ABSTRACT
Background: Studies on safety culture maturity in health care is very rare, and the existing ones only focus on patients and the use of Manchester Patients Safety Framework (MaPSaF) instrument. The objective of this study is to develop a comprehensive instrument for measuring safety culture maturity in hospitals.
Design and methods: This study used a cross-sectional design with three stages. First, we used secondary data analysis from the Hospital Accreditation Commission. Second, evaluation of primary data obtained from safety climate questionnaire. Third, we did focus group discussions, and in-depth interviews for validation of secondary data and development of DUTA-RS website. We analyzed using Structural Equation Modeling (SEM) test.
Results: DUTA-RS instrument contains 1,118 elements based on the first edition of the Indonesian Hospital Accreditation National Standard. Its safety culture maturity is at the proactive level (58.0%), with the highest accreditation levels of proactive (50.8%) and generative (48.7%). The variables affecting the safety culture maturity are situational and safety behavior variables, with leadership, risk management, and safety compliance as the strongest indicators. The weakest indicators of climate are organizational learning and communication. The mean value of climate for primary and secondary data is in the good category and showed in proactive level.
Conclusions: The DUTA-RS as a website to measure the safety culture maturity in accredited hospitals by taking the advantage of the existing information technology of hospital accreditation committee as the benchmark enables improvement of SCML in hospitals. Further studies are required for the development of DUTA-RS website.
REFERENCES
Ministry of Health of the republic of Indonesia. Patient Safety Incident Report in Indonesia. Jakarta; 2020.
Ministry of Health of the Republic of Indonesia. Occupational Health and Safety from Data and Information Center (Ministry of Health Indonesia). Pusdatin Kemkes. 2017.
Occupational Safety and Health Administration [Internet]. Worker Safety in Your Hospitals. 2013. Available from: https://www.osha.gov/dsg/hospitals/documents/1.1_Data_highlights_508.pdf
Isara A, Oguzie K, Okpogoro O. Prevalence of needlestick injuries among healthcare workers in the accident and emergency department of a teaching hospital in Nigeria. Ann Med Health Sci Res 2015;5:392–6. DOI: https://doi.org/10.4103/2141-9248.177973
Hughes P, Ferrett E. Promoting a positive health and safety culture. Hughes P, Ferrett E, editors. Introduction to health and safety in construction. Taylor & Francis; 2013. p. 51–68. DOI: https://doi.org/10.1016/B978-1-85617-521-0.50011-0
Henriqson É, Schuler B, van Winsen R, Dekker SWA. The constitution and effects of safety culture as an object in the discourse of accident prevention: A Foucauldian approach. Saf Sci 2014;70:465–76. DOI: https://doi.org/10.1016/j.ssci.2014.07.004
Guldenmund FW. Understanding safety culture and its relationship to safety management. Risk Anal 2010;30:1466–80. DOI: https://doi.org/10.1111/j.1539-6924.2010.01452.x
Reason J. Managing the risks of organizational accidents. Ashgate; 1997.
Goncalves Filho AP, Waterson P. Maturity models and safety culture: A critical review. Saf Sci 2018;105:192–211. DOI: https://doi.org/10.1016/j.ssci.2018.02.017
Fleming M. Safety culture maturity model. HSE Offshore Technology Report 2000/049: Sudbury, 2000.
University of Manchester [Internet]. Manchester Patient Safety Framework (MaPSaF) Acute. 2006. Available from: http://www.ajustnhs.com/wp-content/uploads/2012/10/Manchester-Patient-Safety-Framework.pdf
El-Jardali F, Dimassi H, Jamal D, et al. Predictors and outcomes of patient safety culture in hospitals. BMC Health Serv Res 2011;11:45. DOI: https://doi.org/10.1186/1472-6963-11-45
Devkaran S, O’Farrell PN. The impact of hospital accreditation on clinical documentation compliance: A life cycle explanation using interrupted time series analysis. BMJ Open 2014;4:e005240. DOI: https://doi.org/10.1136/bmjopen-2014-005240
Indonesia Hospital Accreditation Commission. National Standard for Hospital Accreditation. 1st ed. Jakarta: KARS; 2018.
Cooper D. Navigating the safety culture construct: A review of the evidence [Internet]. 2016. Available from: https://www.behavioral-safety.com/articles/safety_culture_review.pdf
Sunindijo RY, Loosemore M, Lestari F, et al. Comparing safety climate in infrastructure and building projects in Indonesia. MATEC Web Conf 2019;258:02024. DOI: https://doi.org/10.1051/matecconf/201925802024
Preece J, Sharp H, Rogers Y. Interaction design – Beyond human-computer interaction. 4th ed. J. Wiley & Sons, Inc.; 2015.
Badenes-Ribera L, Frías-Navarro D, Monterde-i-Bort H, Pascual-Soler M. Interpretation of the p value: A national survey study in academic psychologists from Spain. Psicothema 2015;27:290–5.
