Background
Methods
Questionnaire
Characteristics
|
Physicians (n = 301)
|
Nurses (n = 722)
|
Others (n = 137)
|
Total (n = 1160)
|
---|---|---|---|---|
Working units | ||||
Internal medicine | 79(23.1) | 234(68.2) | 30(8.7) | 343(100 a ) |
Surgery department | 106(27.4) | 250(64.8) | 30(7.8) | 386(100) |
Other units | 116(26.9) | 138(52.4) | 77(17.7) | 431(100) |
Years in hospital | ||||
< 1 | 55(17.5) | 192(61.1) | 67(21.3) | 314(100) |
1-5 | 89(19.6) | 336(74.0) | 29(6.4) | 454(100) |
6-10 | 44(27.3) | 108(67.1) | 9(5.6) | 161(100) |
≥11 | 113(48.9) | 86(37.2) | 32(13.9) | 231(100) |
Years in department | ||||
< 1 | 64(16.9) | 243(64.1) | 72(19.0) | 379(100) |
1-5 | 103(20.6) | 365(73.2) | 31(6.2) | 499(100) |
6-10 | 49(37.1) | 74(56.1) | 9(6.8) | 132(100) |
≥11 | 85(56.7) | 40(26.7) | 25(16.6) | 150(100) |
Hours working per week | ||||
<20 | 11(42.3) | 7(26.9) | 8(30.8) | 26(100) |
20-39 | 31(15.7) | 129(65.5) | 37(18.8) | 197(100) |
40-59 | 136(18.3) | 531(71.5) | 76(10.2) | 743(100) |
≥60 | 123(63.4) | 55(28.4) | 14(8.2) | 194(100) |
Contact with patient directly | ||||
Yes, often | 294(26.8) | 702(64.1) | 99(9.0) | 1095(100) |
No | 6(9.5) | 19(30.2) | 38(60.3) | 63(100) |
Sample
Data analysis
Data collection
Descriptive statistics
Ethic
Results
Sample and response statistics
Dimension/items(internal consistency reliability coefficient) | US | China |
---|---|---|
1.Teamwork Within Units (Cranach’s α = 0.72)
| 80% | 84% |
A1. People support one another in this facility | 86% | 87% |
A3. When a lot of work needs to be done quickly, we work together as a team to get the work done | 86% | 87% |
A4. In facility, people treat each other with respect | 78% | 80% |
A11. When one area in this unit gets really busy, others help out | 69% | 81% |
2.Supervisor/Manager Expectations & Actions Promoting Patient Safety (Cranach’s α = 0.51)
| 75% | 63% |
B2. Manager says a good word when he/she sees a job done according to established | 76% | 76% |
B3. Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts | 74% | 36% |
B4. My supervisor/manager overlooks patient safety problems that happen over and over | 76% | 78% |
3.Organizational Learning—Continuous Improvement (Cranach’s α = 0.74)
| 72% | 88% |
A6. We are actively doing things to improve patient safety. | 84% | 87% |
A13. After we make changes to improve patient safety, we evaluate their effectiveness. | 69% | 89% |
4.Management Support for Patient Safety (Cranach’s α = 0.67)
| 72% | 69% |
F1. Hospital management provides a work climate that promotes patient safety. | 81% | 71% |
F8. The actions of hospital management show that patient safety is a top priority. | 75% | 70% |
F9. Hospital management seems interested in patient safety only after an adverse event happens | 61% | 65% |
5.Overall Perceptions of Patient Safety (Cranach’s α = 0.64)
| 66% | 55% |
A10. It is just by chance that more serious mistakes don't happen around here. | 62% | 61% |
A17. We had patient safety problems in this unit. | 64% | 37% |
A18. Our procedures and systems are good at preventing errors from happening. | 72% | 65% |
6.Feedback & Communication About Error (Cranach’s α = 0.64)
| 64% | 50% |
C1. We are given feedback about changes put into place based on event reports. | 56% | 54% |
C3. We are informed about errors that happen in this unit. | 65% | 64% |
C5. In this unit, we discuss ways to prevent errors from happening again. | 72% | 53% |
7 Communication Openness (Cranach’s α = -0.47)
| 62% | 65% |
C2. Staff will freely speak up if they see something that may negatively affect patient care. | 75% | 51% |
C4. Staffs are afraid to ask questions when something does not seem right. | 47% | 80% |
C6. Staffs feel free to question the decisions or actions of those with more authority. | 63% | 64% |
8.Nonpunitive Response to Errors (Cranach’s α = 0.75)
| 44% | 60% |
A8. Staff feel like their mistakes are held against them. | 50% | 53% |
A12. When an event is reported, it feels like the person is being written up, not the problem. | 46% | 67% |
