Search results

Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e., shared values regarding safety management, is considered a key driver of high-quality, safe healthcare delivery. However, changing organizational culture so that it emphasizes and promotes safety is often an elusive goal. The Safe Surgery Checklist is an innovative tool for improving safety culture and surgical care safety, but evidence about Safe Surgery Checklist effectiveness is mixed. We examined the relationship between changes in management practices and changes in perceived safety culture during implementation of safe surgery checklists. Using a pre-posttest design and survey methods, we evaluated Safe Surgery Checklist implementation in a national sample of 42 general acute care hospitals in a leading hospital network. We measured perceived management practices among managers (n = 99) using the World Management Survey. We measured perceived preoperative safety and safety culture among clinical operating room personnel (N = 2,380 (2016); N = 1,433 (2017)) using the Safe Surgical Practice Survey. We collected data in two consecutive years. Multivariable linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following Safe Surgery Checklist implementation.

The voluntary hospital trustee has traditionally seen issues of medical care, including those of patient safety, as falling within the delegated sphere of the medical staff. This customary distancing of the trustee from direct involvement in patient safety issues is now challenged by unprecedented scrutiny of hospital safety results through voluntary disclosure or mandatory public reporting. This new climate, fostered by the Institute of Medicine's To Err is Human and the Institute for Healthcare Improvement's 100,000 Lives campaign, has complicated the role of the trustee in satisfying the traditional “prudent person” test for meeting fiduciary obligation as the trustee's breadth of involvement expands. Viewed theoretically, Mintzberg models the hospital as a case of a professional bureaucracy, in which the professional staff is responsible for standard setting and regulation. This traditional role of the professional staff is potentially assumed by others lacking technical background. Trustees are now asked to examine reports identifying physician compliance in attaining safety standards without education in the practice supporting those standards. Physician board members, whose numbers have increased in the past decade, are often sought to take the lead on interpretation of patient safety standards and results. The very public nature of patient safety reporting and its reflection on the reputation of the organization for which the trustee is ultimately accountable create a new level of tension and workload that challenges the dominant voluntary model of trusteeship in the United States health system.

There is increasing recognition amongst healthcare providers on the necessity to improve fire safety management in healthcare facilities. This is possibly not yet satisfactory because of recent fire incidents in Asia. This paper set out to analyse the literature because of the paucity of systematic reviews on fire safety management of public healthcare facilities and proffer preventive measures.

Thirty related studies were identified with the support of the Preferred Reporting Items for Systematic reviews and Meta-Analyses via Scopus and Web of Science databases.

Influencing factors, hindrances to fire safety management and preventive measures for fire-related occurrence in Asian hospital buildings were the three themes that emerged from the reviewed. The factors that influence fire in Asian hospital buildings were categorised into technical, management and legislation factors.

The recommendations of this paper were based on literature that was systematically reviewed but does not compromise the robustness concerning fire safety management in hospital buildings across Asian countries. Much is needed to be known regarding fire safety in healthcare buildings across Asian countries. This paper recommended exploratory sequential mixed-methods approach as part of the implications for further studies. This will allow in-depth face-to-face interviews and increase the generalisability of future findings concerning fire safety management in hospital buildings across Asian countries to a larger population.

As part of the practical implications, this paper recommends fire safety management plan as one of the practical possible measures for addressing technical, management and legislation factors. Also recommended is training and fire safety education of healthcare staff in collaboration with safety firefighters to address major issues that may arise from management factors. The government should upgrade the safety technology equipment in healthcare facilities as part of measures to mitigate issues concerning technical and legislation factors. Also, the identified factors are part of the theoretical contributions to the advancement of knowledge and this brings to the front burners new opening.

This is probably the first systematic review paper on fire safety hospital buildings in Asia.

The occurrence of fire accidents in hospital buildings has become a serious challenge and more serious in developing nations. The purpose of this paper intends to assess fire safety measures in Nigerian hospital facilities. The significance of this study is to ensure that the design and construction of hospital facilities enhance the safety of users and properties.

