Introduction
Patient safety incidents (PSIs) are unintended and harmful consequences of medical treatment or care. In high-income countries (HICs), an estimated 10% of patients experience PSIs while in low- and middle-income countries (LMICs), the rates may be even higher due to a lack of adequate resources and systems for patient safety [
1]. It ranges from minor side effects to serious injuries and even death. It is regarded as a major concern because it may adversely impact hospitals’ patient safety and the quality of healthcare delivery [
2,
3].
Incidents from iatrogenicity rank among the three leading causes of death in HICs [
4]. It can also have serious consequences for patients, including prolonged hospital stays and complications including disabilities. The PSI incidence is alarming in that up to 1.1% of hospital admissions result in death [
2,
5]. Moreover, the high financial costs associated with PSIs burden the healthcare system and can lead to increased healthcare costs for everyone. According to Mikos et al. [
6], the estimated annual cost of PSIs is 17.1 billion dollars. The two most frequent types of PSIs (pressure sores and post-operative infections) alone account for the largest portion of the costs at 6.5 billion dollars. Catheter infections, infections resulting from transfusion and infusion sites, injections, and similar procedures also result in significant extra healthcare costs, totalling over one billion dollars [
7,
8].
Healthcare providers must be conscious of PSI risks and take steps to prevent them as much as possible. Most healthcare organizations have, therefore, initiated and prioritised patient safety strategies to prevent PSIs from occurring. This includes implementing evidence-based practices, improving communication among healthcare team members, and investing in quality improvement efforts [
9]. Providing staff training, and continuously monitoring and reviewing care processes have also been highlighted as ways to improve patient safety efforts [
10,
11].
Besides these strategies, health systems play a crucial role in reducing PSIs in patients. This is done by investing in resources and implementing systems to quickly respond to patient harm. Measuring and reporting PSIs raises awareness of potential errors and promotes a safety culture. An effective response to PSIs not only remedies problems but also provides a surveillance process that helps identify risks and improve patient and staff safety [
12,
13]. One way to do this is by implementing a quick response system to PSIs and conducting retrospective analyses to understand the root causes of these events. This can help healthcare providers identify patterns and trends and mitigate risks of similar events in the future [
14,
15].
Additionally, measuring and reporting PSIs can help raise awareness of potential errors and promote a safety culture within the healthcare system. By paying attention to PSIs, healthcare systems can address problems as they arise. Moreover, healthcare organizations can also identify and assess patient and staff risks of PSIs and minimize them [
16].
It has been established that having an effective response system in place for reporting and addressing vulnerabilities in healthcare systems can promote resilience and prevent further harm [
17]. Nevertheless, such a response system can harm the positive campaign on PSIs by reducing open reporting and discussion of mistakes. This can hinder efforts to improve care quality. In effect, negative responses from managers to PSIs occurrence can also create a culture of fear around reporting and discussing mistakes. This can hinder patient safety efforts [
18,
19]. It is important to encourage open and honest discussion of PSIs to continuously improve patient care. This can be achieved through effective healthcare systems to respond to vulnerabilities and incidents through incident reporting policies and tools. This will help identify and address problems as they arise [
20]. These proactive efforts when implemented can also optimize care delivery to promote resilient healthcare systems [
21].
Teamwork has been identified as indispensable for safeguarding patient safety and promoting healthcare quality [
12]. This can involve implementing strategies such as regular team meetings, effective communication practices, and shared decision-making processes to promote collaboration and coordination among healthcare staff [
22,
23].
It is also vital to ensure healthcare team members feel comfortable speaking up and voicing concerns. This can help identify and address potential problems before they lead to adverse events. Overall, promoting a culture of teamwork and continuous improvement enhances patient safety practices, especially reporting incidents [
24‐
26].
Teamwork among healthcare staff is critical to improving PSI response. Teamwork perceptions of healthcare professionals play a significant role in improving adverse events reporting rates [
27], patient outcomes [
28], enhancing job performance in healthcare teams [
29‐
31], and overall patient safety in healthcare facilities [
31,
32]. A human factors approach, which considers healthcare professionals’ physical, cognitive, and social characteristics, helps to identify and address potential obstacles to teamwork. This ensures that all team members can effectively contribute to patient care [
33].
Additionally, in a system as multifaceted as healthcare, collaboration within and across organizations through teamwork and communication has reduced the amount of the health workforce’s contribution to PSIs in about 20% of cases [
34,
35]. This is achieved by ensuring that all parties involved in a patient’s care know the patient’s medical history and treatment plan. This can reduce the risk of misdiagnosis, medication errors, and others [
36,
37].
Handoffs make information and responsibilities between healthcare practitioners possible, which are a crucial part of the healthcare industry [
38]. Because inadequate communication leads to multiple difficulties, it has long been recognized that the transfer of patient knowledge, professional responsibility, and accountability between caregivers presents a potentially difficult period for patient safety [
39]. The second Institute of Medicine (IOM) report,
Crossing the Quality Chasm, highlighted the need for standardization and accountability in handoffs to ensure that the transfer of care is smooth and that patient safety is not compromised [
40]. Standardization can be achieved through structured handoff protocols and tools, such as checklists and electronic medical records. These protocols help to ensure that all necessary information is shared and responsibilities. When combined with accountability, standardization helps minimize communication errors during transfers of care. This has been shown to promote patient safety through positive responses to PSIs [
41].
