Le Thi Cuc Lecturer of Hanoi Medical University lecuc@hmu.edu.vn Assessing Patient Safety Culture in Vietnamese hospitals: An evidence in developing country Assessment, in some hospitals in The North of VN Le Thi Cuc Lecturer of Hanoi Medical University lecuc@hmu.edu.vn

CONTENT 2. Research objectives 3.Research Method 1. Introduction 2. Research objectives 3.Research Method 4.Results and discussion 5.Conclusion

Introduction

Background “The prevention of harm to patients” Prevent errors Patient safety is a serious global health issue The definition of patient safety: WHO, 2014; Philip Aspden, 2004 “The prevention of harm to patients” Learn from the errors Built on a culture of safety Prevent errors Health care professional

Global trend of patient safety Developed countries 40,000-98,000 Americans die/year 4% patients suffered harm; 70% short-lived disability 14% lead to death (Leape et al., 1991; Brennan et al., 1991) 7.5% (Baker et al.,2004) In developing countries: The probability of adverse events was much higher 20 times than in developed countries (WHO, 2002) 16.6% (Wilson et al., 1995) 12.5% (Davis et al., 2002)

Problem statement Hospital overcrowding affects patient safety and health care quality (MOH 2011) The rising number of unexpected medical incidents is common in every hospital levels Patient safety concept has not been systematically and appropriately taught in Vietnamese medical schools Chuyen mau, cho it chu

No study has been done about patient safety culture in Vietnam Research significant No study has been done about patient safety culture in Vietnam Very few studies conducted from lower income countries The results will contribute to the body of knowledge about patient safety to promote patient safety culture and quality of health care services

Study objectives To assess the attitudes and perceptions of healthcare provider regarding patient safety culture. To make a comparison of patient safety culture across the Vietnamese hospitals. To explore the factors associated with patient safety culture.

Research Method

Conceptual model Independent variables Dependent variables Hospital characteristics Hospital level Respondent characteristics Gender, Age Education level, Staff position Year of experience Hours worked/week Patient safety training course 10 patient safety dimensions Supervisory Expectation Organizational Learning Teamwork within Units Communication Openness Staffing Management Support PS Teamwork across Units Hospital Handoffs and Transitions Feedback and Commination Non-punitive Response Overall perception of patient safety Frequency of event reporting Overall patient safety grade

Research method Respondences: physicians, nurses, midwives, and technician - Exclusion criteria: experiences <6 month, unavailable, decline Method: A cross-sectional Time: From 3 to 5/2015 Setting: Five hospitals VGFH, NPH, NO&GH, HMUH, TSGH Data collection: Questionaire Data collection instrumenttion: The Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was used. It was originally designed by the Agency for Healthcare research and Quality (AHRQ) Data analysis: SPSS 20.0 Ethical consideration : the ethics committee of the Hanoi Public Health University

Results and discussion

2035 questionnaires given out in total. 1314 questionnaires returned fully completed 65% response rate.

Table 2: Descriptive demographic (cont) Gender Female 966 (73.5%) Male Respondent’ characteristic Count (ratio) Gender Female 966 (73.5%) Male 348 (26.5%) Age Less than 25 years old 211 (16%) From 26 to 35 years old 753 (57.3%) From 36 to 45 years old 200 (15.2%) More than 46 years old 150 (11.4%) Respondent’ characteristic Count (ratio) Working hours/week 20 to 39 hours/week 26 (2%) 40 to 59 hours/week 1017 (77.5%) 60 to 79 hours/week 251(19.1%) Over 80 hours/week 17(1.4%) Position Supervisor 83(6.3%) Non-Supervisor 1231(93.7%)

Descriptive demographic (cont) Quay lai education

Descriptive Patient safety training

Patient safety dimensions Positive response rate Table 3: The positive response rate of Patient safety dimensions Patient safety dimensions Positive response rate The unit level   Teamwork within hospital 87% Supervisor/Manager Expectations & Actions Promoting PS 78% Organizational Learning—Continuous Improvement 73% Feedback & Communication About Error 63% Non-punitive Response to Errors 41% Communication Openness 58% Staffing 32% The hospital level Hospital Support for Patient Safety 79% Teamwork Across Units 67% Handoffs & Transitions The outcome level Overall Perceptions of Patient Safety 47% Frequency of Events Reported 37% Bo, cho vao binh luan

