الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Adverse events and medical errors are serious problems in public health throughout the world, endangering patient safety in both developed and developing countries. The World Health Organization (WHO) estimated that globally, every year, 1 in every 10 patients suffer injuries or die as a result of adverse events.4 The Institute of Medicine (MIO) report entitled “To Err is Human” estimated that each year between 44,000 to 98,000 Americans suffered harm as a result of medical errors.1 In developing countries adverse events ranged from 2.5% to 18.4% per country. Of these events, 83% were considered to be preventable and about 30% were associated with death of the patient, and about 34% of the adverse events were from therapeutic errors.9 The Institute of Medicine (IOM) emphasize that healthcare organization should maintain patient safety as a top priority.1
The WHO defines patient safety as “Freedom, for a patient, from unnecessary harm or potential harm associated with healthcare”.9 The Institute of Medicine (IOM) suggests that the biggest challenge to moving toward a safer health care system is changing the patient safety culture (PSC) from one in which people are blamed for errors to one in which errors are treated as opportunities to improve the system and prevent harm.43 Patient safety culture is the perceptions, behaviors, and competencies of individuals and groups, that determine an organization’s commitment, style, and proficiency in health and safety management.1,36 PSC assessments have been used by organizations to determine targets for interventions to improve patient safety, evaluate the success of patient safety interventions, and conduct benchmarking.
As a tool to measure patient safety culture of healthcare organizations, identifying areas for improvement and monitoring evolution, the World Health Organization has decided the use of Hospital Survey of Patient Safety Culture (HSOPSC) that was developed by the Agency for Health Research and Quality (AHRQ) in the U.S.20,103, 129 The survey has been psychometrically tested and validated in different settings and is one of the few instruments that provides an extensive comparative database.75, 130
In Egypt, few studies addressing patient safety have been conducted. 114,127, 128 In Alexandria, patient safety culture was not assessed before using HSOPSC and no benchmarking was done as well, to the best of our knowledge.
Aim of work
Measuring the current patient safety culture in Alexandria governmental hospitals from the perspective of clinical healthcare providers using HSOPSC, to identify patient safety points of strength and opportunities for improvement among clinical healthcare providers in Alexandria governmental Hospitals and to compare the perception of patient safety culture among clinical healthcare providers in Alexandria governmental Hospitals with recent international benchmarks.
Subjects and methods
This study was a cross sectional study. A sample of 237 was taken, achieving a 95% confidence about the estimate.
Data was randomly collected by proportional allocation from three hospitals representing different administrative types of Governmental hospitals in Alexandria; Medical research institute hospital representing university teaching hospitals, Karmouz hospital representing health insurance organization hospitals, and Ras el teen hospital representing ministry of health hospitals. from each of the selected hospitals the following departments were included: internal medicine, general surgery, radiology, laboratory, and the pharmacy.
The clinical healthcare providers (doctors, nurses, pharmacists, technicians and assistants) in the aforementioned hospitals’ departments who have direct contact with patients and who had being in their position for at least six months (to ensure their acquaintance with the hospital processes and system) were included in the study.
The data was collected by translated Arabic version of Hospital Survey of patient safety culture (HSOPSC). Data was coded and checked. Negatively worded items were reversely coded.
Quantitative data were described using mean, and standard deviation. While qualitative data were described in frequency and percent.
Pearson’s Chi-Square test and One way ANOVA were used to compare the positive response rates. Gabriel and Games-Howell tests were conducted for post-hoc pairwise comparisons. Positive response rates were compared to AHRQ 2014 comparative database. Pearson r correlation analysis was used to test the correlation between independent and outcome dimensions. To test for factors affecting the overall perception of patient safety Linear multivariate regression was performed.
The most important findings in our study were:
In Alexandria governmental hospitals, dimensions with the highest average positive response rate were: teamwork within hospital units (75%), feedback and communication about error (68%) and supervisor expectations and actions promoting safety (66%).
In Alexandria governmental hospitals, dimensions with the lowest average positive response rate were: frequency of event reporting (37%), hospital management support for patient safety (40%) and teamwork across hospital units (40%).
