1. 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

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

3. Introduction

4. 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

5. 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)

6. 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

7. 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

8. 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.

9. Research Method

10. 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

11. 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

12. Results and discussion

13. 2035 questionnaires given out in total.
1314 questionnaires returned fully completed
65% response rate.

14. 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%)

15. Descriptive demographic (cont)
Quay lai education

16. Descriptive Patient safety training

17. 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

18. 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)
< (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)
< (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)
(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)

19. 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
(0.033)
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

20. 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

21. 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.

23. 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.

24. 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.

25. 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.

26. Thank you for your attention!