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Article

Wael Abdallah, Craig Johnson, Cristian Nitzl and Mohammed A. Mohammed

The purpose of this paper is to explore the relationship between organizational learning and patient safety culture in hospital pharmacy settings as determined by the…

Abstract

Purpose

The purpose of this paper is to explore the relationship between organizational learning and patient safety culture in hospital pharmacy settings as determined by the learning organization survey short-form (LOS-27) and pharmacy survey on patient safety culture instruments, and to further explore how dimensions of organizational learning relate to dimensions of pharmacy patient safety culture.

Design/methodology/approach

This study is a cross-sectional study. Data were obtained from three public hospital pharmacies and three private hospital pharmacies in Kuwait. Partial least square structural equation modeling was used to analyze the data.

Findings

A total of 272 surveys (59.1 percent response rate) were completed and returned. The results indicated a significant positive relationship between organizational learning and patient safety culture in hospital pharmacy settings (path coefficient of 0.826, p-value <0.05 and R2 of 0.683). Several dimensions of the organizational learning showed significant links to the various dimensions of the pharmacy patient safety culture. Specifically, training (TRN), management that reinforces learning (MRL) and supportive learning environment (SLE) had the strongest effects on the pharmacy patient safety culture dimensions. Moreover, these effects indicated that MRL, SLE and TRN were associated with improvements in most dimensions of pharmacy patient safety culture.

Originality/value

To the best of the authors’ knowledge, this is the first attempt to assess the relationship between organizational learning, patient safety culture and their dimensions in hospital pharmacy settings.

Details

Journal of Health Organization and Management, vol. 33 no. 6
Type: Research Article
ISSN: 1477-7266

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Article

Susan Brandis, Stephanie Schleimer and John Rice

Creating a culture of patient safety and developing a skilled workforce are major challenges for health managers. However, there is limited information to guide managers…

Abstract

Purpose

Creating a culture of patient safety and developing a skilled workforce are major challenges for health managers. However, there is limited information to guide managers as to how patient safety culture can be improved. The purpose of this paper is to explore the concept of reflexivity and develop a model for magnifying the effect of patient safety culture and demonstrating a link to improved perceptions of quality of care.

Design/methodology/approach

This research employed a correlational case study design with empirical hypothesis testing of quantitative scores derived from validated survey items. Staff perceptions of patient safety, reflexivity and quality of patient care were obtained via a survey in 2015 and analysed using inferential statistics. The final sample included 227 health service staff from clinical and non-clinical designations working in a large Australian tertiary hospital and health service delivering acute and sub-acute health care.

Findings

Both patient safety culture and reflexivity are positively correlated with perceived quality of patient care at the p<0.01 level. The moderating role of reflexivity on the relationship between patient safety culture and quality of care outcomes was significant and positive at the p<0.005 level.

Practical implications

Improving reflexivity in a health workforce positively moderates the effect of patient safety culture on perceptions of patient quality of care. The role of reflexivity therefore has implications for future pre-professional curriculum content and post-graduate licencing and registration requirements.

Originality/value

Much has been published on reflection. This paper considers the role of reflexivity, a much less understood but equally important construct in the field of patient safety.

Details

Journal of Health Organization and Management, vol. 33 no. 5
Type: Research Article
ISSN: 1477-7266

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Article

Susan Brandis, Stephanie Schleimer and John Rice

Building a new hospital requires a major investment in capital infrastructure. The purpose of this paper is to investigate the impact of bricks-and-mortar on patient safety

Abstract

Purpose

Building a new hospital requires a major investment in capital infrastructure. The purpose of this paper is to investigate the impact of bricks-and-mortar on patient safety culture before and two years after the move of a large tertiary hospital to a greenfield site. The difference in patient safety perceptions between clinical and non-clinical staff is also explored.

Design/methodology/approach

This research uses data collected from the same workforce across two time periods (2013 and 2015) in a large Australian healthcare service. Validated surveys of patient safety culture (n=306 and 246) were analysed using descriptive and inferential statistics.

Findings

Using two-way analysis of variance, the authors found that perceived patient safety culture remains unchanged for staff despite a major relocation and upgrade of services and different perceptions of patient safety culture between staff groups remains the same throughout change.

