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Rationale, aims, and objectives Patient safety is recognized as a key indicator of quality of medical care. International experience has shown that all efforts should focus on the delivery of a safer work environment and health care system as a whole in order to reduce or mitigate medical errors and their impact on society. The aim of this study is to investigate and classify the most common incidents regarding patient safety as well as their contributory factors, based on personal real-life experiences and situations in medical care reported by health care professionals. Methods A mixed-methods study design was used. Sixty-five respondents participated (aged from 23 to 58 y). Reported cases of undesirable events (UE), medical errors (ME), and near misses (NM) were collected, processed, and analysed based on our original conceptual framework. A qualitative content analysis and descriptive statistics were conducted on the narratives in all 34 reported valid case files. Intercoder reliability was measured through the kappa statistics (κ = .69). The overall agreement of judgments on all codes was excellent (95%). Results A total of 29 MEs in 34 cases were reported. In 85% of them, an average of 1.83 contributory factors were identified. The most common contributory factors were "Incompetence," "Neglect," "Severe work overload," and "Shortage of staff." Discussion Important steps to prevent medical errors are their identification and reporting. Conclusion Health care professionals appear able to report UEs, MEs, and NMs occurring in medical care practice. They seem more willing to report and distinguish incidents related to MEs than to UEs and NMs.

This paper aimed to review and analysis of current literature, based on the complex evaluation of the publications in the available national and international literature, related to hospital patient safety culture. >A literature review was conducted via searching the MEDLINE, PubMed, Google Scholar and Sofia Central Medical Library electronic databases. Relevant publications were also retrieved from the paper-based collection at the Medical University in Plovdiv, using the “de visu” approach. "Patient safety", "safety culture", "hospital safety culture", "prevention of medical errors", "patient safety reporting system" and "medical error" served as search keywords. The study selection identified a total of 224 surveys. Finally, only 21 articles were examined and discussed in the review. The current literature review shows the need to develop and maintain a positive patient safety culture in the healthcare settings in Bulgaria. It requires amendments to the existing regulations, the introduction of uniform taxonomy, universal measuring instruments of patient safety culture and registration of medical errors in healthcare settings.

Background and aims. Patient safety culture (PSC) is an essential component of the quality of healthcare. Improving PSC is considered a priority in many developed countries. A specialized software platform for registration and evaluation of hospital patient safety culture has been developed with the support of the Medical University Plovdiv Project №11/2017. The aim of the study is to assess the status of PSC in Bulgarian hospitals and to compare it to that in USA and Croatian hospitals. Methods. The study was conducted from June 01 to July 31, 2018 using the web-based Bulgarian Version of the Hospital Survey on Patient Safety Culture Questionnaire (B-HSOPSC). Two hundred and forty-eight medical professionals from different hospitals in Bulgaria participated in the study. In order to quantify the differences of positive scores distributions for each of the 42 HSOPSC items between Bulgarian, Croatian and USA samples, the χ2-test was applied. The research hypothesis assumed that there were no significant differences between the Bulgarian, Croatian and US PSCs. Results. The results revealed 14 significant differences in the positive scores between the Bulgarian and Croatian PSCs and 15 between the Bulgarian and the USA PSC, respectively. Bulgarian medical professionals provided less positive responses to 12 items compared with Croatian and USA respondents. The Bulgarian respondents were more positive compared to Croatians on the feedback and communication of medical errors (Items - C1, C4, C5) as well as on the employment of locum staff (A7) and the frequency of reported mistakes (D1). Bulgarian medical professionals were more positive compared with their USA colleagues on the communication of information at shift handover and across hospital units (F5, F7). The distribution of positive scores on items: “Staff worry that their mistakes are kept in their personnel file” (RA16), “Things ‘fall between the cracks’ when transferring patients from one unit to another” (RF3) and “Shift handovers are problematic for patients in this hospital” (RF11) were significantly higher among Bulgarian respondents compared with Croatian and US respondents. Conclusions. Significant differences of positive scores distribution were found between Bulgarian and USA PSC on one hand and between Bulgarian and Croatian on the other. The study reveals that distribution of positive responses could be explained by the cultural, organizational and healthcare system differences.

Patient safety is an essential element of healthcare quality and an important component of organizational culture. The aim of the study was to compare patient safety culture between private and public hospitals in Bulgaria using a web-based version of the Hospital Survey on Patient Safety Culture. A cross-sectional survey was conducted among 384 healthcare specialists: 206 from public and 152 from private hospitals. Twenty-six of the respondents did not specify the hospital ownership type. The data were exported to SPSS 17.0 statistical software and analyzed with descriptive statistics and non-parametric Mann-Whitney U test. The results showed that private hospitals staff provided higher mean rates to all questionnaire items, except to items: “Staff in this unit work longer hours than is best for patient care”, “We use more agency staff than is best for patient care” and “Whenever pressure builds up, my supervisor wants us to work faster, even if it means taking shortcuts”. The type of hospital ownerships did not seem to affect significantly positive responses given to items: “We use more agency staff than is best for patient care”, “Patient safety is never sacrificed to get more work done”, “Staff worry that mistakes they make are kept in their personnel file”, “My supervisor overlooks patient safety problems that happen over and over” and “Important patient care information is often lost during shift changes”. Significant differences of positive scores distribution were found between patient safety culture in public and private hospital due to the differences in the organizational culture and management style in the two different hospital types.