Hospital management priorities and key factors affecting overall perception of patient safety: a cross-sectional study

Evaluating a staff's perception of patient safety is a vital factor in hospital management. Studies of the awareness of a safety culture among medical staff are helpful to hospital managers.^1,2 Recently, a researcher suggested that knowledge-oriented objective learning may not lead to improvement, since the real challenge is to discover an effective means to address the shortcomings embedded in staff's attitudes and culture.³ Others have claimed that staff members’ subjective feelings of procedures and systems in hospitals are more important than their cognition level or background characteristics.^4,5 Understanding how procedures and systems function and how to prevent errors is beneficial; the overall perception of patient safety, a dimension of the hospital survey on patient safety culture (HSOPSC), measures this understanding.⁶ More specifically, an understanding of the factors associated with increased staff perception of patient safety is important.^4,5 Other experts have emphasized that a successive measurement of safety culture and a tailored safety program could be effective.^7,8 Furthermore, the HSOPSC is widely used and has been improved to meet changing needs.⁹

Studies conducted in countries using the HSOPSC have produced varied results, and several critical points should be noted. Critical demographic variables can affect the viewpoints of medical staff on patient safety culture and understanding these variables in the local context is important.¹⁰ The disadvantaged domains revealed by the HSOPSC vary by report, and evaluating these differences and measures is key to hospital management.^11,12 The dimensions of the HSOPSC contribute far more to the overall patient safety than do background characteristics, and controlling potential confounders can help prioritize actions.⁵

The value and efficiency are newly recognized aspects of patient safety culture in hospitals and knowledge and data pertaining to patient safety culture are limited. Most studies have centered on cost control, process improvements, and human resource management.^13,14 Few studies have investigated the value and efficiency culture from the viewpoint of medical staffs.^9,15,16 The high-value care culture survey (HVCCS) contains 4 dimensions, namely leadership and health system messaging and data transparency and access, and it targets future improvements in value-based care.¹⁶ Furthermore, the agency for healthcare research and quality (AHRQ) developed supplemental items for the HSOPSC to test value and efficiency in hospitals.⁹ These measures are valuable but have not been used widely.

The aim of this study is to investigate the perceptions of patient safety among medical staff. More specifically, the objectives are to (1) find priorities in hospital management and (2) find the key dimensions that can significantly affect patient safety.

This survey studied 595 medical staff members’ perceptions of patient safety culture using the HSOPSC and its supplemental items. Two dimensions of the HSOPSC, namely nonpunitive response to error and staffing, received low scores. Staff perceptions of the value and efficiency of the hospitals received high scores, but there is an obvious shortage of activities aimed at improving efficiency. The overall perception of patient safety is a core topic in this analysis. Five critical dimensions of safety culture are important and can positively affect the overall perception of patient safety. The scored values of participant demographic and background characteristics were less significant when compared with these 5 critical dimensions. Above all, the results help determine future directions to improve patient safety.

Nonpunitive management in hospitals is vital for patient safety, and it makes staff feel that they can report adverse events and receive support when needed.⁶ The more the number of events reported, the more chances there are to observe issues and improve the medical service system.^20,21 Positive responses to nonpunitive response to error varied from 14% to 49%,^11,22,23 and this core concern of management may be a comprehensiveness problem.²⁴ Studies have shown that nonpunitive response to error relates to the culture of culpability, effective communication, feedback to errors, engaged leadership, second victim focus, nursing peer review, and culture in general.^{24, 25, 26}

The results for staffing suggest that hospital staff members feel that they are hardly able to handle their workload and work hours, which could have a negative effect on patient care.⁶ A study proved that workload and work time correlate with staff health and patient outcomes.^27,28 Experientially, various programs of work-force management, teamwork, or team communication may aid in staffing, but more creative pathways are needed to change the subjective feelings of staff.

Promoting staff participation in efficiency activities is necessary. This study indicated a deficiency in the dissemination of efficiency activities among staff and other workers. According to the AHRQ reports, there is an obvious shortage in staff education on identifying waste and inefficiencies at work,¹⁸ such as by understanding how to make a good suggestion, how to evaluate their work by visual display, and so on. Moreover, low training participation reveals the presence not only of problems in education but also problems with teamwork across units, problems pertaining to open communication, and problems concerning supervisor expectations and support.^22,29 Improving efficiency requires various efforts, and it is of value to create a high-value person-centered care culture.^16,30

Five dimensions of patient safety can explain 37.7% of the variation in the overall perception of patient safety, with handoffs and transitions being the most important factors. Consistent with other studies, the results suggest that communicating care information across hospital units and during shift changes is an important process.^31,32 Many methods can help to make handoffs and transitions safer and more effective.^33,34 Continuous improvement in these processes should be emphasized.

Furthermore, staffing, supervisor expectations, actions promoting patient safety, efficiency and waste reduction, and organizational learning – continuous improvement have positive effects on the overall perception of patient safety. Therefore, improving these 4 factors is a priority. For example, supervisors should consider staff suggestions to improve patient safety; staff and others should try to find additional ways to reduce non-productive time in their work, including elimination of unnecessary tests and procedures for patients.

The present study measured value, efficiency, and patient safety culture views of the medical staffs of 2 hospitals. Hospital managers should pay more attention to nonpunitive management and staffing. Handoffs and transitions are the most important areas for improving patient safety in hospitals.