Factors Predicting Safety Culture Among Nurses in Tertiary Care Hospitals, Thailand
Keywords:
Nursing management, Nurse working hours, Nurse staffing, Safety commitment, safety culture, Structural empowerment, Thailand, work engagementAbstract
Safety culture in healthcare settings is recognized as a critical issue as it enhances the care quality. This predictive study aimed to examine the safety culture and factors predicting safety culture among registered nurses working in four tertiary care hospitals in Thailand. Data were collected from 471 nurses using five research instruments: a demographic data form, the Hospital Survey on Patient Safety Culture, the Managers’ Safety Commitment Scale, the Modified Gallup Q12 Employee Engagement Survey, and the Conditions of Work Effectiveness Questionnaire-II-Thai version. Descriptive statistics and stepwise multiple regression were adopted for data analysis.
The results revealed that the strength composites of safety culture were the feedback and communication about errors (92.63%) and organizational learning continuous improvement (89.57%), while the composites needing improvement were frequency of events reported (44.20%), staffing (40.70%), and non-punitive response to errors (38.93%). The significant predictive factors that explained 33% of the variance in safety culture included structural empowerment, management safety commitment, work engagement, and nurse working hours. Based on the research findings, nursing administrators should strive for an active reporting system for adverse events, particularly non-punitive responses to errors, and manage adequate staffing for patient safety. Critical safety information and necessary resources for nursing practices should be provided to overcome the challenges in their work and thus enhance their learning and growth.
References
1. Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington (DC): National Academies Press (US); 2000. doi:10.17226/9728.
2. Reason J. Human error: models and management. Br Med J. 2000;320(7237):768–70. doi: 10.1136/bmj.320. 7237.768.
3. Damayanti RA, Bachtiar A. Outcome of patient safety culture using the hospital survey on patient safety culture (HSOPSC) in Asia: a systematic review with meta-analysis. Proceedings of the International Conference on Applied Science and Health [Internet] 2019 August; 4: 849-63. [cited 2021Aug 19];4:849-63. Available from: https://publications.inschool.id/index.php/icash/article/view/431
4. Kirwan M, Matthews A, Scott PA. The impact of the work environment of nurses on patient safety outcomes: a multilevel modeling approach. Int J Nurs Stud. 2013;50(2): 253-63. doi: 10.1016/j.ijnurstu.2012.08.020.
5. Wang X, Liu K, You LM, Xiang JG, Hu HG, Zhang LF, Zheng J, Zhu XW. The relationship between patient safety culture and adverse events: a questionnaire survey. Int J Nurs Stud. 2014;51(8):1114-22. doi: 10.1016/j.ijnurstu.2013.12.007.
6. Chaboyer W, Chamberlain D, Hewson-Conroy K, Grealy B, Elderkin T, Brittin M, McCutcheon C, Longbottom P, Thalib L. Safety culture in Australian intensive care units: establishing a baseline for quality improvement. J Crit Care. 2013; 22(2):93-102. doi: 10.4037/ajcc2013722.
7. Ammouri AA, Tailakh AK, Muliira JK, Geethakrishnan R, Al Kindi SN. Patient safety culture among nurses. Int Nurs Rev. 2015; 62(1):102-10. doi: 10.1111/inr.12159.
8. Fassarella CS, Camerini FG, Henrique DDM, Almeida LFD, Figueiredo MDCB. Evaluation of patient safety culture: comparative study in university hospitals. Rev Esc Enferm USP. 2018;52:e03379. doi: 10.1590/S1980-220X2017033803379.
9. Fassarella CS, Silva LDD, Camerini FG, Figueiredo MDCAB. Nurse safety culture in the services of a university hospital. Rev Bras Enferm. 2019; 72(3):767-73. doi:10.1590/0034-7167-2018-0376.
10. Okuyama JHH, Galvão TF, Crozatti MTL, Silva MT. Health professionals’ perception of patient safety culture in a university hospital in São Paulo: a cross-sectional study applying the Hospital Survey on Patient Safety Culture. Sao Paulo Med J. 2019;137(3):216-22. doi: 10.1590/1516-3180. 2018.0430140319.
11. Rajalatchumi A, Ravikumar TS, Muruganandham K, Thulasingam M, Selvaraj K, Reddy MM, Jayaraman B. Perception of patient safety culture among healthcare providers in a tertiary care hospital, South India. J Nat Sci Biol Med. 2018;9(1): 14-8. doi: 10.4103/jnsbm.JNSBM_86_17.
