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The COVID-19 pandemic has posed unprecedented challenges with its impact on patient safety culture and staff well-being. This study was to identify potential changes in safety culture among health care workers from before to during the COVID-19 pandemic, and to determine the differences across occupational groups. The Safety Attitudes Questionnaire (SAQ) was administered electronically in both English and Malay languages using the Google Forms platform in 2018 and was repeated in 2021, during the COVID-19 pandemic. Comparisons were made between 2018 and 2021 to determine changes in patient safety culture for the overall staff population and by occupational groups. A total of 3175 health care workers completed the questionnaire in 2021. Overall, a comparable percentage agreement was found for all SAQ domains in 2018 and 2021 with visible improvements for doctors and support staff. Safety Attitudes Questionnaire domain scores differed in teamwork, safety climate, perception of hospital management, and working condition domains across occupational groups. Self-isolation and COVID-19 were associated with poorer SAQ domain scores, while redeployment was associated with improvements in SAQ domain scores. Interventions targeting areas of weakness as well as utilizing positive experiences such as redeployment should be explored to enhance patient safety in hospitals settings postpandemic. [ABSTRACT FROM AUTHOR]

Chih-Hsuan Huang,1– 3 Hsin-Hung Wu,4,5 Yii-Ching Lee,6 Xiumei Li1 1Business School, Hubei University of Economics, Wuhan City, People’s Republic of China; 2Hubei Enterprise Culture Research Center, Hubei University of Economics, Wuhan, People’s Republic of China; 3Research Center of Hubei Logistics Development, Hubei University of Economics, Wuhan, People’s Republic of China; 4Department of Business Administration, National Changhua University of Education, Changhua City, Taiwan; 5Faculty of Education, State University of Malang, Malang, East Java, Indonesia; 6Department of Health Business Administration, Hung Kuang University, Taichung City, TaiwanCorrespondence: Yii-Ching Lee, Department of Health Business Administration, Hung Kuang University, No. 34 Zhongqi Road, Shalu District, Taichung City, Taiwan, Tel +886-4-26318652, Email yiiching.lee@sunrise.hk.edu.twPurpose: This research aims to investigate the role of management leadership in promoting a culture of patient safety within healthcare organizations. Through a comprehensive mediation analysis of the Chinese version of the safety attitudes questionnaire (CSAQ) and patient safety culture, the study examines the interplay between these critical factors and their combined influence on healthcare outcomes.Patients and Methods: In a medical center located in Taiwan, a cross-sectional survey was carried out utilizing the CSAQ. Among the 1500 distributed surveys, 1037 were returned and deemed valid, resulting in a return rate of 69.13%. To investigate the main measures, Structural Equation Modeling with mediation analysis was employed to scrutinize the direct and indirect effects of factors including teamwork climate, job satisfaction, stress recognition, perceptions of management, working conditions, and emotional exhaustion on safety climate.Results: The findings reveal that effective management leadership plays a pivotal role in shaping safety attitudes and fostering a robust patient safety culture. The study identifies three critical facets of patient safety that are entirely mediated by management perceptions: teamwork climate, working conditions, and stress recognition. The results highlight the importance of enhancing these dimensions to advance the patient safety culture within healthcare organizations. Moreover, stress recognition is identified as a critical factor influencing the organizational culture of patient safety.Conclusion: This research offers valuable insights for healthcare organizations seeking to prioritize patient safety and improve overall quality of care. By enhancing our understanding of the critical factors that shape safety attitudes and patient safety culture, this study provides a roadmap for effective management leadership and a culture of patient safety within healthcare organizations. The study underscores the significance of management leadership in promoting patient safety culture and highlights the importance of enhancing teamwork climate, working conditions, and stress recognition to advance patient safety culture.Keywords: management leadership, safety attitudes questionnaire, patient safety culture, mediation effect

Tien Zubaidah,1 Norlaila Sofia2 1Environmental Health Department, Poltekkes Kemenkes, Banjarmasin, Indonesia; 2Midwifery Department, Poltekkes Kemenkes, Banjarmasin, IndonesiaCorrespondence: Tien Zubaidah, Department of Health, Poltekkes Kemenkes, Jl. H. Mistar Cokrokusumo No. 1A Kelurahan Sei Besar Banjarbaru, Banjarmasin, Kalimantan Selatan, Indonesia, Email tien.zubaidah@gmail.com

Introduction: This paper takes a detailed look at safety culture, different roles, and powers shared by managers, lessons from which can be applied in any form of management. It also focuses on the job of managers in enhancing safety standards in a health institution. The objective of this paper was to examine the managers’ perception of patient safety culture. Methods: This study followed a quantitative cross-sectional design. The research procedure involved all middle-level managers in Aseer Central Hospital in Abha, Saudi Arabia (N = 52). To assess the status of patient safety culture and the role of healthcare managers in the field study, the researchers constructed a study questionnaire; it included questions adapted and modified from the Safety Attitudes Questionnaire, the Hospital Survey on Patient Safety Culture questionnaire, the 10 Mintzberg managerial roles and the six types of power for healthcare managers. Results: Most participants were Saudi nationals (73.1%) aged 31 to 40 years (44.2%). The managerial role practiced frequently was leadership (85%), but the least managerial role was the figurehead (23%). Mangers held positive attitudes toward patient safety culture with 100% positive replies. No significant association was found between sex, nationality, years of experience, and professions concerning patient safety. Additionally, the results indicated that most managers were willing to uphold a safe environment for their patients and ready to involve employees in decision-making strategies to motivate them. Conclusion: The managerial choices in Aseer Central Hospital are based on the culture and tradition of the community, which might negatively undermine the capability of other individuals handling the same office based on their educational backgrounds and competency. Such situations also may demoralize the employees, leading to poor employee performance Suboptimal achievement was exhibited primarily by middle-level healthcare managers of all six power types: resource allocator, negotiator, liaison, spokesperson, figurehead, and entrepreneur. Therefore, there is a pressing need to improve managers’ attitudes toward patient safety and activate managerial roles to ensure patients’ safety is practiced unequivocally.

