Dissertations / Theses on the topic 'Patient safety climate'

ABSTRACT Objectives: To develop and validate in an Australian setting, an instrument to effectively measure patient safety culture; to survey health care workers (HCWs) in a large public healthcare system to establish baseline patient safety culture; and, using the Theory of Planned Behaviour (TPB), to use behavioural modelling to identify the factors that predict and influence Patient Safety Behavioural Intent (PSBI) Eg. Reporting clinical incidents and speaking up when a colleague makes an error. Design: Cross sectional survey analysed with multiple logistic regression (MLR). Setting: Metropolitan, regional and rural public hospitals in Queensland, Australia. Participants: 5294 clinical and managerial staff. Main outcome measures: 1) Behavioural models for high-level Patient Safety Behavioural Intent (PSBI) for senior and junior doctors, senior and junior nurses, and allied health professionals. 2) Odds ratios to compare levels of PSBI between professional groups. Results: 1) The factors that influence high-level PSBI for each professional group give rise to unique predictive models. Two factors stand out as influencing high-level PSBI for all HCWs (R2 0.21). These are: i) Preventive Action Beliefs (Adjusted Odds Ratio (AOR) 2.38) (HCWs??? belief that engaging in the target behaviour(s) will lead to improved patient safety) and ii) Professional Peer Behaviour (AOR 1.79) (HCWs??? perceptions of the safety behaviour(s) of one???s professional peers). 2) There was a six-fold difference in the level of target behaviour (PSBI) across the clinical groups with few (29.6%) junior doctors having a high-level of PSBI. When compared with the junior doctors, the senior doctors were nearly 1.5 times more likely (Odds Ratio (OR) 1.46, 95% Confidence Interval (CI) 1.01-2.13), allied health staff 2.7 times more likely (OR 2.71, 95%CI 1.91-3.73), junior nurses 3.9 times more likely (OR 3.86, 95%CI 2.83-5.26), and senior nurses 6.0 times more likely (OR 6.01, 95%CI 4.78-9.16) to have high-level PSBI. Conclusions: This is the first published study to develop behavioural models of factors that influence HCWs??? intention to engage in behaviours known to be associated with improved patient safety. The findings of this study will greatly assist in the future design and implementation of targeted and cost-effective patient safety improvement initiatives.

The purpose of this study was to explore Zohar’s Multi-Climate Framework for Occupational Safety to determine the effects of staff nurse perceptions of safety priorities in their organization (safety climate) and their work ownership climate (Magnet Hospital designation) on safety citizenship behaviors viewed as in role or extra role. Safety citizenship behaviors are described as behaviors that go beyond the job description to ensure safety. Participants from a convenience sample of three Magnet designated community hospitals in New England completed three scales (Zohar’s Safety Climate Questionnaire, Essentials of Magnetism II and the Safety Citizenship Role Definitions Scale) representing the study variables via an online survey platform. Multivariate analysis of covariance informed the results. Findings include a positive unadjusted relationship between safety climate and work ownership climate (rs=.492, pF (1, 86) = 8.4, p=.005, N=92), controlling for work ownership climate and hospital. Implications include support for a continued focus on better understanding the importance of a positive nursing work environment, a characteristic shared by Magnet designated hospitals, on the presence of safety citizenship behaviors in the acute care environment. A professional work environment should be considered as an important factor in reducing errors in the acute care setting.

Il est préconisé de développer le climat de sécurité (CS) pour améliorer la sécurité des soins. Dans cette thèse, nous essaierons de préciser l’utilisation du concept de CS pour l’évaluation d'interventions d’amélioration de la sécurité des soins.Les objectifs des travaux présentés étaient d’élaborer un questionnaire de CS en français et d’évaluer l’impact de l’analyse de vignettes d’événements indésirables associés aux soins (EIAS) sur le CS d’unités de soins en milieu hospitalier.Ces travaux ont montré la faisabilité de mesurer le CS avec une version française du questionnaire américain, le Hospital Survey On Patient Safety Culture (HSOPSC). Ils ont permis de proposer une version française aux performances psychométriques suffisantes. Ils ont montré l’importance du rôle de l’encadrement, de l’organisation apprenante et du travail d’équipe entre services. La version française de l’HSOPSC a été utilisée pour évaluer l’effet de l’analyse de vignettes d’EIAS. Testée dans un essai contrôlé randomisé en clusters, cette intervention a amélioré les perceptions des professionnels sur l’organisation apprenante et l’amélioration continue, sans modifier les autres dimensions.Face à la difficulté de modifier dans un temps court l’ensemble des dimensions, le CS devrait être utilisé pour caractériser le contexte d'implémentation des interventions afin de les adapter et de mieux en comprendre l’impact, plutôt que pour servir de critère de résultat.Les pistes de recherche sont d’étudier la pérennité d’une intervention au-delà de son évaluation initiale au travers du maintien ou du développement de la culture de sécurité ; et d’étudier les perceptions des patients en matière de sécurité de soins
It is recommended to develop the safety climate (SC) to improve patient safety. In this thesis, we will try to clarify the use of the CS concept for the evaluation of interventions aiming to improve patient safety.The objectives of the articles presented were to develop a French version of a SC questionnaire and to assess the impact of a vignette-based analysis of adverse events (AEs) on the SC of care units.The studies demonstrated the feasibility of measuring the SC with a French version of the American questionnaire, the Hospital Survey On Patient Safety Culture (HSOPSC). They made it possible to propose a French version with sufficient psychometric performance. They showed the importance of the role of supervision, the organisational learning and teamwork between units. The French version of the HSOPSC was used to evaluate the effect of the vignette-based analysis of AEs. Tested in a randomized controlled cluster trial, this intervention improved professionals' perceptions of the organisational learning and continuous improvement, without modifying other dimensions.Given the difficulty of modifying all dimensions in a short period of time, SC should be used to characterize the context in which interventions are implemented in order to adapt them and better understand their impact, rather than being used as an outcome criterion.The research areas are to study the sustainability of an intervention beyond its initial evaluation through the maintenance or development of a safety culture; and to study patients' perceptions of care safety

Insight into opportunities for process improvement provides a competitive advantage through increases in organizational effectiveness and innovation As a result, it is important to understand the conditions under which employees are willing to communicate this information. This study examined the relationship between trust and psychological safety on the willingness to report errors in a medical setting. Trust and psychological safety were measured at the team and leader level. In addition, the moderating effect of a learning orientation climate at three levels of the organization (i.e., team members, team leaders, organizational) was examined on the relationship between trust and psychological safety on willingness to report errors. Traditional surveys and social network analysis were employed to test the research hypotheses. Findings indicate that team trust, when examined using traditional surveys, is not significantly associated with informally reporting errors. However, when the social networks within the team were examined, evidence that team trust is associated with informally discussing errors was found. Results also indicate that trust in leadership is associated with informally discussing errors, especially severe errors. These findings were supported and expanded to include a willingness to report all severity of errors when social network data was explored. Psychological safety, whether within the team or fostered by leadership, was not found to be associated with a willingness to informally report errors. Finally, learning orientation was not found to be a moderating variable between trust and psychological safety on a willingness to report errors. Instead, organizational learning orientation was found to have a main effect on formally reporting errors to risk management and documenting errors in patient charts. Theoretical and practical implications of the study are offered.
Ph.D.
Department of Psychology
Sciences
Psychology PhD

Background: Hospitals face an increasing pressure towards efficiency and cost reduction while ensuring patient safety. This warrants a closer examination of the trade-off between production and protection posited in the literature for a high-risk hospital setting (intensive care). Purposes: Based on extant literature and concepts on both safety management and organizational/safety culture, this study investigates to which extent production pressure (i.e., increased staff workload and capacity utilization) and safety culture (consisting of safety climate among staff and safety tools implemented by management) influence the occurrence of medical errors and if/how safety climate and safety tools interact. Methodology / Approach: A prospective, observational, 48-hour cross-sectional study was conducted in 57 intensive care units. The dependent variable is the incidence of errors affecting those 378 patients treated throughout the entire observation period. Capacity utilization and workload were measured by indicators such as unit occupancy, nurse-/physician-to-patient ratios, levels of care, or NEMS scores. The safety tools considered include Critical Incidence Reporting Systems, audits, training, mission statements, SOPs/checklists and the use of barcodes. Safety climate was assessed using a psychometrically validated four-dimensional questionnaire. Linear regression was employed to identify the effects of the predictor variables on error rate, as well as interaction effects between safety tools and safety climate. Findings: Higher workload has a detrimental effect on safety while safety climate - unlike the examined safety tools - has a virtually equal opposite effect. Correlations between safety tools and safety climate as well as their interaction effects on error rate are mostly nonsignificant. Practice Implications: Increased workload and capacity utilization increase the occurrence of medical error; an effect that can be offset by a positive safety climate but not by formally implemented safety procedures and policies. (authors' abstract)

