Background
Objectives
Methods
Setting
Sampling and data collection
-
Healthcare organization leaders (Hospital Director, Deputy Director, Assistant director).
-
Heads of administrative departments (Social Services, Public Relations, Medical Records, Hotel Services, Accounting Services, Engineering, inventory, etc.).
-
Physicians of all specialties and ranks (including those working in radiology, laboratory, nuclear medicine, etc.)
-
Pharmacists
-
Nurses
-
Dieticians
-
Infection control physicians and nurses including sterilization department staff.
-
Quality physicians and nurses
-
Physical, occupational, and speech therapist/ technicians
-
Technicians (sterilization, lab, radiology, anaesthesia, pharmacy etc.)
-
Medical engineering staff
-
Medical records staff
-
Staff on administrative or extended sick leave,
-
Staff who have moved to another hospital area/unit, and
-
Staff with less than 1 year of experience in the hospital.
Study instrument
Ethical approval
Data management and analysis
Results
Demographics
Number | Percent | |
---|---|---|
Gender | ||
Male | 3406 | 28.6 |
Female | 8508 | 71.4 |
Education | ||
High school or below | 572 | 4.8 |
University | 8551 | 72.3 |
Technical | 2573 | 21.7 |
Other | 137 | 1.2 |
Profession | ||
Physician | 1425 | 11.9 |
Pharmacist | 283 | 2.4 |
Nurse | 7987 | 66.8 |
Physiotherapist | 434 | 3.6 |
Technician | 1381 | 11.5 |
Nutritionist/Dietician | 84 | 0.7 |
Administration | 121 | 1 |
Medical Records | 191 | 1.6 |
Others | 56 | 0.5 |
Experience in Hospital | ||
Physician | 1425 | 11.9 |
Pharmacist | 283 | 2.4 |
Nurse | 7987 | 66.8 |
Physiotherapist | 434 | 3.6 |
Technician | 1381 | 11.5 |
Nutritionist/Dietician | 84 | 0.7 |
Administration | 121 | 1 |
Medical Records | 191 | 1.6 |
Others | 56 | 0.5 |
Interaction with patients | ||
Yes | 10,838 | 91.6 |
No | 993 | 8.4 |
Nationality | ||
Kuwaiti | 1609 | 13.6 |
Non-Kuwaiti | 10,255 | 86.4 |
Areas of strengths and areas requiring improvement
% Positive | % Neutral | % Negative | |
---|---|---|---|
1. Teamwork Within Units | |||
People support one another in this unit. (A1) | 94.9 | 2.9 | 2.2 |
When a lot of work needs to be done quickly, we work together as a team to get the work done. (A3) | 93.1 | 4.1 | 2.9 |
In this unit, people treat each other with respect. (A4) | 90.9 | 6.1 | 3.1 |
When one area in this unit gets really busy, others help out. (A11) | 79.9 | 8.8 | 11.3 |
Average Teamwork Within Units | 89.7 | 5.5 | 4.9 |
2. Supervisor/Manager Expectations & Actions Promoting Patient Safety | |||
My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures. (B1) | 80.4 | 11.3 | 8.2 |
My supervisor/manager seriously considers staff suggestions for improving patient safety. (B2) | 83.9 | 10.0 | 6.1 |
Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts. (B3R) | 61.3 | 17.5 | 21.2 |
My supervisor/manager overlooks patient safety problems that happen over and over. (B4R) | 82.6 | 8.0 | 9.4 |
Average Supervisor/Manager Expectations & Actions Promoting Patient Safety | 77.1 | 11.7 | 11.2 |
3. Organizational Learning—Continuous Improvement | |||
