Original Article A Study On Patient Safety Culture Among Nurses in A Tertiary Care Hospital of Puducherry

Indian Journal of Advanced Nursing ISSN online (2394-7160), ISSN print (2319-815X) Volume III, Issue
III, July- Sept 2017, Balamurugan E, Dr. Josephine R Little Flower , Safety Culture among Nurses, p-7-9
ORIGINAL ARTICLE
A STUDY ON PATIENT SAFETY CULTURE AMONG NURSES IN A
TERTIARY CARE HOSPITAL OF PUDUCHERRY
Balamurugan E1 and Josephine Little Flower2
Author’s affiliation
1. Ph.D Scholar, National Consortium for PhD in Nursing, Indian Nursing

council, New Delhi
2. Nursing Advisor to the Government of India, Nirhman Bhavan, New Delhi,
India.
Corresponding author
Balamurugan E, Ph.D Scholar, National Consortium for PhD in Nursing, Indian
Nursing council, New Delhi
ABSTRACT
Patient safety culture is an important measure in assessing the quality of health care. There is a
growing recognition of the need to establish a culture of hospital focused on patient safety. The
current study aimed to assess the Nurses Perception of Safety culture in their respective working
units. The study was conducted in a tertiary care hospital of Puducherry among 141 randomly
chosen nurses. Hospital Survey on Patient Safety culture Questionnaire was used to collect data
regarding safety culture among nurses. Collected data were analysed using SPSS using
appropriate descriptive and inferential statistics. The mean age of the subjects was 30.2 years. Of
the total 9 dimension assessed to measure the safety culture; team work within units was rated
positively by 80.2% of the subjects followed by supervisors action prompting patient safety i.e.
74.7%, the least positively rated dimension was non punitive response to Errors i.e.42.7%.
Overall only 12.7 % of the nurses reported excellent level of safety culture in their units, whereas
majority reported only acceptable level of safety culture i.e. 31.9%. Examining the safety culture
of our hospitals can help to identify the existing gap in the system. The current study explored
the areas that should be fixed to improve the safety culture of our hospitals. Future studies
focused on patient safety events along with patient safety culture may yield more findings.
Keyword: Patient Safety Culture; Nurse; Hospitals
INTRODUCTION be reported without people being blamed