Introdução: A segurança do paciente tornou-se uma preocupação formal em diversos sistemas de saúde no mundo nas últimas décadas. Em 2004 a Organização Mundial da Saúde (OMS) propõe a Aliança para segurança do paciente e aponta a avaliação da cultura de segurança nas instituições de saúde como um dos aspectos chave para esse processo. Método: pesquisa transversal de abordagem quantitativa, realizada em um hospital de ensino no interior do estado de são Paulo entre os meses de março e abril de 2014. A população de estudo foi composta por todos os profissionais que faziam parte da escala de trabalho das unidades de terapia intensiva (UTI) adulto, pediátrica e neonatal e não se enquadravam no critério de exclusão (menos de 6 meses na unidade). Foram aplicados dois instrumentos para avaliação da cultura e clima de segurança do paciente, o Hospital Survey on Patient Safety (HSOPSC) e o Safety Attitudes Questionnaire (SAQ), e um instrumento para levantamento das informações sociodemográficas e profissionais. Para a análise de dados utilizou-se o teste de confiabilidade das escalas pelo Alfa de Cronbach. Foi verificada a presença de associações das escalas com variáveis de estudo pelo qui-quadrado de Pearson ou teste exato de Fischer nas variáveis qualitativas, a ANOVA para as variáveis quantitativas. A presença de correlação entre os instrumentos SAQ e HPSOPSC foi verificada pelo teste de correlação de Pearson. Resultado: os dados sociodemográficos quanto a sexo e idade e cargo foram homogêneos nas três UTI. A UTI Neonatal possuía profissionais com mais tempo de trabalho na unidade e na especialidade quando comparada as demais unidades. Ambas as escalas apresentaram boa confiabilidade pelo alfa de Cronbach, 0,853 para o SAQ e 0,889 para o HSPOSC. Na análise dos domínios do SAQ, observou-se pontuação 62 para as Condições de Trabalho e para Percepções da Gerência, enquanto para o HSPOSC a dimensão Resposta não punitiva aos erros obteve o menor percentual de repostas positivas (29,6%), e as dimensões Abertura da comunicação e Retorno da comunicação e das informações sobre o erro uma proporção de neutros maior de 30%. A nota total de segurança do paciente pelo HSPOSC foi de 85% (somados ótima e muito boa). Analisando-se o comportamento das UTIs através de cada escala, a UTI Neonatal apresentou maior satisfação no trabalho do que as demais UTIs. A UTI Adulto apresentou menores pontuações em cada domínio quando comparada com as demais e para os domínios do HSPOSC somente o domínio Abertura de comunicação obteve uma proporção de respostas positivas discretamente superior às demais UTIs. A correlação entre as escalas através da correlação de Pearson foi de força moderada (coeficiente de Pearson de 0,656). As respostas abertas evidenciaram que as mudanças ocorridas no hospital em decorrência dos processos de acreditação, contribuíram para a melhor percepção dos profissionais sobre a segurança do paciente. Conclusões: há diferenças de percepções quanto a segurança do paciente entre as UTIs dentro de um mesmo hospital, o que corrobora com a existência de microculturas locais. As escalas de avaliação de clima/ cultura de segurança do paciente parecem medir fenômenos semelhantes.
Introduction: Patient safety has become a formal concern in several health systems in the world, in the last decades. In 2004 the World Health Organization (WHO) proposes the Alliance for patient safety and aims safety culture evaluation in healthcare institutions as one of the key aspects to this process. Method: Cross-sectional quantitative research approach, performed in a teaching hospital in São Paulo State between the months of March and April 2014. The study population was composed of all the professional who were part of the work schedule of intensive care unit (ICU) adult, pediatric and neonatal and did not fit the exclusion criteria (less than six months in the unit). Two instruments for assessing the culture environment and patient safety, the Hospital Survey on Patient Safety (HSOPSC) the Safety Attitudes Questionnaire (SAQ), and an instrument for survey of demographic and professional information were applied. For data analysis, the test of reliability of the scales by Cronbachs alpha was used. The presence of associations of scales with study variables was checked by Pearsons chi-square test or Fishers exact test in the qualitative variables, the ANOVA for quantitative variables. The presence of correlation between the SAQ and the HPSOPSC instruments was tested by Pearson correlation test. Result: sociodemographic data regarding gender and age and position were homogenous in the three ICUs. Professional of the Neonatal ICU had worked longer time in this unit and specialty when compared to other units. Both scales showed good reliability by Cronbachs alpha, 0.853 for SAQ and 0.889 for HSPOSC. In the analysis of the SAQ domains, it was observed score 62 for Working Conditions and Perceptions of Management, while for HSPOSC dimension Non-punitive Response to Error had the lowest percentage of positive responses (29.6%), the dimension Open Communication and Return of Communication and Information on the Error a proportion of neutral responses more than 30%. The total score of patient safety by HSPOSC was 85% (summed up great and very good). Analyzing the behavior of ICUs through each scale, Neonatal ICU had higher job satisfaction than the other ICUs. Adult ICU had lower scores in each domain compared to other domains and for HSPOSC only the area Open Communication obtained the proportion of positive responses slightly superior to the other ICUs. The correlation between the scales through Pearson correlation was of moderate strength (Pearson correlation coefficient of 0.656). The open responses showed that changes in hospital as a result of accreditation processes, contributed to a better perception of professionals about patient safety. Conclusions: There are differences in perceptions of patient safety among ICUs within the same hospital, which corroborates the existence of local microcultures. Rating scales of climate/culture of patient safety seems to measure similar phenomena.

RESUMO - Introdução: Os blocos operatórios têm uma prevalência alta de incidentes sendo uma prática complexa, interdisciplinar, com forte dependência da atuação individual, onde a ergonomia e os fatores organizacionais desempenham um papel fundamental. Devido a estes fatores torna-se imperativo que o clima de segurança seja analisado de forma a melhorar a segurança do doente. Metodologia: A versão original anglo-saxónica do “Safety Attitudes Questionnaire” ou SAQ foi traduzida e adaptada para o contexto português e aplicada no serviço de cirurgia de um centro hospital público. As escalas psicométricas foram analisadas usando o alfa de Cronbach e interpelações entre as escalas. Resultados: O teste de validade interna do instrumento foi de 0.90 para os 73 itens. Os dados de 82 questionários foram analisados revelando diferenças significativas na classificação da qualidade de comunicação entre os vários grupos profissionais. Verificou que o clima de equipa e segurança é afetado em larga parte pela satisfação profissional e condições de trabalho. Conclusão: O SAQ revela boas capacidades psicométricas para o estudo do clima de segurança no entanto são necessários estudos mais extensos para colmatar a falta de dados nalguns itens. Os resultados obtidos permitem concluir que as condições de trabalho e a satisfação profissional são satisfatórias, no entanto é sugestivo a necessidade de melhoria do clima de segurança e do envolvimento da gestão de topo.
ABSTRACT - Introduction: Operating rooms can have a high prevalence of errors, being a interdisciplinary, complex activity with a strong dependence on technical skill, where ergonomics and organizational factors play an essential role. Due to these factors it is imperative that the safety climate in the OR is analysed in order to improve patient safety. Methods: The original English version of the Safety Attitudes Questionnaire or SAQ was translated and adapted to the Portuguese setting and applied in a central public hospital. Scale psychometrics were analysed using Cronbach alphas and inter-correlations among the scales. Results: The internal consistency test yielded values around 0.9 for all 73 items. 82 valid questionnaires were analysed revealing significant differences in communication ratings between different professions. Team climate and safety climate is strongly affected by professional satisfaction and working conditions Conclusion: The SAQ reveals good psychometric properties for studying the safety climate of organizations, however further studies are required to compensate the lack of subjects in some items. Results allowed to conclude that working conditions and professional satisfaction are satisfactory, however the need for improving the safety climate and the involvement of the management is strongly suggested.

A vulnerabilidade dos pacientes, que se submetem ao procedimento cirúrgico, e a complexidade de atividades e das relações interpessoais entre as equipes cirúrgicas são consideradas elementos intervenientes na segurança do paciente. Nesse sentido, pesquisas vêm sendo conduzidas visando mensurar o clima de segurança percebido pelos profissionais, com vistas a avaliar a cultura de segurança nos serviços de saúde. Objetivo: Realizar a adaptação transcultural e a validação do Safety Attitudes Questionnaire/Operating Room Version (SAQ/OR) para o contexto brasileiro. Método: Trata-se de um estudo de cunho metodológico, de adaptação e validação de um questionário destinado a mensurar o clima de segurança em centro cirúrgico, desenvolvido em duas etapas: a primeira consistiu na tradução linguística e na adaptação cultural e a segunda na validação do instrumento. Para a tradução e adaptação transcultural o método empregado foi constituído pelas fases: tradução, síntese, retrotradução, avaliação por comitê de juízes, pré-teste com 30 sujeitos e submissão e avaliação dos relatórios pelos autores do instrumento original. Doze juízes realizaram a validação das equivalências experiencial, conteúdo, conceitual, semântica e idiomática; o índice de Validade de Conteúdo estabelecido foi a 80%. Os dados desta etapa foram coletados de agosto de 2013 a abril de 2014. A validação de constructo do instrumento foi realizada pela análise fatorial exploratória e a análise da confiabilidade por meio do alpha de Cronbach. O questionário foi aplicado a uma amostra de 590 profissionais de saúde atuantes em centro cirúrgico, em quatro hospitais do Município de São Paulo. O período de coleta de dados foi de maio a agosto de 2014. Resultados: As etapas de tradução e retrotradução foram consideradas adequadas e a avaliação pelos juízes apresentou os seguintes resultados para as equivalências: experiencial 82,3%, de conteúdo 82,8%, conceitual 85%, de semântica 85,2% e idiomática 85,5%. A análise fatorial exploratória resultou em um questionário com 40 assertivas, sendo 30 alocadas em seis domínios, a saber: clima de segurança, percepção da gerência, percepção do estresse, condição do trabalho, comunicação no ambiente cirúrgico e percepção do desempenho profissional. Dez assertivas foram agrupadas em fatores que apresentaram alpha de Cronbach inferior a 0,50 e baixa correlação ao item total; assim não foram descritas como domínio. A versão adaptada mostrou-se confiável, obtendo o valor geral do alpha de Cronbach de 0,87. O domínio comunicação no ambiente cirúrgico apresentou o menor valor de alpha 0,59; nos outros cinco domínios os valores variaram de 0,71 a 0,82. Conclusões: Os achados desta pesquisa produziram a versão brasileira do questionário, denominada SAQ/Centro Cirúrgico, a qual foi adaptada e validada na amostra estudada. Contudo, recomenda-se a aplicação do questionário em outras instituições do país para proceder a novas análises psicométricas.
The vulnerability of patients, who have underwent a surgical procedure, the complexity of activities and the interpersonal relationships between surgical teams are considered intervening elements for patient safety. Thus, researches are being conducted aiming to measure the safety climate perceived by professionals, directed towards evaluation of the safety climate in healthcare services. Objective: Do the transcultural adaptation and validation of Safety Attitudes Questionnaire/Operating Room Version to Brazilian context. Method: This is a study, with methodological emphasis, of the adaptation and validation of a questionnaire intended for measuring the safety climate in surgical centers, and developed in two stages: the first was the linguistics translation and cultural adaptation, and the second was instrument validation. For the translation and transcultural adaptation, the method employed was constituted by the steps: translation, synthesis, retrotranslation, evaluation by a judges committee, pretesting with 30 subjects, and submittal to and evaluation of the reports by the authors of the original instrument. Twelve judges have executed the experiential, content, conceptual, semantics and idiomatic equivalences; the index defined for content validity was 80%. The data for this stage was collected from August 2013 to April 2014. The instrument construct validation was done through exploratory factor analysis and the reliability analysis through Cronbachs alpha. The questionnaire was applied to a sample of 590 health professionals working in surgical centers in four hospitals of the municipality of São Paulo. The data collection period went from May to August 2014. Results: The stages of translation and retrotranslation were considered proper, and the judges evaluation presented the following results for the equivalences: experiential 82.3%, content 82.8%, conceptual 85%, semantics 85.2%, and idiomatic 85.5%. The exploratory factor analysis resulted in a questionnaire with 40 statements, 30 of them assigned to six domains, that is: safety climate, management perception, stress perception, working conditions, communications in the surgical environment and professional performance perception. Ten statements were grouped in factors presenting Cronbachs alpha less than 0.50 and low correlation with the total item; thus, they were not described as a domain. The adapted version has proven reliable, reaching a general value of 0.87 for Cronbachs Alpha. The domain Communications on Surgical Environment presented the less value of 0.59 for Alpha; on the other domains the values varied from 0.71 to 0.82. Conclusions: The findings of this research resulted in a Brazilian version of the questionnaire, called SAQ/Centro Cirúrgico (SAQ/Surgical Center), which was adapted and validated through the studied sample. However, we recommend applying the questionnaire in other institutions of the country to do new psychometric analyses.

