Roadmap for patient safety research: approaches and roadforks

På bakgrunn av en litteraturgjennomgang foreslå forskningsområder relatert til pasientsikkerhet.Patient safety improvement is a healthcare priority worldwide. Pioneer research reports include the 1984 Harvard Medical Practice Study, and the 1999 report "To err is human''. Patient safety research is expanding rapidly. Among the Scandinavian countries, Denmark is the patient safety improvement leader, and Norway is the laggard, having only recently institutionalized safety research and then having started with industrial safety research, and only recently having expanded into patient safety research. AIMS: to produce a roadmap for patient safety research, indicating three main roadforks. Patient safety research can be conducted along a number of lines. To identify patient safety problems and come up with ideas for patient safety improvement one can investigate 1) particular cases of adverse events, 2) the design of healthcare delivery systems, or 3) the culture of the care-giving institutions. The study of safety culture can be subdivided into the study of organization culture in general (and in particular of leadership culture) and the study of patient safety culture. The article provides a number of references to existing instruments of patient safety research. METHODS: qualitative interpretation of the referenced literature. RESULTS: scrutinizing adverse events for errors is health care's traditional way of improving patient safety. The idea of rethinking the design of care delivery systems has been accompanied by claims of modernity. The study of patient safety culture is the most recent approach. The three approaches are discussed in separate sub-chapters. CONCLUSIONS: although chronology suggests a developmental trend, the three approaches should not necessarily be seen as steps up the ladder of evolution. Each approach does have its merits

Psychometric properties of a modification of the Safety Attitudes Questionnaire (SAQ) for child protection services

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http:// creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.The concept of a safety culture is crucial to improving organisational risk management in several sectors, including health and aviation. However, social and welfare services are also sectors where organisations should be aware of the risk in their daily practice. The aim of the present article is to confirm the usability of a modified Safety Attitudes Questionnaire (SAQ) in the Norwegian child protection services CPS by checking a number of its psychometric properties. The SAQ is an instrument that has been widely applied and understood as valid and trustworthy for mapping employees’ views of their organisation’s safety culture. A confirmative factor analysis of data from a national survey of Norwegian CPSs demonstrated that the modified questionnaire has a factor structure which is internally consistent and matches the structure of the widely used SAQ health care questionnaire. The results indicate that the CPS-modified SAQ questionnaire could help understanding and mapping safety culture in the child protection services.publishedVersio

Physician participation in quality improvement work- interest and opportunity: a cross-sectional survey

Background: Lack of physician involvement in quality improvement threatens the success and sustainability of quality improvement measures. It is therefore important to assess physicians´ interests and opportunities to be involved in quality improvement and their experiences of such participation, both in hospital and general practice. Methods: A cross-sectional postal survey was conducted on a representative sample of physicians in different job positions in Norway in 2019. Results: The response rate was 72.6% (1513 of 2085). A large proportion (85.7%) of the physicians wanted to participate in quality improvement, and 68.6% had actively done so in the last year. Physicians’ interest in quality improvement and their active participation was significantly related to the designated time for quality improvement in their work-hour schedule (p < 0.001). Only 16.7% reported time designated for quality improvement in their own work hours. When time was designated, 86.6% of the physicians reported participation in quality improvement, compared to 63.7% when time was not specially designated. Conclusions: This study shows that physicians want to participate in quality improvement, but only a few have designated time to allow continuous involvement. Physicians with designated time participate significantly more. Future quality programs should involve physicians more actively by explicitly designating their time to participate in quality improvement work. We need further studies to explore why managers do not facilitate physicians´ participation in quality improvement.publishedVersio

