Evolution of Culture on Patient Safety in the Clinical Setting of a Spanish Mutual Insurance Company: Observational Study between 2009 and 2017 Based on AHRQ Survey
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Aspects of the Safety Culture | |
---|---|
Block A. Results of the safety culture | |
1. Frequency of notified events | The errors that are discovered and corrected before affecting the patients are notified (Q 40). The errors that are not going to foreseeably harm the patient are notified (Q 41). The errors that have not had adverse consequences, even though they could have foreseeably harmed the patient, are notified (Q 42). |
2. Perception of safety | The pace of work is never increased if that would imply sacrificing patient safety (Q 15). Our procedures and work resources are good for preventing errors in providing care (Q 18). More mistakes are not made by chance (Q 10). In this unit, there are problems related to patient safety (Q 17). |
Block B. Aspect of the culture of safety at the unit/service level | |
3. Expectations and actions of directors and supervisors of the Unit/Service which foster safety | My supervisor/boss expresses their satisfaction when we try to prevent risks to patient safety (Q 19). My supervisor/boss seriously takes into account the suggestions personnel make to improve patient safety (Q 20). When work pressure increases, my supervisor/boss tries to get us to work more quickly, even if that would put the patient’s safety at risk (Q 21). My supervisor/boss overlooks patient safety problems which occur habitually (Q 22). |
4. Organizational learning/Continuous improvement | We have activities aimed at improving patient safety (Q 6). When a fault is detected in patient care, appropriate measures are taken to prevent it from happening again (Q 9). The changes we make to improve patient safety are evaluated so as to check their effectiveness (Q 13). |
5. Teamwork in the Unit/Service | Personnel support each other (Q 1). When we have a lot of work, we all collaborate as a team to finish it (Q 3). In this unit, we treat each other with respect (Q 4). When someone is overloaded with work, they can get help from their colleagues (Q 11). |
6. Frankness in communication | When personnel see something that could negatively affect the care a patient receives, they can speak about it with complete freedom (Q 35). Personnel may question the decisions or actions of supervisors with complete freedom (Q 37). Personnel fear asking questions about what seems to be something done incorrectly (Q 39). |
7. Feedback and communication about errors | When we notify of an incident, we are informed about what type of actions have been carried out (Q 34). We are informed about errors that occur in this service/unit (Q 36). In my service/unit, we argue about how we can prevent an error from occurring again (Q 38). |
8. Non-punitive response to errors | If colleagues or superiors discover you have committed an error, they use it against you (Q 8). When an error is detected, before trying to find the cause, they try to try to lay blame (Q 12). When an error is made, personnel fear that this may be reflected in their file (Q 16). |
9. Sufficient personnel | There are enough personnel to deal with the workload (Q 2). Sometimes, the best patient care cannot be provided because the workday is exhausting (Q 5). Occasionally, the best patient care is not provided because there are too many substitutes or temporary personnel (Q 7). We work under pressure to carry out too many things in too much of a hurry (Q 14). |