This research initiates a comprehensive evaluation of safety awareness among emergency medical service (EMS) practitioners in Riyadh, Saudi Arabia, an area experiencing substantial academic and regulatory transformation. By employing the Safety Attitudes Questionnaire, the study explores safety awareness across various EMS domains, unveiling a significant consistency that is unaffected by the work environment, professional tenure, or gender. Importantly, there are no significant disparities in safety awareness between hospital-based EMS practitioners and their pre-hospital counterparts, regardless of their tenure or gender. The findings highlight a homogenous safety awareness landscape among Riyadh's EMS practitioners, suggesting strategies to sustain and strengthen patient safety culture irrespective of workspace, experience, or gender. This research not only presents these key findings but also advocates for sustainable resilience in healthcare delivery. It emphasizes the need for continued efforts to instill a culture of safety, underpinned by regular training and the adoption of swift response strategies, ensuring a sustainable approach to patient safety in times of crisis. [ABSTRACT FROM AUTHOR]

IntroductionImproving patient safety is one of the most critical components of modern healthcare. Emergency medical services (EMS) are, by nature, a challenging environment for ensuring patient safety. It is fast-paced, physically dangerous, and highly stressful, requiring rapid decision-making and action. This can create risks not only for patients but also for employees. We assessed variations in perceptions of safety culture in prehospital emergency care among an international sample of paramedics and nurses.MethodsThe Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ) was used for the study. The instrument measures six domains of safety culture in the workplace: teamwork climate, job satisfaction, safety climate, working conditions, stress recognition, and perceptions of management. A total of 1,128 EMS from 9 countries participated in this study.ResultsSafety Climate was 81.32/100 (SD 6.90), Teamwork Climate 84.14/100 (SD 8.74), Perceptions of Management 76.30/100 (SD 10.54), Stress Recognition 89.86/100 (SD 5.70), Working Conditions 81.07/100 (SD 9.75), and Job Satisfaction 70.71/100 (SD 7.21). There was significant variation in safety culture scores across countries for teamwork climate (TWC), working conditions (WC), and job satisfaction (JS). Among the individual variables (age, gender, level of education, and work experience), variations in safety culture scores were unaffected by age, gender, or work experience. Organizational characteristics: employment status and position type were linked to significant variations in safety culture domain scores.ConclusionParticipants’ perceptions of the patient safety climate were not particularly satisfactory, confirming that there is still a need to develop a culture of patient safety in prehospital emergency care.

The study aimed to compare the evolution of patient safety culture perceived by high-risk hospital staff in the context of the COVID-19 pandemic and non-COVID-19 pandemic and to examine the variations in patient safety culture across demographic variables. The study found that the COVID-19 pandemic has significantly impacted patient safety culture in healthcare settings, with an increased focus on safety climate, job satisfaction, teamwork climate, stress recognition, and emotional exhaustion. Safety culture and work stress vary among medical professionals of different age groups. To reduce stress, workload should be minimized, work efficiency improved, and physical and mental health promoted. Strengthening safety culture can reduce work-related stress, improve job satisfaction, and increase dedication towards work. The study recommends interventions such as psychological and social support, along with emotional management training, to reduce emotional exhaustion. Healthcare institutions can set up psychological counseling hotlines or support groups to help medical professionals reduce stress and emotional burden.

La cultura della sicurezza in sala operatoria viene misurata sistematicamente e con strumenti validati solo in poche realtà: a tale scopo, l’obiettivo dello studio è adattare al contesto italiano il Safety Attitudes Questionaire OR Version (SAQ-OR). La versione tradotta in italiano è testata su 48 operatori e su un gruppo di esperti, ricercando la validità di facciata e di contenuto [indice di Validità del Contenuto (I-CVI); indice di Validità della Scala (S-CVI)]; l’affidabilità della consistenza interna con Alpha di Cronbach; la stabilità dell’affidabilità con l’indice di Pearson. Cinquantasei dei cinquantanove item sono stati considerati chiari da almeno l’80% del campione: gli item non chiari sono stati rivalutati. Otto item presentavano I-CVI minore della soglia di 0.8, e sono stati riesaminati. S-CVI = 0.9; Alpha di Cronbach = 0,95; indice di Pearson = 0,861. L’adattamento linguistico-culturale in italiano del SAQ-OR rappresenta un punto di partenza per verificarne la validità di costrutto.