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Since the publication of the report "To Err is Human" by the Institute of Medicine (IOM) , which estimated that between 44.000 to 98.000 Americans die annually as a result of errors in health care, patient safety spent gaining prominence, emerging studies assess the safety culture by measuring the safety climate. In this context, the aim of this study was to identify safety culture perceived by nursing professionals working in the intensive care unit of a maternity school in Natal/RN through the Security Attitudes Questionnaire (SAQ). This was a descriptive study, cross-sectional and quantitative approach undertaken in the Intensive Care Unit Maternal and Neonatal a maternity school in Natal/RN. The project was submitted to and approved by Brazil Platform Zip/UFRN under number 309 540 and CAAE 16489713.7.0000.5537. It was used to collect data two instruments: a questionnaire in order to collect socio-demographic data of the subjects and the Question?rio Atitudes de Seguran?a , a cultural adaptation to Portuguese of the instrument of the World Health Organization titled Safety Attitudes Questionnaire - (SAQ ) Short Form 2006. The collected data were analyzed quantitatively by the organization in electronic databases in Microsoft Excel 2010 spreadsheet and exported to statistical software for free access to be coded, tabulated and analyzed using descriptive statistics. The study included a total of 50 nurses, 31 and 19 of the NICU Maternal ICU, predominantly female, mean age 35 years, median time of 10 years training and working in maternity, mostly, less than 05 anos. As a result, two articles were produced. The first refers to the first two domains of the instrument entitled "climate of teamwork" and "climate security" . The scores of the two areas were slightly higher in Maternal ICU compared to the NICU, but no sector has reached the ideal minimum score of 75: in the first domain Maternal ICU had an average of 74.77, with medians of 75 and 100, while Neonatal ICU reached an average of 69.61 with median also 75 and 100, while the second field means were 69.35 and 66.01 for Maternal and Neonatal ICUs respectively, with a median of 100 in the two sectors. The second article relates to the field "Perception Management Unit and Hospital", which 9 assessed the perception of management units and motherhood by professionals. In general, the items of the domain in question also obtained scores below the ideal minimum: 63.68 to 51.02 and maternal ICU for neonatal, featuring a clear separation between the management and the professionals who work in direct care. These findings indicate a warning sign for the institution and point to the need to implement actions aimed at patient safety
A partir da publica??o do relat?rio Errar ? Humano pelo Institute of Medicine (IOM), o qual estimou que entre 44.000 e 98.000 americanos morrem anualmente em decorr?ncia de erros da assist?ncia ? sa?de, a seguran?a do paciente passou ganhar destaque, surgindo estudos que avaliam a cultura de seguran?a atrav?s da mensura??o do clima de seguran?a. Nesse contexto, o objetivo deste estudo foi identificar a cultura de seguran?a percebida pelos profissionais de enfermagem que atuam nas unidades de terapia intensiva de uma maternidade-escola em Natal/RN, atrav?s do Question?rio Atitudes de Seguran?a (SAQ). Tratou-se de um estudo do tipo descritivo, transversal, com abordagem quantitativa, realizado nas Unidades de Terapia Intensiva Materna e Neonatal de uma maternidade-escola na cidade de Natal/RN. O projeto foi submetido ? Plataforma Brasil e aprovado pelo CEP/UFRN sob o n?mero 309.540 e CAAE 16489713.7.0000.5537. Utilizaram-se para a coleta de dados dois instrumentos: um question?rio com a finalidade de coletar dados sociodemogr?ficos dos sujeitos e o Question?rio Atitudes de Seguran?a, uma adapta??o transcultural para a l?ngua portuguesa do instrumento da Organiza??o Mundial da Sa?de intitulado Safety Attitudes Questionnaire (SAQ) Short Form 2006. Os dados coletados foram analisados quantitativamente atrav?s da organiza??o em banco de dados eletr?nico no Microsoft Excel 2010 e exportados para planilha do SPSS (Statistical Package for the social sciences) vers?o 2.0 para serem codificados, tabulados, e analisados mediante estat?stica descritiva. Participaram do estudo 50 profissionais de enfermagem, sendo 31 da UTI Neonatal e 19 da UTI Materna, predominantemente do sexo feminino, com idade m?dia de 35 anos, tempo de forma??o m?dio de 10 anos e que trabalhavam na maternidade, em sua maioria, havia menos de 5 anos. Como resultado, foram produzidos dois artigos. O primeiro refere-se aos dois primeiros dom?nios do instrumento, intitulados Clima de trabalho em equipe e Clima de seguran?a . Os escores dos dois dom?nios foram ligeiramente mais elevados na UTI Materna se comparada ? UTI Neonatal, por?m nenhum setor atingiu o escore m?nimo ideal de 75: 7 no primeiro dom?nio a UTI Materna obteve m?dia de 74,77, com medianas de 75 e 100, e a UTI Neonatal atingiu m?dia de 69,61 com medianas tamb?m de 75 e 100; enquanto que no segundo dom?nio as m?dias foram de 69,35 e 66,01 para as UTIs Materna e Neonatal respectivamente, com mediana de 100 nos dois setores. O segundo artigo diz respeito ao dom?nio Percep??o da Ger?ncia da Unidade e do Hospital , que avaliou a percep??o da ger?ncia das unidades e da maternidade por parte dos profissionais. Em geral, os itens do dom?nio em quest?o tamb?m obtiveram escores aqu?m do m?nimo ideal: 63,68 para a UTI Materna e 51,02 para a Neonatal, caracterizando um evidente distanciamento entre a gest?o e os profissionais que atuavam na assist?ncia direta. Tais achados indicam um sinal de alerta para a institui??o e apontam para a necessidade de implementar a??es que visem a seguran?a do paciente

Em 2004, a Organização Mundial de Saúde (OMS) definiu como prioridade o desenvolvimento de pesquisas baseadas em evidências científicas com melhores práticas voltadas para a segurança do paciente. Desde então, vários estudos surgiram com o objetivo de avaliar a cultura de segurança nas instituições de saúde, por meio de instrumentos de mensuração do clima de segurança. Dessa forma, o objetivo desse estudo foi realizar a adaptação transcultural do Safety Attitudes Questionnaire (SAQ) - Short Form 2006 para a língua portuguesa. O instrumento foi aplicado em seis hospitais de três regiões do Brasil, Nordeste, Sudeste e Centro- Oeste. Para a tradução e adaptação cultural do instrumento seguiu-se a proposta metodológica de Beaton et al (2002). A validade de conteúdo e face foi realizada pela análise dos juízes e pelo pré-teste. A validade de construto foi realizada pelas análises fatorial exploratória e confirmatória e comparação entre grupos. A análise da confiabilidade do instrumento foi realizada por meio da análise da consistência interna dos itens, através do coeficiente alfa de Cronbach. A amostra do estudo foi composta por 1301 profissionais das enfermarias clínicas e cirúrgicas dos seis hospitais. A aplicação do instrumento ocorreu nos meses de julho a outubro de 2010. O estudo foi aprovado pelos comitês de Ética em Pesquisa das seis instituições. A versão adaptada para a língua portuguesa do SAQ apresentou alfa de Cronbach total de 0,89. As correlações item-total entre os domínios foram consideradas de moderada a forte, com exceção do domínio Percepção do Estresse. A análise confirmatória mostrou que o ajuste do modelo final dos 41 itens foi considerado satisfatório. Na análise fatorial exploratória o item 14, que não pertence a nenhum domínio na escala original, foi alocado no domínio Percepção da Gerência e os itens 33, 34 e 35 foram alocados em um único domínio. Quanto ao método de comparação de grupos identificou-se diferença de médias estatisticamente significativa entre hospitais e tempo de atuação. Conclui-se, portanto que a versão adaptada do Safety Attitudes Questionnaire para o Português é considerada válida e confiável em nossa amostra.
In 2004, the World Health Organization (WHO) has defined as priority the development of evidence-based research with best practices for patient safety. Since then, several studies have begun to evaluate the safety culture in healthcare institutions, by means of instruments measuring the safety climate. Thus, the objective of this study was the cultural adaptation of the Safety Attitudes Questionnaire (SAQ) - Short Form 2006 for the Portuguese language. The instrument was applied in six hospitals in three regions of Brazil: Northeast, Southeast and Midwest. For the translation and cultural adaptation of the instrument followed the methodological approach of Beaton et al (2002). The face and content validity analysis was performed by judges and the pre-test. Construct validity was performed by exploratory and confirmatory factor analysis and method of comparison groups. Analysis of instrument reliability was performed by analyzing the internal consistency of items through the Cronbach coefficient. The study sample was comprised of 1,301 professionals in clinics and surgical wards of six hospitals. The application of the instrument occurred from July to October 2010. The study was approved by the Research Ethics Committee of six institutions. A version adapted to Portuguese SAQ showed Cronbach\'s alpha of 0.89. The item-total correlations between the domains were considered moderate to strong, except for domain Stress Recognition. The confirmatory analysis showed that the model fitting end of the 41 items was satisfactory. The exploratory factor analysis the item 14, which has no domain in the original scale, was allocated in the domain Perception of Management and items 33, 34 and 35 were allocated in a single component. The method of comparison groups were identified statistically significant average difference between hospitals and years specialty. We conclude that the SAQ Portuguese version was considered valid and reliable in our sample.

A elevada frequência dos eventos adversos compromete a qualidade da assistência prestada nos serviços de saúde e revela a importância da cultura e do clima de segurança do paciente. No entanto, é escassa a produção de estudos sobre o clima de segurança do paciente nos serviços de atendimento às urgências e emergências, ambientes complexos, dinâmicos e propensos aos incidentes e eventos adversos. Em vista disso, o objetivo desta pesquisa foi avaliar o clima de segurança do paciente sob a perspectiva dos profissionais atuantes nos setores de atendimento às urgências e emergências de uma Unidade de Emergência do interior do Estado de São Paulo. Tratou-se de estudo descritivo, transversal, de levantamento (survey) e com abordagem quantitativa. Foi utilizado o instrumento Safety Attitudes Questionnaire (SAQ) - Short Form 2006, validado e adaptado para a língua portuguesa, o qual é dividido em duas partes, sendo a primeira composta por 41 itens distribuídos em seis domínios e a segunda por dados sociodemográficos dos participantes. O escore final do instrumento varia de 0 a 100 e são considerados valores positivos quando o escore total é maior ou igual a 75. As respostas foram dadas por meio da escala do tipo Likert de cinco pontos e o processamento e a análise dos dados foram realizados com o auxílio do Programa R versão 3.1.2 e do Statistical Package for Social Science (SPSS), versão 22.0. A amostra do estudo foi constituída por 125 participantes e composta por médicos, chefe de enfermagem, enfermeiros, auxiliares e técnicos de enfermagem, psicólogos, assistentes sociais, técnicos em radiologia, pessoal administrativo (escriturários), suporte ambiental (pessoal da limpeza), auxiliares de saúde e equipe de distribuição. Predominaram participantes do gênero feminino, profissionais de enfermagem e com mais de 10 anos de tempo na especialidade. A percepção dos participantes quanto ao clima de segurança do paciente foi considerada desfavorável e não houve diferenças significativas quando analisadas as variáveis gênero, cargo e tempo na especialidade. Por meio dos seis domínios do SAQ foi possível avaliar as atitudes, o clima de trabalho em equipe, a satisfação profissional, as condições de trabalho e os fatores estressores dos participantes. De modo geral, os participantes demonstraram-se satisfeitos com o trabalho. No entanto, desaprovam as ações da gerência quanto às questões de segurança. A satisfação do profissional, a comunicação entre gerentes e profissionais da linha de frente e as condições de trabalho influenciam no clima de segurança do paciente, especialmente no contexto das unidades de urgência e emergência. Sendo assim, conhecer a percepção dos profissionais sobre o clima a segurança do paciente nestes setores auxilia no diagnóstico da cultura de segurança, contribui para a melhoria dos cuidados de saúde, reduz os incidentes e os eventos adversos e visa à melhoria da qualidade da assistência prestada aos pacientes
The high frequency of adverse events compromises the quality of care in health services and reveals the importance of culture and patient safety climate. However, there is little scientific research about the patient safety climate in care services to urgencies and emergencies, complex, dynamic and prone to incidents and adverse environments. As a result, the objective of this research was to evaluate the climate patient safety from the perspective of professionals working in service industries to emergency care of an Emergency Unit of the State of São Paulo. This was a descriptive, cross-sectional study of survey and quantitative approach. It used the instrument Safety Attitudes Questionnaire (SAQ) - Short Form 2006, validated and adapted to the Portuguese language, which is divided into two parts, the first consisting of 41 items divided into six domains and the second by demographic data of the participants. The final score of the instrument ranges from 0 to 100 and positive values are considered when the total score is greater than or equal to 75. The answers were given by Likert scale of five points and the processing and data analysis were performed with the help of R version 3.1.2 and the Statistical Package Program for Social Sciences (SPSS) version 22.0. The study sample consisted of 125 participants and consists of physicians, nurse boss, nurses, nursing assistants and technicians, psychologists, social workers, radiology technicians, administrative staff (clerks), environmental media (cleaning staff), health aides and distribution team. Predominated female participants, nursing professionals and over 10 years in specialty. The perception of participants as to patient safety climate was considered unfavorable and no significant differences when analyzed variables gender, position and years in specialty. Through the six domains of the SAQ was possible to evaluate the attitudes, the climate of teamwork, job satisfaction, working conditions and stress factors of the participants. Overall, participants showed their satisfaction with the work. However, disapprove of the actions of management regarding security issues. The satisfaction of the professional, communication between managers and front-line professionals and working conditions influence the patient safety climate, especially in the context of urgency and emergency units. So know the perception of professionals on climate patient safety in these sectors assists in the diagnosis of safety culture, contributes to the improvement of health care, reduce incidents and adverse events and aims to improve the quality of care to patients