Among Alexandria governmental hospitals only three safety culture dimensions exhibit statistically significant difference:
• Hospital handoffs and transitions: HIO denoted positive response rate (48%) higher than MRI (46%) and MOH (32%) (X 2(2) =20.5, P<.001).
• Communication openness: HIO denoted positive response rate (73%) higher than MRI (61%) and MOH (57%) (X 2(2) =12.9, P= .002).
• Hospital management support for patient safety: HIO denoted positive response rate (50%) higher than MRI (37%) and MOH (36%) (X 2(2) =11.5, P=.003).
Comparing composite positive response rate of healthcare providers by profession revealed:
• MOH nurses showed positive response rate higher than MRI and HIO nurses on staffing, Supervisor/manager expectations & actions promoting safety, Communication openness, Hospital Management Support for patient safety, and Teamwork across hospital units (p<.05).
• HIO physicians showed positive response rate higher than MRI and MOH physicians on Supervisor/manager expectations & actions promoting safety, Hospital Management Support for patient safety and frequency of event reporting (p<.05). While MRI physicians showed positive responses than HIO and MOH physicians on hospital handoffs and transitions (p<.05).
• HIO paramedical staffs showed positive response rate higher than MRI and MOH physicians on communication openness and hospital handoffs and transitions (p<.05). While MRI paramedical staffs showed positive response rate higher than HIO and MOH physicians on overall perception of safety (p<.05) .On the other hand, MOH paramedical staffs showed positive response rate higher than HIO and MIR physicians on frequency of event reporting (p<.05).
Comparing patient safety culture dimensions average positive response rate of Alexandria governmental hospitals to AHRQ 2014 benchmark revealed:
• Only non-punitive response to error in Alexandria hospitals (58%) had significantly higher average positive response rate than AHRQ 2014 comparative database (44%)
• In Alexandria hospitals Frequency of event reporting (37%) scored lower than the minimum score of the hospitals in the AHRQ 2014 comparative database (48%).
Comparing patient safety culture items average positive response rate of Alexandria governmental hospitals to AHRQ 2014 benchmark database revealed:
• Teamwork within units: QA11 showed positive response rate (52%) close to the minimum score of AHRQ 2014 comparative database (49%).
• Organizational learning – continuous improvement: QA13 showed positive response rate (49%) close to the minimum score of AHRQ 2014 (47%) comparative database.
• Staffing: QA14 showed positive response rate (0 %) lower than the minimum score of AHRQ 2014 comparative database (17%).
• Non-punitive response to error: QA8 showed positive response rate (85%) higher than the maximum score of AHRQ 2014 comparative database (82%).
• Supervisor/ manager expectations and actions promoting safety: QB4 showed positive response rate (61%) close to the minimum score of AHRQ 2014 comparative database.
• Feedback and communication about errors: QC5 showed positive response rate (62%) lower than AHRQ 2014 comparative database 10th percentile (64%).
• Communication openness: QC6 showed positive response rate (53%) lower than 10th percentile of AHRQ 2014 comparative database (54%).
• Hospital management support for patient safety: all items (QF1, QF8, and QF9) showed positive response rate (44%, 40%, and 37%) close to the minimum score of AHRQ 2014 comparative database (40%, 39%, and 19%).
• Teamwork across hospital units: QF10 showed positive response rate (35%) lower than the minimum score of AHRQ 2014 comparative database (41%).
• Handoffs and transitions: QF5 showed positive response rate (45%) close to AHRQ 2014 comparative database 10th percentile (41%).
• Overall perceptions of safety: QA18 showed positive response rate (47%) close to the minimum score of AHRQ 2014 comparative database (40%).
• Frequency of event reporting: QD2 & QD3 (31%& 38%) showed positive response rate lower than the minimum score of AHRQ 2014 comparative database (38%) & (50%) respectively.
Health insurance hospital showed significantly higher positive response rate than ministry of health hospital and medical research institute hospital regarding Communication openness (73%, p=.002), Hospital Management Support for patient safety (50%, p=.003), and Hospital handoffs & Transitions (48%, p<.001).
Non-punitive response to error, Hospital handoffs & Transitions and Teamwork across hospital units are intrinsic factors for improving overall perception of patient safety among healthcare providers in Alexandria governmental hospitals (F-value=28.8, p<.001,R-squared=.28, R-square adjusted=.27).