1. REPLACE THIS BOX WITH YOUR ORGANIZATION’S Haetham Doweire, MD;BMCA,RM
Since there was no previous literature or current research studies at Ministry of Health hospitals that measured the organization’s safety culture, the objective of this study is to assess healthcare professionals’ perception of patient safety culture at the Ministry of Health nationally accredited hospitals and to describe patients’ safety culture dimensions within the context of the Jordanian healthcare system. The findings of this study will provide health care organizations with an understanding of the patient safety culture and help hospitals better plan for future quality and patient safety improvements.
According to the Agency of Healthcare Research and Quality (AHRQ), developing a patient safety culture requires an understanding of the values, beliefs, and norms about what is important in an organization and what attitudes and behaviors related to patient safety are supported, rewarded, and expected. Therefore, it is critical for health care organizations to assess their culture regarding patient safety in order to allow healthcare organizations to obtain a clear view of the patient safety aspects requiring urgent attention, and identify the strengths and weaknesses of their safety culture (‎10).
Since there was no previous literature or current research studies at Ministry of Health hospitals that measured the organization’s safety culture, the objective of this study is to assess healthcare professionals’ perception of patient safety culture at the Ministry of Health nationally accredited hospitals and to describe patients’ safety culture dimensions within the context of the Jordanian healthcare system. The findings of this study will provide health care organizations with an understanding of the patient safety culture and help hospitals better plan for future quality and patient safety improvements.
The population of the study was recruited from four accredited MOH hospitals. Accredited MOH hospitals are secondary and tertiary care centers, which achieved Health Care Accreditation Council (HCAC) accreditation since 2010/2011
Figure 16. Average Percentages of Positive scores of patient safety culture dimensions
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Patient Safety Culture among Healthcare Professionals
Working in Ministry of Health Accredited Hospitals in Jordan:
A Baseline Survey, 2013
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HIGH RESOLUTION LOGO
Haetham Doweire, MD;BMCA,RM
ABSTRACT
INTRODUCTION
RESULTS
DISCUSSION
Patient safety is an essential component of healthcare quality. Even with continuous alertness, health care providers face many challenges in today’s health care environment in trying to keep patients safe. The Institute of Medicine (IOM) has summarized the evidence about medical errors in the United States. This evidence estimates that up to 98,000 individuals die every year in hospitals as a result of medical errors. The IOM has suggested that the biggest challenge to move toward a safer health care system is changing the patient safety culture (PSC) from one in which people are blamed for errors to one in which errors are treated as opportunities to improve the health care system and prevent harm (‎1).
Patient safety culture examines how the perceptions, behaviors, and competencies of individuals and groups determine an organization’s commitment, style, and proficiency in health and safety management (‎3), and it is used by organizations to determine targets for interventions to improve patient safety, evaluate the success of patient safety interventions, fulfill regulatory requirements, and conduct benchmarking (‎4, ‎5). Since there was no previous literature or current research studies at Ministry of Health hospitals that measured the organization’s safety culture, the objective of this study is to assess healthcare professionals’ perception of patient safety culture at the Ministry of Health nationally accredited hospitals and to describe patients’ safety culture dimensions within the context of the Jordanian healthcare system. The findings of this study will provide health care organizations with an understanding of the patient safety culture and help hospitals better plan for future quality and patient safety improvements.
Since there was no previous literature or current research studies at Ministry of Health hospitals that measured the organization’s safety culture, the objective of this study is to assess healthcare professionals’ perception of patient safety culture at the Ministry of Health nationally accredited hospitals and to describe patients’ safety culture dimensions within the context of the Jordanian healthcare system. The findings of this study will provide health care organizations with an understanding of the patient safety culture and help hospitals better plan for future quality and patient safety improvements.
The ability to improve the safety of patient care delivery is dependent on the safety culture, or the norms surrounding reactions following an error, the learning that takes place, and the proactive strategies in place to prevent future errors.
The aim of this study was to describe the perception of healthcare professionals at Ministry of Health (MOH) accredited hospitals on patient safety culture, identify areas for improvement, and to raise awareness about patient safety, provide MOH accredited hospitals with data on the status of the patient safety culture within their institutions.
To fulfill this purpose a cross-sectional survey was carried out in 2012, using a modified version of a patient safety culture instrument “Hospital Survey on Patient Safety Culture” which was developed by the Agency for Healthcare Research and Quality (AHRQ). The questionnaire was distributed to all accredited MOH hospital staff, which included two general profile hospitals and two specialized hospitals. A total of 1671 questionnaires were returned over a six-month period, giving a response rate of 81% .
Survey respondents, which were primarily nurses and physicians. Of the twelve dimensions of a patient safety culture explored during the study, teamwork within units was rated the highest with a positive response of 79%, while the lowest rating was staffing at 34%. The key areas identified for improvement in accredited hospitals included non-punitive response to error (37%), frequency of events reported (44%), communication openness (50%), and staffing (34%). Most respondents reported "no events" in the twelve months preceding the survey. Only 25% of the respondents gave their work area or unit a safety grade of “A” (Excellent). Significant differences between health care professionals’ perceptions of patient safety culture were noted based on the area in which they worked, hours worked per week, time staff worked in their current work area and staff position.
