-department-health-national-core-standards-health-establishments-south-africa-0/
Effective hospital monitoring system essential - Cohsasa. Cape Times [Internet]. [cited 2021 Jun 18]; Available from: https://www.iol.co.za/capetimes/arts-portal/lifestyle/effective-hospital-monitoring-system-essential-cohsasa-1849286
Abraham V, Meyer JC, Godman B, Helberg E. Perceptions of managerial staff on the patient safety culture at a tertiary hospital in South Africa. Int J Qual Stud Health Well-Being. 2022 Dec 31;17:2066252. DOI: https://doi.org/10.1080/17482631.2022.2066252
Matlala M, Gous AGS, Meyer JC, Godman B. Formulary Management Activities and Practice Implications Among Public Sector Hospital Pharmaceutical and Therapeutics Committees in a South African Province. Front Pharmacol [Internet]. 2020 [cited 2021 Jun 18];11. Available from: https://www.frontiersin.org/articles/10.3389/fphar.2020.01267/full DOI: https://doi.org/10.3389/fphar.2020.01267
Terblanche A, Meyer JC, Godman B, Summers RS. Impact of a pharmacist-driven pharmacovigilance system in a secondary hospital in the Gauteng Province of South Africa. Hosp Pract 1995. 2018 Oct;46:221–8. DOI: https://doi.org/10.1080/21548331.2018.1510708
Meyer JC, Schellack N, Stokes J, Lancaster R, Zeeman H, Defty D, et al. Frontiers | Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study | Pharmacology [Internet]. [cited 2021 Jun 18]. Available from: https://www.frontiersin.org/articles/10.3389/fphar.2017.00751/full
Agency for Healthcare Research and Quality. Hospital Survey on Patient Safety Culture [Internet]. [cited 2021 Nov 4]. Available from: http://www.ahrq.gov/sops/surveys/hospital/index.html
Altwaijry N, Ibrahim A, Binsuwaidan R, Alnajjar LI, Alsfouk BA, Almutairi R.
Distance Education During COVID-19 Pandemic: A College of Pharmacy Experience. Risk Manag Healthc Policy. 2021 May 21;14:2099–110. DOI: https://doi.org/10.2147/RMHP.S308998
Tomczyk S, Taylor A, Brown A, de Kraker MEA, El-Saed A, Alshamrani M, et al. Impact of the COVID-19 pandemic on the surveillance, prevention and control of antimicrobial resistance: a global survey. J Antimicrob Chemother. 2021 Oct 11;76:3045–58. DOI: https://doi.org/10.1093/jac/dkab300
Reis CT, Paiva SG, Sousa P. The patient safety culture: a systematic review by characteristics of Hospital Survey on Patient Safety Culture dimensions. Int J Qual Health Care. 2018 Nov 1;30:660–77. DOI: https://doi.org/10.1093/intqhc/mzy080
Okuyama JHH, Galvao TF, Silva MT. Healthcare Professional’s Perception of Patient Safety Measured by the Hospital Survey on Patient Safety Culture: A Systematic Review and Meta-Analysis. Sci World J. 2018 Jul 19;2018:e9156301. DOI: https://doi.org/10.1155/2018/9156301
Nie Y, Mao X, Cui H, He S, Li J, Zhang M. Hospital survey on patient safety culture in China. BMC Health Serv Res. 2013 Jun 24;13:228. DOI: https://doi.org/10.1186/1472-6963-13-228
Alahmadi HA. Assessment of patient safety culture in Saudi Arabian hospitals. Qual Saf Health Care. 2010 Oct;19(5):e17. DOI: https://doi.org/10.1136/qshc.2009.033258
Clinton HR, Obama B. Making patient safety the centerpiece of medical liability reform. N Engl J Med. 2006 May 25;354:2205–8. DOI: https://doi.org/10.1056/NEJMp068100
Nordin A, Theander K, Wilde-Larsson B, Nordström G. Health care staffs’ perception of patient safety culture in hospital settings and factors of importance for this. 28-40 [Internet]. 2013 [cited 2021 Jun 18]; Available from: https://brage.inn.no/inn-xmlui/handle/11250/191652 DOI: https://doi.org/10.4236/ojn.2013.38A005
Aveling EL, Kayonga Y, Nega A, Dixon-Woods M. Why is patient safety so hard in low-income countries? A qualitative study of healthcare workers’ views in two African hospitals. Glob Health [Internet]. 2015 Feb 25 [cited 2021 Jun 18];11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349795/ DOI: https://doi.org/10.1186/s12992-015-0096-x
Aiken LH, Sloane DM, Clarke S, Poghosyan L, Cho E, You L, et al. Importance of work environments on hospital outcomes in nine countries. Int J Qual Health Care J Int Soc Qual Health Care. 2011 Aug;23:357–64. DOI: https://doi.org/10.1093/intqhc/mzr022
Naicker S, Eastwood JB, Plange-Rhule J, Tutt RC. Shortage of healthcare workers in sub-Saharan Africa: a nephrological perspective. Clin Nephrol. 2010 Nov;74 Suppl 1:S129-133. DOI: https://doi.org/10.5414/CNP74S129
Deilkås E, Hofoss D. Patient safety culture lives in departments and wards: Multilevel partitioning of variance in patient safety culture. BMC Health Serv Res. 2010 Dec;10:85. DOI: https://doi.org/10.1186/1472-6963-10-85
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