Table 4: Comparison of Patient safety culture across 5 hospitals   PSC Dimensions VGFH (n=348) NPH (n=347) NOGH (n=352) HMUH (n=192) TSGH (n=75) P-Value Mean (SD) Mean(SD) Teamwork within units/hospital 4.10(0.61) 4.16(0.59) 4.23(0.52) 4.21(0.53) 4.26(0.47) 0.016 (f) Organization Learning -continuous Improvement 3.74(0.53) 3.85(0.60) 3.84(0.57) 3.83(0.51) 3.81(0.57) 0.078 Manager support for Patient safety 3.96(0.57) 3.91(0.58) 3.95(0.69) 3.96(0.54) 3.99(0.54) 0.809 Feedback and communication about errors 3.66(0.62) 3.67(0.60) 3.65(0.63) 3.74(0.52) 3.38(0.54) <0.0001 (a,b,c,d) Communication openness 3.58(0.67) 3.66(0.66) 3.50(0.75) 3.77(0.61) 3.52(0.59) <0.0001 (i,j,k) Teamwork across units 3.70(0.55) 3.70(0.56) 3.73(0.66) 3.74(0.55) 4.10(0.58) Staffing 2.99(0.48) 2.91(0.54) 2.90(0.49) 2.91(0.48) 2.92(0.31) 0.129 Handoff and Transition 3.70(0.60) 3.58(0.58) 3.69(0.72) 3.72(0.60) 3.90(0.58) 0.0011 (b) Non-punitive Response to Errors 3.32(0.60) 3.24(0.64) 3.27(0.66) 3.39(0.67) 3.07(0.87) 0.056 Frequency of Event reporting 3.28(0.55) 3.24(0.55) 3.27(0.56) 3.37(0.56) 3.22(0.44) 0.101 Overall perception of Patient Safety 3.30(0.50) 3.20(0.55) 3.07(0.62) 3.26(0.61) 2.85(0.66) 0.041 (a,b,c,d,e,f,k)

Patient safety dimension <0.0001 0.003 0.050 0.021 0.014 0.040 Table 5: Association between outcome variables and PSC dimensions by Linear regression   Patient safety dimension Perception of Patient Safety Frequency of Event Reporting Beta (Standard Error) P-Value Teamwork within units -0.041(0.035) 0.243 -0.023 (0.033) 0.486 Supervisor/Management expectation and action promoting PS 0.139(0.037) <0.0001 0.1(0.034) 0.003 Organization Learning -continuous Improvement 0.066(0.034) 0.050 0.009(0.032) 0.774 Manager support for Patient safety 0.012(0.035) 0.727 0.027(0.033) 0.411 Feedback and communication about errors 0.040(0.030) 0.188 0.102(0.028) Communication openness 0.064(0.028) 0.021 -0.014(0.026) 0.597 Teamwork across units -0.074(0.040) 0.064 0.015(0.037) 0.687 Staffing 0.082(0.034) 0.014 0.047(0.031) 0.135 Handoff and Transition 0.073(0.035) 0.040 0.064(0.033) Non-punitive Response to Errors 0.000(0.022) 0.989 -0.017(0.020) 0.394

Table 6: Association between outcome variables and respondent’ characteristic by Linear regression   Respondent’ characteristic Perception of Patient Safety Frequency of Event Reporting Beta (Standard Error) P-Value Age Less than 25 years old -0.133(0.063) 0.036 -1.33(0.059) 0.023 From 26 to 35 years old -0.033(0.053) 0.528 -0.114(0.049) 0.020 From 36 to 45 years old 0.016(0.064) 0.805 -0.161(0.059) 0.007 More than 46 years old  0 Education level PhD 0.384(0.096) <0.0001 -0.067(0.092) 0.466 Master/ Specialist 1 0.400(0.054) -0.075(0.052) 0.145 Bachelor 0.340(0.037) -0.108(0.036) 0.03 College 0.152(0.059) 0.011 -0.042(0.057) 0.457 Junior Staff position Nurse -0.203(0.039) 0.094(0.037) 0.01 Technician/others -0.272(0.075) 0.113(0.070) 0.106 Midwives -0.284(0.063) 0.131(0.059) 0.026 Physician Experience in Unit/ Hospital Less than 3 years -0000(0.068) 0.996 -0.185(0.063) 0.003 From 4 to 15 years -0.005(0.65) 0.943 -0.205(0.060) 0.001 From 15 to 25 years 0.154(0.083) 0.063 -0.192(0.076) 0.012 Morethan 26 years Hospital level National Hospital 0.343(0.070) 0.038(0.066) 0.563 Provincial Hospital 0.414(0.080) 0.143(0.075) 0.050 District Hospital Xoas other

Limitations Firstly, five hospitals were selected; this implies that the sample size might not be large enough comparing with the population size of thousands of Vietnamese health care organizations. Secondly, this questionnaire might be not effective on some items Finally, limited responses from the manager's perspective, and the majority of respondent was the nurses.

Conclusion A big difference between hospital levels on dimensions such as: “Teamwork within units/hospital”, “Feedback and communication about errors”, “Communication openness”, “Teamwork across units”, “Handoff and Transition”, “Overall perception of patient safety”. This indicates that patient safety dimensions is influenced by the hospital level and size. Outcome variables: Frequency of event reporting” “ Overall perception of Patient safety” are associated with medical staff’ characteristic and PSC dimensions. The finding highlights that the existence of a punitive and blame culture, lack of : 1)staff, 2)openness in communication, and 3) frequency event reporting. Overall, the perception of patient safety culture is not high comparing with USA and Taiwan.

Suggestions for further research Conclusion (cont) Suggestions for further research To promote patient safety and improve health care quality, the health care management should measure patient safety culture nationally The researcher should study more specifically patient safety problems in each hospital.

CLOSING REMARKS Assessing patient safety culture is only the first step to identify the issues for further improvement. This study can contribute the understanding of patient safety culture for policy makers to make deliberation about potential next step.

Thank you for your attention!