Introduction: Patient safety depends on a number of factors such as teamwork, working climate, employee satisfaction, work environment, stress awareness, management perception, and attitude. Nurses have a key role to play in protecting and supporting patients, and their assessment serves as a reliable predictor of overall hospital safety. A positive attitude toward patient safety is associated with a significant reduction in complications. The aim of the study was to analyze the perception of nurses about all aspects of patient safety in relation to the workplace and length of service. Methods: The research included 647 nurses employed in health care institutions at the primary, secondary, and tertiary levels of health care. A descriptive and cross-sectional study included nurses from the Federation of Bosnia and Herzegovina. It was conducted in the period from November to December 2021, during the COVID pandemic. A standardized questionnaire on the perception of patient safety was used – Safety Attitudes Questionnaire – SAQ. Results: The analysis of the examined factors in relation to the workplace of the respondents revealed a statistically significant difference in job satisfaction (p < 0.001), as well as in the safety climate at work in relation to the workplace (p = 0.005), working conditions (p < 0.001), and management perception (p < 0.001). Stress levels showed significant differences regarding working position (p = 0.017), but also through the years of service (p = 0.012). Stress was significantly correlated with teamwork (r = 0.124; p = 0.003), showing that better teamwork will help with stress. Conclusion: The synthesis of concepts that includes patient safety and orientation toward patients should be implemented as a strategic quality orientation and set as a priority of every health care system.

Introduction: Patient safety depends on a number of factors such as teamwork, working climate, employee satisfaction, work environment, stress awareness, management perception, and attitude. Nurses have a key role to play in protecting and supporting patients, and their assessment serves as a reliable predictor of overall hospital safety. A positive attitude toward patient safety is associated with a significant reduction in complications. The aim of the study was to analyze the perception of nurses about all aspects of patient safety in relation to the workplace and length of service. Methods: The research included 647 nurses employed in health care institutions at the primary, secondary, and tertiary levels of health care. A descriptive and cross-sectional study included nurses from the Federation of Bosnia and Herzegovina. It was conducted in the period from November to December 2021, during the COVID pandemic. A standardized questionnaire on the perception of patient safety was used – Safety Attitudes Questionnaire – SAQ. Results: The analysis of the examined factors in relation to the workplace of the respondents revealed a statistically significant difference in job satisfaction (p < 0.001), as well as in the safety climate at work in relation to the workplace (p = 0.005), working conditions (p < 0.001), and management perception (p < 0.001). Stress levels showed significant differences regarding working position (p = 0.017), but also through the years of service (p = 0.012). Stress was significantly correlated with teamwork (r = 0.124; p = 0.003), showing that better teamwork will help with stress. Conclusion: The synthesis of concepts that includes patient safety and orientation toward patients should be implemented as a strategic quality orientation and set as a priority of every health-care system. [ABSTRACT FROM AUTHOR]

Patient safety concept has achieved more attention from healthcare organizations to improve the safety culture. This study aimed to investigate patient safety attitudes among doctors and nurses and explore associations between workload, adverse events, and experience with patient safety attitudes. The study used a descriptive cross-sectional design and the Turkish version of the Safety Attitudes Questionnaire. Participants included 73 doctors and 246 nurses working in two private hospitals in Northern Cyprus. The participants had negative perceptions in all patient safety domains. The work conditions domain received the highest positive perception rate, and the safety climate domain received the lowest perception rate among the participants. Nurses showed a higher positive perception than doctors regarding job satisfaction, stress recognition, and perceptions of management domains. There were statistically significant differences between experiences, workloads, adverse events, and total mean scores of patient safety attitudes. Policymakers and directors can improve the quality of care of patients and patient safety by boosting the decision-making of health care providers on several domains of safety attitudes. Patient safety needs to be improved in hospitals through in-service education, management support, and institutional regulations. [ABSTRACT FROM AUTHOR]

Abstract: This study uses a medical center in Taiwan as an example to analyze medical staff’s emotional exhaustion by independent sample t test and analysis of variance. Eight out of ten demographic variables are considered as essential variables to influence emotional exhaustion excluding respondents reporting events in the past 12 months and job status. The results show that female employees and employees who are not supervisors/managers tend to have higher burnout. Employees whose ages are 21–30, 31–40, and 41–50 years old also have a higher degree of fatigue. In addition, nurses are more stressful than the others in this medical center. The detailed post hoc analyses enable hospital management to identify employees with high burnout. Finally, this study also provides some recommendations to help hospital management reduce employees’ burnout. Abstrak: Penelitian ini bertujuan untuk menganalisis kelelahan emosional para staf di sebuah pusat medis di Taiwan. Analisis data dilakukan dengan uji t (sampel independen) dan analisis variansi. Hasil analisis menunjukkan bahwa delapan dari sepuluh variabel demografis merupakan variabel yang berpengaruh pada kelelahan emosional para subjek. Lebih lanjut, ditemukan bahwa staf medis perempuan dan staf yang tidak berposisi sebagai supervisor/manajer cenderung mengalami burnout yang lebih tinggi. Staf yang berusia 21–30, 31–40, dan 41–50 tahun juga memiliki tingkat kelelahan emosional yang lebih tinggi. Selain itu, para perawat mengalami stres yang lebih tinggi dibandingkan dengan staf lainnya. Analisis post hoc secara detail dalam penelitian ini memberikan informasi tentang staf-staf yang mengalami burnout tingkat tinggi. Berdasarkan hasil tersebut, beberapa saran diajukan pada manajemen pusat medis dimaksud untuk meningkatkan ketahanan staf-stafnya terhadap burnout.

