PATIENT SAFETY CULTURE IN TÜRKIYE: A SYSTEMATIC REVIEW

Abstract

Developing a safety culture in healthcare is a key component of preventing errors and improving the overall quality of healthcare. Therefore, healthcare organizations strive to create a positive patient safety culture. The aim of this study is to systematically review the patient safety culture measurements performed in Turkey using the "Patient Safety Culture Hospital Survey 1.0", summarize the results obtained by weighting, and compare them with the selected "benchmark" scores. The PRISMA statement was used in the study. The search was conducted in databases with high national and international recognition. The obtained studies were subjected to abstract and title screening, full text evaluation, and reporting quality analysis. In this context, 9 studies that met the inclusion criteria were included in the study. It was determined that the weighted averages of the included studies were generally lower than the benchmark scores, except for hospital handoffs and transitions. In the conclusion section of the study, recommendations for health managers and other practitioners were presented for the development of patient safety culture in health institutions.

Keywords

• Patient Safety
• Patient Safety Culture
• Healthcare Workers
• Healthcare Management

TÜRKİYE’DE HASTA GÜVENLİĞİ KÜLTÜRÜ: SİSTEMATİK BİR DERLEME

Abstract

Sağlık hizmetlerinde güvenlik kültürünün geliştirilmesi, hataların önlenmesinin ve genel sağlık hizmetleri kalitesinin iyileştirilmesinin temel bir bileşenidir. Bu nedenle sağlık kurumları pozitif bir hasta güvenliği kültürü oluşturmaya çalışmaktadır. Bu çalışmanın amacı Türkiye’de “Hasta Güvenliği Kültürü Hastane Anketi 1.0” kullanılarak gerçekleştirilen hasta güvenliği kültürü ölçümlerinin sistematik olarak derlenmesi, elde edilen sonuçların ağırlıklandırılarak özetlenmesi ve belirlenmiş olan “kıyas ölçütü (benchmark)” skorları ile karşılaştırılmasıdır. Çalışmada PRISMA bildirimi kullanılmıştır. Araştırma ulusal ve uluslararası tanınırlığı yüksek olan veritabanlarında gerçekleştirilmiştir. Elde edilen araştırmalar özet ve başlık incelemesi, tam metin incelemesi ve raporlama kalitesi incelemesine tabi tutulmuştur. Bu kapsamda çalışmaya, dahil edilme kriterlerini sağlayan 9 adet araştırma dahil edilmiştir. Dahil edilen araştırmaların Hasta Güvenliği Kültürü Hastane Anketi 1.0 bileşenlerinden, hastane müdahaleleri ve değişim dışında, aldıkları ağırlıklı ortalamaların genel olarak benchmark skorlarından düşük olduğu tespit edilmiştir. Çalışmanın son bölümünde sağlık kurumlarında hasta güvenliği kültürünün geliştirilmesi için sağlık yöneticileri ve diğer uygulayıcılara yönelik öneriler sunulmuştur.

Keywords

• Hasta Güvenliği
• Hasta Güvenliği Kültürü
• Sağlık Çalışanları
• Sağlık Yönetimi