The data were collected via a case study and questionnaire survey and administered to the facility users. The study survey is to assess the respondents' perception of fire safety measures in hospital facilities and suggest possible policy measures that will be employed to enhance safety.

This paper found that 91% of the respondents have awareness of fire safety measures in hospital facilities. Electrical faults and combustible materials were identified as the frequent causes of fire occurrences in hospital facilities. This can be averted where flammable materials and electrical appliances are correctly installed, and safety rules enforced. Findings show that safety rules are lax in public than standard private hospitals.

This paper is limited to fire safety measures in Nigerian healthcare facilities. Future research is needed to evaluate the level of compliance from design, construction and post-construction of precautionary fire safety measures in hospital facilities in Nigeria.

This paper recommended that designers and hospital administrators should improve on fire safety measures via the development of fire safety management plan and education. Thus, enforcement of fire safety measures in hospital facilities as specified in building codes should be implemented and monitored during and after the design of the hospital buildings. Findings provide valuable lessons on how to improve the fire safety measures in healthcare facilities across the states and other developing countries with similar healthcare situations.

This paper demonstrates that the stakeholders, especially government agencies concern with approval and enforcement of fire safety measures in healthcare facilities need to reawaken to her responsibility because of the lax implementation across the states.

The purpose of this paper is to explore the relationship between hospitals’ electronic health record (EHR) adoption characteristics and their patient safety cultures. The “Meaningful Use” (MU) program is designed to increase hospitals’ adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated.

Providers’ perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality’s surveys on patient safety culture (level 1) and the American Hospital Association’s survey and healthcare information technology supplement (level 2).

The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers’ perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research.

Relating EHR MU and providers’ care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.

Improving hospital patient safety means an open and stimulating culture is needed. This article aims to describe a patient safety culture improvement approach in five Belgian hospitals.

Patient safety culture was measured using a validated Belgian adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Studies before (autumn 2005) and after (spring 2007) the improvement approach was implemented were completed. Using HSOPSC, safety culture was measured using 12 dimensions. Results are presented as evolving dimension scores.

Overall, 3,940 and 3,626 individuals responded respectively to the first and second surveys (overall response rate was 77 and 68 percent respectively). After an 18 to 26 month period, significant improvement was observed for the “hospital management support for patient safety” dimension – all main effects were found to be significant. Regression analysis suggests there is a significant difference between professional subgroups. In one hospital the “supervisor expectations and actions promoting safety” improved. The dimension “teamwork within hospital units” received the highest scores in both surveys. There was no improvement and sometimes declining scores in the lowest scoring dimensions: “hospital transfers and transitions”, “non‐punitive response to error”, and “staffing”.

The five participating hospitals were not randomly selected and therefore no representative conclusions can be made for the Belgian hospital sector as a whole. Only a quantitative approach to measuring safety culture was used. Qualitative approaches, focussing on specific safety cultures in specific parts of the participating hospitals, were not used.

Although much needs to be done on the road towards better hospital patient safety, the study presents lessons from various perspectives. It illustrates that hospital staff are highly motivated to participate in measuring patient safety culture. Safety domains that urgently need improvement in these hospitals are identified: hospital transfers and transitions; non‐punitive response to error; and staffing. It confirms that realising progress in patient safety culture, demonstrating at the same time that it is possible to improve management support, is complex.

Safety is an important service quality aspect. By measuring safety culture in hospitals, with a validated questionnaire, dimensions that need improvement were revealed thereby contributing to an enhancement plan.

Hospitals in North America consistently have employee injury rates ranking among the highest of all industries. Organizations that mandate workplace safety training and emphasize safety compliance tend to have lower injury rates and better employee safety perceptions. However, it is unclear if the work environment in different national health care systems (United States vs. Canada) is associated with different employee safety perceptions or injury rates. This study examines occupational safety and workplace satisfaction in two different countries with employees working for the same organization.

