Health professionals’ perception of patient safety culture in acute hospitals: an integrative review
Julie Willmott A B and Jon Mould AA School of Nursing, Midwifery & Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email: jon.mould@curtin.edu.au
B Corresponding author. Email: Julie.Willmott@student.curtin.edu.au
Australian Health Review 42(4) 387-394 https://doi.org/10.1071/AH16274
Submitted: 1 December 2016 Accepted: 2 April 2017 Published: 30 May 2017
Journal compilation © AHHA 2018 Open Access CC BY-NC-ND
Abstract
Objective Globally, the degree of patient harm occurring in healthcare was first publicised in the 1990s. Although many factors affect patient safety, in the US the Institute of Medicine identified hospital organisational culture as one factor contributing to a reduction in errors. This led to the development of many tools for measuring the safety culture of hospital staff. The aim of the present study was to review the literature on patient safety culture in acute hospitals to identify: (1) how patient safety is viewed by health professionals; (2) whether patient safety culture is perceived differently at the hospital versus ward level; and (3) whether clinicians and managers place the same importance on patient safety.
Methods Following a search of electronic databases using OneSearch and a manual search of grey literature, an integrative review method identified 11 articles as being suitable to meet the review’s aims. The search terms of patient safety culture, patient safety and safety climate were used. To ensure relevancy to current practice, the search was restricted to the period 2010–15.
Results Hospital patient safety culture is not a shared vision, because health professional groups have different views. In the present study, 67% of articles examined found doctors to have a poorer perception of the patient safety culture than nurses and allied health professionals. All health professional groups reported a more positive view of their ward safety culture than that of the hospital safety culture. Furthermore, managers of the health professionals reported more positively on patient safety culture than bedside clinicians.
Conclusion This review provides an international understanding of health professionals’ views of patient safety. From an Australian context, the review highlights the need for further investigation, because there is a lack of recent Australian literature in the acute hospital setting relating to patient safety culture.
What is known about the topic? Globally, many research papers have reported upon the correlation between a positive patient safety culture and a reduction in healthcare errors.
What does this paper add? The present integrative review highlights that regardless of the country of origin, there are differences in the way that a hospital patient safety culture is perceived among different health professional groups, particularly between managers and bedside clinicians.
What are the implications for practitioners? Individual health professional groups, and managers and clinicians, have different views on the patient safety culture; therefore, training needs to involve everyone to create a shared vision for patient safety.
References
[1] Agency for Healthcare Research and Quality. Surveys on patient safety culture. 2016. Available at: http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html [verified March 2016].[2] WorkCover Queensland. Safety climate and safety culture. 2017. Available at: https://www.worksafe.qld.gov.au/safety-leadership-at-work/tools-and-resources/safety-climate-and-safety-culture [verified February 2017].
[3] Patient Safety Surveillance Unit. Your safety in our hands in hospital. An integrated approach to patient safety surveillance in WA hospitals, health services and the community: 2015. Perth: Department of Health; 2015.
[4] Leape L, Brennan T, Laird N, Lawthers A, Localio A, Barnes B, Hebert L, Newhouse J, Weiler P, Hiatt H. The nature of adverse events in hospitalized patients. N Engl J Med 1991; 324 377–84.
| The nature of adverse events in hospitalized patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M7gtFKksA%3D%3D&md5=e0bfa77cc98e46078c0fc13d25369a52CAS |
[5] Wilson R, Runciman W, Gibberd R, Harrison B, Newby L, Hamilton J. The quality in Australian health care study. Med J Aust 1995; 163 458–71.
| 1:STN:280:DyaK28%2FosV2qsQ%3D%3D&md5=f1ece175b58d32e99fefc909ed2476e6CAS |
[6] Kohn L, Corrigan J, Donaldson M. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.
[7] Singer S, Meterko M, Baker L, Gaba D, Falwell A, Rosen A. Patient Safety Climate in Healthcare Organizations (PSCHO) Measurement Instrument Database for the Social Science. 2012. Available at: www.midss.ie [verified March 2017].
[8] Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, Roberts PR, Thomas EJ. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 2006; 6 44
[9] Ginsburg L, Gilin D, Tregunno D, Norton P, Flemons W, Fleming M. Advancing measurement of patient safety culture. Health Serv Res 2009; 44 205–24.
| Advancing measurement of patient safety culture.Crossref | GoogleScholarGoogle Scholar |
[10] Westrum R. A typology of organisational cultures. Qual Saf Health Care 2004; 13 ii22–7.
| A typology of organisational cultures.Crossref | GoogleScholarGoogle Scholar |
[11] Robbins S, Judge T, Millett B, Boyle M. Organisational behaviour . 7th edn. Frenchs Forest, NSW: Pearson; 2013.
[12] Soares C, Hoga L, Peduzzi M, Sangaleti C, Yonekura T, Silva D. Integrative review: concepts and methods used in nursing. Crit Rev 2014; 48 329–39.
[13] Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs 2005; 52 546–53.
| The integrative review: updated methodology.Crossref | GoogleScholarGoogle Scholar |
[14] Crawford C, Rondinelli J. The integrative review process. 2013. Available at: www.academyebp.org [verified March 2016].