References

1. AHRQ. (2022). What is patient safety culture?. Content last reviewed March 2022. Agency for Healthcare Research and Quality, Rockville, MD. Erişim adresi https://www.ahrq.gov/sops/about/patient-safety-culture.html
2. AHRQ. (2023). Hospital survey on patient safety culture. Content last reviewed March 2023. Agency for Healthcare Research and Quality, Rockville, MD. Erişim adresi https://www.ahrq.gov/sops/surveys/hospital/index.html
3. Antonakos, I., Souliotis, K., Psaltopoulou, T., Tountas, Y., ve Kantzanou, M. (2021, July). Patient safety culture assessment in primary care settings in Greece. Healthcare, 9(7), 880-89.
4. Arslan, S., Cetisli, N. E., Bakan, G., ve Erkan, S. (2015). Patient safety culture of health professionals. European Journal of Therapeutics, 21(2), 78-83.
5. Aydemir, A., ve Koç, Z. (2023). Patient safety culture and attitudes among emergency care unit nurses in Türkiye. Eastern Mediterranean Health Journal, 29(3), 195-204.
6. Azyabi, A., Karwowski, W., ve Davahli, M. R. (2021). Assessing patient safety culture in hospital settings. International Journal of Environmental Research and Public Health, 18(5), 2466.
7. Berman, L., Rangel, S., Goldin, A., Skarda, D., Ottosen, M., Bliss, D., Valusek, P., Fallat, M., Tsao, K., APSA Quality and Safety Committee. (2018). Safety culture among pediatric surgeons: a national survey of attitudes and perceptions of patient safety. J Pediatr Surg, 53, 381-95
8. Bodur, S., and Filiz, E. (2010). Validity and reliability of Turkish version of "Hospital Survey on Patient Safety Culture" and perception of patient safety in public hospitals in Turkey. BMC Health Services Research, 10, 1-9.

