The approach of healthcare professionals to patient safety

Abstract

Patient safety and ensuring it up until 1999 was perceived as part of health care rather than a separate object to ensure patient rights, but attitudes toward patient safety changed radically when the U.S.-based Medical Institute published a study, “To Err is Human: Building a Safer Health System”. This study, not only in the United States, but also worldwide, has generated unprecedented interest in patient safety, which has not previously been studied as a stand-alone area of independent and critical importance in the health care system [1].

World Health Organization announced 17th September, 2019 the first World Patient Safety Day. The motto of the day was "Talk for patient safety". The main goal of the campaign is to mobilize patients and their families, healthcare professionals, politicians, academics, researchers, professional networks and the healthcare industry, drawing attention to the fact that around 134 million adverse events happen each year around the world, and 2.6 million people die each year as a result of unsafe healthcare practices [31]. Patient safety is a major public health concern and one of the priorities in the healthcare system. People expect safe healthcare when needed, but statistics show that of all hospital admissions in the European Union each year, between 4% and 17% are due to adverse events. The increase and recurrence of adverse events not only causes social, moral or financial loss to the patient, but also affects public attitudes towards the healthcare facility, the quality of its services and the competence of its staff [1].
Patients admitted in health care facilities in the European Union make up between 4% and 17% of all hospital admissions. For this reason, ensuring patient safety is receiving increasing attention from practitioners and researchers, which has been identified as one of the key health care challenges in the 21st century. Problems with patient safety affect all parts of the world, regardless of their level of development. The main risk of medical error lies with nurses, who perform many different and complex tasks on a daily basis, saving the patient’s life and organizing individual care [5]. General practitioners, like all other healthcare professionals, must adhere to the principles of patient safety and ensure the safe care of patients [8]. Although patient safety issues are known and many initiatives have been successful in improving patient safety in healthcare settings, there are still a number of challenges to improving patient safety that have not been completed or have been unsuccessful, leaving room for improvement. One of the main reasons why it is so difficult to improve patient safety is a flawed system in which individuals tend to blame each other or even deny the existence of systematic errors. Denial of systematic errors not only leads to inadequate patient safety in healthcare settings, but also affects personal error management [9]. In Lithuania, the problem of adverse events is usually solved in ineffective ways - the person who made the mistake is identified and he is directly punished as the guilty person. The patient is usually compensated, and it is not delved into the real causes of such events, although research shows that adverse events often occur for a variety of reasons (managerial, organizational, clinical, systemic). The identification, registration and learning from mistakes of adverse events have common objectives: to prevent and develop a culture of patient safety through collaboration, learning and systematic practice in other countries or institutions [10]. Proper management of adverse events is one of the key elements in ensuring patient safety [23].
Organizations with a strong safety culture are characterized by good staff relations, mutual trust and a common understanding of the importance of patient safety and the effectiveness of preventive measures [25]. Patient safety culture plays a very important role in improving patient safety in healthcare facilities, so knowledge of patient safety culture is becoming increasingly important in organizations seeking to improve and better the quality of patient healthcare. Strengthening the safety culture of healthcare organizations is recognized as crucial to the continuous improvement of the quality of healthcare [11]. Employees working in institutions that foster this culture are aware of the potential for mistakes in their work and understand the need to talk about them and find solutions [26].
Assessing the attitudes of nurses and physicians towards factors related to the safety of hospitalized patients, Polish researchers emphasized the importance of understanding staff attitudes toward patient safety. Patient safety during treatment is closely linked to the actions taken by healthcare professionals [40]. High awareness of occupational safety, communication and cooperation in an interdisciplinary team, assessment of the organization's safety culture, problem analysis and solution not only increase the quality of services provided, but also ensure a safe environment for healthcare professionals and patients.
The non-probabilistic target sampling method was chosen to implement the research goal, i.e., selected respondents who work in health care institutions providing multidisciplinary services. The study group consisted of health care professionals (physicians, nurses) who voluntarily agreed to participate in the study and were in the workplace during the study. The survey in the health care institutions was conducted by an employee appointed by the head of the institution, who was introduced to the purpose of the research and the use of the obtained data by the researcher. This study was conducted in March - August of 2020 in one district of Kaunas county, in institutions providing public health care services. The survey was conducted in accordance with the principles of voluntariness, anonymity, confidentiality and equivalence. According to the publicly available annual activity reports of the heads of health care institutions, 312 health care professionals worked in public medical institutions in this district. Depending on the size of the population, the sample was calculated using the Paniotto formula [48]. During the study, 200 questionnaires were distributed, 175 returned, 3 were incorrectly filled in, 172 (N = 172) questionnaires were used for the analysis of the study results.

In order to analyze the attitudes of healthcare professionals towards patient safety, a two-part questionnaire was provided to respondents. The first part of the questionnaire consisted of demographic questions, which sought to find out additional information related to the respondents (position, gender, age, seniority) during the survey. The second part of the study used a Safety Attitudes Questionnaire (SAQ). The Patient Safety Attitudes Questionnaire consists of 32 questions divided into six dimensions of patient safety: team work environment, safety environment, job satisfaction, the impact of stress at work, and management attitudes toward safety and the work environment.
The study contingent consisted of a quarter of physicians and three-quarters of nurses. Due to the apparent dominance of women, analysis of the data by gender in the study was not appropriate. Two-thirds of the subjects are over the age of 50, and three-quarters have more than 21 years of work experience in health care facilities.
The analysis of the data obtained during the study showed that the attitude towards patient safety is more positive than negative, because out of 6 dimensions of patient safety assessment, 4 (job satisfaction, working conditions, management attitude towards safety, safety environment) were assessed positively. According to healthcare professionals, patients' safety is best ensured by their job satisfaction (84.65 points) and favourable working conditions (84.27 points). According to the respondents, ensuring the safety of patients is most complicated by the stress experienced at work and disagreements while working in a team. These two dimensions were assessed negatively because the sum of the individual scale scores was less than 75. Physicians' and nurses’ attitudes toward patient safety overlap in many respects: management's attitudes toward safety, working conditions, safety environments, and the impact of stress at work are very similar. The approach of healthcare professionals to patient safety differs when assessing the teamwork environment and job satisfaction in terms of patient safety. Doctors feel more part of a team than nurses at work: their work input is valued, they find it easier to ask co-workers when they do not know something about themselves or talk about patient care issues, and they get more support from other staff. In addition, doctors' job satisfaction is higher than that of nurses: they prefer their job and feel like they are working in a large family.
Keywords: patient safety, healthcare professionals, professional errors, attitudes towards patient safety.