We are actively doing things to improve patient safety. (A6) | 95.1 | 3.1 | 1.8 |
Mistakes have led to positive changes here. (A9) | 76.0 | 14.1 | 9.9 |
After we make changes to improve patient safety, we evaluate their effectiveness. (A13) | 87.2 | 8.0 | 4.7 |
Average Organizational Learning—Continuous Improvement | 86.1 | 8.4 | 5.5 |
4. Management Support for Patient Safety | |||
Hospital management provides a work climate that promotes patient safety. (F1) | 81.3 | 10.4 | 8.3 |
The actions of hospital management show that patient safety is a top priority. (F8) | 86.1 | 8.5 | 5.4 |
Hospital management seems interested in patient safety only after an adverse event happens. (F9R) | 65.9 | 13.7 | 20.4 |
Average Management Support for Patient Safety | 77.8 | 10.9 | 11.4 |
5. Overall Perceptions of Patient Safety | |||
It is just by chance that more serious mistakes don’t happen around here. (A10R) | 36.2 | 15.1 | 48.6 |
Patient safety is never sacrificed to get more work done. (A15) | 79.7 | 6.1 | 14.3 |
We have patient safety problems in this unit. (A17R) | 45.2 | 15.6 | 39.2 |
Our procedures and systems are good at preventing errors from happening. (A18) | 81.1 | 10.6 | 8.2 |
Average Overall Perceptions of Patient Safety | 60.6 | 11.9 | 27.6 |
6. Feedback and Communication About Error | |||
We are given feedback about changes put into place based on event reports. (C1) | 50.8 | 29.6 | 19.6 |
We are informed about errors that happen in this unit. (C3) | 79.9 | 14.1 | 6.1 |
In this unit, we discuss ways to prevent errors from happening again. (C5) | 81.5 | 12.7 | 5.8 |
Average Feedback and Communication About Error | 70.7 | 18.8 | 10.5 |
7. Communication Openness | |||
Staff will freely speak up if they see something that may negatively affect patient care. (C2) | 67.7 | 20.7 | 11.6 |
Staff feel free to question the decisions or actions of those with more authority. (C4) | 30.0 | 28.3 | 41.7 |
Staff are afraid to ask questions when something does not seem right. (C6R) | 43.1 | 36.7 | 20.2 |
Average Communication Openness | 46.9 | 28.6 | 24.5 |
8. Frequency of Events Reported | |||
When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported? (D1) | 55.5 | 20.4 | 24.1 |
When a mistake is made, but has no potential to harm the patient, how often is this reported? (D2) | 54.7 | 21.7 | 23.6 |
When a mistake is made that could harm the patient, but does not, how often is this reported? (D3) | 66.9 | 14.3 | 18.8 |
Average Frequency of Events Reported | 59.0 | 18.8 | 22.2 |
9. Teamwork Across Units | |||
Hospital units do not coordinate well with each other. (F2R) | 55.9 | 16.5 | 27.7 |
There is good cooperation among hospital units that need to work together. (F4) | 71.1 | 15.6 | 13.3 |
It is often unpleasant to work with staff from other hospital units. (F6R) | 46.3 | 21.1 | 32.6 |
Hospital units work well together to provide the best care for patients. (F10) | 82.9 | 10.7 | 6.4 |
Average Teamwork Across Units | 64.1 | 16.0 | 20.0 |
10. Staffing | |||
We have enough staff to handle the workload. (A2) | 60.8 | 11.9 | 27.3 |
Staff in this unit work longer hours than is best for patient care. (A5R) | 27.6 | 16.7 | 55.7 |