9. Cebeci, F., Gürsoy, E., ve Tekingündüz, S. (2012). Hemşirelerin tıbbi hata yapma eğilimlerinin belirlenmesi. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi, 15(3), 188-196.
10. Cox, S. and Cox, T. (1991). The structure of employee attitudes to safety: A European example. Work & Stress, 5(2), 93-106.
11. Çelen, Ö., Teke, A. ve Cihangiroğlu, N. (2014). Gülhane askeri tıp fakültesi eğitim hastanesi çalışanlarının hasta güvenliği kültürü düzeylerinin incelenmesi. Gülhane Tıp Dergisi, 56, 85-92.
12. Çilhoroz, Y. and İlgün, G. (2022). Examination of nurses’ attitudes about patient safety according to sociodemographic characteristics. Sudan Journal of Medical Sciences, 17(4), 444-458.
13. Datpınar, M., ve Torun, N. (2023). Hemşirelerin hasta güvenliği konusunda farkındalıkları: güçlü ve zayıf yönleri. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 10(2), 145-153.
14. Dincer, M., Torun, N., and Aksakal, H. (2018). Determining nurses’ perceptions of patient safety culture in palliative care centres. Contemporary Nurse, 54(3), 246-257.
15. Draganović, Š., and Offermanns, G. (2022). Patient safety culture in Austria and recommendations of evidence-based instruments for improving patient safety. Plos One, 17(10), e0274805.
16. Eraslan, N., Hayran, O., ve Yüksel, S. (2022). Klinik yönetişim ikliminin hasta güvenliği kültürü ile ilişkisinin yapısal eşitlik modellemesiyle incelenmesi. ESTÜDAM Halk Sağlığı Dergisi, 7(3), 444-460.
17. Famolaro, T., Hare, R., Yount, N. D., Fan, L., Liu, H. and Sorra, J. (2021). Surveys on patient safety cultureTM (SOPS®) hospital survey 1.0: 2021 user database peport. (Prepared by Westat, Rockville, MD, under Contract No. HHSP233201500026I/HHSP23337004T). Rockville, MD: Agency for Healthcare Research and Quality; March2021. AHRQ Publication No. 21-0016.
18. Filiz, E. (2023). Safety culture among operating room healthcare workers: still a long way to go. An analytical cross-sectional study from Turkey. Revista Cuidarte, 14(2), e2872.
19. Hellings, J., Schrooten, W., Klazinga, N. and Vleugels, A. (2007) Challenging patient safety culture: survey results. Int J Health Care Qual Assur, 20, 620-32.
20. Huang, H., Xiao, L., Chen, Z., Cao, S., Zheng, S., Zhao, Q., and Xiao, M. (2022). A national study of patient safety culture and patient safety goal in chinese hospitals. Journal of Patient Safety, 18(8), e1167.
21. Jha, A. K., Larizgoitia, I., Audera-Lopez, C., Prasopa-Plaizier, N., Waters, H., and Bates, D. W. (2013). The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Quality & Safety, 22(10), 809-815.
22. Karaçam, Z. (2013). Sistematik derleme metodolojisi: sistematik derleme hazırlamak için bir rehber. Dokuz Eylül Üniversitesi Hemşirelik Yüksekokulu Elektronik Dergisi, 6(1), 26-33.
23. Karademirler, Y., and Manav, G. (2020). Perceptions and factors affecting patient safety culture of employees in pediatric services. The Journal of Pediatric Research, 7(4), 301-8.
24. Kaya, S., Goncuoglu, M. B., Mete, B., Asilkan, Z., Mete, A. H., Akturan, S., ... Gumus, R. (2023). Patient safety culture: effects on errors, incident reporting, and patient safety grade. Journal of Patient Safety, 19(7), 439-446.
25. Kohn, L., Corrigan, J. and Donaldson, M. (1999). To err is human: building a safer health system. Washington, DC: National Academy Press.
26. Kosydar-Bochenek, J., Krupa, S., Religa, D., Friganović, A., Oomen, B., Brioni, E., ... Mędrzycka-Dąbrowska, W. (2022). The perception of the patient safety climate by health professionals during the COVID-19 pandemic—international research. International Journal of Environmental Research and Public Health, 19(15), 9712.
27. Kucuk Alemdar, D., and Yilmaz, G. (2020). Evaluation of the relationship between the patient safety culture and medical error attitudes of the pediatric nurses. Clinical and Experimental Health Sciences, 10(1), 60-67.
28. Makary, M. A., and Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ, 353, i2139. Millson, T., Hackbarth, D. and Bernard, HL. (2019). A demonstration project on the impact of safety culture on infection control practices in hemodialysis. Am J Infect Control. 47(9):1122–1129.
29. National Academies of Sciences, Engineering, and Medicine. (2018). Crossing the global quality chasm: improving health care worldwide. Washington, DC: The National Academies Press.
30. Nwosu, A. D., Ossai, E., Ahaotu, F., Onwuasoigwe, O., Amucheazi, A., and Akhideno, I. (2022). Patient safety culture in the operating room: a cross-sectional study using the Hospital Survey on Patient Safety Culture (HSOPSC) Instrument. BMC Health Services Research, 22(1), 1-13.
31. Özcan, T. H., Kaya, S., and Teleş, M. (2021). Evaluating patient safety culture at a private hospital. International Journal of Healthcare Management, 14(4), 1161-1170.
32. Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., ... Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372:n71. doi: 10.1136/bmj.n71