[15] Campbell E, Singer S, Kitch B, Iezzoni L, Meyer G. Patient safety climate in hospitals: act locally on variation across units. Jt Comm J Qual Patient Saf 2010; 36 319–26.
| Patient safety climate in hospitals: act locally on variation across units.Crossref | GoogleScholarGoogle Scholar |
[16] El-Jardali F, Di Massi H, Jamal D, Jaafar M, Hemadeh N. Predictors and outcomes of patient safety culture in hospitals. BMC Health Serv Res 2011; 11 45
| Predictors and outcomes of patient safety culture in hospitals.Crossref | GoogleScholarGoogle Scholar |
[17] Zhou P, Bundorf K, Gu J, He X, Xue D. Survey on patient safety climate in public hospitals in China. BMC Health Serv Res 2015; 15 53
| Survey on patient safety climate in public hospitals in China.Crossref | GoogleScholarGoogle Scholar |
[18] Blegen M, Sehgal N, Alldredge B, Gearhart S, Auerbach A, Wachter R. Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPS project. Qual Saf Health Care 2010; 19 346–50.
| Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPS project.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cjjt1Cntw%3D%3D&md5=b0ffcbdc852244c523c810f95357790bCAS |
[19] Kristensen S, Hammer A, Bartels P, Sunol R, Groene O, Thompson C, Arah O, Kutaj-Wasikowska H, Michel P, Wagner C. Quality management and perceptions of teamwork and safety climate in European hospitals. Int J Qual Health Care 2015; 27 499–506.
| Quality management and perceptions of teamwork and safety climate in European hospitals.Crossref | GoogleScholarGoogle Scholar |
[20] Chaboyer W, Chamberlain D, Hewson-Conroy K, Grealy B, Elderkin T, Brittin M, McCutcheon C, Longbottom P, Thalib L. Safety culture in Australian intensive care units: establishing a baseline for quality improvement. Am J Crit Care 2013; 22 93–102.
| Safety culture in Australian intensive care units: establishing a baseline for quality improvement.Crossref | GoogleScholarGoogle Scholar |
[21] Mallidou A, Cummings G, Estabrooks C, Giovannetti P. Nurse specialty subcultures and patient outcomes in acute care hospitals: a multiple-group structural equation modelling. Int J Nurs Stud 2011; 48 81–93.
| Nurse specialty subcultures and patient outcomes in acute care hospitals: a multiple-group structural equation modelling.Crossref | GoogleScholarGoogle Scholar |
[22] Kagan I, Barnoy S. Organizational safety culture and medical error reporting by Israeli nurses. J Nurs Scholarsh 2013; 45 273–80.
[23] Ballangrud R, Hedelin B, Hall-Lord M. Nurses’ perceptions of patient safety climate in intensive care units: a cross-sectional study. Intensive Crit Care Nurs 2012; 28 344–54.
| Nurses’ perceptions of patient safety climate in intensive care units: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
[24] Fujita S, Seto K, Kitazawa T, Matsumoto K, Hasegawa T. Characteristics of unit-level patient safety culture in hospitals in Japan: a cross-sectional study. BMC Health Serv Res 2014; 14 508
| Characteristics of unit-level patient safety culture in hospitals in Japan: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
[25] Agnew C, Flin R, Mearns K. Patient safety climate and worker safety behaviours in acute hospitals in Scotland. J Safety Res 2013; 45 95–101.
| Patient safety climate and worker safety behaviours in acute hospitals in Scotland.Crossref | GoogleScholarGoogle Scholar |
[26] Turunen H, Partanen P, Kvist T, Miettinen M, Vehviläinen-Julkunen K. Patient safety culture in acute care: a web-based survey of nurse managers’ and registered nurses’ views in four Finnish hospitals. Int J Nurs Pract 2013; 19 609–17.
| Patient safety culture in acute care: a web-based survey of nurse managers’ and registered nurses’ views in four Finnish hospitals.Crossref | GoogleScholarGoogle Scholar |
[27] Zaheer S, Ginsburg L, You-Ta C, Grace SL. Patient safety climate (PSC) perceptions of frontline staff in acute care hospitals: examining the role of ease of reporting, unit norms of openness, and participative leadership. Health Care Manage Rev 2015; 40 13–23.
| Patient safety climate (PSC) perceptions of frontline staff in acute care hospitals: examining the role of ease of reporting, unit norms of openness, and participative leadership.Crossref | GoogleScholarGoogle Scholar |
[28] Braithwaite J, Travaglia J. An overview of clinical governance policies, practices and initiatives. Aust Health Rev 2008; 32 10–22.
| An overview of clinical governance policies, practices and initiatives.Crossref | GoogleScholarGoogle Scholar |
[29] Thomas L, Galla C. Building a culture of safety through team training and engagement. BMJ Qual Saf 2013; 22 425–34.
| Building a culture of safety through team training and engagement.Crossref | GoogleScholarGoogle Scholar |
[30] Vertino K. Evaluation of a TeamSTEPPS© initiative on staff attitudes toward teamwork. J Nurs Adm 2014; 44 97–102.
| Evaluation of a TeamSTEPPS© initiative on staff attitudes toward teamwork.Crossref | GoogleScholarGoogle Scholar |
[31] Etchegaray J, Thomas E. Comparing two safety culture surveys: Safety Attitudes Questionnaire and Hospital Survey on Patient Safety. BMJ Qual Saf 2012; 21 6
| Comparing two safety culture surveys: Safety Attitudes Questionnaire and Hospital Survey on Patient Safety.Crossref | GoogleScholarGoogle Scholar |
