A comparative investigation into the culture of safety in public hospitals in Saudi Arabia

  Patient safety culture is key to determining the ability of healthcare organisations to address and reduce risks to patients. The concept of a culture of patient safety has become a topic of much discussion in recent times in the high-risk health sector but little is known about health professionals’ views. Several studies have limited investigations to how nurses perceive patient safety culture, and others have explored patient safety culture by other health professionals such as physicians, pharmacists and allied health personnel. No Saudi study has examined the relationship between accreditation status and patient safety culture.
   The aim of this study was to assess the current patient safety culture in a sample of Saudi public hospitals in the Riyadh Region. The study explored the perceived facilitators, barriers and challenges of a range of health professionals to safety culture through survey with open comments. The study also explored any association between health service accreditation status and patient safety culture. The conceptual framework underpinning this study was drawn from the Donabedian quality of care model (1980).
   This study employed a convergent parallel mixed method design In Group 1, a convenience sample of 1313 participants (831 nurses, 284 physicians, 97 allied health personnel and 76 pharmacists) was recruited and a questionnaire on patient safety culture (HSOPSC) was administered. Participants were invited from six hospitals. Group 2 involved interviews with 23 senior managers. Descriptive statistical analysis was undertaken, Group 1 63% were female, 51.5% were non-Saudi, 45.6% had diploma, and 64.6% were nurses. Group 2, 73.9% were male and 87% were Saudi. Group 1, identified teamwork within units, and organisational learning-continuous improvement as areas of strength, which is similar to many other patient safety culture measurement studies reported in other countries.      
   In addition, there were areas identified as areas of potential for improvement: non-punitive response to error, staffing, communication openness, handoffs and transitions, frequency of events reported, teamwork across units, supervisor/manager expectations actions promoting patient safety, and hospital management support for patients. The findings were different to those reported by Sorra et al. (2014); however, they are consistent with the literature. These results reveal that the most common problems that face Saudi hospitals are the extent to which staff feel that their mistakes and event report are not held against them, and shortages in staff. At the end of HSOPSC questionnaire, respondents were asked to write their comments about patient safety issues, medical errors, and event reporting concerning their hospital, which was not covered in the questionnaire. Of the 1313 participants, 168 (12.80%) responded. Five themes emerged: staff shortage, job satisfaction, medical supply, reporting and culture of blame. The health professionals considered these five themes as major issues that could affect patient safety in their hospitals.
   In Group 2, a deeper understanding of senior manager’s experiences was obtained through the qualitative results. The thematic analysis was conducted on data obtained from 23 transcribed interviews The analysis of the interview transcripts revealed seven explicit themes: (1) fostering an environment of patient safety; (2) safety resources; (3) reporting and the process of review for serious adverse events; (4) communication of the decision to staff; (5) patient safety culture; (6) interdepartmental collaboration; and (7) strategies to establish a national patient safety culture in Saudi Arabia (SA). This study is the first study that has examined the relationships between accreditation status and patient safety culture in health services in SA. The integrated data from health professionals and senior managers in this study provided observers in healthcare with an enriched view of the safety culture in public hospitals in the Kingdom.
   One interesting outcome revealed in this study is that there is no influence of accreditation status on patient safety culture outcomes. Non-accredited hospitals were found to have a more positive effect on many patient safety culture dimensions such as teamwork within units, supervisor/manager expectations and actions promoting patient safety, organisational learning-continuous improvement, management support for patient safety, overall perception of patient safety, feedback and communication about error, teamwork across units and patient safety grade. However, frequency of events reported and non-punitive response to error received lower scores in non-accredited hospitals. However, this result differs from those of El-Jardali et al. (2012), who found that accreditation had a positive effect on numerous patient safety culture predictors, except staffing, which received lower scores in accredited hospitals.