12. Ramos RR, Calidgid CC. Patient safety culture among nurses at a tertiary government hospital in the Philippines. Appl Nurs Res. 2018;44:67-75. doi: 10.1016/j.apnr. 2018.09.007.
13. Ribeliene J, Blazeviciene A, Nadisauskiene RJ, Tameliene R, Kudreviciene A, Nedzelskiene I, Macijauskiene J. Patient safety culture in obstetrics and gynecology and neonatology units: The nurses’ and the midwives’ opinion. J Matern Fetal
Neonatal Med. 2019;32(19):3244-50. doi: 10.1080/14767058.2018.1461831.
14. Zhang L, Thungjaroenkul P, Chitpakdee B. Perceived leadermember exchange and patient safety culture among nurses in tertiary hospitals, Kunming, the People’s Republic of China. Nursing J. 2019;46(2):210-23. Available from: http://cmuir.cmu.ac.th/jspui/handle/ 6653943832/66267
15. Kamsawang N, Supamanee T, Jitpakdee B. Perception of registered nurses towards patient safety culture. Buddhachinaraj Med J. 2017;34(3):330-41 [in Thai]. Available from: https://he01.tci-thaijo.org/index.php/BMJ/article/view/122894/93549
16. Feng XQ, Acord L, Cheng YJ, Zeng JH, Song JP. The relationship between management safety commitment and patient safety culture. Int Nurs Rev. 2011;58(2):249-54. doi: 10.1111/j.1466-7657.2011.00891.x.
17. Wu Y, Fujita S, Seto K, Ito S, Matsumoto K, Huang CC, Hasegawa T. The impact of nurse working hours on patient safety culture: a cross-national survey, including Japan, the United States, and Chinese Taiwan using the Hospital Survey on Patient Safety Culture. BMC Health Serv Res. 2013;13(1):394. doi: 10.1186/1472-6963-13-394.
18. Thorp J, Baqai W, Witters D, Harter J, Agrawal S, Kanitkar K, Pappas J. Workplace engagement and workers’ compensation claims as predictors for patient safety culture. J Patient Saf. 2012;8(4):194-201. doi: 10.1097/PTS.0b013e3182699942.
19. Collier SL, Fitzpatrick JJ, Siedlecki SL, Dolansky MA. Employee engagement and a culture of safety in the intensive care unit. J Nurs Adm. 2016;46(1):49-54. doi: 10.1097/NNA.0000000000000292.
20. Armellino D, Quinn Griffin MT, Fitzpatrick JJ. Structural empowerment and patient safety culture among registered nurses working in adult critical care units. J Nurs Manag. 2010;18(7):796-803.doi: 10.1111/j.1365-2834.2010.01130.x.
21. Armstrong KJ, Laschinger H. Structural empowerment, magnet hospital characteristics, and patient safety culture: making the link. J Nurs Care Qual. 2006;21(2):124-32. doi: 10.1097/00001786-200604000-00007.
22. Health and Safety Commission. ACSNI Human Factors Study Group third report: organising for safety (Third report). Great Britain: HM Stationery Office; 1993. 100p.
23. Jones KJ, Skinner A, Xu L, et al. The AHRQ Hospital Survey on Patient Safety Culture: a tool to plan and evaluate patient safety programs. In: Henriksen K, Battles JB, Keyes MA, et al., editors. Advances in patient safety: new directions and alternative approaches (Vol. 2: culture and redesign). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug [cited 2021 Aug 19]. 22p. Available from: https://www.ncbi.nlm.nih.gov/books/NBK43699/
24. Sorra JS, Nieva VF. Hospital survey on patient safety culture (Prepared by Westat, under contract no. 290-96-0004) [Internet]. AHRQ publication no. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality; 2004. [cited 2021 Aug 19]. 66p. Available from: https://www.ahrq.gov/sites/default/files/publications/files/nhguide.pdf
25. Eraut M. Learning from other people in the workplace. Oxf Rev Educ. 2007;33(4):403-22. doi: 10.1080/03054980701425706.
26. Lacerenza, CN, Marlow SL, Tannenbaum SI, Salas E. Team development interventions: evidence-based approaches for improving teamwork. Am Psychol. 2018;73(4):517-31. doi: 10.1037/amp0000295.
27. Thailand Nursing and Midwifery Council [TNMC]. Nurse Nursing and Midwifery Council Announcement: nursing working hours for patient safety. [Internet]. [cited 2021 Aug 19]. Available from: https://www.tnmc.or.th/images/userfiles/files/H002.pdf [in Thai]
28. Hoffman AJ, Scott LD. Role stress and career satisfaction among registered nurses by work shift patterns. J Nurs Adm. 2003;33(6):337-42. doi:10.1097/00005110-200306000-00006.
