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Title: Patient Safety Culture : A Study of Public Hospitals in Maharashtra
Authors: Mankar, Dhananjay Deolal
Keywords: School of Health Systems Studies
Mariappan, M.
Patient Safety Culture - Public Hospitals - Maharashtra
Issue Date: 2018
Abstract: Background: Adverse events occurring in medical care delivery are a crucial source of morbidity and mortality throughout the world. Although there are no reliable estimates of the size of the problem in developing countries, it is likely that millions of disabling injuries or deaths can be directly attributable to medical care. “Doing no harm” to the patients is the motto, however, it is always that the problems occur in the course of healthcare delivery. Hospitals are trying to prevent a number of medical errors both latent conditions and active through appropriate tools and techniques which ensures patient safety. Therefore patient safety has become an important component of health care quality. Patient safety is a practice and continuous efforts of care providers at all levels and at all time. It is associated with hospital work culture. It can be term as patient safety culture. Patient Safety Culture is an important measure in assessing the quality of healthcare (Aspden et al., 2004). There is a growing recognition of the need to establish a culture of hospital focused on patient safety. Patient safety in the context of healthcare organizations was highlighted following the Institute of Management (IOM) Report “To Err is Human: Building a Safer Health System” (Kohn et al., 1999). This report argued for a safety culture in which adverse events can be reported without people being blamed and that when mistakes occur that lessons are learned. Therefore, if hospitals want to improve patient safety, it is important to know more about the views of their staff in relation to the culture of patient safety. To date, many developed countries have initiated the research into the role played by patient safety culture. But in developing countries like India, research in this vital area is still limited. India has faced several high profile incidents in which the safety of patients was grossly neglected (Gupta and Sriniviasan, 2012). During the course of treatment, there is number of incidents as well as accidents happen which either reported or considered for improvement or development. This has been happening due to the absence of patient safety culture. Therefore, it is one of the vital areas or need of the hour to address as part of the research. A research has been undertaken to address these issues. Methods: This research study has aimed to understand the health care worker’s perceptions of the importance of patient safety culture in their respective working units in public hospitals of Maharashtra. The Mixed Methods Study Design, in other words largely explanatory method was used for data collection giving priority to quantitative data (Patient Safety Culture Questionnaire). The qualitative information was collected through semi-structured interviews to get know their understanding of patient safety and their involvement in the whole process. The data was collected from six district hospitals of Maharashtra by using random sampling. From all the six hospitals, including all the four categories of staff were 1951, out of which 688 participated in this study. This sample consists of 19.62 percent doctors, 59.3 percent nurses, 17.88 percent Para-medical staff and 3.2 percent of administrative staff. The respondent, as well as the unit of analysis, is healthcare worker (all strata in hospitals). Formal Ethical clearance to conduct the study was obtained before the subject’s recruitment. The data were analyzed by using SPSS (for quantitative data) and using appropriate descriptive and inferential statistics and the thematic analysis of qualitative data. Results: The study findings reveal that, out of the twelve dimensions of patient safety culture measured in this research, the three dimensions that had the lowest percentage of positive responses were “Staffing”, “Non-punitive response to errors” and “Frequency of events reporting”, meaning that most of the respondents feel that the staff allocation is not adequate to handle patient safety-related workload and that the mechanism needs to be improved. The results show that hospital staffs in these hospitals feel negatively toward patient safety culture in their organization. The dimension that received the highest positive response rate was “Teamwork within units”, which is very similar to the results of the studies reported in US, Belgium, and Dutch. Overall, the respondents have indicated that there has been inadequate measures with regard to patient safety culture. This reflects on the staffs’ responses that nearly 41 percent of the respondents feel that there are some measures of patient safety culture and nearly 59 percent of the respondents feel that there was no patient safety culture existing in these public hospitals. Furthermore, the study identified significant differences between the six hospitals and their staff and departments with regard to patient safety culture dimensions. It is evident that there were different factors and aspects like; patient factors, task factors, individual factors, work factors, organization and management factors that led to poor patient safety culture in these six public hospitals. Importantly, the study revealed that there was a lack of support or commitment of the management of the hospitals in the addressing patient safety issues; this was considered by the health care workers as one of the main reasons for poor patient safety practice. Our results demonstrate that patient safety should be a top strategic priority in health care systems. There should be blame-free systems for identifying threats to patient safety, sharing information and learning from events. In addition, a collaborative environment should exist that allows all health workers in the healthcare organization to share and exchange information about patient safety in public hospitals of India. Conclusions: The findings showed that patient safety issues were not a policy priority for the agenda of the management of these public hospitals. It was noted that there was no effective patient safety system in any of these six public hospitals, to deal with patient safety issues, and there were no proactive patient safety measures in place to reduce the level of risk to patients. Therefore, there is a need for well-structured continuing and in- service education programmes for administrators, doctors and nurses to enable them to provide a high quality and clinically safe care. It is also recommended that the perceptions and attitudes of all health-care professionals be measured at regular intervals to improve and establish a patient safety culture. Policy makers and educators should address the development of necessary competencies in doctors, nurses & hospital administrators to bring creativity into the style of patient safety education and consider the cultural specific aspects of the phenomenon of patient safety when designing medical & nursing education curricula. In the future, it is also important to explore the perceptions of medical and nursing students. Moreover, this study suggests that patient safety concepts and required competencies and skills need to be incorporated into the Continuing medical education (CME) of doctors & in Management development program (MDP) of hospital manager’s and in nurse’s orientation programmers’. There is a need for policy and educational initiatives to improve patient safety. Also, workshops and continuous educational sessions concerning patient safety issues should be conducted for Paramedical staff on a regular basis. Moreover, hospital management should provide their health professionals with comprehensive training on patient safety concepts, tools, and implementation methods. Along with the responsibility of hospital employees in patient safety, the improvement of the patient safety culture should be the main priority in hospital settings in India and in other countries. Keywords: Patient Safety; Patient Safety Culture; Health care workers; Hospitals
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01_Title Page.pdf38.71 kBAdobe PDFView/Open
02_Declaration.pdf111.25 kBAdobe PDFView/Open
03_Certificate.pdf111.26 kBAdobe PDFView/Open
04_Dedication.pdf42.81 kBAdobe PDFView/Open
05_Contents.pdf5.34 kBAdobe PDFView/Open
06_Acknowledgement.pdf94.7 kBAdobe PDFView/Open
07_Abstract.pdf76.41 kBAdobe PDFView/Open
08_List of Abbreviation.pdf66.72 kBAdobe PDFView/Open
09_List Of Figures.pdf54.99 kBAdobe PDFView/Open
10_List of Tables.pdf63.43 kBAdobe PDFView/Open
11_Chapter 1.pdf550.5 kBAdobe PDFView/Open
12_Chapter 2.pdf2.07 MBAdobe PDFView/Open
13_Chapter 3.pdf565.41 kBAdobe PDFView/Open
14_Chapter 4.pdf1.01 MBAdobe PDFView/Open
15_Chapter 5.pdf430.9 kBAdobe PDFView/Open
16_Chapter 6.pdf272.32 kBAdobe PDFView/Open
17_Bibliography.pdf200.25 kBAdobe PDFView/Open
18_Appendix.pdf2.1 MBAdobe PDFView/Open

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