33. Page, A. (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academies Press (US).
34. Palmieri, P. A., Leyva-Moral, J. M., Camacho-Rodriguez, D. E., Granel-Gimenez, N., Ford, E. W., Mathieson, K. M., and Leafman, J. S. (2020). Hospital survey on patient safety culture (HSOPSC): A multi-method approach for target-language instrument translation, adaptation, and validation to improve the equivalence of meaning for cross-cultural research. BMC Nursing, 19, 1-13.
35. Pronovost, P.J., Thompson, D.A., Holzmueller, C.G., Lubomski, L.H. and Morlock, L.L. (2005). Defining and measuring patient safety. Crit Care Clin. 21(1), 1-19.
36. Rafter, N., Hickey, A., Conroy, R. M., Condell, S., O'Connor, P., Vaughan, D., ... Williams, D. J. (2017). The Irish National Adverse Events Study (INAES): the frequency and nature of adverse events in Irish hospitals—a retrospective record review study. BMJ Quality & Safety, 26(2), 111-119.
37. Sağlık Kurum ve Kuruluşlarında Hasta ve Çalışan Güvenliğinin Sağlanması ve Korunmasına İlişkin Usul ve Esaslar Hakkında Tebliğ. (2009). T.C. Resmi Gazete (27214, 29 Nisan 2009).
38. Hasta ve Çalışan Güvenliğinin Sağlanmasına Dair Yönetmelik. (2011). T.C. Resmi Gazete (27897, 6 Nisan 2011).
39. Rızalar, S., Büyük, E. T., Şahin, R., Tülin, A. S., ve Uzunkaya, G. (2016). Hemşirelerde hasta güvenliği kültürü ve etkileyen faktörler. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 9(1), 9-15.
40. Sağlıkta Kalite Standartları Hastane (Sürüm 6.1). (2020). Sağlık Hizmetleri Genel Müdürlüğü sağlıkta kalite standartları hastane (Sürüm 6.1). Ankara: Sağlık Bakanlığı Yayın No: 1156.
41. Sağlık Hizmetleri Genel Müdürlüğü. (2022). Ulusal hasta güvenliği hedefleri hakkında. Erişim tarihi: 18.04.2024, Erişim adresi: https://shgmkalitedb.saglik.gov.tr/TR-94080/ulusal-hasta-guvenligi-hedefleri-hakkinda.html
42. Sammer C.E., Lykens K., Singh K.P., Mains D.A. and Lackan N.A. (2010) What is patient safety culture? A review of the literature. Journal of Nursing Scholarship, 42(2), 156–165.
43. Sivanandy, P., Maharajan, M. K., Rajiah, K., Wei, T. T., Loon, T. W., and Yee, L. C. (2016). Evaluation of patient safety culture among Malaysian retail pharmacists: Results of a self-reported survey. Patient Preference and Adherence, 10, 1317–1325.
44. Slawomirski L, Auraaen A and Klazinga N. (2017). The economics of patient safety: strengthening a value-based approach to reducing patient harm at national level. Paris: OECD Health Working Papers No. 96
45. Slawomirski, L., Auraaen, A. and Klazinga, N. (2018). The economics of patient safety in primary and ambulatory care: flying blind. OECD Health Working Papers No. 106. Paris: Organisation for Economic Co-operation and Development.
46. Sur, H., Özsarı, S. H., ve Say, B. (2013). Hasta güvenliği. H. Sur ve T. Palteki (Ed.), Hastane Yönetimi içinde (509-519. ss.). İstanbul: Nobel Tıp Kitabevi.
47. Teleş, M., and Kaya, S. (2019). Staff perceptions of patient safety culture in general surgery departments in Turkey. African Health Sciences, 19(2), 2208-2218.
48. Top, M., and Tekingündüz, S. (2015). Patient safety culture in a Turkish public hospital: A study of nurses’ perceptions about patient safety. Systemic Practice and Action Research, 28, 87-110.
49. Tosun Öztürkci, Z., and Filiz, E. (2023). Nurses’ perceptions of patient safety culture and evaluation of organizational commitment level. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 12(3), 958-966.
50. Vaismoradi, M., Griffiths, P., Turunen, H., and Jordan, S. (2016). Transformational leadership in nursing and medication safety education: A discussion paper. Journal of Nursing Management, 24(7), 970-980.
51. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet. 2007 Oct 20; 370(9596):1453-7. PMID: 18064739
52. Waterson, P., Carman, E. M., Manser, T., and Hammer, A. (2019). Hospital Survey on Patient Safety Culture (HSPSC): a systematic review of the psychometric properties of 62 international studies. BMJ Open, 9(9), e026896: 1-11.
53. WHO. (2021). Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care (Licence: CC BY-NC-SA 3.0 IGO). Geneva: World Health Organization.
54. WHO. (2023). Patient safety. Erişim adresi https://www.who.int/news-room/fact-sheets/detail/patient-safety Yapucu Güneş, Ü., Gürlek, Ö., and Sönmez, M. (2016). A survey of the patient safety culture of hospital nurses in Turkey. Collegian, 23(2), 225-232.
55. Yesilyaprak, T., and Demir Korkmaz, F. (2023). The relationship between surgical intensive care unit nurses' patient safety culture and adverse events. Nursing in Critical Care, 28(1), 63-71.
56. Yılmaz, A., and Duygulu, S. (2021). The relationship between charge nurses and clinical nurses' perceptions of patient safety culture and leadership practices. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 14(1), 29-37.
57. Yilmaz, Z., and Goris, S. (2015). Determination of the patient safety culture among nurses working at intensive care units. Pakistan Journal of Medical Sciences, 31(3), 597-601.