29. McGonagle AK, Essenmacher L, Hamblin L, Luborsky M, Upfal M, Arnetz J. Management commitment to safety, teamwork, and hospital worker injuries. J Hosp Adm. 2016;5(6):46-52. doi: 10.5430/jha.v5n6p46.
30. Harter JK, Schmidt FL, Hayes TL. Business-unit-level relationship between employee satisfaction, employee engagement, and business outcomes: a meta-analysis. J Appl Psychol. 2002; 87(2): 268-79. doi: 10.1037/0021-9010.87.2.268.
31. Kanter RM. Men and women of the corporation: new edition. New York: Basic books; 2008. 416 p.
32. Laschinger HKS, Finegan J, Shamian J. The impact of workplace empowerment, organizational trust on staff nurses› work satisfaction and organizational commitment. Health Care Manage Rev. 2001;26(3):7-23. doi:10.1097/00004010-200107000-00002.
33. Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970;30(3):607-10.doi: 10.1177/001316447003000308.
34. Sorra J, Franklin M, Streagle S. Survey User’s guide nursing home survey on patient safety culture. Rockville, MD: Agency for Healthcare Research and Quality; 2008 Sept [cited 2021Aug 19]. 57p. Available from: https://www.ahrq.gov/sites/default/files/publications/files/nhguide.pdf
35. Laimek S. The influence of work environment and structural empowerment on job satisfaction among Thai nurses [Doctoral dissertation]. [Madison, WI]: University of Wisconsin-Madison; 2014. 168 p.
36. Brislin RW. The wording and translation of research instruments. In: Lonner WJ, Berry JW, editors. Field methods in cross-cultural research. Beverly Hills, CA: Sage Publications, 1986. pp. 137-64.
37. Hospital Accreditation Institution (Public organization). Patient safety goals: SIMPLE. Nonthaburi: Famous and Successful; 2018 (in Thai).
38. Gurková E, Zeleníková R, Friganovic A, Uchmanowicz I, Jarošová D, Papastavrou E, Žiaková K. Hospital safety climate from nurses’ perspective in four European countries. Int Nurs Rev. 2020;67(2):208-17. doi:10.1111/inr.12561.
39. Tomazani A, Rocha PA, Sauza S, Anders JA, Malfussi HFC. Patient safety culture at neonatal intensive care units:perspectives of the nursing and medical team. Rev Esc Enferm USP. 2016:50(5);756-62. doi: 10.1590/0104-1169.3624.2477.
40. Williams JC. Nurses’ organizational commitment, job satisfaction, and perception of their managers’ leadership style as predictors of perception of patient safety culture [Doctoral dissertation]. [Minneapolis, MN]: Capella University; 2014. 197 p.
2. Reason J. Human error: models and management. Br Med J. 2000;320(7237):768–70. doi: 10.1136/bmj.320. 7237.768.
3. Damayanti RA, Bachtiar A. Outcome of patient safety culture using the hospital survey on patient safety culture (HSOPSC) in Asia: a systematic review with meta-analysis. Proceedings of the International Conference on Applied Science and Health [Internet] 2019 August; 4: 849-63. [cited 2021Aug 19];4:849-63. Available from: https://publications.inschool.id/index.php/icash/article/view/431
4. Kirwan M, Matthews A, Scott PA. The impact of the work environment of nurses on patient safety outcomes: a multilevel modeling approach. Int J Nurs Stud. 2013;50(2): 253-63. doi: 10.1016/j.ijnurstu.2012.08.020.
5. Wang X, Liu K, You LM, Xiang JG, Hu HG, Zhang LF, Zheng J, Zhu XW. The relationship between patient safety culture and adverse events: a questionnaire survey. Int J Nurs Stud. 2014;51(8):1114-22. doi: 10.1016/j.ijnurstu.2013.12.007.
6. Chaboyer W, Chamberlain D, Hewson-Conroy K, Grealy B, Elderkin T, Brittin M, McCutcheon C, Longbottom P, Thalib L. Safety culture in Australian intensive care units: establishing a baseline for quality improvement. J Crit Care. 2013; 22(2):93-102. doi: 10.4037/ajcc2013722.
7. Ammouri AA, Tailakh AK, Muliira JK, Geethakrishnan R, Al Kindi SN. Patient safety culture among nurses. Int Nurs Rev. 2015; 62(1):102-10. doi: 10.1111/inr.12159.
