NURS 675L Patient Safety Outcomes Discussion
NURS 675L Patient Safety Outcomes Discussion
Interoperability is a big focus with current healthcare
system implementation. Why do you feel interoperability is so important? Does
it affect patient safety outcomes? Why or why not? Talk to your preceptor or
another team member at your facility about the current interoperability status
they have between their systems. Have them expand on future opportunities they
see and share your findings with your peers.
Methods
Sixty-eight hospitals and 6,807 respondents participated in the study. The study which adopted a cross sectional research design utilized an Arabic-translated version of the Hospital Survey on Patient Safety Culture (HSOPSC). The HSOPSC measures 12 patient safety composites. Two of the composites, in addition to a patient safety grade and the number of events reported, represented the four outcome variables. Bivariate and mixed model regression analyses were used to examine the association between the patient safety culture predictors and outcomes.
Results
Significant correlations were observed among all patient safety culture composites but with differences in the strength of the correlation. Generalized Estimating Equations for the patient safety composite scores and respondent and hospital characteristics against the patient safety grade and the number of events reported revealed significant correlations. Significant correlations were also observed by linear mixed models of the same variables against the frequency of events reported and the overall perception of safety.
Conclusion
Event reporting, communication, patient safety leadership and management, staffing, and accreditation were identified as major patient safety culture predictors. Investing in practices that tackle these issues and prioritizing patient safety is essential in Lebanese hospitals in order to improve patient safety. In addition, further research is needed to understand the association between patient safety culture and clinical outcomes.
Background
Developing a patient safety culture was one of the recommendations made by the Institute of Medicine to assist hospitals in improving patient safety [1,2]. Assessing the organizations existing safety culture is the first stage of developing a safety culture [3]. Patient safety culture assessments, required by international accreditation organizations, allow healthcare organizations to obtain a clear view of the patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture [4], help care giving units identify their existing patient safety problems [5], and benchmark their scores with other hospitals [6].
According to literature, the major predictors of a positive patient safety culture in healthcare organizations specifically hospitals include communication founded on mutual trust, good information flow, shared perception of the importance of safety, organizational learning, commitment from management and leadership, and the presence of a non-punitive approach to incident and error reporting [7]. Patient safety culture outcomes include the staff members perception of safety, the willingness of staff members to report events, the number of events reported, and an overall patient safety grade given by staff members to their units [8].
A multitude of evidence has been published in the area of patient safety culture in recent years. Some of the available evidence tackles patient safety culture issues that require attention, factors affecting incident reporting by hospital staff, the role of workplace environment in shaping safety, and steps that can be followed to improve safety.
Despite the wealth of evidence on patient safety culture, limited evidence still exists about the linkage between predictors and outcomes of patient safety culture especially in countries of the Eastern Mediterranean Region. One of the first efforts to assess the culture of safety in hospitals in the region was conducted in Lebanon by El-Jardali et al. [9].
Lebanese Context
The study by El-Jardali et al. (2010) entitled The Current state of Patient Safety Culture in Lebanese Hospitals: A study at Baseline [9] utilized an Arabic translated version of the Hospital Survey on Patient Safety Culture (HSOPSC) [8]. It aimed at identifying the most critical issues related to patient safety culture and potential strategies to implement the patient safety accreditation standards in the light of a newly added chapter to the Lebanese handbook of hospital accreditation [10].
The HSOPSC measures 12 patient safety culture composites representing several patient safety culture predictors (See Box 1). The HSOPSC also requires respondents to give their work area/unit a patient safety grade and to answer a question on the number of events reported in the past 12 months [8].
Calculating the percentage of positive responses for each composite revealed that the composites with the highest positive ratings were teamwork within units, hospital management support for patient safety, and organizational learning and continuous improvement. However, composites with the lowest ratings were teamwork across hospital units, hospital handoffs and transitions, staffing, and non-punitive response to error [9]. Approximately 60% of respondents reported not completing any event reports in the past 12 months and over 70% gave their units an Excellent/Very Good patient safety grade. Bivariate and multivariate analyses revealed significant differences across hospitals of different size and accreditation status [9].
Study findings outlined above represent the first component of data analysis for that stage [9]. Findings provided evidence that communication across units, staffing, event reporting, and the culture of response to error were major patient safety culture issues [9]. This paper, though, will further explore the association between patient safety culture predictors and outcomes, taking into consideration respondent and hospital characteristics. In addition, it will examine the correlation between the patient safety culture composites. Thus, the objective of this paper is to address the afore-mentioned objectives using bivariate as well as multivariate analyses.
Methods
Study Design, Setting, and Sample
The study adopted a cross sectional research design utilizing a customized version of the HSOPSC. A pilot testing phase preceded data collection in order to ensure the validity and reliability of the Arabic translated version of the questionnaire. Of the 126 hospitals registered in the Lebanese Syndicate of Private Hospitals that were contacted and asked to participate, 68 consented [9]. The survey targeted hospital employees including physicians, nurses, clinical and non-clinical staff, pharmacy and laboratory staff, dietary and radiology staff, supervisors, and hospital managers. The questionnaire was distributed to 12,250 hospital employees and 6807 were returned yielding an overall response rate of 55.56%. Additional details on the study methodology can be found in El-Jardali et al. [9].
Survey Measures and Outcome Variables
The HSOPSC is composed of 42 items that measure 12 composites of patient safety culture (See Box1, Additional file1 ). Items were scored using a five-point scale reflecting the agreement rate on a five-point frequency scale. The percentage of positive responses for each item was calculated; negatively worded items were reversed when computing percent positive response. Composite level scores were computed by summation of the items within the composite scales and dividing by the number of items with non-missing values [9].