Background: Treatment of acute stroke is highly time-dependent and performed by a multiprofessional, interdisciplinary team. Interface problems are expectable and issues relevant to patient safety are omnipresent. The Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure patient safety climate. The objective of this study was to evaluate the SAQ for the first time in the context of acute stroke care.Methods: A survey was carried out during the STREAM trial (NCT 032282) at seven university hospitals in Germany from October 2017 to October 2018. The anonymous survey included 33 questions (5-point Likert scale, 1 = disagree to 5 = agree) and addressed the entire multiprofessional stroke team. Statistical analyses were used to examine psychometric properties as well as descriptive findings.Results: 164 questionnaires were completed yielding a response rate of 66.4%. 67.7% of respondents were physicians and 25.0% were nurses. Confirmatory Factor Analysis revealed that the original 6-factor structure fits the data adequately. The SAQ for acute stroke care showed strong internal consistency (α = 0.88). Exploratory analysis revealed differences in scores on the SAQ dimensions when comparing physicians to nurses and when comparing physicians according to their duration of professional experience.Conclusion: The SAQ is a helpful and well-applicable tool to measure patient safety in acute stroke care. In comparison to other high-risk fields in medicine, patient safety climate in acute stroke care seems to be on a similar level with the potential for further improvements.Trial registration:www.ClinicalTrials.gov Identifier: NCT032282.

Objectives: To evaluate the patient safety culture perception of a private hospital staff in a less developed region, to compare these perceptions according to socio-demographic and professional characteristics of the staff, and to investigate the effects of these characteristics on the patient safety culture. Methods: The Turkish version of the Safety Attitudes Questionnaire (SAQ) was administered to all staff members (340 people) of a private hospital in the less developed eastern region of Turkey. Data was analysed by independent samples t-test, ANOVA, Welch statistics and multiple linear regression analyses. Results: The response rate was 76%. Among six dimensions of the SAQ (teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions), stress recognition was the dimension with the lowest average. According to multivariate analyses; being younger, having a position as a nurse or technician/technical staff, working day–night and having longer years in the current hospital have an effect on the staff's more negative safety culture perception (p < 0.05). Conclusion: This study provides important information on patient safety attitudes of a private hospital staff in the least developed region of a country. Stress recognition and safety climate dimensions are the areas that primarily need improvement. [ABSTRACT FROM AUTHOR]

Background: Treatment of acute stroke is highly time-dependent and performed by a multiprofessional, interdisciplinary team. Interface problems are expectable and issues relevant to patient safety are omnipresent. The Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure patient safety climate. The objective of this study was to evaluate the SAQ for the first time in the context of acute stroke care. Methods: A survey was carried out during the STREAM trial (NCT 032282) at seven university hospitals in Germany from October 2017 to October 2018. The anonymous survey included 33 questions (5-point Likert scale, 1 = disagree to 5 = agree) and addressed the entire multiprofessional stroke team. Statistical analyses were used to examine psychometric properties as well as descriptive findings. Results: 164 questionnaires were completed yielding a response rate of 66.4%. 67.7% of respondents were physicians and 25.0% were nurses. Confirmatory Factor Analysis revealed that the original 6-factor structure fits the data adequately. The SAQ for acute stroke care showed strong internal consistency (α = 0.88). Exploratory analysis revealed differences in scores on the SAQ dimensions when comparing physicians to nurses and when comparing physicians according to their duration of professional experience. Conclusion: The SAQ is a helpful and well-applicable tool to measure patient safety in acute stroke care. In comparison to other high-risk fields in medicine, patient safety climate in acute stroke care seems to be on a similar level with the potential for further improvements. Trial registration: www.ClinicalTrials.gov Identifier: NCT032282. [ABSTRACT FROM AUTHOR]

Abstract Background Patient safety culture involves leader and staff interaction, routines, attitudes, practices and awareness that influence risks of adverse events in patient care. The Safety Attitudes Questionnaire (SAQ) is an instrument to measure safety attitudes among health care providers. The instrument aims to identify possible weaknesses in clinical settings and motivate quality improvement interventions leading to reductions in medical errors. The Ambulatory Version of the SAQ (SAQ-A) was developed to measure safety climate in the primary care setting. The original version of the SAQ includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition. Patients in nursing homes are particularly vulnerable to adverse events. We present the psychometric properties of the Norwegian translation of the SAQ-A for the nursing home setting. Methods The study was conducted in five nursing homes in Tønsberg, Norway, in February 2016. A total of 463 employees working more than 20% received a paper version of the translated SAQ-A adapted to the Norwegian nursing home setting and responded anonymously. Filled-in questionnaires were scanned and transferred to an SPSS file. SPSS was used to estimate Cronbach alphas, corrected item-total correlations, item-to-own and item-to-other correlations, and item-descriptive statistics. The confirmatory factor analysis was done by AMOS. Results Of the 463 health care providers, 288 (62.2%) responded to the questionnaire. The confirmatory factor analysis showed that the total model of the six factors Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition had acceptable goodness-of-fit values in the nursing home setting. Conclusions The results of our study indicate that the Norwegian translated version of the SAQ-A, with the confirmed six factor model, is an appropriate tool for measuring patient safety climate in the nursing home setting. Future research should study whether there is an association between patient safety climate in nursing homes and occurrence of adverse events among the patients.

