Health professionals’ perception of patient safety culture in a university hospital in São Paulo: A cross-sectional study applying the Hospital Survey on Patient Safety Culture

ABSTRACT BACKGROUND: Patient safety culture is part of the organizational profile of healthcare institutions and is associated with better quality of care. OBJECTIVE: To assess patient safety culture in a university hospital. DESIGN AND SETTING: Hospital-based cross-sectional study conducted in a public university hospital in São Paulo, Brazil, between September and December 2015. METHODS: We randomly selected 68 sectors of the hospital, to include up to 5 employees from each sector, regardless of length of experience. We used the validated Brazilian version of the Hospital Survey on Patient Safety Culture (HSOPS) via an electronic interface. We calculated the percentage of positive responses for each dimension of the HSOPS and explored the differences in age, experience, occupation and educational level of respondents using the chi-square test. RESULTS: Out of 324 invited respondents, 314 (97%) accepted the invitation and were surveyed. The sample presented predominance of women (72%), nursing staff (45%) and employees with less than six years’ experience at the hospital (60%). Nine out of the 12 dimensions showed percentages of positive responses below 50%. The worst results related to “nonpunitive response to errors” (16%). A better safety culture was observed among more experienced staff, nurses and employees with a lower educational level. In the previous year, no events were reported by 65% of the participants. CONCLUSIONS: The patient safety culture presented weaknesses and most of professionals had not reported any event in the previous year. A policy for improvement and cyclical assessment is needed to ensure safe care.

摘要：研究背景：患者安全文化属于医疗机构的组织特征范畴，与更优质的医疗服务质量呈正相关。
研究目的：评估某大学附属医院的患者安全文化现状。
研究设计与研究地点：本研究为基于医院的横断面研究，于2015年9月至12月间在巴西圣保罗的一所公立大学附属医院开展。
研究方法：我们随机选取了该院68个科室，每个科室最多纳入5名员工，不考虑其从业时长。我们通过电子平台使用经过验证的巴西版《患者安全文化医院调查问卷（Hospital Survey on Patient Safety Culture, HSOPS）》开展调研。我们计算了HSOPS各维度的阳性应答占比，并采用卡方检验分析受访者在年龄、从业年限、职业及受教育水平方面的差异。
研究结果：共计邀请324名受访者，其中314人（97%）同意参与并完成调研。样本群体中女性占比最高（72%），护理人员占比45%，在该院从业不足6年的员工占比60%。12个维度中有9个维度的阳性应答占比低于50%，其中“对差错的非惩罚性回应”维度得分最差，阳性占比仅为16%。从业年限更长的员工、护理人员及受教育水平较低的员工中，患者安全文化表现更佳。在过去一年中，65%的参与者未上报过任何不良事件。
研究结论：本次调研显示该医院患者安全文化存在诸多短板，且多数医护人员在过去一年未上报过任何不良事件。因此，亟需制定改善患者安全文化的相关政策，并开展周期性评估，以保障医疗服务的安全性。