A16. Staff worry that mistakes they make are kept in their personnel file. | 35% | 60% |
9 Teamwork Across Units (Cranach’s α = -0.63)
| 58% | 66% |
F4. There is good cooperation among hospital units that need to work together. | 60% | 66% |
10. Staffing (Cranach’s α = 0.63)
| 56% | 45% |
A2. We have enough staff to handle the workload. | 56% | 42% |
A5. Staffs in this unit work longer hours than is best for patient care. | 51% | 38% |
A7. We use more agency/temporary staff than is best for patient care. | 44% | 37% |
A14. We work in “crisis mode” trying to do too much, too quickly. | 45% | 61% |
Comparative results
Items |
Nurse
|
Physicians
| χ2
| p | ||
---|---|---|---|---|---|---|
NPR | NOR | NPR | NOR | |||
A1. People support one another in this facility | 624 | 97 | 270 | 31 | 1.93 | 0.17 |
A3. When a lot of work needs to be done quickly, we work together as a team to get the work done | 647 | 75 | 250 | 51 | 8.45 | 0.01 |
A4. In facility, people treat each other with respect | 692 | 29 | 267 | 34 | 19.42 | 0.01 |
A11. When one area in this unit gets really busy, others help out | 607 | 115 | 231 | 70 | 7.7 | 0.01 |
B2. Manager says a good word when he/she sees a job done according to established | 540 | 182 | 242 | 59 | 3.78 | 0.06 |
B3. Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts | 458 | 264 | 203 | 98 | 1.49 | 0.22 |
B4. My supervisor/manager overlooks patient safety problems that happen over and over | 559 | 163 | 243 | 58 | 1.37 | 0.24 |
A6. We are actively doing things to improve patient safety. | 646 | 75 | 250 | 51 | 8.41 | 0.01 |
A13. After we make changes to improve patient safety, we evaluate their effectiveness. | 654 | 68 | 258 | 43 | 5.2 | 0.02 |
F1. Hospital management provides a work climate that promotes patient safety. | 536 | 186 | 193 | 108 | 10.62 | 0.01 |
F8. The actions of hospital management show that patient safety is a top priority. | 590 | 132 | 233 | 68 | 2.51 | 0.11 |
F9. Hospital management seems interested in patient safety only after an adverse event happens | 478 | 244 | 193 | 108 | 0.41 | 0.52 |
A10. It is just by chance that more serious mistakes don't happen around here. | 556 | 166 | 271 | 30 | 23.27 | 0.01 |
A17. We had patient safety problems in this unit. | 446 | 276 | 195 | 106 | 0.82 | 0.36 |
A18. Our procedures and systems are good at preventing errors from happening. | 497 | 225 | 174 | 127 | 11.45 | 0.01 |
C1. We are given feedback about changes put into place based on event reports. | 385 | 337 | 169 | 132 | 0.68 | 0.41 |
C3. We are informed about errors that happen in this unit. | 490 | 232 | 163 | 139 | 17.31 | 0.01 |
C5. In this unit, we discuss ways to prevent errors from happening again. | 419 | 303 | 136 | 165 | 14.13 | 0.01 |
C2. Staff will freely speak up if they see something that may negatively affect patient care. | 347 | 375 | 175 | 126 | 8.63 | 0.01 |
C4. Staffs are afraid to ask questions when something does not seem right. | 596 | 126 | 224 | 77 | 8.83 | 0.01 |
C6. Staffs feel free to question the decisions or actions of those with more authority. | 593 | 129 | 232 | 69 | 3.48 | 0.06 |
A8. Staff feel like their mistakes are held against them. | 646 | 75 | 237 | 64 | 21.74 | 0.01 |
A12. When an event is reported, it feels like the person is being written up, not the problem. | 615 | 107 | 250 | 51 | 0.73 | 0.39 |
A16. Staff worry that mistakes they make are kept in their personnel file. | 644 | 75 | 273 | 28 | 0.29 | 0.59 |
F4. There is good cooperation among hospital units that need to work together. | 480 | 242 | 184 | 117 | 2.67 | 0.10 |
A2. We have enough staff to handle the workload. | 457 | 265 | 146 | 155 | 19.21 | 0.01 |
A5. Staffs in this unit work longer hours than is best for patient care. | 450 | 272 | 182 | 118 | 0.25 | 0.81 |
A7. We use more agency/temporary staff than is best for patient care. | 489 | 233 | 171 | 130 | 11.06 | 0.01 |
A14. We work in “crisis mode” trying to do too much, too quickly. | 606 | 116 | 250 | 51 | 0.12 | 0.79 |
Items | Residents | Attending physicians | Deputy directors | Chief physicians |