10. Hospital management support regarding patient safety | The management or directors of the hospital provide a working climate that fosters patient safety (Q 23). The management or directors of the hospital prove with actions that patient safety is one of their priorities (Q 30). The management or directors of the hospital only seem to be interested in patient safety when an adverse event happens to a patient (Q 31). |
Block C. Aspects of the culture of safety at the whole hospital level | |
11. Teamwork between units/services | There is close cooperation between the units/services which have to work together (Q 26). Services/units work together in a coordinated way to provide the best care possible (Q 32). Different hospital units are not well coordinated (Q 24). It is usually uncomfortable to work with personnel from other units/services (Q 28). |
12. Problems when shifts change or in transitions between services/units | Patient information is lost, in part, when transferred from one unit/service to another (Q 25). During shift changes, important information about the care a patient has received is frequently lost (Q 27). The exchange of information between different services is regularly problematic (Q 29). Problems with patient care arise as a consequence of shift changes (Q 33). |
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Mutualia 2009 | Mutualia 2017 | |
---|---|---|
Number of hospitals | 2 | 3 |
Number of professionals | 349 | 395 |
Number of responses | 130 | 152 |
Response rate (%) | 37.2 | 38.5 |
Tenure in current profession (years, mean ± SD) | 14.4 ± 9.6 | 18.1 ± 9.43 ** |
Tenure with Mutualia (years, mean ± SD) | 11.1 ± 9.3 | 13.5 ± 8.9 * |
Tenure in current work area (years; median and range) | 6 (1–35) | 11 (40–1) ** |
Full-time employees (>37.5 h/s) (%) | 89.54 | 90.5 (n.s.) |
Mutualia 2009 | Mutualia 2017 | |
---|---|---|
1. Anesthesiology/Reanimation | ||
2. Surgery | ||
3. Diverse Units | 3.3% | 10.7% |
4. Pharmacy | ||
5. Laboratory | ||
6. Internal Medicine | 1.7% | 0.7% |
7. Obstetrician and Gynecology | ||
8. Admission | 5.8% | 8.1% |
9. Nephrology | ||
10. Urology | ||
11. Oncology | ||
12. Pediatrics | ||
13. Radiology | 2.5% | 4.7% |
14. Rehabilitation | 33.1% | 20.1% |
15. Mental Health/Psychiatry | ||
16. Emergency Service | 14.0% | 14.1% |
17. ICU (any type) | ||
18. Neurology | ||
19. Traumatology | 27.3% | 18.1% |
20. Hemodialysis | ||
21. Nuclear Medicine | ||
22. Other | 12.4% | 18.1% |
Job Post | Mutualia 2009 | Mutualia 2017 |
---|---|---|
Management | ||
Administration | 8.2% | 14.2% |
Nursing Assistant | 11.5% | 7.7% |
Dietician | ||
Nurse | 21.3% | 32.4% |
Pharmacist | ||
Resident Pharmacist | ||
Physiotherapy | 22.1% | 14.9% |
Doctor | 29.5% | 24.3% |
Resident Doctor | 0.8% | 0.7% |
Technician (ECG, laboratory, X-ray diagnosis…) | 2.5% | 2.0% |
Other personnel | 4.1% | 4.1% |
Aspects of the Survey | Mutualia 2009 | Mutualia 2017 | p Value | ||
---|---|---|---|---|---|
% Positive (Mean ± SD) | 95% CI (%) | % Positive (Mean ± SD) | 95% CI (%) | ||
1. Frequency of reports of events | 53.51 ± 7.42 | 46.53–60.47 | 68.60 ± 5.04 | 63.86–73.30 | p < 0.01 |
2. Perception of Safety | 59.15 ± 13.8 | 48.50–69.85 | 65.12 ± 15.39 | 53.21–77.04 | n.s. |
3. Expectations and actions of management/supervisors of the unit/service which foster PS | 73.19 ± 8.41 | 59.81–86.59 | 70.23 ± 9.05 | 55.85–84.65 | n.s. |
4. Organizational learning/continuous improvement | 61.14 ± 19.87 | 42.48–79.79 | 69.38 ± 14.85 | 55.42–83.31 | n.s. |
5. Teamwork in the unit/service | 79.13 ± 7.65 | 66.98–91.32 | 77.93 ± 7.14 | 66.56–89.29 | n.s. |
6. Frankness in communication | 54.06 ± 12.61 | 48.50–72.17 | 59.29 ± 9.96 | 52.08–70.78 | n.s. |
