Measuring the Current Patient Safety Culture in Public General Hospitals of Southern Nations Nationalities and Peoples Region (SNNPR), Ethiopia: Perspective of Health Care Workers

Research Article

J Fam Med. 2017; 4(5): 1124.

Measuring the Current Patient Safety Culture in Public General Hospitals of Southern Nations Nationalities and Peoples Region (SNNPR), Ethiopia: Perspective of Health Care Workers

Ejajo T¹, Arega A²* and Batebo B³

¹Department of Public Health, Dilla University, Ethiopia

²Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia

³Hadiya Zone Health Department, Southern Nations, Nationalities and Peoples, Ethiopia

*Corresponding author: Abinet Arega, Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia

Received: July 27, 2017; Accepted: August 21, 2017; Published: August 28, 2017


Background: Patient safety is crucial to the quality of patient care and remains challenging for countries at all levels of development. There is a popular acknowledgement of the importance of establishing patient safety culture in healthcare organizations. As a result, assessing patient safety culture and frequent event reporting in healthcare organizations has become a common activity to improve quality of health care.

Objective: The aim of this study was to examine the current patient safety culture from the perspective of healthcare workers in Southern Nations Nationalities and Peoples Region Public General Hospitals.

Methods: A cross-sectional study conducted fromFebruary 16 to March 16, 2015 using Hospital Survey on Patient Safety Culture questionnaire, which has 12 dimensions. Overall, we distributed 540 questionnaires and received 433 respondents. Patient safety grade and number of event reports computed descriptively. Then, the effect of various independent variables on frequency of events reported had assessed using multiple linear regressions analysis. Data were analyzed using SPSS version 16.0. In all cases, P <0.05 and 95% confidence interval had used to check statistical associations.

Results: The overall patient safety grade as rated by the participants was acceptable (58.4%) and poor (20.1%). PSC (patient safety culture) dimensions found to have a significant association with frequency of events reported in the studied hospitals. Overall perceptions of safety and Non-punitive response to error were positively associated with frequency of events reported (ß=1.052, 0.44, P=0.000). Organizational learning and continuous improvement, Communication openness and feedback about error, Teamwork across and within hospital unit were also positively associated with frequency of events reported at (P < 0.001).

Conclusion: This study indicated that poor PSC dimension system and low event reporting frequency in the respective hospitals, and there should be strong work on PSC dimension to increase frequency of event reporting.

Keywords: Patient safety culture; Frequency of events reported; An event


Patient safety is the central theme and ultimate objective of health care quality. The World Health Organization (WHO) has defined patient safety as “the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum” [1].

Health care organizations around the world have lately observed to pay more attention to the importance of establishing a culture of safety. To achieve a culture of safety, it is necessary to understand the principles, attitudes, and standards related to an organization and what behavior related to patient safety are expected and appropriate [2].

According to WHO estimates tens of millions of patients worldwide endure disabling injuries or death each year that relate directly to unsafe medical practices and care. “It also affects the lives of doctors, nurses and other health care staff who become the 'second victims' in a chain of events. ”The incidence of medical errors during healthcare procedures is 7.5%, and majorities of the adverse events has identified as preventable [3]. For instance, a Harvard Medical Study of an acute care hospital in 1984 found an adverse event rate of 3.8%. Similarly, in 1992, a study on quality in Australian acute care hospitals found the rate to be 16.6%. Furthermore, studies conducted in acute care hospitals in UK (1999-2000), Denmark (1998), New Zealand (1998) and Canada (2001) found the adverse event rates to be 11.7%, 9.0%, 12.9%, and 7.5% respectively [4].

It is likely that millions of patients globally suffer from injuries, disabilities or even death due to medical errors. WHO reported an adverse event rate of about 10 percent [1], which would mean that one in every ten patients facing suffers from adverse events. Twenty five percent of patients in ambulatory care practices experience adverse drug events [5]. Commonwealth Fund studies in 2002 revealed that 25 percent of patients across four countries reported that they had experienced some form of medical error in the past two years [6]. Although medical errors happen in countries at all levels of development, there is a fear that developing countries may affected disproportionately.

In developed countries, information technologies are increasingly been used in healthcare to improve patient safety. Studies have shown that Computerized Physician Order Entry (CPOE), especially when combined with Decision Support System (DSS), improves patient safety [7].

