Advances in Biological Research 7 (5): 155-158, 2013

ISSN 1992-0067
IDOSI Publications, 2013
DOI: 10.5829/idosi.abr.2013.7.5.74191

Emergency Medicine Residents Perception About Patient Safety Culture

Javad Mozafari, Mohammad Ali Fahimi, Kambiz Masoumi, Ali Asgari Darian and Arash Forouzan
Department of Emergency Medicine,
Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
Abstract: Patient safety is considered as acore component ofquality in healthcare services. Accordingly, in this
study the perception of emergency medicine residents about patient safety was evaluated. This crosssectionalstudy was conducted toassessthe culture ofpatient safety among 29 consecutive subjects including
medical residents in emergency medicine field in Ahwaz Jundishapour University of Medical Sciences,
Southwestern Iran. Data was collected by Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire
designed by the Agency for Healthcare Research and Quality (AHRQ). The overall percentage of positive
responses was 75.9%. The percentage of positive responses was highest for management support for patient
safety (89.7%) and communication openness (75.9%) and lowest was for non-punitive responses to the error
(13.8%) and frequency of events reported (24.1%). Totally, according to the obtained results, it may be
concluded that the patients' safety perception is in a relatively good level among medical residents in the field
of emergency medicine.
Key words: Emergency Department

Patient Safety Culture

INTRODUCTION

Perception

error would be seen to the attitude that encourage

reporting the errors even those without patient's injury
may lead to improved quality and prevention of errors
[11]. Safety culture in organizations results from
attitudes, perceptions and behavioral patterns in work
teams that would provide type and skill of health and
safety [12].
These common values and characteristics are very
essential in creation of basic permanent changes in
patients' safety culture [13]. Despite long time attention to
development and improvement of patient safety culture,
the exact impacts on patients' outcome are not yet clear
[14-16]. During last decades, this idea that health care
system is not sufficiently safe and need to improvement
has been considered worldwide. On the other hand,
advances in patient safety helped to health care
organizations to recognize the risks and develop solution
for them. However without patient safety culture in all
health care facilities, no rapid persistent development in
patient health care provision would be seen. Also attitude
about patient safety is mainly evaluated among health
care staff and the matter is less assessed among medical
students including residents. Hence in this study the
perception of residents of emergency medicine about
patient safety was evaluated.

Safety from injuries and hazards is a major human

right especially when health care is provided for people
[1]. However medical errors are main challenging problem
for health care organizations world wide [2]. Since
responsibility for public health maintenance and
improvement is with health care providers, the quality of
care prepared by these sectorsis very important [3].
This quality includes some factors including patient
safety [4]. Patient safety means prevention and reduction
of terrible events and outcomes that may be seen during
provision of health care services [5]. These events include
aspects such as drug errors, surgical faults, incorrect
diagnoses, hospital-acquired infections, falling down, bed
sore, false treatment, etc [6].
Such adverse events may be seen in
significantnumber of patients during taking health care
services [2]. There are numerous annual fatal cases even
in developed countries [7, 8]. The frequency of complaints
from health care providers has shown a significant trend
in Iran [9] and these errors would result insignificant
financial burden and fatal events [10].
Health care organizations, improvement in patients
safety culture and a transition from the attitude that no

Corresponding Author: Ali Asgari Darian, Department of Emergency Medicine,

Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran .

155

Advan. Biol. Res., 7 (5): 155-158, 2013

MATERIALS AND METHODS

Table 1: Percentage of positive responses in different dimensions of patient

safety culture
Patient Safety Culture Dimension

In this cross-sectional study, 29 consecutive

subjects including senior and junior medical residents in
emergency medicine field in Ahvaz Jundishapour
University of Medical Sciences, Southwestern Iran,
were enrolled in a census manner in 2012. The only
exclusion criterion was dissatisfaction for incorporation in
the study. However all subjects responded and were
included in the study, the questionnaires and informed
consent forms werehand-distributed to them.
The survey included a section that asked questions
from the Hospital Survey on Patient Safety Culture
(HSOPSC) developed by the Agency for Healthcare
Research and Quality (AHRQ) [17]. This instrument
contains12 subscales and 42 items that consider many
attributes known to be associated with a culture of
patient safety, identified above [18]. Specifically, the
subscales of the instrumentinclude: (i) manager
expectations and actions promoting safety; (ii)
organizational learning; (iii) teamwork within units; (iv)
communication
openness;
(v)
feedback
and
communicationabout errors; (vi) non-punitive response to
errors; (viii) staffing; (viii) management support for patient
safety; (ix) teamwork across units and (x) handoffs and
transitions. The HSOPSC also includes two subscales that
are presentedas outcome dimensions: (i) overall
perceptions of safety and (ii) frequency of event
reporting. The HSOPSC has a good validity and reliability
according to previous studies, cognitive tests and factor
analyses toassess the patient safety culture in health care
centerswithconstructvalidities of each safety culture
dimension between 0.20 and 0.40 [17]. It was previously
translated, validated and used in some studies in Iran
[4, 5].
Data analysis was performed among 29 subjects by
SPSS (version 13.0) software [Statistical Procedures for
Social Sciences; Chicago, Illinois, USA]. IndependentSample-T and Fisher's Exacttests were used for analysis
and P values less than 0.05 were considered statistically
significant.