7. Feedback and communication of errors | 58.48 ± 5.35 | 51.45–61.49 | 68.94 ± 6.56 | 62.80–75.13 | p < 0.05 |
8. Non-punitive response to errors | 60.34 ± 10.92 | 51.94–58.73 | 61.45 ± 8.26 | 54.8–68.06 | n.s. |
9. Sufficient personnel | 65 ± 10.94 | 47.59–82.41 | 54.28 ± 4.01 | 47.89–60.66 | n.s. |
10. Support of hospital management regarding patient safety | 65.53 ± 3.15 | 57.75–73.4 | 73.89 ± 4.74 | 62.11–85.69 | n.s. |
11. Teamwork among the units/services | 57.46 ± 9.01 | 50.47–64.43 | 64.59 ± 9.75 | 49.09–80.11 | n.s. |
12. Problems in shift changes and transitions between services | 65.24 ± 7.29 | 53.64–76.86 | 69.44 ± 4.2% | 62.7–76.15 | n.s. |
Strengths | Weaknesses | |||||
---|---|---|---|---|---|---|
Dimension | Item/Question | 2009 | 2017 | Item/Question | 2009 | 2017 |
Dimension 2 | The pace of work is never increased if that would imply sacrificing patient safety (Q 15) | 46.7% | 46.1% | |||
Dimension 3 | My supervisor/boss overlooks patient safety problems which occur habitually (Q 22) | 83.7% | 80.3% | |||
Dimension 4 | When a fault is detected in patient care, appropriate measures are taken to prevent it from happening again (Q 9) | 83.1% | 85.3% | |||
Dimension 5 | Teamwork in the Unit/Service | 79% | 77.9% | |||
Personnel support each other (Q 1) | 82.3% | 84.1% | ||||
In this unit, we treat each other with respect (Q 4) | 88.5% | 84.1% | ||||
Dimension 6 | When personnel see something that could negatively affect the care a patient receives, they can speak about it with complete freedom (Q 35) | 71.5% | 75% | Frankness in communication | 59.3% | 54% |
Personnel may question the decisions or actions of supervisors with complete freedom (Q 37) | 35.3% | 37% | ||||
Dimension 8 | When an error is made, personnel fear that this may be reflected in their file (Q 16) | 50.3% | 48.5% | |||
Dimension 9 | Sufficient personnel | 65% | 54.3% | |||
Dimension 10 | The management or directors of the hospital provide a working climate that fosters patient safety (Q 23) | 69.2% | 75% | |||
The management or directors of the hospital prove with actions that patient safety is one of their priorities (Q 30) | 63.6% | 78% | ||||
Additional information | Information concerning patient’s diagnosis is communicated clearly and quickly to all the professionals involved in the care of that patient. | 75.9% | 80.9% |
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Ulibarrena, M.Á.; Sainz de Vicuña, L.; García-Alonso, I.; Lledo, P.; Gutiérrez, M.; Ulibarrena-García, A.; Echenagusia, V.; Herrero de la Parte, B. Evolution of Culture on Patient Safety in the Clinical Setting of a Spanish Mutual Insurance Company: Observational Study between 2009 and 2017 Based on AHRQ Survey. Int. J. Environ. Res. Public Health 2021, 18, 9437. https://doi.org/10.3390/ijerph18189437
Ulibarrena MÁ, Sainz de Vicuña L, García-Alonso I, Lledo P, Gutiérrez M, Ulibarrena-García A, Echenagusia V, Herrero de la Parte B. Evolution of Culture on Patient Safety in the Clinical Setting of a Spanish Mutual Insurance Company: Observational Study between 2009 and 2017 Based on AHRQ Survey. International Journal of Environmental Research and Public Health. 2021; 18(18):9437. https://doi.org/10.3390/ijerph18189437
Chicago/Turabian StyleUlibarrena, Miguel Ángel, Leire Sainz de Vicuña, Ignacio García-Alonso, Pablo Lledo, Marta Gutiérrez, Asier Ulibarrena-García, Víctor Echenagusia, and Borja Herrero de la Parte. 2021. "Evolution of Culture on Patient Safety in the Clinical Setting of a Spanish Mutual Insurance Company: Observational Study between 2009 and 2017 Based on AHRQ Survey" International Journal of Environmental Research and Public Health 18, no. 18: 9437. https://doi.org/10.3390/ijerph18189437