Patient safety is an important component of and that when mistakes occur that lessons
health care quality. Patient safety, including are learned. Therefore, if hospitals want to
the measurement of patient safety culture is improve patient safety, it is important to
a top priority in developed countries today know more about the views of their staff in
(Aspden et al., 2004). Research shows that relation to the culture of patient safety.
safety and efficient care requires all the Patient safety culture, also referred to patient
various elements of a health care system be safety climate, is the overall behaviour of
well integrated and coordinated (Reid et al., individuals and organizations, based on a
2005 & Hughes et al., 2005). Patient safety common set of beliefs and values that are
in the context of health care organizations aimed at reducing the opportunities for
was highlighted following the Institute of patient harm (Schein, 1985& Ronald, 2005).
Medicine (IOM) report ―To Error is Related research shows that when a positive
Human: Building a Safer Health System‖ patient safety culture exists, it will promote
(Kohn et al., 1999). This report argued for a patient safety and help to improve patient
safety culture in which adverse events can safety standards, including the capacity and
willingness to report minor errors, self- between January to March, 2013. 141
reporting errors, safety behaviours and Subjects were chosen randomly from the
safety audit rating (Clarke, 1999, Zohar, nurse’s attendance register who fulfilled
1980 & Zohar, 2000). To date, many the following inclusion criteria a) Nurses
developed countries have initiated the who were working in the current setting at
research into the role played by patient least for the past 6 months. b) Nurses with
safety culture. But in a developing country grade II and Grade I designation and c)
like India research in this vital area is still Nurses who consented to participate in the
limited. India has faced several high-profile study. Every subject was explained about
incidents in which the safety of patients was the study purpose and informed consent
grossly neglected. These include the deaths was obtained before actual data
of 14 patients in the J.J. Group of Hospitals collection. Formal Ethical clearance to
following the administration of conduct the study was obtained before the
contaminated glycerol, an incident that was subject’s recruitment.
probed by the 1997 Lentin Commission Tools and Techniques
(Visvanthan, 1999), the report of which held To collect data regarding patient safety
the physicians liable; the Hepatitis B culture, Hospital Survey on Patient Safety
epidemic in the district of Sabarkantha, Culture (HSOPSC) tool was used. It was
Gujarat in which 94 persons died (Gandhi, developed by Agency for Healthcare
2009) the deaths of 18 pregnant women at Research and Quality (AHRQ) in 2004. It
Umaid Hospital in Jodhpur; (Gupta and is a 32 items questionnaire with 10
Srinivasan, 2012) and most recently, the fire dimension that measure the different
at the AMRI hospital and Administration of aspect of patients safety culture. Those
Hepatitis Vaccine instead of Polio Vaccine were as detailed in Table 1
in West Bengal (Nagral, 2012).
Investigating these incidents alone may not Items were scored using a five-point scale
reflecting the agreement rate on a five-
help in reducing these adverse events in
point frequency scale. The percentage of
future. It is very important to know the positive responses for each item was
attitudes and belief of the health works in calculated; negatively worded items were
relation to patient’s safety first. A strong reversed when computing percent positive
patient-safety culture has been shown to be a response. The reliability and validity of
successful predictor of medication errors the tool was well established and reported
and falls injuries outcomes for AHRQ- elsewhere (Sorra and Nieva, 2004)
patient-safety indicators treatment errors, Data Analysis
and accidents and injuries in the work place.
The data collected were abstracted in the
It is very important to assess the safety spread sheet and analyzed using SPSS for
culture of our hospital to plan intervention windows version 14. Descriptive statistics
programme to curtail adverse events related like frequency, Mean, Standard deviation
to patient safety. Nurses being the front line and percentage were used to express
care provider, spend most of their time in demographic data and dimension of safety
direct patient care activities than any other culture. Pearson correlation coefficient
professionals. Hence it’s in important to was used to find out the relation within
understand the safety culture behavior different dimension of safety culture and
prevailing among our nurses to ensure Independent t test was used to find out
patient safety. Hence the current study tried association of safety culture with
to explore the safety culture prevailing demographic variables.
among nurses working in Indian setting. RESULTS
The mean age of the subjects was 30.2
MATERIALS AND METHODS years. Majority of the subjects i.e. 50.3%
The present study was conducted in a of the subjects were working in medical
Tertiary care hospital of Puducherry U.T units with professional experience less
than 1 year but more than 6 months DISCUSSION
(48.2%).
The current study explored the prevailing
Most of the subjects were with Sister safety culture in relation to patient in a
Grade II designation (65.2) involved in tertiary care hospital of pudhucherry U.T.
direct patient care with a diploma degree This the first of its kind conducted
in nursing (72.3%).More details regarding exclusively among nurses. This adds its
demographic characteristic can be found strength. The study found team work
in Table 2 within the units to be rated highly by the
Dimensions of Patient Safety Culture subjects, which signifies the importance
Of the different dimension assessed of team work contributing to patient
Teamwork within Units (80.2%) were the safety. The least reported response in
highest positively rated dimension relation to patient safety was Non punitive
followed by Supervisor Actions response to errors, this finding demand
Prompting patient safety (74.7%) the creation of a blame free environment
organizational learning continuous for reporting errors in relation to patient
improvement (72.1%), communication care. These findings were similar to the
openness (71.2%), Teamwork Across findings of Hala et al.,2011. Unless a
units(68.3%), Feedback and blame free environment is created the root
communication about error (68.2%), cause of the incidents related to patient
management support for patient safety safety cannot be explored. Overall rating
(53.1%), Staffing(52.1%), and non of patient safety grade in our study was in
punitive response to Errors (42.7%). More contrast to the findings of western studies
details can be found in Table 3. but more similar to results of Asian
Overall Patient Safety Grade studies. (Yanli, 2013) The positive
While asked to rate the overall all patient correlation which existed between the
safety grade in their respective units only dimensions of safety culture with the
12.7% of the subjects reported that the overall patient safety grading denotes the
patients safety action were excellent, direct relation between the two concepts.
whereas majority reported the patient It can be comparable with the finding of a
safety action to be only acceptable western study (Fitzpatrick, 2010 & Neal,
(31.9%) More details can be found in 2000) which indicated a strong patient-
Figure 1 safety culture to predict medication errors,
falls injuries, outcomes for AHRQ-
Relationship between Patient Safety
patient-safety indicators, treatment errors
Actions with Different Dimension of
and accidents and injuries in the work
Safety Culture
place. Previous studies have reported
While assessing the correlation between association between demographic
different dimensions of safety culture characteristics and patient safety
with Overall all patient safety grade done dimensions. But in contrast in the present
by the subjects, every dimension was study no such association was found, it
found to have a positive correlation with
may be due to lesser sample size.
the overall patient safety grade. Details
can be found in Table 4. CONCLUSION
Examining the safety culture of our
Association between Demographic hospitals can help to identify the existing
Characteristics and Patient Safety gap in the system. The current study
Grade explored the areas that should be fixed to
While trying to associate the different improve the safety culture of our hospitals.
safety culture dimension with the overall Future studies are recommended in this area
all patients safety grade no association with a longitudinal design to indentify the
was found between the variables. effect of time in reporting safety culture.
And further studies may also be conducted
to assess the relation between safety cultures Policy makers and leaders should develop
with actual patient safety errors. While acceptable standards for patient safety
culture can be easily defined as ―the way system. This can be achieved through
we do things around here,‖ understanding initiated and supported an effective safety
culture and creating a given type of culture culture assessment among all working
within a healthcare organization can be nurses while providing patient care.
elusive, baffling, and challenging. Yet, the
success of providing patients with the safest Acknowledgements
and highest quality of care is becoming The authors would like to extend their
recognized as being dependent upon a thanks to all nurses who participated in this
strong cultural foundation at the unit level. study for their cooperation.
Table 1: Dimension of Safety culture