We use more agency/temporary staff than is best for patient care. (A7R) | 52.5 | 19.5 | 27.9 |
We work in “crisis mode” trying to do too much, too quickly. (A14R) | 18.5 | 13.8 | 67.7 |
Average Staffing | 39.9 | 15.5 | 44.7 |
11. Handoffs & Transitions | |||
Things “fall between the cracks” when transferring patients from one unit to another. (F3R) | 54.6 | 18.7 | 26.7 |
Important patient care information is often lost during shift changes. (F5R) | 75.5 | 12.5 | 12.1 |
Problems often occur in the exchange of information across hospital units. (F7R) | 48.5 | 24.2 | 27.3 |
Shift changes are problematic for patients in this hospital. (F11R) | 70.3 | 15.5 | 14.2 |
Average Handoffs & Transitions | 62.2 | 17.7 | 20.1 |
12. Non-punitive Response to Error | |||
Staff feel like their mistakes are held against them. (A8R) | 29.5 | 19.5 | 50.9 |
When an event is reported, it feels like the person is being written up, not the problem. (A12R) | 38.1 | 18.4 | 43.4 |
Staff worry that mistakes they make are kept in their personnel file. (A16R) | 15.6 | 13.7 | 70.8 |
Average Non-punitive Response to Error | 27.7 | 17.2 | 55.0 |
Association between patient safety grade and number of events with composites
Patient Safety Grade | Number of Events Reported | |||||||
---|---|---|---|---|---|---|---|---|
Sig. | Poor or Failing | Acceptable | Excellent/ Very Good | Sig. | No event reports | 1 to 5 event reports | > 5 events reported | |
Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | |||
Supervisor/manager expectations and actions promoting safety | a,b,c | 3.15 (0.88) | 3.62 (0.62) | 3.94 (0.56) | 3.87 (0.60) | 3.85 (0.60) | 3.86 (0.61) | |
Organizational Learning-Continuous Improvement | a,b,c | 3.39 (0.89) | 3.85 (0.61) | 4.16 (0.47) | a,b | 4.07 (0.54) | 4.10 (0.52) | 4.13 (0.55) |
Teamwork Within Hospital Units | a,b,c | 3.64 (0.92) | 3.96 (0.62) | 4.26 (0.49) | 4.19 (0.56) | 4.19 (0.52) | 4.19 (0.58) | |
Communication Openness | a,b,c | 2.59 (0.94) | 3.01 (0.83) | 3.46 (0.80) | a | 3.40 (0.83) | 3.31 (0.83) | 3.35 (0.86) |
Feedback and Communication About Errors | a,b,c | 2.87 (1.08) | 3.60 (0.83) | 4.10 (0.69) | a,c | 3.98 (0.78) | 3.97 (0.75) | 4.03 (0.76) |
Non-punitive Response to Error | b,c | 2.38 (0.84) | 2.44 (0.73) | 2.69 (0.74) | a,b | 2.66 (0.74) | 2.60 (0.76) | 2.60 (0.76) |
Staffing | b,c | 2.72 (0.62) | 2.80 (0.55) | 2.93 (0.55) | a,b | 2.92 (0.56) | 2.87 (0.54) | 2.84 (0.57) |
Hospital Management Support for Patient Safety | a,b,c | 2.68 (0.93) | 3.44 (0.69) | 3.96 (0.61) | a,b | 3.88 (0.69) | 3.80 (0.67) | 3.74 (0.78) |
Hospital Handoffs and Transitions | a,b,c | 2.92 (0.88) | 3.23 (0.75) | 3.56 (0.71) | a,b | 3.51 (0.71) | 3.47 (0.74) | 3.36 (0.80) |
Teamwork Across Hospital Units | a,b,c | 2.69 (0.85) | 3.20 (0.67) | 3.63 (0.63) | a,b,c | 3.56 (0.67) | 3.50 (0.67) | 3.44 (0.72) |