Practical implications

A dramatic change in physical context, such as moving an entire hospital, made no measurable impact on perceived patient safety culture by major groups of staff. Improving patient safety culture requires more than investment in buildings and infrastructure. Understanding differences in professional perspectives of patient safety culture may inform organisational management approaches, and enhance the targeting of specific strategies.

Originality/value

The authors believe this to be the first empirically based paper that investigates the impact of a large investment into hospital capital and a subsequent relocation of services on clinical and non-clinical staff perceptions of patient safety culture.

Details

Journal of Health Organization and Management, vol. 31 no. 4
Type: Research Article
ISSN: 1477-7266

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Article

Yong-Mi Kim and Donna Newby-Bennett

Patient safety improvement through management has been a prime issue since 2000, when the Institute of Medicine reported that preventable mismanagement was responsible for…

Abstract

Patient safety improvement through management has been a prime issue since 2000, when the Institute of Medicine reported that preventable mismanagement was responsible for the majority of medical errors. Learning culture, interdisciplinary action teams, and punitive culture have been discussed as viable ways to address these errors. While these individual factors have been found to be significant, we have yet to understand the interactions of these elements. The role of leadership, which has been overlooked, is critical to facilitate or constrain these elements. The interactions of these three elements and the role of leadership were analyzed using structural equation modeling. Our finding revealed the three elements were closely knitted, and leadership roles had considerable impact in nurturing learning culture and constraining punitive culture, which in turn enhanced patient safety

Details

International Journal of Organization Theory & Behavior, vol. 15 no. 2
Type: Research Article
ISSN: 1093-4537

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Article

Swee C. Goh, Christopher Chan and Craig Kuziemsky

This article aims to encourage healthcare administrators to consider the learning organization concept and foster collaborative learning among teams in their attempt to…

Abstract

Purpose

This article aims to encourage healthcare administrators to consider the learning organization concept and foster collaborative learning among teams in their attempt to improve patient safety.

Design/methodology/approach

Relevant healthcare, organizational behavior and human resource management literature was reviewed.

Findings

A patient safety culture, fostered by healthcare leaders, should include an organizational culture that encourages collaborative learning, replaces the blame culture, prioritizes patient safety and rewards individuals who identify serious mistakes.

Practical implications

As healthcare institution staffs are being asked to deliver more complex medical services with fewer resources, there is a need to understand how hospital staff can learn from other organizational settings, especially the non‐healthcare sectors.

Originality/value

The paper provides suggestions for improving patient safety which are drawn from the health and business management literature.

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 5
Type: Research Article
ISSN: 0952-6862

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Article

Eric W. Ford, Geoffrey A. Silvera, Abby S Kazley, Mark L. Diana and Timothy R Huerta

The purpose of this paper is to explore the relationship between hospitals’ electronic health record (EHR) adoption characteristics and their patient safety cultures. The…

Abstract

Purpose

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.

Design/methodology/approach

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).

Findings

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.

Originality/value

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.

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Article

Gregory N. Stock and Kathleen L. McFadden

The purpose of this paper is to examine the relationship between patient safety culture and hospital performance using objective performance measures and secondary data on…

Abstract

Purpose

The purpose of this paper is to examine the relationship between patient safety culture and hospital performance using objective performance measures and secondary data on patient safety culture.

Design/methodology/approach

Patient safety culture is measured using data from the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture. Hospital performance is measured using objective patient safety and operational performance metrics collected by the Centers for Medicare and Medicaid Services (CMS). Control variables were obtained from the CMS Provider of Service database. The merged data included 154 US hospitals, with an average of 848 respondents per hospital providing culture data. Hierarchical linear regression analysis is used to test the proposed relationships.

Findings

The findings indicate that patient safety culture is positively associated with patient safety, process quality and patient satisfaction.

Practical implications

Hospital managers should focus on building a stronger patient safety culture due to its positive relationship with hospital performance.

