A Culture of Safety
In your own words, describe what is meant by a culture of safety. Next, research and define at least two current trends, best practices, or models that promote a culture of safety in the typical health care setting.
Brasaite et al. BMC Res Notes (2016) 9:177
DOI 10.1186/s13104-016-1977-7
BMC Research Notes
RESEARCH ARTICLE
Open Access
Health care professionals’ attitudes
regarding patient safety: cross‑sectional survey
Indre Brasaite1,3*, Marja Kaunonen1,2, Arvydas Martinkenas3 and Tarja Suominen1
Abstract
Background: Patient safety is being seen as an increasingly important topic in the healthcare fields, and the rise in
numbers of patient safety incidents poses a challenge for hospital management. In order to deal with the situation,
it is important to know more about health care professionals’ attitudes regarding patient safety. This study looks to
describe health care professionals’ attitudes regarding patient safety, and whether differences exist based on the background factors of study participants.
Methods: A quantitative study using a questionnaire was conducted in three multi-disciplinary hospitals in Western
Lithuania. Data was collected in 2014 from physicians, nurses and nurse assistants.
Results: The results showed positive safety attitudes, and these were especially related to the respondents’ levels
of job satisfaction. A respondent’s older age was associated with how they evaluated their teamwork climate, safety
climate, job satisfaction, and perception of management. Profession, working unit, length of work experience, information received about patient safety during education, further education, and working shifts were all associated with
several safety attitude areas.
Conclusions: The safety attitudes of respondents were generally found to be positive. Attitudes related to patient
safety issues were positive among health care professionals and opens the door for the open discussion of patient
safety and adverse events. However, in future we also need to investigate the knowledge and skills professionals have
in relation to patient safety, in order to gain a deeper understanding of the present situation.
Keywords: Attitude, Health care professionals, Nurses, Patient safety, Physicians, Nurse assistants
Background
Attitudes regarding safety-related issues are an important part of what is often called a hospital’s safety culture [1, 2]. An organization’s safety culture consists of
components concerning healthcare provider attitudes
about organizational factors such as safety climate and
morale, work environment factors such as staffing levels
and managerial support, team factors such as teamwork
and supervision, and staff factors such as overconfidence and being overly self-assured [3]. Some authors
[4–6] have noticed that a safety culture is a part of the
wider organisational culture, and may be defined as the
attitudes, beliefs, perceptions, competencies and values
*Correspondence: Brasaite.Indre.X@student.uta.fi
3
Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
Full list of author information is available at the end of the article
that determine an organisation’s health and safety management, and are held in common by employees in relation to safety. An understanding of nurses’ perceptions
and expectations regarding adverse events is therefore
essential for the implementation of appropriate strategies
to manage nursing care. In this sense, the beliefs, values
and organizational culture of registered nurses (RNs) are
important aspects to be considered [7].
Ethical issues are integral to the topic of patient safety
because it is known that millions of patients worldwide
suffer injury or death every year as a result of unsafe
medical practices and care, and patients are mostly
harmed due to preventable causes that they receive during health care in hospital settings [8]. Health care professionals may know that their role is important in the
delivery of safe care and that they should have positive
safety attitudes. However, the results of a safety culture
© 2016 Brasaite et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
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publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Brasaite et al. BMC Res Notes (2016) 9:177
study [9] showed that both RNs and nurse managers were
critical of the state of patient safety in acute care hospitals, with RNs being the more critical group. That said,
generally positive attitudes to patient safety have been
reported among health care professionals [10], and the
safety climate within healthcare has been evaluated more
positively by physicians than nurses [11].
Previous literature has shown some differences in attitudes regarding patient safety, based on profession, age,
gender and working area. In one study, the connection of
safety attitudes to profession was measured by researchers
[12]. The results showed that only 39 % of physicians had a
positive attitude towards safety climate, and less than half
of the physicians and nurses surveyed were satisfied with
their jobs (47 and 45 %, respectively). Physicians, nurses,
and medical assistants had relatively similar but low perceptions of their working conditions when compared to
managers (29, 36, and 35 %, respectively). Researchers
have explored professional differences in patient safety
attitudes among operating room (OR) care givers in nine
medical centres [13]. Of the six patient safety domains
covered in the study, stress recognition and working
conditions showed significant differences by univariate analysis of profession. Regression analysis revealed
that differences for job satisfaction and working conditions were seen among the professions studied. In intensive care units, surgeons have expressed more favourable
perceptions of working conditions than nurses [14], and
surgeons have also been seen to have a more favourable
perception of management than OR nurses [13].
In a study conducted in the field of obstetrics, the highest positive safety attitudes score (48.3 %) was reported
by the 30–35 years age group of health care professionals
[15]. Associations between gender differences and patient
safety attitudes are also to be found in the literature. Gender differences in patient safety attitudes were explored
among OR care givers, and of the six patient safety scales,
four showed significant differences in univariate analysis
(teamwork climate, job satisfaction, perceptions of management, and working conditions). Women were found
to have less favourable perceptions of teamwork [69, versus (vs) 76 for men], job satisfaction (74, vs 80 for men),
management (60, vs 69 for men), and working conditions
(57, vs 72 for men) [13].
Work area and discipline have also been reported to be
associated with attitudes [4]. One of the key findings was
that emergency department (ED) personnel, particularly
ED nurses, perceived substantially lower levels of safety
climate than workers in other areas. This suggests that
the higher levels of risk and complexity, and the faster
pace associated with work performed in emergency
departments continue to require relatively more attention to be paid to safety issues than other areas.
