Article Review on "Patient Safety Culture"

Article Review 9 pages (3866 words) Sources: 30

[EXCERPT] . . . .

Patient Safety Culture

Patient safety in hospitals has been given a great deal of attention by the scholarly community. Kohn, Corrigan, & Donaldson (2000) in their study found that nearly one hundred thousand people die each year because of errors made by hospital staff (Kohn, Corrigan, & Donaldson, 2000). In addition, Stelfox, Palmisani, Scurlock, Orav and Bates (2006) and Vira et al. (2006) in their respective study found that researchers have used both qualitative and quantitative techniques to investigate the difficulties faced by the medical staff whilst providing a safe and secure hospital environment.

In an earlier study, Lee (1996) found that with regards to patient safety culture (PSC) the point-of-views, actions and activities, along with ability of the organizational workforce determines the level of patient safety in an environment. Furthermore, Singer et al. (2003) found that PSC has become a benchmark for successful healthcare institutions. Similarly, a number of studies have investigated the relationship between PSC constructs and actual safety results (see details Hofmann & Mark, 2006; Itoh, Abe, & Andersen, 2002; Pronovost et al., 2005).

Additionally, a number of researchers have started to focus on developing a standard PSC metrics within hospital settings for quantitative measurements (for details see Sexton et al., 2006; Singla et al., 2006; Sorra & Nieva, 2004). Similarly, other researchers have started to quantify the time spent by patients in ambulances along with other acute healthcare centers (for details see Sexton et al., 2006; Sorra & Nieva, 2004). In the same way, nursing homes too have started to develop and measure PSC models and metrics in order to reduce death rates and increase quality care in hospital settings (Castle, 2006a; Castle & Sonon, 2006).

With regards to the relationship between PSC constructs and actual safety results, Bonner (2008) argued that very few researchers have shown the relationship between PSC and actual outcomes. In his study, Bonner found that nursing homes studies have newly appeared in the current literature available in the medical domain. Nursing homes and hospitals have become very different from each other because in nursing homes the certified nursing assistants (CNAs) provided the special care. As a result nursing home PSC is different from PSC acute care institutions (Bonner, 2008). Furthermore, PSC is higher in nursing homes than in hospitals. Bonner (2008) concluded his study by arguing that creating higher reliability in hospitals has become the most significant feature is PSC.

In his study, Bonner (2008) focused on the use of secondary data analysis to examine whether the CNA s perception of the PSC was linked with the clinical outcomes in a random model of 74 nursing homes. He selected these nursing homes from five random states. The study reveals that in the first half of 2005, the selected nursing homes and states have synchronization between the certified nursing assistants PSC analysis data using the hospital survey of patient safety culture (HSOPSC) with least data set (MDA), Area Resource File (ARF) and Online Survey Certification and Reporting (OSCAR) .Studies showed that, out of 2872 nurses only 1579 of the nurses were aids out and when the survey was completed the response rate was 55% (Bonner, 2008).

Similarly, in the context of the viewpoints, actions, along with the ability of the hospital workforce, Carroll and Quijada (2010) found that the professional doctors, surgeons, nurses along with other hospital staff often recognize organizational culture as an obstruction to positive and necessary change. They argue that focus of the patient safety culture concept is based around the individual sovereignty. This sovereignty seems to be working in conflict with the already established standards of teamwork, problem solving and the procedures of knowledge and learning. With the help of the definitions, they explained that for the change efforts culture is one of the important factors. To up hold the change the professional values can be redirected as explained by the cultural analysis. The cultural strength which had created the new working ways and gradual shift in culture is explained by examples of the organizations (Carroll and Quijada, 2010).

While it is clear from Carroll and Quijada's study that organizational culture needs a paradigm shift, studies have also focused on measures that can provide sustained improvement in quality and PSC results. For instance, Davies and colleagues (2000) explained that the health policy in the industrialized and developed countries in the world is dedicated to analyzing and enhancing the overall delivery of health care facilities. In USA there has been an identification of specific concern over the quality issues. There have been a high number of medical errors reported over the years as indicated in the recent report by the Institute of Medicine (as cited in Davies et al., 2000). Quality improvement has become one of the most important areas of medical discussions as the scandals have propelled quality issues throughout the developed world (Davies et al., 2000).

Another one of the current dilemmas when assessing the quality of safety and service in health care is the impact of the potential changes in the organizational structure in health care; many practitioners refer to this as "the key to quality improvement." In dotting down how such evolving organizational structures can influence patient safety culture, one of the researchers suggested that the cultural change needs to be created next to structural reorganization and system restructuring. This in turn will result in the formation of a culture that complements changes and adaptation to methods that improve the level of quality. A continuous evaluation of the changes in the past two decades had also been discussed thoroughly by Davies and colleagues (2000), and they concluded that cultural change had come in various forms. In fact it was the only constant and was not something new or unpredictable. On the other hand, discussion of "culture" and "cultural change" entreat some complex questions regarding the nature of fundamental structures where the adaptation or change programs are applied within the hospital settings. (Davies et al., 2000)

Another study on the viewpoint and attitude of the hospital workforce was carried out by Flin (2007). He observed that safety measure techniques, which are being used in hospital settings are adopted by the western healthcare organizations as the result of the recent concern about the patient's safety. In his study, Flin studied the perception and attitude of the workforce towards the worker and patients in the organization using one of the techniques used in the safety climate questionnaire. He concluded that the psychological standards were not accepted by the earlier procedures of the safety climate and in his study designed a model using prior research as basis to attempt to explain the hypothetical relationship between the perception of the patient safety climate and the worker's behavior (Flin, 2007) highlighting new psychological and practical examples of the relation between the two aspects like employee satisfaction, employee-patient communication, lateral and top-down/down-up understanding of responsibilities.

As mentioned above, researchers have been developed and testing different PSC metrics. Schein (1992) is not exception to this as he employed a different approach towards gathering the literature on safety culture and safety climate. He focused on the social psychological and organizational psychological traditions. He asserts that even though the safety culture and safety climate both are recognized to be important concepts, not much consent has been reached on the origin, the context or the results of the both safety culture and patient safety culture and climate for the past decades. In addition to this, it is been observed that there are limited models focused primarily on illustrating the relationship between the concepts of safety and risk management in the hospital settings or an analysis of patient safety and care procedures. According to the Schein, there is a difference between the safety culture and safety climate based on the universal organizational cultural structures established previously (1992). This universal structure showed three levels on that can be used to evaluate an organizational culture in any setting; these levels include

D basic assumptions,

Espoused values

Artifacts

Espoused values are the attitudes associated directly with the phenomenon of patient safety climate. However, the core patient safety climate culture has been shaped by the D. basic assumptions. It has been debated in the past years if d basic assumptions aren't necessarily considered when dealing with the aspect of patient safety specifically; many researchers believe that if considered, it could have a significantly positive impact in the patient safety culture structure. However, in the end one can conclude that one might consider the factors shaping organizational culture as the potential indicators of the safety performance but the research should be more focused on its scientific validity. As Guldenmund (2000) supports this statement by asserting that assessment of the D. basic assumptions of an organization are important because they are considered as the explanations of the attitudes existing when dealing with patient safety culture (Guldenmund, 2000).

Yet another different PSC metrics had been developed by Turnberg and Daniell (2008) who assumed that in order to successfully measure the organizational climate psychometrically, validated… READ MORE

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