Patient safety culture from the perspective of employees in a university hospital

Abstract Safety culture is a product of values, attitudes, skills, and behavioral patterns, and it determines the commitment of the management to a secure organization. The evaluation of safety culture in hospitals helps to identify and manage the relevant patient safety issues in hospital routines and working conditions proactively. Thus, this study is aimed to evaluate patient safety culture in all the departments of a university hospital of medium complexity. This study employed a cross-sectional and analytical design employed in the Portuguese version of the Hospital Survey on Patient Safety Culture. A sample of all hospital staff participated in this study, which was conducted from December 2016 to May 2017. The percentage of positive responses was calculated to identify the strong and weak areas in patient safety. Of the 413 questionnaires distributed, 368 valid responses were returned. The response rate was, therefore, 89%. The overall percentage of positive responses was 50.3%. The “Supervisor/manager expectations and actions promoting patient safety” dimension obtained the highest percentage of positive responses (67.1%). The “Nonpunitive response to error” dimension was considered the weakest for safety culture, with only 22.9% positive responses. Furthermore, most professionals (70.6%) did not report any events in the previous 12 months. Nevertheless, 69.5% of participants considered patient safety within their unit/work area as “very good” or “great.” The results showed that the employees’ perception of patient safety diverged from the reality within the institution. Therefore, efforts should be made to promote an acceptable safety culture in all hospital areas.

摘要 安全文化是价值观、态度、技能与行为模式的有机统一产物，决定了管理层对构建安全型组织的投入力度。医院患者安全文化评估有助于前瞻性识别并管控医院日常运营与工作场景中的各类患者安全隐患。据此，本研究旨在对一家中等复杂度的大学附属医院的所有科室开展患者安全文化评估。本研究采用横断面分析性研究设计，依托《患者安全文化医院调查问卷（Hospital Survey on Patient Safety Culture）》葡萄牙语版本开展调研，全体医院工作人员均纳入研究样本，调研周期为2016年12月至2017年5月。研究通过计算正向应答占比，明确患者安全文化建设的优势领域与薄弱环节。本次共发放问卷413份，回收有效问卷368份，有效应答率达89%。总体正向应答占比为50.3%。其中，"督导者/管理者促进患者安全的期望与行动"维度的正向应答占比最高，达67.1%；而"差错非惩罚性应对"维度被认为是患者安全文化建设中最薄弱的环节，正向应答占比仅为22.9%。此外，70.6%的受访医护人员表示在过去12个月内未上报过任何不良事件。尽管如此，仍有69.5%的受访者认为其所在科室/工作区域的患者安全状况为"极佳"或"优秀"。研究结果显示，医护人员对患者安全的认知与医院内部的实际情况存在偏差。因此，需采取相关举措在医院各区域推广适配的安全文化建设工作。