Results from this study provide a baseline measurement for patient safety cultures at accredited hospitals and develop interventions aimed at improving patient safety.
Survey respondents, which were primarily nurses and physicians. Figure 15 shows the number of events reported in the 12 months preceding the survey. The results show that 47%(n=785) of the respondents(n=1667) reported no events; 20%(n=334) acknowledged reporting from1 to 2 events, 15%(n=251) mentioned from 3 to 5 events, 10%(n=167) acknowledged 6 to 10 events and 9% (n=130) acknowledged more than eleven events.
Figure 14 shows the Overall Patient Safety Grade. 44%( n=735) of the respondents (n=1671) graded their hospitals' safety performance as ‘very good’, 25% (n= 418) of respondents gave their hospital an ‘excellent’ patient safety grade, while 26% (n=434) of respondents gave their hospital as ’acceptable ’ and 4% (n=67) graded as ’poor ’.only 1% (n=17) graded as ’failing ’
Of the twelve dimensions of a patient safety culture explored during the study, teamwork within units was rated the highest with a positive response of 79%, while the lowest rating was staffing at 34%.
Significant differences between health care professionals’ perceptions of patient safety culture were noted based on the area in which they worked, hours worked per week, time staff worked in their current work area and staff position.
Based on the positive responses for each of the 12 dimensions of the patient safety culture dimensions, results suggest that two areas were identified as areas of strength: Teamwork within Units (79%), and Organizational Learning-Continuous Improvement (77%); and the following dimensions met AHRQ's definition of areas needing improvement: Staffing (34%), Non-punitive Response to Error (37%), Frequency of Events Reported (44%), and Communication Openness (50%). These results suggest that a non-punitive environment (Balm Free Culture) has not yet been established at accredited MOH hospitals. MOH leaders should focus on the barriers for not reporting the errors to improve patient safety.
The results shows that the increase in the hours worked per week is associated with a decrease in the overall score of patient safety, This result supports Rogers’ study which indicated that the risk of making an error were significantly increasing when work shifts were longer than twelve hours, when staff worked overtime, or when they worked more than forty hours per week. (‎67)
Results of this study indicate that staff was not reporting when a mistake was made but was caught or corrected, or when the mistake did not harm the patient and did not feel the need to report when an outcome was already clear. However, learning from near misses can be very important to increasing patient safety
Findings from this study indicates that staffing and workload factors seem to have been a negative issue for the majority of respondents and warrants further evaluation for their contribution to patient safety culture. This finding is relevant and consistent with other researchers who found that staffing and workload has an impact on patients’ health conditions. (‎67)
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CONCLUSIONS
METHODS AND MATERIALS
A descriptive cross-sectional design was used due to a lack of data regarding patient’s safety culture in Jordanian accredited MOH hospitals .The results of this research will provide a baseline for patient safety practices in the Jordanian hospitals. This research design is cross-sectional because the data are collected from participants at a single point in time or during a single, relatively brief time period, and comparisons are made across the variables of interest.  
The population of the study was recruited from four accredited MOH hospitals. Accredited MOH hospitals are secondary and tertiary care centers, which achieved Health Care Accreditation Council (HCAC) accreditation since 2010/2011
An anonymous paper-based self-administered Arabic language version of El-Jardali’s Hospital Survey on Patient Safety Culture questionnaire (HSOPSC) (52), developed by the Agency for Healthcare Research and Quality (AHRQ), was adapted and used in this study to examine patient safety culture from a hospital staff perspective. The HSOPSC is composed of 42 items that measure 12 dimensions and includes both positively and negatively worded items. Items were scored on a five point Likert scale.
Sorra and Rockville defined “patient safety culture areas of strengths as those survey dimensions where the overall mean positive response rate to items in the dimension was 75% or more, indicating that respondents answered “Strongly Agree/Agree” or “Most of the time/Always”, or when 75% or more of respondents disagreed (strongly disagree/disagree) with negatively worded items. Individual survey items within dimensions can also be considered areas of strength where the item positive response rate was 75% or greater. Similarly, areas needing improvement are identified as those items where 50 percent or more of respondents did not answer”. (58)
This study highlights the existence of a punitive and blame culture, under-reporting of events, lack of communication openness, inadequate staffing and work hours that are key challenges for patient safe hospital care.
The survey findings provide evidence that can be used by policy makers, managers and leaders who are able to create the culture and commitment needed to identify and solve underlying systemic causes related to patient safety and quality improvement. In order to deliver a high quality of care, it is important to assess patients’ perceptions of hospital patient safety culture and compare them with the healthcare professionals’ perceptions.
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REFERENCES
Sorra J, Nieva V, Schreiber G, et al. Safety culture and event reporting in hospital transfusion services. Orlando, FL: American Association of Blood Banks (AABB) Annual Meeting; 2002.
Aneesh K. Singla, Barrett T. Kitch, el Assessing Patient Safety Culture: A Review and Synthesis of the Measurement Tools. J Patient Saf 2006; 2:
Cooper MD. Towards a model of safety culture. Safety Sci. 2000; 36(2):
Grote G, Kunzler C. Diagnosis of safety culture in safety management audits. Safety Sci 2000;34: .
CONTACT
Haitham Doweri
MOH
Phone:
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