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To maintain a safe patient environment and safe practices, it is very important to promote the measurement and
improvement of safety attitudes among health care professionals [16]. The research presented in this paper looks
to describe health care professionals’ attitudes regarding
patient safety, and whether differences exist based on the
background factors of the study participants.
Methods
Data collection
The study was carried out in three hospitals in one region
of Lithuania, and involved all of the health care professionals (physicians, head nurses, nurses and nurse assistants) who worked with adult patients. The hospitals
involved are of similar size and provide multi-profile care
for Western Lithuanian residents. The criteria for inclusion in the research were that participants were health
care professionals, working in health care organizations
(hospitals) with adult patients, and would participate voluntarily in the study.
Data was collected using a questionnaire consisting of
background questions based on existing literature, and
an instrument measuring patient safety attitudes. Twenty
background questions investigated the basic demographic characteristics of participants (e.g. work position, place of work, age, gender, education, years at work,
usual shift, working hours per week), as well as information concerning the type and hours of training they had
received regarding patient safety. Finally, participants
were asked how many adverse events they had reported
during the previous year. They were also asked what
kind of patient safety related events they had faced, and
whether they had reported them.
The data for measuring safety attitudes was collected
using the University of Texas safety attitudes questionnaire (SAQ) [3] (short form version) that consists of
six scales: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions, and stress recognition. Additional to the SAQ,
five further statements examining safety attitudes were
included, such as the health care professionals’ perceptions of whether safety issues would be acted upon if
they expressed them to management, and whether they
experienced good collaboration with other nurses, staff
physicians and pharmacists in their clinical area. A final
statement examined if communication breakdowns that
lead to delays in the delivery of care were common. The
SAQ (short form version) used in this study comprised
of 36 items, each answered using a six-point Likert scale:
1 = disagree strongly, 2 = disagree slightly, 3 = neutral,
4 = agree slightly, 5 = agree strongly, and 6 = not applicable. Negatively worded items were reverse scored so
that their valence matched the positively worded items.
Brasaite et al. BMC Res Notes (2016) 9:177
The SAQ (short form version) was used because of its
usability, the good psychometric properties it has shown
in previous studies, and its broad potential for implementation [3, 17]. The instrument was originally developed in the United States of America and was translated
from English into Lithuanian using the back-translation
technique [18]. Permission to use the instrument in this
study was obtained from the copyright holder of the
instrument by the one of the authors. The questionnaire
was piloted in one regional hospital with health care
professionals to evaluate the validity of the instrument,
and also its use in the Lithuanian context. The pilot data
collection took place in February 2014, and included the
hospital staff (n = 90). The pilot study hospital was not
included in the main study. The SAQ showed good psychometric properties. The scales reliability was assessed
with a total Cronbach’s alpha of .78, corrected by interitem correlation from .05 to .69. The Cronbach’s alpha
values were good for all scales for the main (and pilot)
study: for teamwork climate .62 (.66), safety climate .74
(.78), job satisfaction .87 (.86), stress recognition .79
(.88), perceptions of management .90 (.92), and Working
Conditions .74 (.78).
Ethical approval for the study was obtained from the
Ethics Committee of Klaipeda University, Faculty of
Health Sciences (Nr. 46 Sv-SL-1), and permission to collect data was also obtained from the hospitals participating in the pilot and main phases of the study. The ethical
considerations related to the data collection were focused
on the ethical principles for research, namely confidentiality (related to questionnaires), privacy, and the voluntary nature of participation in the study [19].
The main study data was collected in May 2014 in three
regional hospitals. In each hospital, questionnaires with
return envelopes were delivered to established contact
persons. The contact persons circulated the questionnaires to all staff (n = 1687). After 2 weeks, the researcher
collected the returned questionnaires in sealed envelopes
from each unit. Because of a low response rate [46 %
(n = 774)], reminder letters were left for the contact persons who were asked to circulate them. An additional
2 weeks were given to respond, and the final response
rate was 64 % (n = 1082).
Statistical analyses
Descriptive statistics were used to describe the characteristics of respondents (physicians, head nurses,
nurses and nurse assistants), the SAQ items, and the
scale-level results of the three hospitals. Differences in
sample characteristics between hospitals and professional groups were tested using one-way analysis of variance (ANOVA) and the Tukey HSD (honest significant
difference) multiple comparison test, or the Tamhane
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multiple comparison test (when the assumption of equal
variances was not correct). Non-normally distributed
characteristics were analysed using the Kruskal–Wallis
test. Data was presented using mean [standard deviation
(SD)] or median [interquartile range (IQR)] expression.
Any negatively worded items of the SAQ were reversed
before analysis. The internal consistency of the SAQ and
its scales of safety climate, job satisfaction, perception
of management, and working conditions (for SAQ) was
measured by calculating the Cronbach’s alpha for each
area. Associations between variables were calculated by
means of Spearman correlations.
For further analysis, the units in which the respondents
worked were re-grouped as internal medicine (e.g. internal diseases, neurology, cardiology, heart arrhythmia,
haemodialysis, nephrology etc.), surgical (e.g. surgery,
traumatology), psychiatric (e.g. mental health, treatment of addiction), acute (e.g. resuscitation, anaesthesiology, emergency, operating room, intensive care), and
others (e.g. rehabilitation, laboratory, polyclinics etc.).
Head nurses and nurses were also combined into one
group (756 nurses including 54 head nurses). All of the
data was analyzed using SPSS (Statistical package for
social sciences) (version 22.0; SPSS Inc., Chicago, Illinois,
USA). A p value of