8. Fassarella CS, Camerini FG, Henrique DDM, Almeida LFD, Figueiredo MDCB. Evaluation of patient safety culture: comparative study in university hospitals. Rev Esc Enferm USP. 2018;52:e03379. doi: 10.1590/S1980-220X2017033803379.
9. Fassarella CS, Silva LDD, Camerini FG, Figueiredo MDCAB. Nurse safety culture in the services of a university hospital. Rev Bras Enferm. 2019; 72(3):767-73. doi:10.1590/0034-7167-2018-0376.
10. Okuyama JHH, Galvão TF, Crozatti MTL, Silva MT. Health professionals’ perception of patient safety culture in a university hospital in São Paulo: a cross-sectional study applying the Hospital Survey on Patient Safety Culture. Sao Paulo Med J. 2019;137(3):216-22. doi: 10.1590/1516-3180. 2018.0430140319.
11. Rajalatchumi A, Ravikumar TS, Muruganandham K, Thulasingam M, Selvaraj K, Reddy MM, Jayaraman B. Perception of patient safety culture among healthcare providers in a tertiary care hospital, South India. J Nat Sci Biol Med. 2018;9(1): 14-8. doi: 10.4103/jnsbm.JNSBM_86_17.
12. Ramos RR, Calidgid CC. Patient safety culture among nurses at a tertiary government hospital in the Philippines. Appl Nurs Res. 2018;44:67-75. doi: 10.1016/j.apnr. 2018.09.007.
13. Ribeliene J, Blazeviciene A, Nadisauskiene RJ, Tameliene R, Kudreviciene A, Nedzelskiene I, Macijauskiene J. Patient safety culture in obstetrics and gynecology and neonatology units: The nurses’ and the midwives’ opinion. J Matern Fetal
Neonatal Med. 2019;32(19):3244-50. doi: 10.1080/14767058.2018.1461831.
14. Zhang L, Thungjaroenkul P, Chitpakdee B. Perceived leadermember exchange and patient safety culture among nurses in tertiary hospitals, Kunming, the People’s Republic of China. Nursing J. 2019;46(2):210-23. Available from: http://cmuir.cmu.ac.th/jspui/handle/ 6653943832/66267
15. Kamsawang N, Supamanee T, Jitpakdee B. Perception of registered nurses towards patient safety culture. Buddhachinaraj Med J. 2017;34(3):330-41 [in Thai]. Available from: https://he01.tci-thaijo.org/index.php/BMJ/article/view/122894/93549
16. Feng XQ, Acord L, Cheng YJ, Zeng JH, Song JP. The relationship between management safety commitment and patient safety culture. Int Nurs Rev. 2011;58(2):249-54. doi: 10.1111/j.1466-7657.2011.00891.x.
17. Wu Y, Fujita S, Seto K, Ito S, Matsumoto K, Huang CC, Hasegawa T. The impact of nurse working hours on patient safety culture: a cross-national survey, including Japan, the United States, and Chinese Taiwan using the Hospital Survey on Patient Safety Culture. BMC Health Serv Res. 2013;13(1):394. doi: 10.1186/1472-6963-13-394.
18. Thorp J, Baqai W, Witters D, Harter J, Agrawal S, Kanitkar K, Pappas J. Workplace engagement and workers’ compensation claims as predictors for patient safety culture. J Patient Saf. 2012;8(4):194-201. doi: 10.1097/PTS.0b013e3182699942.
19. Collier SL, Fitzpatrick JJ, Siedlecki SL, Dolansky MA. Employee engagement and a culture of safety in the intensive care unit. J Nurs Adm. 2016;46(1):49-54. doi: 10.1097/NNA.0000000000000292.
20. Armellino D, Quinn Griffin MT, Fitzpatrick JJ. Structural empowerment and patient safety culture among registered nurses working in adult critical care units. J Nurs Manag. 2010;18(7):796-803.doi: 10.1111/j.1365-2834.2010.01130.x.
21. Armstrong KJ, Laschinger H. Structural empowerment, magnet hospital characteristics, and patient safety culture: making the link. J Nurs Care Qual. 2006;21(2):124-32. doi: 10.1097/00001786-200604000-00007.
22. Health and Safety Commission. ACSNI Human Factors Study Group third report: organising for safety (Third report). Great Britain: HM Stationery Office; 1993. 100p.