Hair J, Black W, Babin B, Anderson R, et al. Multivariate Data Analysis (MVDA). In: Schlindwein WS, Gibson M, editors. Pharmaceutical quality by design: A practical approach. J. Wiley & Sons, Inc.; 2014. p. 201-25.
Latan H. Theory and implementation of structural equation model in AMOS 21.0. Bandung: Alfabeta; 2013.
Halligan M, Zecevic A. Safety culture in healthcare: A review of concepts, dimensions, measures and progress. BMJ Qual Saf 2011;20:338–43. DOI: https://doi.org/10.1136/bmjqs.2010.040964
Fleming M, Wentzell N. Patient safety culture improvement tool: Development and guidelines for use. Healthc Q 2008;11:10-5. DOI: https://doi.org/10.12927/hcq.2013.19604
Hudson P. Applying The lessons of high risk industries to health care. Qual Saf Heal Care 2003;12:7i-12. DOI: https://doi.org/10.1136/qhc.12.suppl_1.i7
Cooper D. The safety culture construct: Theory and practice. In: Gilbert C, Journé B, Laroche H, Bieder C, editors. Safety cultures, safety models. Springer: 2018. p. 47–61. DOI: https://doi.org/10.1007/978-3-319-95129-4_5
Brown JK. Relationship between patient safety culture and safety outcome measures among nurses. Gardner-Webb Univesity; 2015.
Kurniawidjaja LM. Epidemiology application of occupational safety and health in the business world and the working world. 2013.
Kim Y, Park J, Park M. Creating a culture of prevention in occupational safety and health practice. Saf Health Work 2016;7:89–96. DOI: https://doi.org/10.1016/j.shaw.2016.02.002
Burkgren T. The essentials. J Swine Heal Prod 2018;26:69.
Currie L. Understanding patient safety. Quay Books; 2007.
Wiegmann DA, Zhang H, Von TL. Safety culture: An integrative review. Int J Aviat Psychol 2004;14:117-34. DOI: https://doi.org/10.1207/s15327108ijap1402_1
Hodgen A, Ellis L, Churruca K, Bierbaum M. Safety culture assessment in health care: A review of the literature on safety culture assessment modes. Sydney: ACSQHC; 2017.
European Commission. PentaHelix Guidelines Deliverable 3.2. 2019. Available from: https://pentahelix.eu/
Tourani S, Hassani M, Ayoubian A, Habibi M, Zaboli R. Analyzing and prioritizing the dimensions of patient safety culture in emergency wards using the TOPSIS technique. Glob J Health Sci 2015;7:143–50. DOI: https://doi.org/10.5539/gjhs.v7n4p143
Suyono KZ, Nawawinetu ED. Work safety with safety behavior at PT DOK and shipping in Surabaya Unit Hull construction. Indones J Occup Saf Hea. 2013;2:67–74.
Ali AYS, Ali AA, Adan AA. Working conditions and employees’ productivity in manufacturing companies in Sub-Saharan African context: Case of Somalia. Educ Research Int 2013;2:2307–13.
Lai M, Lombardo MV, Pasco G, et al. A Behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS One 2011;6:e20835. DOI: https://doi.org/10.1371/journal.pone.0020835
Yu A, Flott K, Chainani N, et al. Patient safety 2030. Available from: https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/centre-for-health-policy/Patient-Safety-2030-Report-VFinal.pdf
Health and Safety Executive. Managing for Health and Safety HSG65. 2013. Available from: http://www.hse.gov.uk/managing/delivering/do/organising/communication.htm
Chen IC, Li HH. Measuring patient safety culture in Taiwan using the hospital survey on patient safety culture (HSOPSC). BMC Health Serv Res 2010;10:152. DOI: https://doi.org/10.1186/1472-6963-10-152
Agnew C, Flin R, Mearns K. Patient safety climate and worker safety behaviours in acute hospitals in Scotland. J Safety Res 2013;45:95-101. DOI: https://doi.org/10.1016/j.jsr.2013.01.008
McKean EL, Snyderman CH. Leadership driving safety and quality. Otolaryngol Clin North Am 2019;52:11–22. DOI: https://doi.org/10.1016/j.otc.2018.08.002
Lee JW. Risk management and quality improvement. In: Rajan N, editor. Manual of practice management for ambulatory surgery centers. Springe; Cham. 2013. p. 295–305. DOI: https://doi.org/10.1007/978-3-030-19171-9_20
European Union Agency for Railways. Safety management system requirements for safety certification or safety authorisation. Publications Office of the European Union; 2018.
Neal A, Griffin MA. A Study of the lagged relationships among safety climate, safety motivation, safety behavior, and accidents at the individual and group levels. J Appl Psychol 2006;91:946–53. DOI: https://doi.org/10.1037/0021-9010.91.4.946
Griffin M, Curcuruto M. Safety climate in organizations. Annu Rev Organ Psychol Organ Behav 2016;3:191-212. DOI: https://doi.org/10.1146/annurev-orgpsych-041015-062414