Overall Perceptions of Patient Safety

Frequency of Events Reported
Manager Expectations & Actions Promoting Patient Safety
Organizational Learning-Continuous Improvement
Teamwork Within Units
Communication Openness
Feedback & Communication About Error
Non-punitive Response to Error
Staffing
Management Support for Patient Safety
Teamwork Across Units
Handoffs & Transitions
Overall

Percent
62.1
24.1
58.6
72.4
51.7
75.9
55.2
13.8
72.4
89.7
65.5
72.4
75.9

punitive responses to the error (13.8%) and frequency of

events reported (24.1%). The overall mean score for
positive perception of patient safety culture was
44.1420.35. No relationship was found between age,
gender, or work experience years and total patient safety
culture score.
DISCUSSION
In this study the perception of patient safety culture
among residents in emergency medicine field was
evaluated. It was found that nearly 76 percent of them had
positive overall perception. However the factors such as
age, gender and work experience years were not
contributing for overall perception among subjects.
Highest positive responses seen in "Management
Support for Patient Safety" demonstrated the students
found a good powerful management system in their health
care center and this matter would result in more
cautionaboutpatient safety by them and also more
encouragement for actions in congruence with patient
safety culture. On the other hand lowest positive
response that is related to "Non-punitive Response to
Error" demonstrated more rigidregulationsin hospitals
letting least possible incorrect events and low fault rate
among residents. Totally, these two factors revealed the
fact that obligation is the main factor in understudy
hospitals to respect different dimensions of patients
safety culture. However low sample size in our study was
a restriction but we could evaluate all possible cases
during a census sampling to increase the validity of
current study. Finding no association between all other
variables and the knowledge of safety culture was an
interesting result that shows the probable role of other
contributing factors such as hospital situations and
cultural diversities.

RESULTS
The mean and standard deviation ofage was
32.933.64 years and 55.2% were female. The mean
experience was 4.683.98 years. The overall percentage of
positive responses was 75.9%. As shown in Table 1, the
percentage of positive responses was highest for
management support for patient safety (89.7%) and
communication openness (75.9%) and lowest for non156

Advan. Biol. Res., 7 (5): 155-158, 2013

REFERENCES

Chen and Lee [19] evaluated the perception of safety

culture among health care providers in Taiwan and found
the highest positive response about "teamwork within
units" but it was respected in only half cases in our study
showing less powerful perception for teamwork in our
study. Total perception of safety culture in their study
was 64 percent compared with 76 percent in current study.
The study by Al-Ahmadiin [20] in Saudi Arabiarevealed
that "Organizational Learning-Continuous Improvement"
hasthe highest positive response rate with 75.9 percent
and the lowest rate was related to "Non-punitive
Response to Error" with 21.1 percent. These two
dimensions were similarly among the highest and lowest
aspects from point of positive response rate. Tabrizchi
and Sedaghat [21] reported less overall positive response
rate of 57 percent in Tehran, Iranin comparison with this
study. They similarly reported "Non-punitive Response
to Error" as the item with lowest positive response rate.
However the highest dimension was related to
"Teamwork within Units". Their study similarly found no
significant association between gender and work
experience years with positive overall perception of
patient safety culture.
Handler et al. [22] reported that perception of patient
safety culture among different hospital wards differs that
demonstrates the importance of future comparative
studies between medical residents in different educational
fields. However Vlayenandcolleagues [23] from Belgium
reported a lower positive perception of patient safety
among emergency department personnel compared with
psychiatry and long-term care wards.
The study by Jasti et al. [24] in United States showed
a positive response rate of patient safety culture
ranging from 23 to 82 percent that is near to interval
obtained in current study 14 to 90 percent. Study by
Aboul-Fotouh et al. in Egypt [25] similarly demonstrated
that "Non-punitive Response to Error" gains lowest
positive response rate with 19.5 percent. However in their
study the highest rate was related to "Organizational
Learning-Continuous Improvement".
Totally, according to the obtained results, it may be
concluded that the patients' safety perception is in a
relatively good level among medical residents in the field
of emergency medicine. However further attempts for
achieving higher positive perception rate is encouraged.
Also further comparative studies among medical students
in other fields and in different educational stages is
suggested.

1.