Dimension of Safety culture Items
Teamwork Within Units 4
Supervisor/Manager Expectations & Actions Promoting Patient Safety 4
Organizational Learning—Continuous Improvement 3
Management Support for Patient Safety 3
Feedback & Communication About Error 3
Communication Openness 3
Teamwork Across Units 4
Staffing 4
Non punitive Response to Errors 3
Overall patient safety Grade 1
Table 2: Demographic characteristics of the

subjects n=141
Demographic Variable Frequency Percentage
Working Area
 Medical Unit 71 50.3
 Surgical Units 56 39.7
14 10
 Others (Diagnostics, Administrative)
Professional Experience
 <1 year 68 48.2
 1-5 year 62 43.9
11 7.9
 More than 5 years
Position
 Sister grade II 92 65.2
 Sister Grade I 49 34.8
Education
 Diploma Holder 102 72.3
 Degree Holder 39 27.7
Professional experience in the same unit
 <1 year 65 46
 1-5 year 56 39.7
20 14.3
 More than 5 years
Working Hours per week
 ≤ 40 hours 69 48.9
 >40 hours 72 51.1
Table 3: Response rate on Different Dimension off Safety Culture n=141

Dimensions of safety Culture Mean Standard Positive response
deviation rate (%)
Teamwork Within Units 10 2.3 80.2
Supervisor/Manager Expectations & Actions
Promoting 8 1.7 74.7
Patient Safety
Organizational Learning—Continuous
Improvement 6.5 3.2 72.1
Management Support for Patient Safety 4.5 1.6 53.1
Feedback & Communication About Error 5.7 1.2 68.2
Communication Openness 6.1 2.7 71.2
Teamwork Across Units 5.8 1.4 68.3
Staffing 4.6 1.7 52.1
Non punitive Response to Errors 3.2 0.7 42.7
Figure 1: Grading of Patient safety Action
Table 4: Correlation between patient safety culture dimensions n=141

Pearson’s
Dimension of Patient safety culture Correlation P value
Value
Teamwork Within Units 0.725 0.001
Supervisor/Manager Expectations & Actions
Promoting 0.426 0.05
Patient Safety
Organizational Learning—Continuous Improvement 0.612 0.003
Management Support for Patient Safety 0.428 0.01
Feedback & Communication About Error 0.529 0.003
Communication Openness 0.553 0.04
Teamwork Across Units 0.473 0.02
Staffing 0.328 0.001
Non punitive Response to Errors 0.324 0.04
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Original Article A Study On Patient Safety Culture Among Nurses in A Tertiary Care Hospital of Puducherry

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Original Article A Study On Patient Safety Culture Among Nurses in A Tertiary Care Hospital of Puducherry

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Indian Journal of Advanced Nursing ISSN online (2394-7160), ISSN print (2319-815X) Volume III, Issue

1. Ph.D Scholar, National Consortium for PhD in Nursing, Indian Nursing

Keyword: Patient Safety Culture; Nurse; Hospitals

INTRODUCTION be reported without people being blamed

Table 1: Dimension of Safety culture

Table 2: Demographic characteristics of the

Table 3: Response rate on Different Dimension off Safety Culture n=141

Figure 1: Grading of Patient safety Action

Table 4: Correlation between patient safety culture dimensions n=141

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