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OBJECTIVE To investigate (a) the structural validity of the Greek version of the Safety Attitudes Questionnaire (SAQ), and (b) the relationship between SAQ scores and attitudes and behaviors concerning physical activity, among health care workers in Greek public hospitals. METHOD Three questionnaires were used. The first questionnaire, SAQ, investigated factors related to patient safety. The second questionnaire examined attitudes towards physical activity, and the third questionnaire, the Leisure-Time Exercise Questionnaire, was used to estimate the weekly exercise of the participants. Questionnaires were completed by 508 health care workers, from 10 city and regional hospitals in the 3rd health prefecture of Macedonia (Northern Greece), and the 1st health prefecture of Attica (Athens). RESULTS The study results confirmed the structural validity of the Greek version of SAQ. Significant differences were demonstrated between the items on SAQ, according to (a) the specialty of the health care workers, where doctors had higher scores than nurses in "job satisfaction" and "teamwork climate", (b) hospital category, where workers in regional hospitals had higher scores than those in city hospitals in "job satisfaction", "safety climate" and "work conditions", and (c) exercise, where pro-exercisers had higher scores than non-exercisers in "stress reduction" and "job satisfaction". CONCLUSIONS The Greek version of SAQ is a reliable tool for assessing the safety climate, teamwork, work satisfaction, working conditions, stress recognition and management perceptions among health care workers in Greek hospitals. Investigation of the attitudes and behaviors of health professionals can make a significant contribution to the design and implementation of interventions to reduce workplace stress, and promote healthier lifestyles. [ABSTRACT FROM AUTHOR]

Extensive research on the link between the organizational characteristics of the work environment and patient safety in a healthcare organization has been conducted; yet, only a few studies have concentrated on care providers in a pediatric unit. To determine the correlation between different work environment factors impacting patient safety in a pediatric care unit from the perspective of registered nurses working in these units. Cross-sectional design. The study was conducted with 155 registered nurses from a pediatric unit in a medical center in Taiwan with the Chinese version of the Safety Attitudes Questionnaire (SAQ) 2014–2017. Teamwork climate, higher job satisfaction, and better working conditions are linked to positive perceptions of patient safety culture. Emotional exhaustion is negatively related to most dimensions of patient safety. Teamwork climate, job satisfaction, working conditions, and emotional exhaustion were identified as critical factors impacting the patient safety climate. Investments to improve teamwork climate, job satisfaction, and working conditions and reduce emotional exhaustion may have a positive effect on patient safety in pediatric care units. • This study investigated the link between organizational factors and patient safety. • Although the tool was used, the study did not provide a more comprehensive view of the questionnaire • Teamwork climate, job satisfaction, and working conditions are vital in hospitals. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To measure patient safety climate and the associated factors from the perspective of the multiprofessional team. METHOD: This was an analytical cross-sectional study, developed in a medium-sized hospital in the Southern region of Brazil. The Safety Attitudes Questionnaire (SAQ) was used as the data collection tool and applied to 199 workers of the multiprofessional and support team between November 2017 and February 2018. Data analysis was descriptive and analytical. A positive score was considered when ≥75. RESULTS: The overall SAQ score was positive (75.1). The domain Satisfaction at Work was the one with the highest score (88.7), while Stress Perception showed the worst score (59.1). It was observed that professionals without a College/University degree better evaluated the domains Satisfaction at Work, Management Perception and Working Conditions, whereas the ones with a College/University degree had better stress perception. Medical doctors showed better Stress Perception when compared to the other health professionals. CONCLUSION: There is a positive safety climate in health organizations from the perspective of the multiprofessional team. However, the domains Safety Climate, Working Conditions and Stress Perception constitute areas that need improvement in terms of patient safety in the institution. [ABSTRACT FROM AUTHOR]

Bakgrunn: Betydningen av pasientsikkerhet og kvalitetsforbedring av helsetjenester er viet stor oppmerksomhet både innen forskning og innen helseforvaltningen. Hensikten med studien var å undersøke holdninger til pasientsikkerhet blant helsepersonell i hjemmesykepleien. Metode: En kortversjon av Safety Attitudes Questionnaire (SAQ) ble i 2015−2016 besvart av 160 ansatte i hjemmesykepleien (28 %) i 6 kommuner (totalt 16 enheter) i Midt-Norge. Data ble analysert ved hjelp av deskriptiv statistikk, t-test og ANOVA i SPSS. Bakgrunn: Betydningen av pasientsikkerhet og kvalitetsforbedring av helsetjenester er viet stor oppmerksomhet både innen forskning og innen helseforvaltningen. Hensikten med studien var å undersøke holdninger til pasientsikkerhet blant helsepersonell i hjemmesykepleien. Metode: En kortversjon av Safety Attitudes Questionnaire (SAQ) ble i 2015−2016 besvart av 160 ansatte i hjemmesykepleien (28 %) i 6 kommuner (totalt 16 enheter) i Midt-Norge. Data ble analysert ved hjelp av deskriptiv statistikk, t-test og ANOVA i SPSS. Resultat: Andel enheter med modent sikkerhetsklima (modent= 60 % av medarbeiderne gir skår ≥75) var 31,3 %, mens 68,8 % hadde et modent teamarbeidsklima. Gjennomsnittskår (på en skala fra 1−100) på sikkerhetsklima var 72,3, på teamarbeidsklima 79,1 og på oppfatning av ledelsens fokus på pasientsikkerhet 62,0. Gruppen med lengst erfaring fra arbeidsplassen skåret signifikant høyere på både sikkerhetsklima og teamarbeidsklima enn de med kortere ansettelsesforhold. På oppfatning av ledelsens fokus på pasientsikkerhet skåret gruppen med lav utdanning høyere enn den med høy utdanning, og gruppen med lengst erfaring fra arbeidsplassen skåret høyere enn den med kortere erfaring. Konklusjon: Studien indikerer at en betydelig andel av hjemmesykepleien kan ha en forhøyet risiko for uønskede hendelser grunnet «umodent» sikkerhets- og/eller teamarbeidsklima. Det er behov for mer forskning på pasientsikkerhetskultur og holdninger til pasientsikkerhet blant helsepersonell i hjemmesykepleien.