χ
2
|
P
| ||||
---|---|---|---|---|---|---|---|---|---|---|
NPR | NOR | NPR | NOR | NPR | NOR | NPR | NOR | |||
A1. People support one another in this facility | 98 | 10 | 77 | 8 | 57 | 7 | 38 | 6 | 0.76 | 0.86 |
A3. When a lot of work needs to be done quickly, we work together as a team to get the work done | 98 | 10 | 69 | 16 | 44 | 20 | 39 | 5 | 14.98 | 0.01 |
A4. In facility, people treat each other with respect | 99 | 9 | 72 | 13 | 58 | 6 | 38 | 6 | 2.77 | 0.43 |
A11. When one area in this unit gets really busy, others help out | 88 | 20 | 60 | 25 | 49 | 15 | 34 | 10 | 3.16 | 0.37 |
B2. Manager says a good word when he/she sees a job done according to established | 95 | 13 | 67 | 18 | 47 | 17 | 33 | 11 | 6.81 | 0.08 |
B3. Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts | 66 | 42 | 56 | 29 | 47 | 17 | 34 | 10 | 5.03 | 0.17 |
B4. My supervisor/manager overlooks patient safety problems that happen over and over | 95 | 13 | 66 | 19 | 49 | 15 | 33 | 11 | 5.78 | 0.12 |
A6. We are actively doing things to improve patient safety. | 93 | 15 | 70 | 15 | 49 | 15 | 38 | 6 | 3.00 | 0.39 |
A13. After we make changes to improve patient safety, we evaluate their effectiveness. | 95 | 13 | 69 | 16 | 55 | 9 | 39 | 5 | 2.18 | 0.54 |
F1. Hospital management provides a work climate that promotes patient safety. | 84 | 24 | 42 | 43 | 40 | 24 | 27 | 17 | 16.91 | 0.01 |
F8. The actions of hospital management show that patient safety is a top priority. | 90 | 18 | 61 | 24 | 46 | 18 | 36 | 8 | 5.31 | 0.15 |
F9. Hospital management seems interested in patient safety only after an adverse event happens | 77 | 31 | 51 | 34 | 38 | 26 | 27 | 17 | 3.80 | 0.28 |
A10. It is just by chance that more serious mistakes don't happen around here. | 96 | 12 | 77 | 8 | 57 | 7 | 41 | 3 | 0.74 | 0.86 |
A17. We had patient safety problems in this unit. | 50 | 58 | 64 | 21 | 45 | 19 | 36 | 8 | 26.66 | 0.01 |
A18. Our procedures and systems are good at preventing errors from happening. | 76 | 32 | 40 | 45 | 38 | 26 | 20 | 24 | 13.79 | 0.01 |
C1. We are given feedback about changes put into place based on event reports. | 69 | 39 | 46 | 39 | 32 | 32 | 22 | 22 | 4.41 | 0.22 |
C3. We are informed about errors that happen in this unit. | 64 | 44 | 45 | 40 | 30 | 34 | 24 | 20 | 2.54 | 0.47 |
C5. In this unit, we discuss ways to prevent errors from happening again. | 47 | 61 | 40 | 45 | 46 | 18 | 32 | 12 | 20.78 | 0.01 |
C2. Staff will freely speak up if they see something that may negatively affect patient care. | 76 | 32 | 50 | 35 | 29 | 35 | 20 | 24 | 13.84 | 0.01 |
C4. Staffs are afraid to ask questions when something does not seem right. | 83 | 25 | 64 | 21 | 47 | 17 | 30 | 14 | 1.30 | 0.73 |
C6. Staffs feel free to question the decisions or actions of those with more authority. | 78 | 30 | 68 | 17 | 55 | 9 | 31 | 13 | 5.77 | 0.12 |
A8. Staff feel like their mistakes are held against them. | 92 | 16 | 66 | 19 | 45 | 19 | 34 | 10 | 5.49 | 0.14 |
A12. When an event is reported, it feels like the person is being written up, not the problem. | 99 | 9 | 69 | 16 | 47 | 17 | 35 | 9 | 10.46 | 0.02 |
A16. Staff worry that mistakes they make are kept in their personnel file. | 99 | 9 | 77 | 8 | 57 | 7 | 40 | 4 | 0.33 | 0.96 |
F4. There is good cooperation among hospital units that need to work together. | 85 | 23 | 44 | 41 | 32 | 32 | 23 | 21 | 21.89 | 0.01 |
A2. We have enough staff to handle the workload. | 65 | 43 | 36 | 49 | 35 | 29 | 19 | 25 | 7.56 | 0.06 |
A5. Staffs in this unit work longer hours than is best for patient care. | 64 | 43 | 49 | 36 | 38 | 26 | 31 | 13 | 2.16 | 0.54 |
A7. We use more agency/temporary staff than is best for patient care. | 66 | 42 | 45 | 40 | 40 | 24 | 20 | 24 | 4.47 | 0.21 |
A14. We work in "crisis mode" trying to do too much, too quickly. | 90 | 18 | 67 | 18 | 53 | 11 | 40 | 4 | 3.01 | 0.39 |
Patient safety grade/number of events reported both in China and the US
Patient safety grade | Physicians (%) | Nurses (%) | Others (%) | Overall (%) | Benchmark (%) |