Two of the composites (frequency of events reported and overall perception of safety) are two of the four patient safety culture outcome variables [8]. The remaining two outcome variables are the patient safety grade and the number of events reported [8].
Bivariate Analysis
Bivariate analyses were used to examine the associations between patient safety culture composites and differences across hospitals of different size and accreditation status.
Pearson correlations were used to examine the association between the patient safety culture composites. ANOVA f-test with multiple comparison corrected using the Bonferroni method was used to examine the association between the two outcome variables (patient safety grade and the number of events reported) with the remaining patient safety culture composites.
Student T-Test and ANOVA f-test with multiple comparison corrected using the Bonferroni method were then used to examine how trends in the outcome variables (frequency of events reported and overall perception of safety) differ across hospital and respondent characteristics. Finally, cross tables were constructed and chi-square tests were used to assess how trends in the outcome variables (patient safety grade and the number of events reported) differed across respondent and hospital characteristics.
Multivariate Regression Analysis
The four outcome variables were regressed against the 10 composite scores, respondents position in the hospital, accreditation status, and hospital size. Since the data was clustered by hospital, we used appropriate statistical techniques to control for this effect. Four regression models were constructed, two adopted Generalized Estimating Equations (the two categorical outcome variables: number of events reported and patient safety grade) and the other two models followed a linear mixed regression model (the two composites for frequency of events reported and overall perception of safety).
Results
Comparison of Means for the Frequency of Events Reported and the Overall Perception of Safety across Respondent and Hospital Characteristics
Significant differences were observed between units and positions when comparing results across respondent and hospital characteristics. For both the frequency of events reported and the overall perception of safety, significantly higher means were observed for diagnostics (mean = 3.97 ± 1.01; mean = 3.96 ± 0.68) as compared to surgical (mean = 3.78 ± 1.05; mean = 3.82 ± 0.67) and medical units (mean = 3.93 ± 0.99; mean = 3.83 ± 0.68) (See Table ?Table11).
Table 1
Comparison of means for two outcome composite scores across hospital and respondent characteristics (identical letters represent significance between indicated groups)
| Frequency of Events Reported | Overall Perception of Safety | |||||
|---|---|---|---|---|---|---|
| Mean (SD) | P-Value | Mean (SD) | P-Value | |||
| Unit | ||||||
| ?Many different hospital units/no specific unit | 3.89 (0.96) | a, f | <0.001 | 3.72 (0.66) | a, d, e, f | <0.001 |
| ?Administration | 3.78 (1.16) | b, f | 3.72 (0.75) | b, e, | ||
| ?Medical | 3.93 (0.99) | c, d | 3.83 (0.68) | a, c, e | ||
| ?Surgical | 3.78 (1.05) | c, d, e, f | 3.82 (0.67) | a, d, e, | ||
| ?Diagnostics | 3.97 (1.01) | b, d, e | 3.96 (0.68) | a, b, c, e | ||
| ?Other | 4.06 (0.98) | a, b, d, f | 3.91 (0.64) | a, b, f | ||
| ?N | 5707 | 5201 | ||||
|
|
||||||
| Position | ||||||
| ?Nurse | 3.89 (1.00) | a, e, f | <0.001 | 3.80 (0.66) | a, c | <0.001 |
| ?Physician | 3.78 (0.92) | b, f | 3.69 (0.75) | b, c, d | ||
| ?Pharmacist | 3.87 (1.20) | 3.83 (0.90) | ||||
| ?Other health professions | 3.95 (0.93) | c, e, | 3.90 (0.77) | |||
| ?Unit assistant/clerk/secretary/Technician | 3.92 (1.05) | d, e, | 3.92 (0.68) | a, b | ||
| ?Administration | 3.92 (1.06) | 3.75 (0.85) | ||||
| ?Quality and Safety | 3.49 (1.06) | a, c, d, e | 3.86 (0.63) | |||
| ?Other | 4.04 (0.99) | a, b, e, f | 3.90 (0.71) | b, d | ||
| ?N | 5925 | 5407 | ||||
|
|
||||||
| Experience at hospital | ||||||
| ?Less than 1 year | 3.78 (1.08) | a, b, c, d | 0.001 | 3.81 (0.72) | 0.003 | |
| ?1 to 5 years | 3.88 (1.00) | 3.82 (0.67) | ||||
| ?6 to 10 years | 3.94 (1.00) | a, b | 3.83 (0.67) | |||
| ?11 to 15 years | 3.98 (0.98) | a, c | 3.88 (0.65) | a | ||
| ?16 to 20 years | 3.91 (1.04) | 3.82 (0.69) | ||||
| ?21 years or more | 4.00 (1.02) | a, d | 3.74 (0.79) | a | ||
| ?N | 6132 | 5573 | ||||
|
|
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| Hospital Size (El-Jardali et al., 2010) | ||||||
| ?Small (<100 beds) | 3.95 (1.00) | a, b, c | 0.001 | 3.84 (0.67) | a | 0.012 |
| ?Medium (100-199 beds) | 3.87 (1.03) | a, b | 3.80 (0.69) | |||
| ?Large (>=200 beds) | 3.81 (1.08) | a, c | 3.76 (0.71) | a | ||
| ?N | 6307 | 5742 | ||||
|
|
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| Interaction with patients | ||||||
| ?Yes | 3.90 (1.00) | 0.517 | 3.82 (0.68) | 0.092 | ||
| ?No | 3.93 (1.05) | 3.87 (0.73) | ||||
| ?N | 5707 | 5201 | ||||
|
|
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| Accreditation Status (El-Jardali et al., 2010) | ||||||
| ?Yes | 3.91 (1.03) | 0.047 | 3.84 (0.69) | <0.001 | ||
| ?No | 3.84 (1.03) | 3.71 (0.68) | ||||
| ?N | 6307 | 5742 | ||||