Instituições de saúde onde a cultura de segurança do paciente é positiva caracterizam-se por comunicação pautada em confiança mútua, por percepções compartilhadas sobre a importância de prestar cuidados seguros e pela confiança na eficácia de medidas preventivas. Nesta perspectiva, o objetivo geral do estudo consistiu em analisar a cultura de segurança do paciente junto à equipe multiprofissional de um centro avançado de neurologia e neurocirurgia da região sul do Brasil. À luz do pensamento restaurativo, desenvolveu-se o estudo com método misto sequencial explanatório. A pesquisa tramitou na Plataforma Brasil, obteve aprovação mediante CAAE 39941114.4.0000.5347 e os dados foram coletados entre outubro de 2015 e fevereiro de 2016, em duas fases. A primeira, de abordagem quantitativa, compreendeu a aplicação do Safety Attitudes Questionnaire, totalizando 31 participantes; a segunda, de abordagem qualitativa, foi realizada por meio da técnica de grupos focais com 7 participantes, oriundos da primeira fase, empregando o método fotográfico e a respectiva narração fotográfica, em que se discutiu acerca dos resultados do Safety Attitudes Questionnaire em concomitância à elicitação das fotografias. No grupo focal adotaram-se os princípios do Diálogo Deliberativo como uma estratégia de Translação do Conhecimento para fomentar a aplicabilidade dos resultados da pesquisa no cenário da prática. A estatística descritiva e bivariada ancorou a análise dos dados quantitativos considerando significativo p≤0,05; na fase qualitativa, adotou-se a análise de conteúdo do tipo temática. Os resultados apontaram escore total de 65 relativo ao clima de segurança, sendo considerado positivo quando ≥ a 75. Houve diferença significativa no domínio Percepção da gerência da unidade (p=0,034) entre a média dos médicos (74,2±17,9) e de outros profissionais (77,4±14,7), mostrando-se mais elevadas quando comparadas aos técnicos e auxiliares de enfermagem (52,1±23,2 p<0,05) e enfermeiros (56,0±17,2 p<0,05). Em relação à Percepção da gerência da instituição a diferença significativa (p=0,032) detectada apontou que a média dos médicos (71,7±22,0) e de outros profissionais (76,0±15,8) foram mais elevadas quando comparados aos enfermeiros (53,0±18,3 p<0,05) e técnicos e auxiliares de enfermagem (50,3±18,2 p<0,05). Foi detectada diferença significativa no domínio Condições de Trabalho (p=0,008), indicando que o escore médio dos médicos (81,9±15,1; mediana: 87,5) foi mais elevado quando comparado às médias dos demais profissionais. Durante a elicitação fotográfica e as discussões no grupo focal os participantes puderam discutir com os colegas buscando explicações para os resultados quantitativos, de onde foram elencados entraves organizacionais, tais como: condições de trabalho precárias; dimensionamento de pessoal inadequado; pouca resolutividade nas ações dos gestores; modelo de gestão mecanicista que privilegia a hierarquia; ausência de feedback; franco distanciamento entre os gestores e seus subordinados, especialmente dos trabalhadores considerados como de beira de leito; enfoque punitivo na ocorrência de erros; falta de um plano de educação para o desenvolvimento dos trabalhadores. Estratégias prioritárias para melhorar a cultura de segurança foram elencadas pelos participantes no último encontro do grupo focal, tais como, implantar os processos de segurança do paciente e iniciar uma aproximação da gestão com os demais colaboradores permitindo feedback em todos os turnos. Persiste uma abordagem punitiva que suprime a notificação de eventos adversos, o que impede a instituição de utilizar e ou transformar esses dados em conhecimento para aplicá-lo e, assim, promover mudanças sustentáveis na promoção da cultura de segurança do paciente.
Health care institutions with positive patient safety have their communication based on mutual trust, shared perceptions on the importance of providing safe care, and on reliable preventive measures. Under this perspective, this study aimed to analyze patient safety culture among a multi-professional team in an advanced neurology and neurosurgery center in southern Brazil. In light of restorative thinking, a sequential explanatory mixed methods design was developed. This research was submitted to Plataforma Brasil and received approval (CAAE 39941114.4.0000.5347) and the data were collected in two phases between October 2015 and February 2016. Phase 1 presented a quantitative approach and comprised the application of the Safety Attitudes Questionnaire to a total of 31 participants. Phase 2 followed a qualitative approach and was carried out through focus groups with 7 participants who took part in the previous phase. In addition, the photographic method with photo narration allowed the discussion of the outcomes of Safety Attitudes Questionnaire with photo elicitation. The principles of Deliberative Dialogue were adopted in the focus group as a strategy of Knowledge Translation to foster the application of the research outcomes to clinical practice. The quantitative data analysis was based on descriptive and bivariate statistics, considering p≤0.05 significant. In the qualitative phase, thematic content analysis was adopted. The results showed a total score of 65 regarding safety climate, which is considered positive, when ≥ 75. There was a significant difference in Perception of Unit Management (p=0.034) between the physicians’ average (74.2±17.9) and other professionals’ (77.4±14.7), both being higher when compared with the average of nursing technicians and assistants (52.1±23.2 p<0.05) and nurses (56.0±17,2 p<0.05). Regarding Perception of Hospital Management, the significant difference (p=0.032) showed that both the average of physicians (71.7±22.0) and other professionals’ average (76.0±15.8) were higher when compared to nurses (53.0±18.3 p<0.05) and nursing technicians and assistants (50.3±18.2 p<0.05). A significant difference was detected in Working Conditions (p=0.008), indicating that the average score of the physicians (81.9±15.1; median: 87.5) was higher when compared to the average of the other professionals. During photo elicitation and discussions in the focus group, the participants were able to discuss quantitative results. These outcomes showed organizational barriers such as poor working conditions; inadequate staffing; insufficient resolute actions by managers; mechanistic management which promotes hierarchy; lack of feedback; distance between managers and their employees, especially bedside professionals; punitive approach to errors; lack of a plan for employee training and development programs. In the last focus group meeting the participants worked in priority setting to improve safety culture, such as implementing patient safety processes and decreasing the distance between managers and employees, allowing more feedback in all shifts. A punitive approach that discourages adverse event and error reporting still persists, which prevents the institution from using and/ or transforming these data into applicable knowledge, and then use it toward sustainable changes that promote patient safety culture.
Instituciones de salud en las cuales la cultura de seguridad del paciente es positiva se caracteriza por comunicación basada en confianza mutua, por percepciones compartidas sobre la importancia de servir con cuidados seguros y por la confianza en la eficacia de medidas preventivas. En esta perspectiva, el objetivo general del estudio se constituye en analizar la cultura del paciente junto al equipo multiprofesional de un centro avanzado de neurología y neuroquirurgia de la región sur de Brasil. Con base en el pensamiento de restauración, se desarrolló el estudio con método mixto secuencial explanatorio. La investigación tramitó en la Plataforma Brasil, obteniendo aprobación mediante CAAE 3991114.4.0000.5347 y los datos fueron recolectados entre octubre de 2015 y febrero de 2016, en dos etapas. La primera, de abordaje cuantitativo, comprendió la aplicación del Safety Attitudes Questionaire, con un total de 31 participantes; la segunda, de abordaje cualitativo, fue realizada a través de la técnica de grupos focales con 7 participantes, oriundos de la primera fase, empleando el método fotográfico y la respectiva narrativa fotográfica, en que se discutió sobre los resultados del Safety Attitudes Questionnaire en concomitancia a la explicitación de las fotografías. En el grupo focal se adoptaron principios del Diálogo Deliberativo como una estrategia de Translación del Conocimiento para incentivar la aplicabilidad de los resultados de la investigación en el escenario de la práctica. La estadística descriptiva y bivariada fue utilizada como soporte para el análisis de los datos cuantitativos considerando significativo p≤0,05; en la fase cualitativa, se adoptó el análisis de contenido del tipo temático. Los resultados apuntaron una puntuación del 65 relativo al clima de seguridad, siendo considerado positivo cuando ≥ a 75. Hubo una diferencia significativa en el dominio Percepción del gerenciamiento de la unidad (p=0,034) entre la media de los médicos (74,2±17,9) y de otros profesionales (77,4±14,7), mostrándose más altas cuando comparadas a los técnicos y auxiliares de enfermería (52,1±23,2 p<0,05) y enfermeros (56,0±17,2 p<0,05). Sobre la percepción de la gerencia institucional la diferencia significativa (p=0,032) observada apuntó que la media de los médicos (71,7±22,0) y de otros profesionales (76,0±15,8) fue más alta cuando comparados a los enfermeros (53,0±18,3 p<0,05) y técnicos y auxiliares de enfermería (50,3±18,2 p<0,05). Fue detectada una significativa diferencia en el dominio de las condiciones de Trabajo (p=0,008), indicando que el placar medio de los médicos (81,9±15,1; mediana: 87,5) fue más elevado cuando comparado a las medias de los demás profesionales. Durante la explicación fotográfica y las discusiones en el grupo focal los participantes pudieron discutir con sus colegas buscando explicaciones para los resultados cuantitativos, donde fueron enumerados embargos institucionales, tales como: condiciones de trabajo de poca estabilidad; dimensionamiento de personal de forma inadecuada; poca presteza en las acciones de los gestores; modelo de gestión mecanicista que privilegia la jerarquía; ausencia de respuesta; distancia entre los gestores y sus subordinados, especialmente de los trabajadores considerados como de soporte (costado del lecho); punición cuando ocurren errores; falta de un plan educacional para el desarrollo de los trabajadores. Estrategias prioritarias para mejorar la cultura de seguridad fueron enumeradas por los participantes en el último encuentro del grupo focal, tales como establecer los procesos de seguridad del paciente e iniciar una aproximación de la gestión con los demás colaboradores permitiendo feedback en todos los turnos. Se mantiene un abordaje punitivo que cesa la notificación de eventos adversos, lo que impide a la institución utilizar o transformar esos datos en conocimiento para aplicarlo y, así, promocionar cambios posibles en la promoción de la cultura de seguridad del paciente.

