Patient safety culture in intensive care units and emergency department of an acute care hospital.

Abstract

The aim of this descriptive research was to gain understanding of patient safety culture pertaining to four high dependency patient care areas, at the local general acute care hospital. The study population (n=155) comprised doctors (n=22) and nurses (n=133) that work in these units. Use of the 'Hospital Survey on Patient Safety Culture' (HSPSC) to collect quantitative and qualitative data, provided a measure of patient safety culture, and revealed patient safety culture strengths and weaknesses in practice. Consequently, the main objectives of this study have been addressed. The findings identified areas of strength including "teamwork within units" (positive Response >/ 75%). There were seven patient safety culture composites with potential for improvement (positive response \< 50%), that included "non-punitive response to error" (19%) and "frequency of event reporting" (31 %). These registered the lowest overall positive scores indicating that potential patient safety issues were neither being identified nor addressed within these units. Hospital-level patient safety culture composites were next lowest: "hospital management support for patient safety" (33%), "teamwork across hospital units" (33%) and "hospital handoffs and transitions" (35%). These scores are indicative of gaps in management support for patient safety, and communication throughout the organisation. More than half out of the 42 survey items were identified as patient safety culture areas requiring improvement (positive response \< 50%) for the total respondents. However, significant variances (p = 0.001) were found in the way respondents perceived patient safety culture according to their respective work areas. Differences with respect to "overall perceptions of safety," "organisational learning," "staffing," "management support" and 'teamwork across hospital units" were revealed. Qualitative comments by respondents provided additional information that complemented the quantitative findings, and also served to identify additional areas of concern. Respondents indicated a need for shifting away from the prevalent blame culture to encourage more open event reporting. They also contended in favour of having more management commitment and support. The results of this study showed that whereas respondents considered a strong positive culture regarding teamwork within the units, they also felt that there was a need to improve certain areas affecting patient safety, related to aspects of organisational culture and including staffing, communication, incident reporting and management support. Comparison of the present study findings with the United States HSPSC comparative Database Report by Sorra et al. (2008) revealed similar patterns but suggest a relatively less well-developed patient safety culture for the units in the local general hospital.