23. Jones KJ, Skinner A, Xu L, et al. The AHRQ Hospital Survey on Patient Safety Culture: a tool to plan and evaluate patient safety programs. In: Henriksen K, Battles JB, Keyes MA, et al., editors. Advances in patient safety: new directions and alternative approaches (Vol. 2: culture and redesign). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug [cited 2021 Aug 19]. 22p. Available from: https://www.ncbi.nlm.nih.gov/books/NBK43699/
24. Sorra JS, Nieva VF. Hospital survey on patient safety culture (Prepared by Westat, under contract no. 290-96-0004) [Internet]. AHRQ publication no. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality; 2004. [cited 2021 Aug 19]. 66p. Available from: https://www.ahrq.gov/sites/default/files/publications/files/nhguide.pdf
25. Eraut M. Learning from other people in the workplace. Oxf Rev Educ. 2007;33(4):403-22. doi: 10.1080/03054980701425706.
26. Lacerenza, CN, Marlow SL, Tannenbaum SI, Salas E. Team development interventions: evidence-based approaches for improving teamwork. Am Psychol. 2018;73(4):517-31. doi: 10.1037/amp0000295.
27. Thailand Nursing and Midwifery Council [TNMC]. Nurse Nursing and Midwifery Council Announcement: nursing working hours for patient safety. [Internet]. [cited 2021 Aug 19]. Available from: https://www.tnmc.or.th/images/userfiles/files/H002.pdf [in Thai]
28. Hoffman AJ, Scott LD. Role stress and career satisfaction among registered nurses by work shift patterns. J Nurs Adm. 2003;33(6):337-42. doi:10.1097/00005110-200306000-00006.
29. McGonagle AK, Essenmacher L, Hamblin L, Luborsky M, Upfal M, Arnetz J. Management commitment to safety, teamwork, and hospital worker injuries. J Hosp Adm. 2016;5(6):46-52. doi: 10.5430/jha.v5n6p46.
30. Harter JK, Schmidt FL, Hayes TL. Business-unit-level relationship between employee satisfaction, employee engagement, and business outcomes: a meta-analysis. J Appl Psychol. 2002; 87(2): 268-79. doi: 10.1037/0021-9010.87.2.268.
31. Kanter RM. Men and women of the corporation: new edition. New York: Basic books; 2008. 416 p.
32. Laschinger HKS, Finegan J, Shamian J. The impact of workplace empowerment, organizational trust on staff nurses› work satisfaction and organizational commitment. Health Care Manage Rev. 2001;26(3):7-23. doi:10.1097/00004010-200107000-00002.
33. Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970;30(3):607-10.doi: 10.1177/001316447003000308.
34. Sorra J, Franklin M, Streagle S. Survey User’s guide nursing home survey on patient safety culture. Rockville, MD: Agency for Healthcare Research and Quality; 2008 Sept [cited 2021Aug 19]. 57p. Available from: https://www.ahrq.gov/sites/default/files/publications/files/nhguide.pdf
35. Laimek S. The influence of work environment and structural empowerment on job satisfaction among Thai nurses [Doctoral dissertation]. [Madison, WI]: University of Wisconsin-Madison; 2014. 168 p.
36. Brislin RW. The wording and translation of research instruments. In: Lonner WJ, Berry JW, editors. Field methods in cross-cultural research. Beverly Hills, CA: Sage Publications, 1986. pp. 137-64.
37. Hospital Accreditation Institution (Public organization). Patient safety goals: SIMPLE. Nonthaburi: Famous and Successful; 2018 (in Thai).
38. Gurková E, Zeleníková R, Friganovic A, Uchmanowicz I, Jarošová D, Papastavrou E, Žiaková K. Hospital safety climate from nurses’ perspective in four European countries. Int Nurs Rev. 2020;67(2):208-17. doi:10.1111/inr.12561.
39. Tomazani A, Rocha PA, Sauza S, Anders JA, Malfussi HFC. Patient safety culture at neonatal intensive care units:perspectives of the nursing and medical team. Rev Esc Enferm USP. 2016:50(5);756-62. doi: 10.1590/0104-1169.3624.2477.
40. Williams JC. Nurses’ organizational commitment, job satisfaction, and perception of their managers’ leadership style as predictors of perception of patient safety culture [Doctoral dissertation]. [Minneapolis, MN]: Capella University; 2014. 197 p.
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2021-12-09
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Boonyaphisompan P, Akkadechanunt T, Kunaviktikul W, Chanprasit C. Factors Predicting Safety Culture Among Nurses in Tertiary Care Hospitals, Thailand. PRIJNR [Internet]. 2021 Dec. 9 [cited 2024 Nov. 22];26(1):37-49. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/255273
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