Survey data were collected from environmental services employees (n = 148) at three matched hospitals (two in Canada and one in the United States). The relationships that were examined included: (1) safety leadership and safety training with individual/unit safety perceptions; (2) supervisor and coworker support with individual job satisfaction and turnover intention; and (3) unit turnover, labor usage, and injury rates.

Hierarchical regression analysis and ANOVA found safety leadership and safety training to be positively related to individual safety perceptions, and unit safety grade and effects were similar across all hospitals. Supervisor and coworker support were found to be related to individual and organizational outcomes and significant differences were found across the hospitals. Significant differences were found in injury rates, days missed, and turnover across the hospitals.

This study offers support for occupational safety training as a viable mechanism to reduce employee injury rates and that a codified training program translates across national borders. Significant differences were found between the hospitals with respect to employee and organizational outcomes (e.g., turnover). These findings suggest that work environment differences are reflective of the immediate work group and environment, and may reflect national health care system differences.

This paper aims to evaluate the level of compliance of fire safety with the legal requirements in Malaysia government hospital buildings by evaluating via fire risk management.

Five government hospitals were selected. These five hospitals were selected due to the location of Penang, which is one of the fast-growing states in Malaysia (Salleh, 2019; Ebekozien, 2019). This state is the second most densely populated state after Wilayah Persekutuan Kuala Lumpur, with an average distribution of 1,490 persons per square km. This higher population caused the higher demand on the health-care services by the public (DOSM, 2016). The observation and building audit processes are as described. Hundreds of photos were taken for qualitative analysis, and all fire safety elements were measured for the descriptive analysis for each hospital. The framework of audit elements is created based on the Life Safety Code: NFPA 101 (2018), UBBL 1984: Part VII (Fire Requirements) and Part VIIII (Fire Alarms, Fire Detection, Fire Extinguishment and Fire Fighting Access). The cross-sectional descriptive evaluation is conducted in the case studies building in accordance with Life Safety Code of NFPA, also known as NFPA 101. To conduct the study, the information needed to assess the fire safety status was extracted from the CFSES software based on the NFPA 101 standard and prepared and compiled by the researcher as a checklist. In the next stage, gathered information was analysed using Computerised Fire Safety Evaluation System (CFSES) software. This method was developed based on the NFPA 101 standard and evaluated the fire risk from four dimensions of containment, extinguishment, people movement and general safety. This software gives the risk assessment results in three areas of fire control, exits and general safety. To assess the fire risk of the commercial buildings after entering the background information (height, age, number of stories, etc.) in the software, the software first calculates the score that the building should obtain in the three aspects of fire control, exit routes and general safety (minimum score required).

The utmost zones in the case studies (44.3%) occupied by limited mobility are located at low-rise buildings or at the first floor to third floor of the hospital buildings. Hospitals managements lacked in creating the maximum exit route and egress the occupants to disclosed the building during evacuation, it correlates to the patients' mobility positions strategy to assign their categories that fell on effortless mobilisation. Surveyed hospitals were built with the non-combustible materials, even though four of the case studies were built before 1984. Hospitals were equipped with hazard separations and vertical smoke pores, and in most of the zones, sprinkler system is installed only in the corridors, equipped with communication system and system of communication with fire and relief organisations and has a fire detection and alarm system throughout the building. Results of fire risk assessment on four groups of elements were tested via CFSES revealed from 122 zones of surveyed hospitals; 102 or 84% of zones give the highest failed rate to comply the NFPA 101 requirements in terms of people movement in the building. The high-occupied Penang General Hospital contributed as the highest case study for not complying with the minimum requirements in all dimensions: people movement elements (41 zones), fire containment (31 zones), fire extinguisher (31 zones) and general safety (20). Fire extinguishment (62 zones) recorded the highest numbers of zones that complied with NFPA 101 (2013). The overall results of the fire risk assessment suggested that in terms of the fire control, egress and general safety aspects, the fire risk assessment score was unacceptable (failed) in all hospital buildings studied, and in the three areas mentioned, the general safety, egress/exit routes and fire control were in a worse status in terms of the score obtained in the software. None of the surveyed hospital received the minimum safety score in the three areas mentioned. The involvement of Emergency Response Team is crucial to overcome this egress or fire exit requirement and parameters.