Bakgrund: Bristande kommunikation och informationsöverföring är huvudorsaken till upp-komsten av vårdskador i hälso- och sjukvården. Komplexiteten i hälso- och sjukvårds organisat-ion i kombination med den mänskliga faktorn ställer krav på struktur i kommunikationen med hjälp av standardisering. En utmaning för hälso- och sjukvården är att implementera och studera standardiserade kommunikationsmetoder och studera effekten på patientsäkerhet och arbets-miljö. SBAR (Situation-Bakgrund-Aktuell Status-Rekommendation) är en kunskapsbaserad kommunikationsmetod, utvecklad för överföring av kritisk information i komplexa arbetssituat-ioner. Metoden hjälper till att skapa den struktur och förutsägbarhet som krävs för effektiv kommunikation i komplexa arbetssituationer såväl under normala förhållanden som under stress. Syfte: Att studera implementering av SBAR på en kardiologisk vårdavdelning med fokus på stra-tegier som kan underlätta processen. Metod: Studien är en kvalitativ intervjustudie med analytisk ansats. Den baseras på tio intervjuer med sjuksköterskor och läkare som arbetar på vårdavdelningen. Dessutom har en kvantitativ basundersökning om samarbets- och säkerhetsklimatet (enligt Safety Attitude Questionnaire) och kommunikationen genomförts under implementeringen, mars 2011-december 2011. Resultat: På vårdavdelningen har ca 95 % av sjuksköterskor och ca 70 % av läkare har fått ut-bildning i SBAR och flertalet av dessa har fått repetitionsutbildning. Sjuksköterskorna upplever en förbättring i den intraprofessionella kommunikationen efter att SBAR implementerats. Sjuk-sköterskorna beskriver att kommunikationen efter implementeringen följer SBAR strukturen i högre utsträckning, den är saklig och mer avgränsad samt innehåller i högre omfattning än tidi-gare en planering för och uppföljning av patientens vård. Endast enstaka läkare anger att de an-vänder SBAR i den intra- och interprofessionella kommunikationen. I den kvalitativa studien har såväl strategier som underlättar implementeringen av SBAR som fallgropar identifierats och beskrivits. De strategier som identifierats handlar om bl.a. ledningsan-svar, definiering av ansvar och roller i vård-teamet, skapande av mötesstrukturer för tvärprofess-ionellt samarbete, kommunikation och helhetssyn, identifiering och förebyggande av hierarkiska strukturer och introducering av förbättringskunskap i projektets genomförande. De fallgropar som identifierats har att göra med bristande föranalys, otydliga uppdrag, brister i resurser som metodstöd och tid, bemötande av kritiska röster, bristande läkarmedverkan, yttre påverkans fak-torer. Resultaten av den kvantitativa enkätundersökningen visade att det inte finns några skillna-der mellan läkarnas och sjuksköterskornas uppfattning om säkerhetsklimat eller samarrbete och kommunikation med den egna arbetsgruppen. Däremot finns det signifikanta skillnader mellan läkare och sjuksköterskor beträffande det gemensamma samarbetet och kommunikationen där sjuksköterskor uppfattar samarbetet och kommunikationen som mindre väl fungerande (Bilaga 1-3) Diskussion: Implementeringsprocessen visat sig vara kunskaps- och meningsskapande genom den ovan beskrivna analytiska ansatsen. Resultaten visar att implementeringen av SBAR behöver kompletteras med flera andra åtgärder som kan bidra till att skapa förutsättningar för ökat tvär-professionellt samarbete och kommunikation. Studien bekräftar det kommunikationsgap som finns mellan sjuksköterskor och läkare och behovet av förståelse för varandras olika roller och ansvar för att kunna skapa en helhetssyn med fokus på patienten i vården. Identifiering och före-byggande av de hierarkiska strukturer samt tydliggörande av innebörden i ledarskapet i vårdtea-met har visat sig vara avgörande. Implementering av SBAR är en satsning på en av de viktigaste patientsäkerhetsfrågorna och kräver tydlig och engagerat ledning.
Background: Poor professional communication and information transfer are main causes for medical error in the health care systems. The complexity in health care organisations in combina-tion with human factors issues raises a demand for structured and standardised communication. One challenge is to implement standardised communication models and study its effect on pa-tient safety and working conditions. SBAR (Situation, Background, Assessment and Recommen-dation) is a knowledge based communication model, developed to transfer critical information in complex work environments, both in normal and stressful conditions. Aim: To study implementation of SBAR on a Cardiology ward with focus on strategies that could facilitate the process. Method: Ten qualitative interviews with members of staff during the implementation process and quantitative data (130 anonymous questionnaires among staff, Safety Attitude Questionnaire, SAQ, during the implementation of SBAR have been collected (March- December 2011) Results: 95 % of the nurses and 70 % of the physicians have received SBAR education. In the interviews, the nurses describe an improved intra-professional communication after the imple-mentation of SBAR. The nurses also describe the communication to be more focused on the patients’ care, follow the SBAR process. However, only a few physicians explain that they are using SBAR in the intra- and/or inter professional communication. Strategies (leadership, role definitions within the team, structure for multi-professional cooperation, identification and prevention of hierarchical structures and introduc-tion of improvement knowledge) and hinders (limited clinical analyses before the project, unclear assignment, limited resources e.g. time and methodology, handling critical voices, limited input from physicians and external impact factors) for implementation of the SBAR model were identi-fied. The response rate for the baseline SAQ questionnaire was 94 % among nurses and 69% among physicians. No differences were found in nurses and physicians’ attitudes on safety climate and teamwork within their own groups. Some significant differences however were found concerning cooperation and communication between the two groups; nurses were less satisfied with cooperation and communication compared to the level of satisfaction in the group of physi-cians. Discussion: The implementation process has been meaningful in regards to an increase in knowledge trough the analytic outlook of the study. The result indicates that the actual imple-menting of SBAR requires further steps to create optimal conditions to achieve better results in communication and collaboration in cross-professional teams. The study confirms the communi-cation gap that exist between doctors and nurses and highlights the need for a better understand-ing of each other`s roles and responsibilities, in order to achieve an integral patient-centred ap-proach. It is crucial to identify and to prevent existing structures of hierarchy and to clarify the meaning of leadership within the team. The process of implementing SBAR is an effort to ad-dress one of the most important issues in patient safety and requires firm and committed leader-ship.

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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
INTRODUCTION: The patient's safety climate refers to the perception and attitudes of professionals regarding patient safety at a given moment in the organizational history. The measurement of the safety climate makes it possible to diagnose the predominant culture, which influences the health professionals' safe behaviors and, consequently, the care results. OBJECTIVE: To analyze the patient safety climate of an emergency hospital from the perspective of nursing professionals. METHODOLOGY: An analytical cross-sectional study carried out with the nursing team of an emergency hospital in Goiás, through the application of the Safety Attitudes Questionnaire - Short Form 2006, validated and adapted transculturally into the Portuguese language. The instrument has two parts, one consisting of five items referring to sex, position, time in the specialty and main activity; and the other, with 36 items, encompassing six domains: teamwork climate, safety climate, job satisfaction, perception of stress, perception of unit and hospital management, working conditions. In order to complement socio-demographic and labor information of the professionals, a second instrument was applied. The analysis was descriptive, simple frequency, central tendency and dispersion. Bivariate and multivariate analyzes were performed to verify factors associated with the domains. Study approved by the Research Ethics Committee, CAAE: 49279115.4.0000.5078. RESULTS: The study was attended by 177 nursing professionals, with 72.9% of nursing technicians and auxiliaries and 27.1% of nurses. The population was predominantly female (85.9%) and young adult, with a mean age of 39.5 years (SD: 6.7), 52.0% with a formal relationship and 48.0% with a statutory relationship. Of the total number of participants, 17.0% had moderate / high intention to leave the workplace and 8.5% had moderate / high intention to leave nursing. The analysis of the patient safety climate among nursing professionals was unfavorable (66,7; SD:14,5), except for the satisfaction domain at work, which presented a positive mean of 78.8. There was a correlation between all domains, demonstrating that teamwork, safety climate, job satisfaction, working conditions and management perception are factors that correlate. The perception of stress was associated with the perception of hospital and unit management. A negative association between the general safety situation and the Medical and Surgical Clinic (β = -11,07; p = 0,001) and the Emergency Room (β = -11,30; p < 0,001), night shift (β = -5,60; p = 0,005) and intention to leave nursing (β = -8,27; p = 0,018) were observed. However, being CLT (β = -7.00, p = 0.008) improved the overall patient safety climate. CONCLUSION: The study highlights the need for improved patient safety climate and the factors that may influence it negatively as: work in first aid or in medical and surgical units, working night shift and have intention to leave nursing. These data contribute to the management of health services, pointing issues that can be worked in order to improve the quality of care and patient safety climate.
INTRODUÇÃO: O clima de segurança do paciente refere-se à percepção e às atitudes de profissionais em relação à segurança do paciente, em um determinado momento da história organizacional. A mensuração do clima de segurança possibilita diagnosticar a cultura predominante, a qual influencia os comportamentos seguros dos profissionais de saúde e, consequentemente, os resultados assistenciais. OBJETIVO: Analisar o clima de segurança do paciente de um hospital de urgências sob a perspectiva dos profissionais de enfermagem. METODOLOGIA: Estudo transversal analítico realizado com a equipe de enfermagem de um hospital de urgências de Goiás, por meio da aplicação do instrumento Safety Attitudes Questionnaire - Short Form 2006, validado e adaptado transculturalmente para a língua portuguesa. O instrumento possui duas partes, sendo uma composta por cinco itens referentes a sexo, cargo, tempo na especialidade e atuação principal; e a outra, com 36 itens, englobando seis domínios: clima de trabalho em equipe, clima de segurança, satisfação no trabalho, percepção do estresse, percepção da gerência da unidade e do hospital, condições de trabalho. Para complementação de informações sócio demográficas e laborais dos profissionais foi aplicado um segundo instrumento. A análise foi descritiva, de frequência simples, tendência central e de dispersão. Análises bivariadas e multivariável foram realizadas para verificar fatores associados aos domínios. Estudo aprovado pelo Comitê de Ética Pesquisa, CAAE: 49279115.4.0000.5078. RESULTADOS: Participaram do estudo 177 profissionais de enfermagem, sendo 72,9% técnicos e auxiliares em enfermagem e 27,1% enfermeiros. A população é predominante feminina (85,9%) e adulta jovem, com média de idade de 39,5 anos (DP: 6,7), sendo 52,0% com vínculo celetista e 48,0% estatutário. Do total de participantes, 17,0% possuía a intenção moderada/alta de deixar o local de trabalho e 8,5% intenção moderada/alta de sair da enfermagem. A análise do clima de segurança do paciente entre os profissionais de enfermagem se revelou desfavorável (66,7; DP:14,5), exceto para o domínio satisfação no trabalho, que apresentou média positiva de 78,8. Houve correlação entre todos os domínios, demonstrando que o trabalho em equipe, o clima de segurança, a satisfação no trabalho, as condições de trabalho e a percepção da gerência são fatores que se correlacionam. A percepção do estresse se associou a percepção da gerência do hospital e da unidade. Observou-se associação negativa entre clima de segurança geral e atuar na Clínica Médica e Cirúrgica (β = -11,07; p = 0,001) ou Pronto Socorro (β = -11,30; p < 0,001), turno de trabalho noturno (β = -5,60; p = 0,005) e intenção de sair da enfermagem (β = -8,27; p = 0,018). Contudo, ser celetista (β = -7,00; p = 0,008) melhorou o clima de segurança do paciente geral. CONCLUSÃO: O estudo evidencia a necessidade de melhoria do clima de segurança do paciente e dos fatores que podem influenciá-lo negativamente como: atuar em pronto socorro ou em unidades de clínica médica e cirúrgica, trabalhar em turno noturno e possuir intenção de sair da enfermagem. Estes dados contribuem com a gestão dos serviços de saúde, apontando questões que podem ser trabalhadas em prol da melhoria da qualidade da assistência e do clima de segurança do paciente.