Objective: To assess national trends in patient safety culture in Taiwan.Design: A safety attitudes questionnaire (SAQ) was distributed to 144 hospitals from 2009 to 2016 (n = 392 341).Setting: Taiwan's medical centers, regional hospitals and community hospitals.Participants: Hospital staff in Taiwan.Interventions: None.Main Outcome Measures: 5-point Likert scale to assess changes in patient safety culture dimensions (teamwork, safety climate, job satisfaction, stress recognition, management and working conditions) converted to positive response rate (percentage of respondents who answered slightly agree or strongly agree on Likert scale).Results: Dimensions for patient safety culture significantly increased in Taiwan over a period of 8 years, with an all-composite improvement in positive response rate of 4.6% (P < 0.001). Regional hospitals and community hospitals registered an all-composite improvement of 6.7 and 7.0%, respectively, while medical centers improved by 4.0%. Improvements for regional and community hospitals primarily occurred in teamwork (regional hospitals, 10.4% [95% confidence interval [CI], 10.2-10.6]; community hospitals, 8.5% [95% CI, 8.0-9.0]) and safety climate (regional hospitals, 11.1% [95% [CI], 10.9-11.4]; community hospitals, 11.3% [95% CI, 10.7-11.8]) (P < 0.001, all differences). Compared with nurses (5.1%) and pharmaceutical staff (10.6%), physicians improved the least (2.0%). Improvements for nurses and pharmacists were driven by increases in perceptions of teamwork (nurses, 9.8% [95% CI, 9.7-10.0]; pharmaceutical staff, 14.2% [95% CI, 13.4-14.9]) and safety climate (nurses, 9.0% [95% CI, 8.8-9.1]; pharmaceutical staff, 16.4% [95% CI, 15.7-17.2]) (P < 0.001, all differences). At study end, medical centers (55.1%) had greater all-composite measurements of safety culture than regional hospitals (52.4%) and community hospitals (52.2%) while physicians (63.7%) maintained greater measurements of safety culture than nurses (52.1%) and pharmaceutical staff (56.6%).Conclusion: These results suggest patient safety culture improved in Taiwan from 2009 to 2016. [ABSTRACT FROM AUTHOR]

This study uses the decision-making trial and evaluation laboratory method to identify critical dimensions of the Chinese version of the safety attitudes questionnaire to improve the patient safety culture in Taiwan from experts' viewpoints. Stress recognition, perceptions of management, emotional exhaustion, and work-life balance are causal dimensions, whereas teamwork climate, safety climate, job satisfaction, and working conditions are receiving dimensions. Improving effect-based dimensions might have little impact on effects. In contrast, improving a causal dimension would not only improve the dimension itself but would also result in better performance of other dimension(s) that it directly affects. This work identifies emotional exhaustion as the most critical dimension of the questionnaire, followed by perceptions of management. These two dimensions are main causal dimensions that have significant effects on the other dimensions. Therefore, hospital management needs to address emotional exhaustion and perceptions of management to improve patient safety culture. [ABSTRACT FROM AUTHOR]

Decision making trial and evaluation laboratory method and semantic structure analysis are the two most popular approaches to study structural analysis of critical factors or dimensions but do not have solid theoretical backgrounds to construct causal relationships among critical factors or dimensions. This study proposes a framework by using normalized mutual information for both continuous and discrete random variables to set up the contextual relationships from the raw data. A Monte Carlo simulation based on normalized mutual information is conducted to estimate the threshold value of establishing the causal relationships. Two internal survey data of safety attitudes questionnaire in terms of thirty questions and six dimensions are used from viewpoints of physicians and nurses. Four cases are illustrated to show how the proposed framework works in practice to identify critical factors or dimensions from the internal survey data. This proposed framework enables hospital management to initiate improvements from causal factors or dimensions to effectively enhance patient safety from medical staffs' viewpoints. [ABSTRACT FROM AUTHOR]

Background: Patient safety culture involves leader and staff interaction, routines, attitudes, practices and awareness that influence risks of adverse events in patient care. The Safety Attitudes Questionnaire (SAQ) is an instrument to measure safety attitudes among health care providers. The instrument aims to identify possible weaknesses in clinical settings and motivate quality improvement interventions leading to reductions in medical errors. The Ambulatory Version of the SAQ (SAQ-A) was developed to measure safety climate in the primary care setting. The original version of the SAQ includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition. Patients in nursing homes are particularly vulnerable to adverse events. We present the psychometric properties of the Norwegian translation of the SAQ-A for the nursing home setting.Methods: The study was conducted in five nursing homes in Tønsberg, Norway, in February 2016. A total of 463 employees working more than 20% received a paper version of the translated SAQ-A adapted to the Norwegian nursing home setting and responded anonymously. Filled-in questionnaires were scanned and transferred to an SPSS file. SPSS was used to estimate Cronbach alphas, corrected item-total correlations, item-to-own and item-to-other correlations, and item-descriptive statistics. The confirmatory factor analysis was done by AMOS.Results: Of the 463 health care providers, 288 (62.2%) responded to the questionnaire. The confirmatory factor analysis showed that the total model of the six factors Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition had acceptable goodness-of-fit values in the nursing home setting.Conclusions: The results of our study indicate that the Norwegian translated version of the SAQ-A, with the confirmed six factor model, is an appropriate tool for measuring patient safety climate in the nursing home setting. Future research should study whether there is an association between patient safety climate in nursing homes and occurrence of adverse events among the patients. [ABSTRACT FROM AUTHOR]