Patient Safety Grade a. Significant difference between “Poor or Failing” and “Acceptable” b. Significant difference between “Poor or Failing” and “Excellent/Very Good” c. Significant difference between “Acceptable” and “Excellent/Very Good” | Number of Events Reported a. Significant difference between “No events reported” and “1 to 5 events reported” b. Significant difference between “No events reported” and “> 5 events reported” c. Significant difference between “1 to 5 events reported” and “> 5 events reported” |
Generalized estimating equations
Patient Safety Grade | Number of Events Reported | |||
---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | |
Patient Safety Culture Composites | ||||
Supervisor/Manager Expectations & Actions Promoting Patient Safety | 0.73 (0.67–0.80) | < 0.001 | 1.05 (0.95–1.16) | 0.318 |
Organizational learning and Continuous Improvement | 0.65 (0.55–0.77) | < 0.001 | 1.27 (1.16–1.39) | < 0.001 |
Teamwork within units | 0.75 (0.68–0.83) | < 0.001 | 1.05 (0.95–1.15) | 0.347 |
Communication Openness | 0.78 (0.67–0.91) | 0.002 | 0.91 (0.83–1.01) | 0.077 |
Feedback and Communications About Error | 0.72 (0.63–0.83) | < 0.001 | 1.10 (1.02–1.19) | 0.018 |
Non-punitive Response to Error | 1.01 (0.89–1.15) | 0.850 | 0.96 (0.86–1.07) | 0.448 |
Staffing | 0.84 (0.72–0.97) | 0.021 | 0.88 (0.78–0.99) | 0.038 |
Hospital Management Support for Patient Safety | 0.47 (0.40–0.54) | < 0.001 | 0.81 (0.71–0.92) | 0.002 |
Hospital Handoffs & Transitions | 0.89 (0.75–1.06) | 0.197 | 0.94 (0.86–1.02) | 0.137 |
Teamwork Across Hospital Units | 0.81 (0.67–0.98) | 0.027 | 0.94 (0.82–1.07) | 0.318 |
Gender | ||||
Male | 1.11 (0.90–1.35) | 0.300 | 1.14 (0.97–1.35) | 0.122 |
Female | 1 | 1 | ||
Experience at the hospital | ||||
< 5 years | 0.87 (0.69–1.10) | 0.237 | 1.12 (0.98–1.27) | 0.086 |
5 to 20 years | 0.90 (0.74–1.10) | 0.289 | 0.98 (0.83–1.15) | 0.765 |
More or equal to 21 years | 1 | 1 | ||
Highest Degree | ||||
High school or below | 1.19 (0.71–2.02) | 0.505 | 1.21 (0.74–1.98) | 0.437 |
University Degree | 0.59 (0.35–1.00) | 0.048 | 0.81 (0.55–1.19) | 0.275 |
Technical Degree | 0.89 (0.58–1.35) | 0.577 | 0.95 (0.64–1.41) | 0.795 |
Other | 1 | 1 | ||
Position at the hospital | ||||
Physician | 1.15 (0.86–1.53) | 0.344 | 0.57 (0.47–0.69) | < 0.001 |
Pharmacist | 1.12 (0.69–1.83) | 0.637 | 0.52 (0.32–0.82) | 0.005 |
Nurse | 0.97 (0.73–1.29) | 0.829 | 0.51 (0.43–0.59) | < 0.001 |
Admin | 1.07 (0.61–1.87) | 0.828 | 0.24 (0.14–0.43) | < 0.001 |
Other | 1 | 1 | ||
Nationality | ||||
Kuwaiti | 0.68 (0.49–0.93) | 0.016 | 1.20 (1.04–1.37) | 0.010 |
Non-Kuwaiti | 1 | 1 | ||
Interaction with patients | ||||
Yes | 1.01 (0.76–1.32) | 0.967 | 0.82 (0.68–0.98) | 0.033 |
No | 1 | 1 | ||
Hospital Size | ||||
Small | 1.65 (1.17–2.33) | 0.004 | 2.67 (2.17–3.30) | < 0.001 |
Medium | 2.02 (0.85–4.79) | 0.110 | 1.85 (1.07–3.20) | 0.028 |
Large | 1 | 1 |
Linear mixed model regression
Frequency of Events Reported | Perception of Patient Safety | |||
---|---|---|---|---|
Beta (Standard Error) | P-value | Beta (Standard Error) | P-value | |
Patient Safety Culture Composites | ||||
Supervisor/ Manager Expectations & Actions Promoting Patient Safety | 0.03 (0.02) | 0.112 | 0.12 (0.01) | < 0.001 |
Organizational learning and Continuous Improvement | 0.09 (0.02) | < 0.001 | 0.13 (0.01) | < 0.001 |