Several limitations exist in this research that cannot be controlled. Firstly, the occupancy rates only determined during peak hour. Accessibility into hospital compound permitted only during daytime. Secondly, the fire safety audits and fire safety risk management in this research are not being conducted by a professional architect or engineer and as a result must be relied on the direct inspection checklist to create valid results. Thirdly, this research has some limitations which need to be noted but does not affect the robustness of the study’s findings. This study focuses only on five selected public hospitals in one state of the northern region of Malaysia and excluded data gathering from all other parts of Malaysia. The perception of hospital operators regarding fire safety issues from different state hospitals may allow comparisons.

The findings of this paper should make a key practical contribution to the body of knowledge. In practice, the proposed framework should expand the knowledge of public hospital fire safety management plan concerning the level of fire safety compliance with the requirements in government hospital buildings and develop a fire safety management plan framework for government hospital buildings.

This paper develops an early framework component related to the occupants’ safety which gives the basis for future research in hospital fire safety settings as it imparts early investigation into the consequence of investigating the phenomenon from the operators’ perspective as an attempt to improve public health-care fire safety performance in hospitals.

This paper has created a few measurement tools that can be applied among public hospital buildings stakeholders to perform the fire safety audit and risk management and rate the performance of Fire Safety Management in public hospitals.

There is evidence that patient safety has not improved commensurate with the global attention and resources dedicated to achieving it. The authors explored the perspectives of hospital leaders on the challenges of leading safe care.

This paper reports the findings of a three-year longitudinal study of eight Australian hospitals. A representative sample of hospital leaders, comprising board members, senior and middle managers and clinical leaders, participated in focus groups twice a year from 2015 to 2017.

Although the participating hospitals had safety I systems, the leaders consistently reported that they relied predominantly on their competent well-meaning staff to ensure patient safety, more of a safety II perspective. This trust was based on perceptions of the patient safety actions of staff, rather than actual knowledge about staff abilities or behaviours. The findings of this study suggest this hegemonic relational trust was a defence mechanism for leaders in complex adaptive systems (CASs) unable to influence care delivery at the front line and explores potential contributing factors to these perceptions.

In CASs, leaders have limited control over the bedside care processes and so have little alternative but to trust in “good staff providing good care” as a strategy for safe care. However, trust, coupled with a predominantly safety 1 approach is not achieving harm reduction. The findings of the study suggest that the beliefs the leaders held about the role their staff play in assuring safe care contribute to the lack of progress in patient safety. The authors recommend three evidence-based leadership activities to transition to the proactive safety II approach to pursuing safe care.

This is the first longitudinal study to provide the perspectives of leaders on the provision of quality and safety in their hospitals. A large sample of board members, managers and clinical leaders provides extensive data on their perspectives on quality and safety.

The purpose of this paper is to describe three organizational dimensions that influence hospital patient safety climate, also showing and discussing differences between organizational types.

Surveys were conducted in four types of Saudi Arabian hospitals. Resultant information was analyzed using factor analysis and multiple‐regression.

Management support, a proper reporting system and adequate resources were found to influence the hospital patient safety climate.

The cross‐sectional hospital survey took place in a country that is radically redesigning its healthcare system. Major changes including hospital privatisation and healthcare insurance systems may have significant effects on hospital organizational climates.

Improving a hospital's patient safety climate is critical for decreasing errors and providing optimal services. Although much patient safety research has been published, the organizational climate in non‐Western countries has not been studied. The paper provides a unique Saudi Arabian hospital perspective and suggests that three dimensions influence the patient safety climate. Hospital managers are encouraged to improve these critical dimensions to positively develop their patient safety climate.