Document Type : Original Article

Authors

1 Health Service Management, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran (Corresponding Author) Email: izadi@iaushk.ac.ir

2 Pediatrics, Chief Hospital Administrator, Fatemeh Zahra Hospital, Najafabad, Isfahan, Iran

3 Lecturer, PhD Student, Health Service Management, Chaloos Branch, Islamic Azad University, Chaloos, Iran

Abstract

Introduction: Health care organizations, especially hospitals, must focus on patient safety as their main
strategy. Cultural change is the most important challenge that they are faced with in creating a safe
system. The present article aims to improve the patient safety culture with an assessment of the safety in
Fatemeh Zahra Hospital, Najafabad, Iran.
Methods: This descriptive and cross-sectional research was conducted in 2010. Patient’s safety culture
was measured using the Persian adaptation of the Hospital Survey on Patient Safety Culture. This survey
was validated by the opinion of 15 experts. The reliability of the questionnaire was determined by
Cronbach’s alpha and was 0.846. The questionnaire was sent to all medical employees of Fatemeh Zahra
Hospital. Data were analyzed with t-test and one-way ANOVA by SPSS Software. A P-value of less than
0.05 was considered as statistically significant, and 95% confidence interval was calculated.
Results: Overall, 196 of the 350 individuals responded to the surveys. The overall response rate was 56%.
Supervisor expectations and actions gained 76% of all scores, teamwork within hospital units 75%,
organizational learning 73%, feedback and communication about error 70%, transitions 69%,
communication openness 68%, management support 65%, teamwork across units 62%, non-punitive
response to error 54%, and staffing gained 48%. 64% of all employees had no reports of error. The mean
patient safety score was 3.36 (out of 5). According to t-test results, there was no significance difference
between patient safety scores in direct and indirect contacts with patient (P = 0.373). Moreover, according
to the results of ANOVA, there was a significant difference between the scores of the maternity
department and midwifes, and other wards and employees (P < 0.000). There was no significant difference
between the patient safety culture scores of employees of different wards, work experience in the ward
(their current place of work), work experience in the hospital, and type of contact with patients (P < 0.05).
Conclusion: Although the total score of patient safety culture was acceptable, non-punitive response to
error, staffing, teamwork across units, and management support are in need of immediate intervention.
The hospital can improve the patient safety culture by planning and taking action in these areas.

Keywords

1. Porter ME, Teisberg E. Redefining Health Care: Creating Value-Based Competition on Results. Boston, MA:
Harvard Business Press; 2006. p. 3-8.
2. Joint Commission on Accreditation of Healthcare Organizations. Hospital Accreditation standard. Suwanee, GA:
The Commission; 2000.
3. Williams S, Osborn S. National Patient Safety Agency: an introduction". Clinical Governance: An International
Journal 2004; 9(2): 130-1.
4. Hadizadeh F, Khalighinejad N, Ataie M. An Introduction to Clinical Governance and Clinical Excellence.
Isfahan, Iran: Isfahan University of Medical Sceinces Press; 2008. p. 10-55. [In Persian].
5. Aspden P, Corrigan JM, Wolcott J, Erickson SM. Patient Safety: Achieving a New Standard for Care.
Washington, DC: National Academies Press; 2004. p. 14-45.
6. Kohn L, Corrigan JM, Donaldson M. To Err Is Human: Building a Safer Health System. Washington, DC:
National Academies Press; 2000.
7. Leape LL, Abookire S. WHO Draft Guidelines for Adverse Event Reporting and Learning Systems: from
Information to Action. Geneva, Switzerland: World Health Organization; 2005. p. 5-18.
8. Peters GA, Peters BJ. Medical Error and Patient Safety: Human Factors in Medicine. New York, NY: CRC Press
INC; 2008. p. 22-40.
9. Savage GT, Ford EW. Patient Safety in Health Care Management. New York, NY: Emerald Group Publishing 2008. p. 50-77.                                                                                                                                                                                                10.Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations.
Qual Saf Health Care 2003; 12 (Suppl 2): ii17-ii23.
11. Page A. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National
Academies Press; 2004. p. 15-33.
12. Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, et al. The Safety Attitudes Questionnaire:
psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 2006; 6: 44.
13. Fleming M. Patient Safety Culture Measurement and Improvement: A "How To" Guide. HEALTHCARE
QUARTERLY 2005; 8(SPECIAL ISSUE): 14-9.
14.Matsubara S, Hagihara A, Nobutomo K. Development of a patient safety climate scale in Japan. Int J Qual Health
Care 2008; 20(3): 211-20.
15.Dabagh A, Akbari EM, Fathi M. Medical Errors in the Health System. J Army Univ Med Sci I R Iran 2006; 4(3):
957-66. [In Persian].
16.Hellings J, Schrooten W, Klazinga NS, Vleugels A. Improving patient safety culture. International Journal of
Health Care Quality Assurance 2010; 23(5): 489-506.
17.Walston SL, Al-Omar BA, Al-Mutari FA. Factors affecting the climate of hospital patient safety: a study of
hospitals in Saudi Arabia. Int J Health Care Qual Assur 2010; 23(1): 35-50.
18.Kim J, An K, Kim MK, Yoon SH. Nurses' perception of error reporting and patient safety culture in Korea. West
J Nurs Res 2007; 29(7): 827-44.
19.Hasanzadeh A, Fakhim Alizadeh S. Quality in Healthcare. Tehran, Iran: Social Security Research Institute; 2007.
p. 2-26. [In Persian].
20.Bonner AF, Castle NG, Men A, Handler SM. Certified nursing assistants' perceptions of nursing home patient
safety culture: is there a relationship to clinical outcomes? J Am Med Dir Assoc 2009; 10(1): 11-20.
21.Hurwitz B, Sheikh A. Health Care Errors and Patient Safety. New Jersey, NJ: Wiley; 2009.
22. Linsley P, Mannion R. Risky behaviour and patient safety: a critical culturist perspective. J Health Organ Manag
2009; 23(5): 494-504.
23.Moody RF, Pesut DJ, Harrington CF. Creating Safety Culture on Nursing Units: Human Performance and
Organizational System Factors That Make a Difference. Journal of Patient Safety 2006; 2(4): 198-206.
24.Hughes CM, Lapane KL. Nurses' and nursing assistants' perceptions of patient safety culture in nursing homes.
Int J Qual Health Care 2006; 18(4): 281-6.
25.Clarke JR, Lerner JC, Marella W. The role for leaders of health care organizations in patient safety. Am J Med
Qual 2007; 22(5): 311-8.
26.Moghaddasi H, Sheikhtaheri A, Hashemi N. Reducing medication errors:Role of computerized physician order
entry system. J Health Adm 2007; 10(27): 57-67. [In Persian].
27. Sorokin R, Riggio JM, Hwang C. Attitudes about patient safety: a survey of physicians-in-training. Am J Med
Qual 2005; 20(2): 70-7.