This study intends to identify critical demographic variables that would significant influence on each dimension of the patient safety culture. The internal survey data sets in 2015 and 2016 from the entire medical staffs’ viewpoints are used. Linear regression with forward selection is applied where ten demographic variables are the input variables, while each dimension of the Chinese version of the safety attitudes questionnaire is the dependent variable. Supervisor/manager is the most essential demographic variable that has significant impacts on six dimensions. Experience in position is the other critical demographic variable. Therefore, hospital management needs to focus on medical staffs who are not supervisors/managers first in order to improve the patient safety culture in this regional teaching hospital. [ABSTRACT FROM AUTHOR]

This study proposes a framework to monitor the patient safety culture by means of a safety attitudes questionnaire by using the bootstrap method to determine the performance of each dimension of safety attitudes questionnaire in each year based on a small sample size. The focus is not the bootstrap method itself but the philosophy of using the bootstrap method to construct the control chart-like limits to observe the performance of each dimension based on the small sample size. Hospital management can better understand how each dimension performs on a yearly basis from the data available. When more new data are available, the boundaries generated by the bootstrap method can be adjusted. Besides, the trends and changes for each dimension can be traced in a control chart that enables hospital management to observe how the patient safety culture changes from time to time. This study demonstrates the philosophy of using the bootstrap method when the sample size is seven for each dimension. The trends and changes for each dimension can be observed for hospital management by construction its control chart. [ABSTRACT FROM AUTHOR]

Background: Patient safety culture in healthcare organizations has become an important issue globally for improving medical services. In 2016, Taiwan’s National Health Insurance (NHI) system covered 99.6% of Taiwan’s population. With the enhancement of medical quality, patients expect medical service providers to care more about safety and medical service. Understanding physicians and registered nurses’ attitudes toward patient safety is a critical issue for healthcare organizations wanting to improve the quality of the medical care they provide. Objective: The purpose of this study was to discern physicians and registered nurses’ attitudes toward patient safety using Sexton and colleagues’ Safety Attitudes Questionnaire (SAQ) in order to develop strategies for improving the quality of medical services. Methods: Pearson correlation analyses were conducted to demonstrate the relationships among six patient safety culture dimensions. Physicians and registered nurses were asked to complete the questionnaire in a case hospital in Taiwan in 2016. Results: The results of Pearson correlation analyses demonstrated a strong and positive relationship between perceptions of management and working conditions. Additionally, teamwork climate was highly correlated to safety climate. The results also illustrated that teamwork climate and job satisfaction were significantly related. Conclusion: The assessment of patient safety culture can provide a basis for hospital managers to monitor the quality of the medical care provided at their organizations. Hospital managers should put more efforts into the essentially important elements of patient safety culture, such as teamwork climate, safety climate, perceptions of management, and working conditions, so as to continuously improve the quality of medical care.

Purpose To validate the Swedish Safety Attitudes Questionnaire–operating room (SAQ-OR) version by re-evaluating its psychometric properties for the surgical team. Design Cross-sectional questionnaire study. Methods 541 surgical team members including perioperative nurses, physicians, and licensed practical nurses at three Swedish hospitals were included. Findings For the total sample, the Cronbach's α for the six factors ranged from 0.51 to 0.76. Goodness-of-fit analyses indicated that the six-factor model was acceptable and the factor loadings were statistically significant. The test of the hypothesized relationships among the factors showed a correlation from 0.936 to 0.042. Conclusions The refined Swedish version of the SAQ-OR is a reasonably reliable and acceptably valid instrument for the measurement of patient safety climate in the surgical team. However, the results related to the different analyses varied among the different professionals and further research, using larger samples, is needed to explore these differences, especially among the physicians. [ABSTRACT FROM AUTHOR]

Introdução: A segurança do doente é um parâmetro integrante da qualidade dos cuidados e uma prioridade dos sistemas de saúde. O Safety Attitudes Questionnaire (SAQ) – Short Form 2006 é o instrumento mais utilizado e rigorosamente validado para medir o clima de segurança do doente entre os prestadores de cuidados de saúde. Objetivo: O objetivo deste estudo foi traduzir e adaptar culturalmente este instrumento para Portugal originando a versão SAQ – Short Form 2006 PT. Material e métodos: Para o processo de tra-dução e adaptação cultural realizou-se um estudo meto-do-lógico baseado nas recomendações de Beaton e colaboradores [Recommendations for the Cross-Cultural Adaptation of Health Status Measures, 2002] com as etapas: tradução, síntese, retrotradução, avaliação por uma comissão de especialistas, pré-teste e submissão dos relatórios aos autores do instrumento. Resultados: O SAQ – Short Form 2006 foi traduzido linguisticamente e adaptado culturalmente ao novo contexto mantendo a congruência com a versão original. A validade de conteúdo foi garantida através de uma comissão de especialistas, que assegurou a equivalência semântica, idiomática, experimental e conceitual entre o instrumento original e a versão portuguesa. Conclusão: O SAQ – Short Form 2006 foi traduzido e adaptado para Portugal com sucesso, permitindo a sua aplicação em contexto cultural português. [ABSTRACT FROM AUTHOR]