Quase um em cada dez pacientes é lesionado ao receber cuidados de saúde e, destes, muitos sofrem lesões incapacitantes ou morte todos os anos. Entendendo a importância e o impacto negativo das falhas na segurança do paciente em âmbito global e a influência que a cultura e o clima de segurança exercem sobre a adoção de ações e decisões mais seguras, este estudo teve por objetivo a analise da cultura de segurança do paciente em instituições hospitalares, por meio da mensuração do clima de segurança. Trata-se de pesquisa quantitativa, transversal, do tipo Survey, em que para a realização da coleta de dados foi aplicado o Questionário de Atitudes de Segurança, adaptação transcultural para o Brasil do Safety Attitudes Questionnaire (SAQ) - Short Form 2006. O estudo ocorreu em dois hospitais gerais do estado de São Paulo, localizados em diferentes regiões metropolitanas, sendo um público e o outro privado. Os profissionais Médicos, Enfermeiros, Técnicos e Auxiliares de Enfermagem, Fisioterapeutas, Farmacêuticos e Nutricionistas, que atuavam nestes hospitais há pelo menos 6 meses, com carga horária de trabalho semanal de no mínimo 20 horas, constituíram a população deste estudo. Foi realizado um estudo piloto com 25 profissionais em cada hospital e a prevalência resultante deste teste foi utilizada no cálculo do tamanho amostral com nível de significância de 5%, erro relativo de 10% e perda de 20%, resultando em um total de 235 participantes. Os profissionais escolhidos como parte da amostra foram sorteados empregando-se amostragem aleatória simples computadorizada. As variáveis de cada domínio da escala quando testadas pelo Teste Kolmogorov-Smirnov não apresentaram normalidade. Deste modo, foi aplicado o Teste Mann-Whitney para comparar os valores das pontuações entre os hospitais e entre as categorias profissionais. Com relação aos resultados houve índice de participação de 86,8% da amostra sorteada, prevalecendo os sujeitos com 5 a 20 anos de tempo na especialidade, do gênero feminino, e trabalhadores da enfermagem. Não houve diferenças significantes dentre as pontuações obtidas pelos dois hospitais. Os participantes do estudo apresentaram percepção negativa quanto ao clima de segurança do paciente, com domínios Reconhecimento do Estresse e Percepção da Gestão apresentando resultados negativos, tanto para a amostra como um todo quanto por hospital. Os domínios Clima de Trabalho em Equipe, Satisfação no Trabalho e Comportamento Seguro/Práticas Seguras resultaram em percepções positivas para todas as categorias profissionais. Já o domínio Percepção da Gestão do Hospital resultou em percepção negativa para todas estas. Os Médicos e os Técnicos e Auxiliares de Enfermagem apresentaram percepções negativas em mais domínios. Em contrapartida, os Enfermeiros foram os únicos a apresentar atitude de segurança do paciente positiva, com escore total do SAQ exibindo diferença significante quando comparado a todas as outras categorias, apresentando também percepção positiva em maior número de domínios. Concluiu-se que existe a necessidade de abordagem relacionada ao Reconhecimento do Estresse dos profissionais, além dos aspectos do Gerenciamento. As categorias profissionais diferiram entre si com relação às percepções sobre a atitude de segurança do paciente. Desta forma, o desenvolvimento da cultura de segurança deve englobar todas as categorias profissionais, uma vez que esta abrange toda a organização, destacando-se a necessidade de enfoque de ações com relação a categoria dos Médicos e dos Técnicos e Auxiliares de Enfermagem. Além disso, ficou evidente o papel de destaque e liderança dos profissionais Enfermeiros nos processos de melhoria da qualidade, e colocando-os em posição privilegiada para conduzir os esforços de melhoria contínua da qualidade nos serviços de saúde
Almost one in every ten patients is injured while receiving health care, many of these suffer disabling injuries or death each year. Understanding the importance and the negative impact of patient safety failures globally, and the influence that safety culture and climate have on the adoption of safer decisions and actions, this study aimed to analyze patient safety culture in hospitals through the measurement of safety climate. This study is a quantitative, cross- sectional Survey, in which data collection was conducted using the cultural adaptation to Brazil of the Safety Attitudes Questionnaire (SAQ) - Short Form 2006. The study took place in two general hospitals, one public and one private, located in different metropolitan areas in the state of São Paulo. Physicians, registered nurses, nursing technicians and assistants, physical therapists, pharmacists and nutritionists, who had been working in those hospitals for at least 6 months, for a minimum of 20 hours per week, constituted the study population. A pilot study was carried out with 25 professionals in each hospital and the prevalence resulted was used to calculate the sample size at 5% significance level, 10% relative error, and 20% loss, resulting in a total of 235 participants. Professionals chosen as part of the sample were drawn up using computerized simple random sampling. The Kolmogorov- Smirnov test showed that the variables were not normal. Thus, the Mann-Whitney test was used to compare the values of the scores between hospitals and between professional categories. Regarding the results, we noted a participation rate of 86.8% of the sample selected, prevailing subjects with 5-20 years of time in the specialty, female, and members of the nursing team. There were no significant differences among the scores obtained by the two hospitals. Study participants had a negative perception regarding patient safety climate, with the domains Stress Recognition and Perception of Management presenting negative results, both for the sample as a whole and by the hospital. The domains Teamwork Climate, Job Satisfaction and Safe Behavior/Safe Practices resulted in positive perceptions for all professional categories. Contrarily, the domain Perception of Hospital Management resulted in a negative perception for all of the categories. Nursing technicians and assistants, and physicians were the groups that presented negative perceptions in the most domains. Conversely, registered nurses were the only ones who presented positive patient safety climate, with the SAQ total score showing a significant difference when compared to all other categories, and presenting positive perception in more domains. We concluded that approaches regarding professionals\' Stress Recognition and Perception of Management are of great need. The results among professional categories differed with respect to the perceptions of patient safety attitude. Thus, the development of safety culture must include all professional categories, since it comprises the entire organization, emphasizing the need for specific actions with respect to the category of physicians and nursing technicians and assistants. Moreover, it was evident that the registered nurses can play an important role in leadership of quality improvement processes, placing these professionals in prime position to drive continuous quality improvement efforts in health services

Atualmente, a avaliação do clima organizacional tem sido considerada importante ferramenta de gestão nas instituições de saúde. O objetivo deste estudo foi avaliar o clima organizacional e a sua relação com a ocorrência de acidentes de trabalho com material perfurocortante entre os profissionais de enfermagem em um hospital público de média complexidade do interior do Estado de São Paulo. Trata-se de um estudo de abordagem quantitativa, descritivo e transversal. Para a coleta de dados, foi utilizada a versão validada e adaptada para o contexto brasileiro do Safety Attitudes Questionnaire (SAQ) - Short Form, denominada Questionário de Atitudes de Segurança - QAS. Por meio do QAS foi possível avaliar a percepção dos trabalhadores acerca do clima de trabalho em equipe, clima de segurança, satisfação profissional, percepção do estresse, ações da gerência quanto às questões de segurança e as condições de trabalho. As respostas foram dadas por meio da escala Likert de cinco pontos e o processamento e a análise dos dados foram realizados com o auxílio do programa Statistical Package for Social Science (SPSS), versão 17.0. Para relacionar o clima organizacional com a ocorrência de acidentes de trabalho, inicialmente, foi realizado levantamento junto ao Serviço Especializado de Medicina e Segurança do Trabalho - SESMT dos registros de acidentes de trabalho ocorridos no período 2008-2014 e foram identificados os trabalhadores de enfermagem vítimas desses acidentes. Após este levantamento, foram constituídos dois grupos: Grupo 1 - profissionais de enfermagem que sofreram acidentes de trabalho envolvendo perfurocortantes; Grupo 2 - profissionais de enfermagem que não sofreram acidente de trabalho com perfurocortantes. A análise dos dados foi realizada por meio de estatística descritiva com testes de comparação entre as variáveis dos grupos. A amostra do estudo foi constituída por 116 participantes, técnicos de enfermagem e enfermeiros atuantes em unidades de internação hospitalar, sendo o Grupo 1 composto por 21 participantes e o Grupo 2 composto por 95 participantes. Predominaram participantes do sexo feminino, técnicos de enfermagem e profissionais com cinco a 10 anos de atuação na instituição. A percepção dos participantes quanto ao clima organizacional foi considerada desfavorável; no entanto, foi considerada satisfação no trabalho pela maioria dos participantes. Os resultados não indicaram relação direta entre o clima organizacional e a ocorrência de acidentes com perfurocortante, mas foi possível observar que o grupo que não sofreu acidentes apresentou maior satisfação no trabalho. Considera-se que este estudo permitiu ampliar o conhecimento acerca da percepção de profissionais de enfermagem sobre o clima organizacional, contribuindo para a discussão sobre formas de melhoria da assistência segura, de redução de eventos adversos e sobre a qualidade da assistência de enfermagem
Recently, evaluation of organizational climate has been considered an important management tool in health institutions. The aim of this study was to evaluate the organizational climate and its relationship with the occurrence of accidents with needlestick materials among nursing professionals in a public hospital of medium complexity in the state of São Paulo. It is a study of quantitative, descriptive and cross-sectoral approach. The instrument Safety Attitudes Questionnaire (SAQ) was used - Short Form, 2006, validated and adapted version for the Portuguese language (Safety Attitudes Questionnaire - QAS). Through the areas of QAS was possible to assess attitudes about the working environment in staff, safety climate, job satisfaction, perceived stress, management actions regarding safety issues and working conditions. The answers were given by Likert scale of five points, processing and data analysis was performed with the aid of the Statistical Package for Social Sciences (SPSS) version 17.0. To relate the organizational climate with the occurrence of accidents with sharps survey was carried out by the Specialized Service of Medicine and Safety - SESMT with records of work accidents in the period 2008-2014 and workers were identified nursing victims of these accidents. Constituted two groups: Group 1 - nursing professionals who were victims of work accidents involving sharps; Group 2 - nursing professionals who did not undergo occupational accidents with needlestick during the study period. After conformal groups, the data analysis was performed using descriptive statistics with correlation tests between the variables of the groups in order to analyze possible relationship between accidents and the adoption of safety measures by the professional. The study sample consisted of 116 participants, nursing technicians and nurses working in hospital units. Group 1 consisted of 21 participants and Group 2 consists of 95 participants. Predominated female participants, nursing technicians and professionals with five to 10 years of experience in this institution. The perception of the participants about the organizational climate was considered unfavorable, however it was observed that job satisfaction was evidenced by most of the participants, demonstrating how they feel during the exercise of the profession in this institution. On the relationship between organizational climate and the occurrence of accidents with needlestick materials, the results indicated no direct relationship between organizational climate and the occurrence of such accidents, however it was observed that the group that did not suffer sharps injuries was the group that presented greater job satisfaction. Thus, this study promotes the opportunity to meet the professionals\' perception of the organizational climate and can contribute to improvement of safe care, reduce adverse events and improve the quality of patient care