---|---|---|---|---|---|
Excellent | 55a(18) | 122(17) | 23(12) | 17 | 30 |
Very good | 157(52) | 420(58) | 75(12) | 56 | 45 |
Acceptable | 79(26) | 163(23) | 35(13) | 24 | 20 |
Pool | 10(3) | 15(2) | 4(14) | 3 | 4 |
Failing | 0(0) | 2(0.3) | 0(0) | 0.2 | 1 |
Reliability and validity
Dimensions | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | Total |
---|---|---|---|---|---|---|---|---|---|---|---|
1. Teamwork Within Units | 1.00 | 0.63 | 0.37 | 0.33 | 0.31 | 0.28 | 0.10 | 0.05 | 0.24 | 0.27 | 0.52*
|
2. Supervisor/Manager Expectations & Actions Promoting Patient Safety | 1.00 | 0.32 | 0.44 | 0.55 | 0.48 | 0.19 | 0.13 | 0.42 | 0.43 | 0.64*
| |
3. Organizational Learning—Continuous Improvement | 1.00 | 0.70 | 0.39 | 0.31 | 0.07 | −0.04 | 0.20 | 0.32 | 0.41*
| ||
4. Management Support for Patient Safety | 1.00 | 0.77 | 0.47 | 0.16 | 0.08 | 0.40 | 0.46 | 0.53*
| |||
5. Overall Perceptions of Patient Safety | 1.00 | 0.72 | 0.25 | 0.15 | 0.47 | 0.53 | 0.63*
| ||||
6. Feedback & Communication About Error | 0.18 | 0.42 | 0.43 | 0.65*
| |||||||
7. Communication Openness | 0.67 | 0.26 | 0.14 | 0.48*
| |||||||
8. Nonpunitive Response to Errors | 1.00 | 0.57 | 0.09 | 0.40*
| |||||||
9. Teamwork Across Units | 1.00 | 0.56 | 0.59*
| ||||||||
10. Staffing | 1.00 | 0.60*
|
Items
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
---|---|---|---|---|---|---|---|---|
A1. People support one another in this facility | 0.57 | |||||||
A3. When a lot of work needs to be done quickly, we work together as a team to get the work done | 0.64 | |||||||
A4. In facility, people treat each other with respect | 0.50 | |||||||
A11. When one area in this unit gets really busy, others help out | 0.66 | |||||||
B2. Manager says a good word when he/she sees a job done according to established | 0.63 | |||||||
B3. Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts | 0.50 | 0.44 | ||||||
B4. My supervisor/manager overlooks patient safety problems that happen over and over | 0.58 | |||||||
A6. We are actively doing things to improve patient safety. | 0.47 | |||||||
A13. After we make changes to improve patient safety, we evaluate their effectiveness. | 0.58 | |||||||
F1. Hospital management provides a work climate that promotes patient safety. | 0.65 | |||||||
F8. The actions of hospital management show that patient safety is a top priority. | 0.70 | |||||||
F9. Hospital management seems interested in patient safety only after an adverse event happens | 0.56 | |||||||
A10. It is just by chance that more serious mistakes don't happen around here. | 0.53 | |||||||
A17. We had patient safety problems in this unit. | 0.44 | |||||||
A18. Our procedures and systems are good at preventing errors from happening. | 0.59 | |||||||
C1. We are given feedback about changes put into place based on event reports. | 0.59 | |||||||
C3. We are informed about errors that happen in this unit. |
−0.54
| |||||||
C5. In this unit, we discuss ways to prevent errors from happening again. | 0.41 | 0.43 | ||||||
C2. Staff will freely speak up if they see something that may negatively affect patient care. | 0.57 | |||||||
C4. Staffs are afraid to ask questions when something does not seem right. | 0.48 | |||||||
C6. Staffs feel free to question the decisions or actions of those with more authority. | 0.55 | |||||||
A8. Staff feel like their mistakes are held against them. | 0.42 | |||||||
A12. When an event is reported, it feels like the person is being written up, not the problem. | 0.66 | |||||||
A16. Staff worry that mistakes they make are kept in their personnel file. | 0.59 | |||||||
F4. There is good cooperation among hospital units that need to work together. | 0.66 | |||||||
A2. We have enough staff to handle the workload. | 0.68 | |||||||
A5. Staffs in this unit work longer hours than is best for patient care. |
−0.47
| 0.41 | ||||||
A7. We use more agency/temporary staff than is best for patient care. |
−0.41
| 0.43 | ||||||
A14. We work in “crisis mode” trying to do too much, too quickly. | 0.40 |