Originality/value

This is the first study to test these relationships using several objective performance measures and a comprehensive patient safety culture data set that includes a substantial number of respondents per hospital. The study contributes to the literature by explicitly mapping high-reliability organization (HRO) theory to patient safety culture, thereby illustrating how HRO theory can be applied to safety culture in the hospital operations context.

Details

Journal of Service Management, vol. 28 no. 1
Type: Research Article
ISSN: 1757-5818

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Article

Sujin K. Horwitz and Irwin B. Horwitz

The purpose of this paper is to investigate the relationship between patient safety culture and two attitudinal constructs: affective organizational commitment and…

Abstract

Purpose

The purpose of this paper is to investigate the relationship between patient safety culture and two attitudinal constructs: affective organizational commitment and structural empowerment. In doing so, the main and interaction effects of the two constructs on the perception of patient safety culture were assessed using a cohort of physicians.

Design/methodology/approach

Affective commitment was measured with the Organizational Commitment Questionnaire, whereas structural empowerment was assessed with the Conditions of Work Effectiveness Questionnaire-II. The abbreviated versions of these surveys were administered to a cohort of 71 post-doctoral medical residents. For the data analysis, hierarchical regression analyses were performed for the main and interaction effects of affective commitment and structural empowerment on the perception of patient safety culture.

Findings

A total of 63 surveys were analyzed. The results revealed that both affective commitment and structural empowerment were positively related to patient safety culture. A potential interaction effect of the two attitudinal constructs on patient safety culture was tested but no such effect was detected.

Research limitations/implications

This study suggests that there are potential benefits of promoting affective commitment and structural empowerment for patient safety culture in health care organizations. By identifying the positive associations between the two constructs and patient safety culture, this study provides additional empirical support for Kanter’s theoretical tenet that structural and organizational support together helps to shape the perceptions of patient safety culture.

Originality/value

Despite the wide recognition of employee empowerment and commitment in organizational research, there has still been a paucity of empirical studies specifically assessing their effects on patient safety culture in health care organizations. To the authors’ knowledge, this study is the first empirical study to examine the relationship between structural empowerment as proposed by Kanter and the culture of patient safety using physicians.

Details

Journal of Health Organization and Management, vol. 31 no. 1
Type: Research Article
ISSN: 1477-7266

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Article

Johan Hellings, Ward Schrooten, Niek S. Klazinga and Arthur Vleugels

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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”.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

Details

International Journal of Health Care Quality Assurance, vol. 23 no. 5
Type: Research Article
ISSN: 0952-6862

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Article

Made Indra Wijaya, Abd Rahim Mohamad and Muhammad Hafizurrachman

The purpose of this paper is to assess the association between shift schedule realignment and patient safety culture.

Abstract

Purpose

The purpose of this paper is to assess the association between shift schedule realignment and patient safety culture.

Design/methodology/approach

Using difference in differences model, BIMC Hospitals and Siloam Hospital Bali were compared before and after shift schedule realignment to test the association between shift schedule realignment and patient safety culture.

Findings

Shift schedule realignment was associated with a significant improvement in staffing (coefficient 1.272; 95% CI 0.842 – 1.702; p<0.001), teamwork within units (coefficient 1.689; 95% CI 1.206 – 2.171; p<0.001), teamwork across units (coefficient 1.862; 95% CI 1.415 – 2.308; p<0.001), handoffs and transitions (coefficient 0.999; 95% CI 0.616 – 1.382; p<0.001), frequency of error reported (coefficient 1.037; 95% CI 0.581 – 1.493; p<0.001), feedback and communication about error (coefficient 1.412; 95% CI 0.982 – 1.841; p<0.001) and communication openness (coefficient 1.393; 95% CI 0.968 – 1.818; p<0.001).

Practical implications

With positive impact on patient safety culture, shift schedule realignment should be considered as quality improvement initiative. It stretches the compressed workload suffered by staff while maintaining 40 h per week in accordance with applicable laws and regulations.

Originality/value

Shift schedule realignment, designed to improve patient safety culture, has never been implemented in any Indonesian private hospital. Other hospital managers might also appreciate knowing about the shift schedule realignment to improve the patient safety culture.

Details

International Journal of Health Care Quality Assurance, vol. 33 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

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