“In the African Region, most countries lack national policies on safe health-care practices. Inappropriate funding and unavailability of critical support systems including strategies, guidelines, tools and patient safety standards remain major concerns in the region.” Furthermore, the report implied that understanding of the problems associated with patient safety has hampered by inadequate data [8].

Circumstantial evidences show that almost all medical errors have been treated traditionally through blaming, shaming and punishment. Moreover, most medical errors have not reported and/ or hidden. Consequently; health professionals and managers are not in a position to learn from mistakes committed in the health care institutions” [9]. Therefore, this study concerning to measure the current patient safety culture in public general hospitals of the southern nations nationalities and peoples region.


Study setting and design

A cross-sectional institution based study design was conducted from February 16 to March 16, 2015 among randomly selected health professionals in three selected general hospitals of SNNPR. The region is located in the Southern and south-western part of Ethiopia. Its capital city Hawassa is located 275km far away from Addis Ababa. The region has 15 zones, 4 special woredas, 156 woredas, 22-reform town, 3602 rural kebeles, and 324 urban kebele.

Study populations

The study population comprised of sampled health professionals from all units of the hospital who were full-time employees in three selected general hospitals of SNNPR.

Sample size and sampling procedures

50% of the general hospitals in the region have selected randomly by lottery method; Butajiara from Gurage, Queen Eleni Mohammed from Hadiya, and Yirgalem general hospital from Sidama zone were included.

The list of health workers compiled from the management of each participating hospital. This helped us to track the distribution and collection of the questionnaire.

To have sufficient number of participants from each of the general hospitals, average number of staff was looked at each hospital. ”All health workers fulfilling the inclusion criteria were included in the study” [9]. A total 540 questionnaires distributed to hospitals.

Data collection

The AHRQ Hospital Survey tool for patient safety culture, which was already used in various countries (United States, Saudi Arabia, Canada, the United Kingdom, Belgium, Denmark, Norway, Ethiopia and Taiwan), was used to ask hospital staff about patient safety issue, medical error and event reporting (9, Error! Reference source not found., Error! Reference source not found., Error! Reference source not found., 11, Error! Reference source not found., Error! Reference source not found., 16). For this study, the questionnaire translated into the Amharic language using forward translation technique. Fivepoint Likert scale of agreement (strongly disagree, disagree, neutral, agree and strongly agree) or frequency (never, rarely, sometimes, most of the time, always) were used to ask respondents to rate each item of patient safety dimensions. The instrument includes eight items that ask respondents to provide limited background information related to their work.

Study variables

The dependent variable was patient safety culture as measured by frequency of events reported. Independent variables:- teamwork across and within hospital units, Management expectation and support to patient safety, hospital handoffs & transitions, organizational learning and continuous improvement, communication openness and feedback about errors, non-punitive responses to error, overall perceptions of patient safety, and respondents characteristics and work experiences.

Statistical analysis

The Hospital Survey on Patient Safety Culture (HSOPSC) is composed of 42 items that measure 12 composites. The HSOPSC included both positively and negatively worded items. Items had scored on a five-point frequency scale (including a neutral category).

Descriptive statistics for the characteristics of respondents and survey items had analyzed. It used to present frequency information about the characteristics of all the respondents as a whole, for example, the units to which they belong, how long they have worked in the hospital or their unit, their staff position, etc. Negatively worded items reversed to ensure that positive answers indicated a higher score.

To obtain the dimensions scores, item percent positive scores computed first and then the scores had averaged, which gives weight to each item in a composite.

The HSOPSC also included questions on the number of events reported over the past 12 months and the patient safety grade that respondents gave to their work area/unit and they had described by their frequency.

Reliability test was performed using the patient safety dimensions involved in measuring patient safety as frequency of events reported and Cronbachs alpha was calculated to be greater than 0.7. The variables, which employed to compute the alpha value, entered in to the principal component analysis. Factors having Eigenvalue greater than one after the scale was treated. At the end of the principal component analysis, the dimensions obtained as a continuous scale.

All originally defined items used, except staffing due to cronbachs alpha below 0.7. Internal consistency became more acceptable with the factors, “communication openness and feedback and communication about error” combined into one six-item factor, “teamwork across hospital units and teamwork within units” combined into one eight-item factor, “supervisor/manager expectations and actions promoting patient safety and hospital management support for safety”, combined into one seven-item factor, supporting 7-factor model. All the components/factors had summarized (Table 1).