Aim: To examine first‐line nurse managers’ perceptions of safety culture and explore relationships between their safety attitudes and safety factors in Henan Province, China. Background: Health providers’ perceptions of patient safety culture have been studied widely, but little is known about first‐line nurse managers’ safety attitudes. Methods: A cross‐sectional survey was conducted with a convenience sample of 823 first‐line nurse managers in 216 hospitals across Henan Province, China. The Safety Attitudes Questionnaire (Chinese version) was distributed to first‐line nurse managers during training meetings; responses were returned in a sealed envelope in person or by mail. ANOVAs were used to analyse the differences in Safety Attitudes Questionnaire (Chinese version) scores between first‐line nurse managers’ attitudes and safety factors. Results: The mean scores across the six domains of Safety Attitudes Questionnaire (Chinese version) ranged from 56.6 to 79.4 on a 100‐point scale. First‐line nurse managers: ≥45 years of age perceived better safety climate (p < .05); those with higher professional ranks and medical centre positions reported higher mean scores for teamwork climate (p < .01) and stress recognition (p < .01); and those with baccalaureate degrees or higher had significantly higher mean scores for stress recognition (p < .01). Conclusion: First‐line nurse managers’ safety attitudes were not satisfactory and there is great potential to improve patient safety culture. Age, hospital level, educational background and professional rank are positively related to first‐line nurse managers’ attitudes. Implications for Nursing Management: Hospital administrators and nurse directors should focus on the safety factors identified in this study and enact a variety of strategies to create a strong patient safety culture in China. [ABSTRACT FROM AUTHOR]

Aims In order to pursue a better patient safety culture and provide a superior medical service for patients, this study aims to respectively investigate the perceptions of patient safety from the viewpoints of physicians and nurses in Taiwan. Background Little knowledge has clearly identified the difference of perceptions between physicians and nurses in patient safety culture. Understanding physicians and nurses' attitudes toward patient safety is a critical issue for healthcare organizations to improve medical quality. Methods Confirmatory factor analysis (CFA) is used to verify the structure of data (e.g. reliability and validity), and Pearson's correlation analysis is conducted to demonstrate the relationships among seven patient safety culture dimensions. Results Research results illustrate that more teamwork is exhibited among team members, the more safety of a patient is committed. Perceptions of management and emotional exhaustion are important components that contribute to a better patient safety. More importantly, working conditions and stress recognition are found to be negatively related from the perceptions of nurses. Compared to physicians, nurses reported higher stress and challenges which result from multi-task working conditions in the hospital. Conclusions This study focused on the contribution of a better patient safety culture from different viewpoints of physicians and nurses for healthcare organizations in Taiwan. A different attitudes toward patient safety is found between physicians and nurses. The results enable the hospital management to realize and design appropriate implications for hospital staffs to establish a better patient safety culture. [ABSTRACT FROM AUTHOR]

Introduction This study aimed to design, implement and evaluate the reliability and validity of a multifactorial and multilevel health and safety climate survey (HSCS) tool with utility in the Australian mining setting. Methods An 84-item questionnaire was developed and pilot tested on a sample of 302 Australian miners across two open cut sites. Results A 67-item, 10 factor solution was obtained via exploratory factor analysis (EFA) representing prioritization and attitudes to health and safety across multiple domains and organizational levels. Each factor demonstrated a high level of internal reliability, and a series of ANOVAs determined a high level of consistency in responses across the workforce, and generally irrespective of age, experience or job category. Participants tended to hold favorable views of occupational health and safety (OH&S) climate at the management, supervisor, workgroup and individual level. Conclusion The survey tool demonstrated reliability and validity for use within an open cut Australian mining setting and supports a multilevel, industry specific approach to OH&S climate. Findings suggested a need for mining companies to maintain high OH&S standards to minimize risks to employee health and safety. Future research is required to determine the ability of this measure to predict OH&S outcomes and its utility within other mine settings. Practical applications As this tool integrates health and safety, it may have benefits for assessment, monitoring and evaluation in the industry, and improving the understanding of how health and safety climate interact at multiple levels to influence OH&S outcomes. [ABSTRACT FROM AUTHOR]

Background: In China, increasing attention has been devoted to the patient safety culture within health administrative departments and healthcare organizations. However, no official version of a patient safety culture assessment tool has been published or is widely used, and little is known about the status of the safety culture in Chinese hospitals. The aims of this study were to examine the reliability and validity of the Safety Attitudes Questionnaire in Chinese and to establish benchmark data on the safety culture in Beijing.Methods: Across-sectional survey on patient safety culture was conducted from August to October 2014 using the Safety Attitudes Questionnaire in Chinese. Using a stratified random sampling method, we investigated departments from five integrative teaching hospitals in Beijing; frontline healthcare workers in each unit participated in the survey on a voluntary basis. The internal consistency and reliability were tested via Cronbach's alpha, and the structural validity of the questionnaire was tested using a correlation analysis and confirmatory factor analysis. The patient safety culture in the five hospitals was assessed and analyzed.Results: A total of 1663 valid questionnaires were returned, for a response rate of 87.9%. Cronbach's alpha of the total scale was 0.945, and Cronbach's alpha for the six dimensions ranged from 0.785 to 0.899. The goodness-of-fit indices in the confirmatory factor analysis showed an acceptable but not ideal model fit. The safety attitude score of healthcare workers in the five hospitals was 69.72, and the positive response rate was 38.57% overall. The positive response rates of the six dimensions were between 20.80% and 59.31%.Conclusions: The Safety Attitudes Questionnaire in Chinese has good internal consistency, and the structural validity and reliability are acceptable. This questionnaire can be used to assess the safety culture in Beijing hospitals, but some items require further refinement. The patient safety culture in Beijing hospitals must be improved in certain key areas. [ABSTRACT FROM AUTHOR]