The safety attitudes questionnaire - ambulatory version

Background: Several tools have been developed to measure safety attitudes of health care providers, out of which the Safety Attitudes Questionnaire (SAQ) is regarded as one of the most appropriate ones. In 2007, it was adapted to outpatient (primary health care) settings and in 2014 it was tested in out-of-hours health care settings in Norway. The purpose of this study was to translate the English version of the SAQ-Ambulatory Version (SAQ-AV) to Slovenian languageto test its reliabilityand to explore its factor structure. Methods: This was a cross-sectional study that took place in Slovenian out-of-hours primary care clinics in March- May 2015 as a part of an international study entitled Patient Safety Culture in European Out-of-hours services. The questionnaire consisted of the Slovenian version of the SAQ-AV. The link to the questionnaire was emailed to health care workers in the out-of-hours clinics. A total of 438 participants were invited. We performed exploratory factor analysis. Results: Out of 438 invited participants, 250 answered the questionnaire (response rate 57.1%). Exploratory factor analysis put forward five factors: 1) Perceptions of management, 2) Job satisfaction, 3) Safety climate, 4) Teamwork climate, and 5) Communication. Cronbach\u27s alpha of the whole SAQ-AV was 0.922. Cronbach\u27s alpha of the five factors ranged from 0.587 to 0.791. Mean total score of the SAQ-AV was 56.6 +- 16.0 points. The factor with the highest average score was Teamwork climate and the factor with the lowest average was Job satisfaction. Conclusions: Based on the results in our study, we cannot state that the SAQ-AV is a reliable tool for measuring safety culture in the Slovenian out-of-hours care setting. Our study also showed that there might be other safety culture factors in out-of-hours care not recognised before. We therefore recommend larger studies aiming to identify an alternative factor structure

Variations in patient safety climate and perceived quality of collaboration between professions in out-of-hours care

Purpose: To get an overview of health care workers perceptions of patient safety climates and the quality of collaboration in Slovenian out-of-hours health care (OOHC) between professional groups. Materials and methods: This was a cross-sectional study carried out in all (60) Slovenian OOHC clinics37 (61.7%) agreed to participate with 438 employees. The questionnaire consisted of the Slovenian version of the Safety Attitudes Questionnaire - Ambulatory Version (SAQ-AV). Results: The study sample consisted of 175 (70.0%) physicians, nurse practitioners, and practice nurses. Practice nurses reported the highest patient safety climate scores in all dimensions. Total mean (standard deviation) SAQ-AV score was 60.9+-15.2. Scores for quality of collaboration between different professional groups were high. The highest mean scores were reported by nurse practitioners on collaboration with practice nurses (4.4+-0.6). The lowest mean scores were reported by practice nurses on collaboration with nurse practitioners (3.8+-0.9). Conclusion: Due to large variations in Slovenian OOHC clinics with regard to how health care workers from different professional backgrounds perceive safety culture, more attention should be devoted to improving the team collaboration in OOHC. A clearer description of professional team roles should be provided

The safety attitudes questionnaire – ambulatory version: psychometric properties of the Norwegian translated version for the primary care setting

Background Patient safety culture is how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. The Safety Attitudes Questionnaire is the most widely used instrument to measure safety attitudes among health care providers. The instrument may identify possible weaknesses in clinical settings, and motivate and guide quality improvement interventions and reductions in medical errors. The Safety Attitudes Questionnaire – Ambulatory Version was developed for measuring safety culture in the primary care setting. The original version includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions and Stress recognition. We describe the results of a validation study using the Norwegian translation of the questionnaire in the primary care setting, and present the psychometric properties of this version. Methods The study was done in seven Out-of-hours casualty clinics and 17 regular GP practices employing a total of 510 primary health care providers (194 nurses and 316 medical doctors). In October and November 2012, the translated Safety Attitudes Questionnaire – Ambulatory Version was distributed by e-mail. Data were collected electronically using the program QuestBack, whereby the participants responded anonymously. SPSS was used to estimate the Cronbach’s alphas, item-to-own-factor correlations, intercorrelations of factors and item-descriptive statistics. The confirmatory factor analysis was done by AMOS. Results Of the 510 invited health care providers, 266 (52%) answered the questionnaire - 72% of the registered nurses (n = 139) and 39% of the medical doctors (n = 124). In the confirmatory factor analysis, the following five factor model was shown to have acceptable goodness-of-fit values in the Norwegian primary care setting: Teamwork climate, Safety climate, Job satisfaction, Working conditions and Perceptions of management. Conclusions The results of our study indicate that the Norwegian translated version of the Safety Attitudes Questionnaire – Ambulatory Version, with the five confirmed factors, might be a useful tool for measuring several aspects of patient safety culture in the primary care setting. Further research should investigate whether there is an association between patient safety culture in primary care, as measured by the Safety Attitudes Questionnaire – Ambulatory Version, and occurrence of medical errors and negative patient outcome