Teamwork within units | 0.01 (0.02) | 0.796 | 0.10 (0.01) | < 0.001 |
Communication Openness | 0.02 (0.01) | 0.249 | 0.02 (0.01) | 0.002 |
Feedback and Communications About Error | 0.32 (0.02) | < 0.001 | −0.01 (0.01) | 0.322 |
Non-punitive Response to Error | 0.02 (0.01) | 0.150 | 0.03 (0.01) | < 0.001 |
Staffing | −0.01 (0.02) | 0.457 | 0.11 (0.01) | < 0.001 |
Hospital Management Support for Patient Safety | 0.07 (0.02) | < 0.001 | 0.12 (0.01) | < 0.001 |
Hospital Handoffs & Transitions | 0.07 (0.02) | < 0.001 | 0.09 (0.01) | < 0.001 |
Teamwork Across Hospital Units | −0.02 (0.02) | 0.200 | −0.04 (0.01) | < 0.001 |
Gender | ||||
Male | −0.08 (0.02) | < 0.001 | 0.05 (0.01) | < 0.001 |
Female | 0 | 0 | ||
Highest Degree | ||||
High School or below | 0.05 (0.10) | 0.598 | 0.16 (0.05) | 0.001 |
University or Higher Degree | −0.17 (0.09) | 0.046 | 0.16 (0.04) | < 0.001 |
Technical Degree | −0.10 (0.09) | 0.283 | 0.18 (0.04) | < 0.001 |
Other | 0 | 0 | ||
Experience at the hospital | ||||
< 5 years | 0.05 (0.03) | 0.112 | 0.01 (0.02) | 0.680 |
5 to 20 years | 0.01 (0.03) | 0.825 | −0.01 (0.02) | 0.422 |
More or equal to 21 years | 0 | 0 | ||
Profession | ||||
Physician | −0.26 (0.14) | 0.064 | −0.11 (0.07) | 0.116 |
Pharmacist | −0.25 (0.15) | 0.097 | 0.00 (0.08) | 0.996 |
Nurse | −0.44 (0.14) | 0.002 | 0.13 (0.07) | 0.059 |
Physiotherapist | −0.18 (0.15) | 0.220 | −0.08 (0.07) | 0.292 |
Technician | −0.22 (0.14) | 0.125 | −0.05 (0.07) | 0.484 |
Nutritionist | −0.18 (0.18) | 0.305 | 0.09 (0.09) | 0.314 |
Administrative | −0.30 (0.17) | 0.073 | 0.09 (0.08) | 0.255 |
Medical Records | −0.48 (0.16) | 0.002 | 0.03 (0.08) | 0.679 |
Other | 0 | 0 | ||
Nationality | ||||
Kuwaiti | −0.09 (0.03) | 0.005 | 0.08 (0.02) | < 0.001 |
Non-Kuwaiti | 0 | 0 | ||
Interaction with patients | ||||
Yes | 0.07 (0.04) | 0.052 | 0.02 (0.02) | 0.386 |
No | 0 | 0 | ||
Hospital Size | ||||
Small | 0.14 (0.08) | 0.127 | 0.05 (20.73) | 0.664 |
Medium | 0.05 (0.09) | 0.593 | 0.05 (24.09) | 0.182 |
Large | 0 | 0 |
Benchmarking
Composite | Kuwait | Benchmark US | Benchmark Lebanon | Benchmark KSA | |||
---|---|---|---|---|---|---|---|
Teamwork within units | 89.7% | 81% | ☑ | 82.3% | ☑ | 78.50% | ▣ |
Supervisor/manager expectations and actions promoting patient safety | 77.0% | 76% | ☑ | 66.4% | ▣ | 60.60% | ▣ |
Organizational learning-continuous improvement | 86.1% | 73% | ▣ | 78.3% | ☑ | 79.60% | ☑ |
Management Support for Patient Safety | 77.7% | 72% | ☑ | 78.4% | ☑ | 71.40% | ☑ |
Overall perception of patient safety | 60.5% | 66% | ☑ | 72.5% | ▣ | 58.20% | ☑ |
Feedback and communication about error | 70.6% | 67% | ☑ | 68.1% | ☑ | 63.30% | ☑ |
Communication openness | 47.2% | 62% | ▣ | 57.3% | ▣ | 42.90% | ☑ |
Frequency of events reported | 58.8% | 66% | ☑ | 68.2% | ☑ | 59.40% | ☑ |
Teamwork across hospital units | 63.8% | 61% | ☑ | 56.0% | ☑ | 61.60% | ☑ |
Staffing | 39.6% | 55% | ▣ | 36.8% | ☑ | 35.10% | ☑ |
Hospital handoffs and transitions | 61.9% | 47% | ▣ | 49.7% | ▣ | 51.50% | ▣ |
Non-punitive response to error | 27.6% | 44% | ▣ | 24.3% | ☑ | 26.80% | ☑ |