碩士
國立臺灣大學
醫療機構管理研究所
93
Objectives: In 2000, a medical error report published by Institute of Medicine (IOM)— “To Err is Human”, implied that at least 44,000 and perhaps as many as 98,000 Americans were dead in hospitals each year as a result of medical errors. The estimated total national costs amounted to be between 17 and 29 billion dollars in preventable adverse events. Regarding to this terrifying report, government organizations and NGOs in most advanced countries are taking actions to improve patient safety, and primary of them is to build a patient safety culture in healthcare systems. Measuring safety culture practices for years in foreign countries. As lacking applications of such instruments in relevant domestic hospital researches, this research goes with PATIENT SAFETY CLIMATE IN HEALTHCARE ORGANIZATIONS (PSCHO), which is constructed by Patient Safety Center of Inquiry at Veterans Affairs Palo Alto Health Care System and the Centers for Health Policy and Primary Care and Outcome Research at Stanford. PSCHO is adapted with permission and translated into Chinese to measure patient safety culture in hospitals in Taiwan. Association between patient safety climate and behaviors of healthcare workers is also examined. Methods: This study is a cross-sectional study. By mailing 3,010 questionnaires to the senior executives and healthcare workers of 6 hospitals, 1,098 samples responded (36.48 percent response rate). Result: Confirmatory Factor Analysis (CFA) is carried out to test the factor structure of PSCHO and self-administrated patient safety behavior scale. PSCHO, with the 3 main dimensions as “management and organization,” “individual performance,” and “blame and shame,” performed a validity asχ2(8)=14.64 (p>0.05), RMSEA=0.03, and CFI=0.99. Each item performs reliability indicator (R2) between 0.11 to 0.50. Results indicate an acceptable model fit. The validity of the three-factor structure that constructed by Singer et al. was supported by Taiwan sample of healthcare workers. Through the analyses of T-test and ANOVA, the results show that healthcare workers with seniority, religious belief, or manager position, have higher patient safety climate perception and self-report better patient safety behaviors. There are significant variations among participating hospitals, despite some of them granted the National Quality Award. With multiple regression analysis result, we find the positive correlation between healthcare workers’ patient safety behaviors and perception of patient safety climate. Conclusion: To enhance the health care workers’ participation and compliance in patient safety behaviors, the most important factor is to strengthen the supportive perception of patient safety in management and organization.

碩士
國立雲林科技大學
工業工程與管理研究所碩士班
100
This study, conducted with questionnaire, aims to investigate the effects of hospital safety climate on safety performance, patient safety and outpatient’s security. And work satisfaction is the moderator. The subjects include ward’s nurse and outpatients. Data was evaluated with factor analysis and factor rotation analysis, and tries to find out the construct of safety climate. The results can be applied to hospital management, and managers’ will know how to improve safety climate to increase outpatient’s security, then increase their willing to revisit and enhance the core competence of organizations.

Yes
Purpose: To summarize studies that have examined patient safety culture (PSC) in maternity units and describe the different purposes, study designs and tools reported in these studies, whilst highlighting gaps in the literature. Methodology: Peer-reviewed studies published in English during 1961-2016 across eight electronic databases were subjected to a narrative literature review. Findings: Among 100 articles considered, 28 met the inclusion criteria. The main purposes for studying PSC were: (a) assessing intervention effects on PSC (n= 17); and (b) assessing PSC level (n=7). Patient safety culture was mostly assessed quantitatively using validated questionnaires (n=23). The Safety Attitude Questionnaire was the most commonly used questionnaire (n=17). Intervention varied from a single action lasting five weeks to a more comprehensive package lasting more than four years. The time between the baseline and the follow-up assessment varied from six months up to 24 months. No study reported measurement or intervention costs, and none incorporated the patient’s voice in assessing PSC. Practical Implications: Assessing PSC in maternity units is feasible using validated questionnaires. Interventions to enhance PSC have not been rigorously evaluated. Future studies should report PSC measurement costs, adopt more rigorous evaluation designs, and find ways to incorporate the patient’s voice. Originality/Value: This review summarized studies examining PSC in a highly important area and highlighted main limitations that future studies should consider.

碩士
國立臺灣大學
醫療機構管理研究所
93
Objectives: In 2000, a medical error report published by Institute of Medicine (IOM)﹘ “To Err is Human”, implied that at least 44,000 and perhaps as many as 98,000 Americans were dead in hospitals each year as a result of medical errors. The estimated total national costs amounted to be between 17 and 29 billion dollars in preventable adverse events. Regarding to this terrifying report, government organizations and NGOs in most advanced countries are taking actions to improve patient safety, and primary of them is to build a patient safety culture in healthcare systems. Measuring safety culture practices for years in foreign countries. As lacking applications of such instruments in relevant domestic hospital researches, this research goes with PATIENT SAFETY CLIMATE IN HEALTHCARE ORGANIZATIONS (PSCHO), which is constructed by Patient Safety Center of Inquiry at Veterans Affairs Palo Alto Health Care System and the Centers for Health Policy and Primary Care and Outcome Research at Stanford. PSCHO is adapted with permission and translated into Chinese to measure patient safety culture in hospitals in Taiwan. Association between patient safety climate and behaviors of healthcare workers is also examined. Methods: This study is a cross-sectional study. By mailing 3,010 questionnaires to the senior executives and healthcare workers of 6 hospitals, 1,098 samples responded (36.48 percent response rate). Result: Confirmatory Factor Analysis (CFA) is carried out to test the factor structure of PSCHO and self-administrated patient safety behavior scale. PSCHO, with the 3 main dimensions as “management and organization,” “individual performance,” and “blame and shame,” performed a validity asχ2 (8)=14.64 (p>0.05), RMSEA=0.03, and CFI=0.99. Each item performs reliability indicator (R2) between 0.11 to 0.50. Results indicate an acceptable model fit. The validity of the three-factor structure that constructed by Singer et al. was supported by Taiwan sample of healthcare workers. Through the analyses of T-test and ANOVA, the results show that healthcare workers with seniority, religious belief, or manager position, have higher patient safety climate perception and self-report better patient safety behaviors. There are significant variations among participating hospitals, despite some of them granted the National Quality Award. With multiple regression analysis result, we find the positive correlation between healthcare workers’ patient safety behaviors and perception of patient safety climate. Conclusion: To enhance the health care workers’ participation and compliance in patient safety behaviors, the most important factor is to strengthen the supportive perception of patient safety in management and organization.

碩士
臺北醫學大學
醫務管理學研究所
104
Employee fatalities and injuries among high hazard industries such as nuclear energy and aviation originated attention to assessing safety, driving consciously attention to further aspects as management and human factors than simply errors, and focusing on the assessment of safety systems. Healthcare organizations as complex systems prone to accidents, are considered high hazard industries that also focus attention on patient safety. Furthermore the importance of ongoing improvements among professions as mechanisms that contribute to create a culture of safety and reduction of errors instead of blaming individuals as a more effective process to learn from mistakes. Patient safety climate has been related reciprocally to culture, and it is recognized as a form of organizational climate. Although patient safety culture and patient safety climate have been used as similar constructs, there is still confusion among literature, because discrimination among climate and culture is not clear. However, aspects of organizational climate are easier to measure because they are tangible and quantitative methods are best suited to measure safety climate. In this fashion, we can understand safety climate as surface features from attitudes and perceptions of safety culture, that can be measured from the safety culture elements of health organizations in a given moment. This study aim to know how is the perception of healthcare workers regarding patient safety climate at a public hospital in Nicaragua, from its patient safety culture elements, by the application of the Spanish version of the Hospital survey on patient safety. Furthermore, we made a descriptive analysis regarding patient safety climate at the Humberto Alvarado Vasquez hospital, including socio-professional factors. Also, we made an analysis of strengths and opportunities for improvement in the hospital, following the criteria suggested by The Agency for Healthcare Research and Quality (AHRQ). For the statistical evaluation, we made a correlation test among dimensions of patient safety culture and the outcomes measures of patient safety climate, as well as a regression analysis among the dimensions of patient safety culture as predictor variable, and outcomes of patient safety climate as predictive variable. A total of 298 questionnaires were distributed, of which 232 were responded validly (response rate of 77.85%). Globally, positive responses rate for the 12 dimension, ranged from 39.45% to 79.74%, the average rate was 62.71%. The highest positive responses rates per dimension were “Supervisor/Manager expectations & actions promoting safety” (79.74%), “Organizational learning and continuous improvement” (78.53%), and “Teamwork across hospital units” (76.40%). Following Spearman’s correlation test. The strongest correlations showed, were among “Frequency of events reported” with “Hospital handoffs and transitions” (Rho= .541), and “Frequency of events reported” with “Nonpunitive response to error” (Rho= -.485). The weakest correlations showed were among, “Overall perception of safety grade” with “Hospital management support for patient safety” (Rho=.177), and “Overall perception of safety grade” with “Staffing” (Rho=.143). Regarding the regression analysis, the predictive value of “Teamwork across hospital units” for the variable “patient safety climate grade” is high (adjust R2 =0.67), corresponding to the correlation results. Which indicates that the better the teamwork across the units, the better the patient safety climate. The goodness of fit test, shows that our results by job type are representative of the hospital population. The study shows that, in general the healthcare workers at the hospital in Nicaragua, feel positive towards patient safety climate. Both, strengths and opportunities for improvement have been identified.

abstract: Harm to patients remains high in US hospitals despite significant progress to improve the quality of care in our health systems. Leadership, a culture of patient safety, and a climate conducive to innovation in patient care are necessary to advance positive patient safety outcomes. Yet, little is known about how leadership can impact patient safety within a climate of innovation. This study examines the effects of transformational and transactional leadership (singularly and with transactional augmenting transformational leadership) as related to nurses’ perception of patient safety, how communication elements of a culture of patient safety may strengthen that relationship, and how the mediating role of team innovation climate may help explain the relationship between transformational and transactional leadership and nurses’ perception of patient safety. The variables were measured using three validated and reliable survey instruments: The Multifactor Leadership Questionnaire (MLQ Form 5X), the Team Climate Inventory-short (TCI), the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture. A convenience sample of all staff registered nurses (N=952) from the single academic medical center with direct patient care responsibility was surveyed via e-mail for this research. A total of 210 surveys were returned, 157 met inclusion criteria for a response rate of 16%. Transformational leadership had a statistically significant relationship with patient safety perception, while the relationship of transactional leadership with patient safety perceptions was not significant. The results of the regression analysis that tested the effect of communication elements of a culture of patient safety on the relationship between transactional and transformational leadership and patient safety perception were not significant. Transformational leadership was significantly related with team innovation climate after controlling the effect of transactional leadership supporting the augmentation effect. Mediation analysis showed that team innovation climate had a significant mediating effect on the relationship between transformational leadership and patient safety perception. Team innovation climate had a significant mediating effect on the relationship between managers’ transformational leadership and patient safety perception after controlling for transactional leadership supporting the augmentation effect. This is the first study known to test the augmentation of transformational leadership related to patient safety and the role of team innovation climate.
Dissertation/Thesis
Doctoral Dissertation Nursing and Healthcare Innovation 2019