Johnstone, M. and O.K. Anitsaki, 2006. Culture,

language and patient safety: making the links.
International Journal for Quality in Healthcare,
5: 383-388. Make references like this style.
2. Adams, R.E. and J.A. Boscarino, 2004. A community
survey of medicalerrors in New York. Int. J. Qual.
Health Care, 16: 353-62.
3. Mohammadi, A., H. EftekharArdebili, F. Akbari
Haghighi, M. Mahmudi and A. Pour Reza, 2003.
Services quality measurement based on patient
perceptions and expectations in Zanjan hospitals.
The Magazine of Health Faculty and Health Institute,
2: 71-84.
4. Smites, M, I. Dingelhoff, C. Wagner, G. Vanderwal
and P. Groenewegen, 2008. The psychometric
properties of the Hospital survey on Patient safety
culture in Dutch hospitals. BMC Health Services
Research, 8: 1-9.
5. Alahmadi, H.A., 2010. Assessment of patient safety
culture in Saudi Arabian hospitals. Quality Safety
Health Care, 19: 1-5.
6. Abdi Zh, M Maleki and A. Khosravi, 2012. Staff
perception about patient safety culture in selected
hospitals of Tehran University of Medical Sciences.
Payesh Quarterly, 10: 411-419. Make references like
this style.
7. Solberg, L.I., S.E. Ache, B.M. Averback, et al., 2008.
Can patient safety be measured by surveys of patient
experiences? The Joint Commission Journal on
Quality and Patient Safety, 34: 266-74.
8. National Patient Safety Agency. Seven Steps to
Patient Safety the Full Reference Guide, 2004.
Available from: URL:www.npsa.nhs.uk/sevensteps
9. Moghddasi, H., A. Sheikh Taheri and N. Hashemi,
2007. The role of computerized system of medical
orders registration on reduction of medical errors.
Health Administration, 10: 57-67.
10. Sanderson, J. and G. Cook, 2007. ABC of patient
safety. UK: Blackwell.
11. Wilson, K.A., 2007. Dose Safety culture Predict
Clinical Outcome?,
Ph.D.
Thesis, Florida:
University of Central Florida. Make references like
this style.
12. Cooper, D., 2002. Safety culture: A model for
understanding and qualifying a difficult concept.
Professional Safety, 47: 30-6.
157

Advan. Biol. Res., 7 (5): 155-158, 2013

13. Kirk, S., D. Parker, T. Claridge, A. Esmail and

M. Marshall, 2007. Patient safety culture in primary
care: developing a theoretical framework for practical
use. Qual. Saf. Health Care., 16: 313-20.
14. Huang, D.T., G. Clermont, L. Kong, L.A. Weissfeld,
J.B. Sexton and K.M. Rowan, 2010. Intensive care
unit safety culture and outcomes: a US multicenter
study. International Journal for Quality in Health
Care, pp: 1-11.
15. Singer, S., S. Lin, A. Falwell, D. Gaba and L. Baker,
2009. Relationship of safety climate and safety
performance in hospitals. Health Services Research,
44(2): 399-420.
16. Mardon, R., K. Khanna, J. Sorra, N. Dyer and
T. Famolaro, 2010. Exploring relationships between
hospital patient safety culture and adverse events.
Journal Patient Safety, 6(4): 226-32.
17. Colla, J.B., A.C. Bracken and L.M. Kinney et al., 2005.
Measuring patient safety climate: a review of
surveys. Qual. Saf. Health Care, 14: 364-6.
18. Sorra, J.S. and V.F. Nieva, 2004. Hospital Survey on
Patient Safety Culture. Rockville, MD: AHRQ
Publication No. 04-0041, Available from:
http://www.ahrq.gov/qual/patientsafetyculture/hos
pcult.pdf
19. Chen, I.C. and H.H. Li, 2010. Measuring patient
safety culture in Taiwan using the Hospital Survey
on Patient Safety Culture (HSOPSC). BMC Health
Serv Res., 10: 152.

20. Al-Ahmadi, T.A., 2009. Measuring Patient Safety

Culture in Riyadh's Hospitals: A Comparison
between Public and Private Hospitals. J. Egypt Public
Health Assoc., 84: 479-500.
21. Tabrizchi, N. and M. Sedaghat, 2012. The first study
of patient safety culture in Iranian primary health
centers. Acta Med. Iran, 50: 505-10.
22. Handler, S.M., N.G. Castle, S.A. Studenski, et al.,
2006. Patient safety culture assessment in the
nursing home. QualSaf Health Care, 15: 400-4.
23. Vlayen, A., J. Hellings, N. Claes, H. Peleman and
W. Schrooten, 2012. A nationwide hospital survey
on patient safety culture in Belgian hospitals: setting
priorities at the launch of a 5-year patient safety plan.
BMJ Qual Saf., 21: 760-7.
24. Jasti, H., H. Sheth, M. Verrico, et al., 2009. Assessing
Patient Safety Culture of Internal Medicine House
Staff in an Academic Teaching Hospital. J. Grad Med.
Educ., 1: 139-45.
25. Aboul-Fotouh, A.M., N.A. Ismail, H.S. EzElarab and
G.O. Wassif, 2012. Assessment of patient safety
culture among healthcare providers at a teaching
hospital in Cairo, Egypt. East Mediterr. Health J.,
18: 372-377. Make references like this style.

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