Hospitals and other healthcare organizations need open communication and a safety culture to promote PSI reporting. When staff feel able to speak openly about safety concerns and PSIs, it can help create an environment where issues can be addressed promptly. This can lead to improved patient safety [
42]. This can be achieved through a variety of strategies, including promoting open communication at the unit level. In addition, it provides opportunities for staff to report concerns and creates a culture of transparency and accountability. By fostering an open communication and safety culture, healthcare organizations can prevent PSIs and improve patient outcomes [
43].
Until this study, PSIs have not been studied extensively in healthcare settings, as well as teamwork, effective handoffs, and communication openness among health professionals in Ghana. The study’s findings will help identify innovative protocols and best practices to minimize adverse events. Moreover, it will provide healthcare organizations with strategies for optimizing teamwork and communication. Healthcare networks can share these findings to improve patient safety practices continuously. The study, therefore, assessed PSI occurrence in healthcare facilities. It examined the role teamwork, handoffs and communication openness play in healthcare professionals’ responses to PSIs. The findings from the study may be used to improve the safety culture in Ghana’s healthcare system by reducing PSIs to improve quality care.
Discussion
This study aimed to identify the occurrence of PSIs, the level of teamwork, handoffs and information exchange, and communication openness among health professionals, and to examine predictors of response to PSIs. The daily frequencies of PSIs varied from 2.1% (pressure ulcers) to 33.0% (patient/family complaints) in healthcare facilities. This finding is similar to the results presented by Schwendimann et al. [
53]. Despite variations in frequencies between in-hospital PSIs, they certainly have harmful impacts on patient outcomes and therefore the need for effective strategies to curtail them.
The study asserted that the main types of PSIs reported were associated with medication errors, surgery, and healthcare-related infections. Studies have shown that quality improvement interventions can lead to significant patient safety progress [
54], and evidence of effective strategies is widely available [
55]. For instance, hospitals can adopt individual or bundled interventions from other sectors, such as aviation, to reduce PSIs, and use patient safety practices as a key component [
56,
57]. Vincent et al. [
58] argue that to improve healthcare safety, comprehensive and balanced frameworks should be utilized to measure, monitor, and improve care safety. This includes fostering a safety culture about the most common types of PSIs. It is, therefore, important to put in place accurate monitoring of PSIs in healthcare facilities, and retrospective record reviews as evidence-based strategies to evaluate PSIs occurrence to reduce patient harm.
The finding of higher teamwork scores manifested in this current study is similar to other studies. This suggests that healthcare professionals work together consistently and are stable over time. With their significant role in healthcare delivery, teams with high levels of collaboration and communication have better patient safety scores and patient outcomes [
59]. Further research may, however, be needed to determine if these scores reflect actual teamwork behaviours and if they impact patient outcomes. In healthcare, recent initiatives have been adopted globally to train providers on critical skills, such as communication, and team collaboration [
60].
The findings of the study revealed handoffs and the exchange of information to be satisfactory in healthcare facilities. This is similar to the report in Jordan [
61] and South Korea [
62]. A human-centred approach that focuses on teamwork and communication can help to improve the efficiency and effectiveness of the handoff process [
63]. These can include strategies such as regular training and practice in effective handoff communication. They can also include creating a culture of openness and encouraging healthcare team members to speak up when they have concerns. Implementing these tools and technologies can support effective handoff communication [
64].
Though the study reported satisfactory teamwork and open communication which is supported by studies in Belgium [
65], South Africa [
66] and the USA [
67], there was ironically a higher reported rate for some of the PSIs. This paradox of the “double-edged sword” of teamwork in healthcare possess a challenge to patient safety in PSIs reporting. This statement highlights the importance of transparency and learning cultures in healthcare organizations. This is where PSIs are seen as opportunities for growth and improvement, rather than evidence of failure. High-functioning teams are characterized by their ability to openly discuss and learn from errors, which leads to better patient outcomes. This concept is supported by research that shows the positive impact of systematic team training on patient safety, teamwork, and communication. By fostering a blame-free environment, healthcare organizations can create a culture of continuous learning and improvement.
Moreover, while open and positive communication styles are critical for building trust and cohesion among team members, they can also lead to complacency and a false sense of security. This results in increased PSI rates. It is also necessary, therefore, to highlight the importance of balancing open communication with rigorous systems, processes, and a culture of safety. This encourages reporting and learning from PSIs [
68‐
70]. Additionally, healthcare teams must have an open and honest approach to PSI management and continuous learning. This is to ensure that PSIs are recognized, reported, and used as opportunities for improvement [
71].
The study posited that PSIs occur in any healthcare setting, and open communication, efficient hand-over and teamwork enhance PSI response. This position is supported by Amaniyan et al. [
15] and Baik et al. [
34] who indicated that effective response to PSIs in healthcare requires a team effort and efficient communication. It has been noted that a high level of awareness and an “index of suspicion” when interpreting patient data is crucial in recognizing potential PSIs. Coordination and collaboration among team members can help manage PSIs and ensure timely and effective responses [
72,
73].
Limitations
The study used a cross-sectional approach, which means it only looks at data from one point in time and cannot establish causality. Again, the study relied on self-reported data from health professionals, which may not be completely accurate. There was, however, consistency in the distribution of data with existing literature. Additionally, the study used participant-reported measures of teamwork, handoffs, and communication openness, which may not be as reliable as other types of data. Finally, PSI rates may be low at the unit level to detect differences, even though they can have significant consequences for individual patients.
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