碩士
嘉南藥理科技大學
醫療資訊管理研究所
98
Background and Objectives: Recently, facing to the extreme competition of medical market and frequent medical disputes, hospitals must make rapid and accurate responses to market changes and make medical environment more safe to maintain competitive advantages and improve business performances. Therefore, this study selected hospital staffs as samples and tried to clarify the correlations between the dimensions of market orientation (customer orientation, competitor orientation, and inter-functional coordination) and patient safety climate (safety procedures, perceived managerial patient safety practice, safety information flow, and priority of patient safety). Methods: The study was based on cross-sectional design and selected hospital staff nurses from two regional hospitals as samples in Taiwan. In all 343 valid samples were obtained. We adopted descriptive analysis, confirmatory factor analysis (CFA), Student’s t-test, One-Way ANOVA, Pearson correlation, multiple regression, and path analysis to analyze the data. Results: The findings indicated that customer orientation, one dimension of market orientation, has positive effects on each dimensions of patient safety climate and overall patient safety climate, and it has the most influence on the climate of patient safety procedures (β=0.47). However, competitor orientation only has a positive effect on the climate of patient safety information flow (β=0.17). In addition, hospital support for staffs also has the positive effect on overall patient safety climate, and has the most influence (β=0.43) on the climate of patient safety information flow. Based on the result of correlation matrix analysis, we found that hospital support for staffs has a positive effect on three dimensions of market orientation, especially on competitor orientation and inter-functional coordination. Therefore, we further used path analysis to explore the mediating effect of hospital support for staffs. Results of path analysis showed that competitor orientation and inter-functional coordination would affect patient safety climate positively through mediating effect of hospital support for staffs. Conclusions: Hospitals should implement the concepts of customer orientation to create patient-centered perspective and ask staffs of hospital to improve medical service design and delivery according this perspective. Then, a better of patient safety climate would be built. In addition, although competitor orientation and inter-functional coordination would not affect patient safety climate directly, hospital still could effectively strengthen supports for staffs to engage in patient-centered activities and further improve patient safety climate. Therefore, when hospitals are committed to improving patient safety climate, three dimensions of market orientation should not be ignored.

碩士
大仁科技大學
休閒健康管理研究所
99
People expect patient safety to be paramount in medical treatment. Many patients may leave hospital or abandon treatment if they are anxious that medical negligence or malpractice may represent a threat to life or wellbeing. This makes patient safety an important issue. A recent outbreak of major illness due to inadequate patient safety procedures, has resulted in the government highlighting the importance of patient safety issues. This study aims to understand what constitutes the ‘Patient Safety Climate’ and how does this affect the attitude and behavior of medical staff to patient safety. The subjects of the study were medical staff in Taitung City. We used the Safety Attitudes Measurement Scale,(which measures Climate, Attitudes and Behaviour),and utilised Excel software, with SPSS for Windows (12.0 version) to conduct data processing, and then in the light of the purpose, structure and assumptions of the study we chose appropriate statistical methods to assist the interpretation of the data. The results of our research show there was significant relation between Climate, Attitude and Behavior. The Climate has an indirect effect, and Attitude a direct effect on Patient Safety Behavior. We provide an account of the patient safety climate and its relation to the attitudes of hospital staff and their behaviour in respect of “patent safety” as an integral part of their continuing education. This study also provides data for use by government agencies dealing with policies related to patient safety issues.

博士
國立彰化師範大學
工業教育與技術學系
101
Taiwan’s population structure had become an aging society after 1993. In 2012 the population above the age of 65 accounted for 10.89% of the total population. At the same time, the handicapped population grows annually. To medical and social support services, the domestic demand for long-term care facilities has become increasingly urgent. More professional staffs are needed in long-term care. Through a literature review of social cognitive theory, the study consolidate the interaction and relationship among the environment-person-behavior model. The study applies social cognitive theory as a basis to explore the relationship among organizational safety climate （environmental factor）, energy management, self-efficacy （personal factors） and patient safety behavior （behavioral factor） in the long-term care institutions. There were 363 valid responses with an 80.67% acceptable samples received from survey of the target workers of institutes for long-term care in Taiwan. The hypotheses were tested using descriptive statistics, t-test, one-way ANOVA, persons correlation analysis, and analysis of structural equation model. We found that an organizational safety climate of long-term care institutions is directly and positively related to patient safety behavior, and the energy management and self-efficacy may affect patient safety behavior in a positive way among staffs. Based on a complete structural model analysis, energy management and self-efficacy, rather than an organizational safety climate, is more influential to patient safety behavior （partial mediating effect）. In other words, energy management and self-efficacy play the roles of mediating variables. In this research, the path model of environment, person and behavior in long-term care institutions can provide reference for practical applications and future research. In addition, this study intends to offer suggestions respectively on the aspects of practical application and future research.

Sustainability is a complex system of interaction between a hospital, individual, community, and environmental factors that is required to work in harmony to keep a patient healthy. With the complexities that exist within healthcare, the nurse leader is required to ensure that the care environment, processes and the safety behaviours required from nurses to provide safe healthcare is in place and sustained to contribute to the enhancement of patient safety, whilst in the care of the diverse nursing workforce. The aim of the study is to develop an action plan to sustain best safety culture practices for improved patient outcomes in hospitals with a culturally diverse nursing workforce. Methodology: A multiple method design was utilised to study the safety culture and positive work environment (hospital climate) that exists among culturally diverse nurses and how it is managed by the nurse managers in order to identify and describe actions that can be included in an action plan to sustain best safety culture practices for improved patient outcomes. Purposeful and convenience sampling methods were used in the study. Two hospitals, with a very diverse nursing workforce were purposefully selected to participate in the study. Pretesting of the questionnaire and e-Delphi embedded assessment validation instrument were done by participants not part of sample groups. Phase 1: The Hospitals outcomes data for nursing admission assessment within 24-hours, falls and hospital acquired pressure ulcer incidences and hand hygiene rates were collected on a checklist. Phase 2: Two questionnaires (1) nurses capturing: biographical data and culture, patient safety (nursing admission assessment within 24-hours, falls and HAPU and hand hygiene), and safety culture and positive work environment (hospital climate); (2) nurse managers capturing: biographical data and culture, patient safety (nursing admission assessment within 24- hours, falls and HAPU and hand hygiene), safety culture and Positive Work Environment (hospital climate) and just culture practices. Phase 3: the Draft e-Delphi action plan with embedded assessment validation instrument was developed. Phase 4: The panel experts selected to validate the e-Delphi draft action plan with embedded assessment validation instrument in pre-determined rounds. Data analysis: Phase 1: The outcomes data was displayed in bar graphs and illustrated that (1) the nursing admission assessment within 24 hour period not been sustained over time for the medical, surgical, paediatric and critical care areas; (2) a hundred and sixty two fall incidence; (3) ninety six HAPU incidences and (4) hand hygiene rate of between 80-94% being reported. Phase 2: A participation rate of 46.33% by nurses and 73.91% by nurse managers were achieved. The data for the 2 questionnaires indicated the need to include 54 action statement to address the culture, patient safety, hospital climate (PWE), safety culture and just culture gaps identified. Phase 3: the e-Delphi draft action plan developed based on literature review and data from phase 1 and phase 2. Phase 4: 100% participation rate was achieved. Consensus was reached within two rounds that the 54 action statements are essential and important for patient safety and identified the responsible persons required enacting on action statement and timeframe required to complete action. Recommendation: The Action Plan to enhance a sustainable Culture of Safety to improve patient outcomes were decided by panel experts. Plan to disseminate the plan among the CNO for implementation.
Health Studies
D. Litt. et Phil. (Health Studies)

碩士
逢甲大學
企業管理所
98
Recently ethical climate have become importance subject in medical industry. Many researchers have proved that if organization can creates strong senses of ethical climate could effectively prevent unethical behavior happened (Ahmed and Machold, 2004；Douglas et al., 2001). In this research we suggest that, medical industry do/is really needs to process ethics. Although many have studied explore the importance of ethical climate but in reality it is hard to implement and causing by being lack of recognition and degree of attention. Due to the transformation of Taiwan’s medical industries change, had forced to change their health care policy; rising up with consumer awareness, and manage as non-profit enterprise is no longer appropriate for medical industries and they started to pursue consumer orientation as marketing strategic emphasizes the quality of medical services improved. Apply ethical climate modeling the organization commitment and satisfaction; while the nursing staff are satisfied and also identification with organization. It will cause the customer oriented behavior, and also achieve the goal as the patient safety. So under the moral climate, management concept is fairly important. In medical team, nurses are play in a important role and responsible for patient safety(陳玉枝，2004). Patient safety is the key subject for improving quality of medical, so nurses should clearly understand the importance of patient safety while the providing services. So in this study we applied ethical climate as antecedent advance to organization commitment, customer-oriented behavior, improve medical quality and patient safety. This research is mainly discussion about ethical climate, organization commitment, customer oriented behavior, and relation safety on patient. For data collection we use convenience sampling method, and 426 questionnaires were sent to two middle Taiwan area hospitals from March to June 30, totally 396 were respond, which results in a response rate of 71% in all of which 304 questionnaire were valid and use for model testing. In this study, we implemented SPSS 10 to process descriptive statistical analysis and samples distribution, in data analysis section using AMOS 7.0 to process structural equation modeling (SEM) analysis to verify research model fit and test the hypotheses. The results confirmed that hospital ethical climate has a positive significant effect on organization commitment, customer-oriented behavior and patient safety. Organizational commitment has positive significant effect to customer-oriented behavior, means that the high organization commitment behavior nurses commit to hospital the more willingness to work hard, stand for patient and provide a good quality service. Customer-oriented behavior has positive significant effect to patient safety, in the other words, nurses will considerate from customer perspective and provide medical services to meet patient safety. Result will help hospital in managerial operation by improving medical service quality and performance in order to promote ethical climate for achieve patient safety and customer-oriented.

碩士
國立雲林科技大學
健康產業管理研究所碩士班
101
Medical errors happened in every hospital in the world, and it associated with the high medical expenses. Investigation of patient safety attitudes among the staff is very important to prevent medical mistake. This study aimed to investigate the association of nurses among Patient Safety Climate and Behaviors in National Taiwan University Hospital of Yun-Lin Branch. The questionnaire is distributed to nurses by census, which adapted from Lee safety culture questionnaire and Shih patient safety behavior questionnaire, and the effective return rate achieved 75%. The results are as follows: 1.The patient safety climate score among nurses is above average, and the “Stressrecognition” has the lowest score. 2.The safety behaviors score among nurses is also above average, and the Patient safety compliance is higher than Patient safety participation. 3.Healthcare workers with older age, married, seniority, education and manager position, have higher patient safety climate perception and better patient safety behaviors. 4.Nurses'' perceptions of patient safety climate in intensive care units are lower than nurses in surgical ward, psychiatric ward, outpatient and dialysis chamber. Moreover, nurses work in the emergency room have lower patient safety behaviors than the gynecology &; pediatrics ward, psychiatric ward, outpatient and dialysis chamber. 5.Nurses are afraid of punishment or to consider the friendship, they may hide the medical errors. 6.Patient safety culture can be predict by safety behavior, and it has significant positive correlation with safety behavior , and has negative correlation with “stress recognition” 7.The researcher revealed that “ performance on patient safety behaviors” has positive correlations with “safety climate”, “perception of management” and “working condition”.