Methodological aspects of patient safety culture research: A scoping Review
DOI:
https://doi.org/10.5902/2236583465717Keywords:
Patient safety, Organizational culture, Health Services Research, Research DesignAbstract
Investigating the safety culture has been relevant for more than two decades as a tool to improve the quality of patient care. This is a scope review of the last 20 years, whose objective is to investigate the type and prevalence of methodological approaches to patient safety culture and climate research. A review protocol was registered. The results were reported according to reports of preferred items for systematic reviews and extension of meta-analyzes for scope reviews (PRISMA-ScR). 107 studies were included. From the results, three major themes emerged for discussion, and the studies were classified into 1) Methodological approach and indeterminate use of concepts of climate and safety culture; 2) The isolated use of self-administered questionnaires in safety culture surveys and 3) A survey of the mixed methods approach in patient safety culture research. The quantitative approach was shown to be predominant, with the use of self-administered questionnaires for studies of the climate and culture of patient safety. The studies pointed out several limitations in the exclusive use of questionnaires, emphasizing the need to include multimethod research and the use of qualitative data collection techniques as an essential complement for the diagnosis of the patient safety culture.Downloads
References
Carmo JMA, Mendoza IYQ, Goveia VR, Souza, KV, Manzo, BF, Guimarães GL. Cultura de segurança do paciente em unidades hospitalares de ginecologia e obstetrícia: estudo transversal. Rev. Bras. Enferm. 2020;73(5): e20190576. DOI: 10.1590/0034-7167-2019-0576.
Kawamoto AM, Oliveira JLC, Tonini NS, Nicola AL. Liderança e cultura de segurança do paciente: percepções de profissionais em um hospital universitário Leadership and patient safety culture: perceptions of professionals in a university hospital. Revista de Pesquisa: Cuidado é Fundamental Online. 2016;8(2):4387-4398. DOI: 10.9789/2175-5361.2016.v8i2.4387-4398.
Andrade LEL, Lopes JML, Souza FMCM, Vieira JRF, Farias LPC, Santos CCM. Cultura de segurança do paciente em três hospitais brasileiros com diferentes tipos de gestão. Ciênc. saúde coletiva. 2018;23(1):161-172. DOI: http://dx.doi.org/10.1590/1413-81232018231.24392015.
Noord IV, Smits M, Zwijnenberg NC, Spreeuwenberg P, Wagner C. A nation-wide transition in patient safety culture: a multilevel analysis on two cross-sectional surveys. Int J Qual Health Care. 2019;31(8):627-632. DOI: 10.1093/intqhc/mzy228. PMID: 30395225.
Burström L, Letterstål A, Engström ML, Berglund A, Enlund M. The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study. BMC Health Serv Res. 2014;9( 14):296. DOI: 10.1186/1472-6963-14-296.
Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020. DOI: 10.46658/JBIMES-20-12.
Silva T. Methodological approaches of climate assessment studies and patient safety culture in hospital services: a scooping review protocol. 2020. Available from: https://mfr.osf.io/render?url=https://osf.io/8br65/?direct%26mode=render%26action=download%26mode=render
Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation. Ann Intern Med. 2018;169:467–473. DOI: 10.7326/M18-0850.
Fujita S, Seto K, Ito S, Wu Y, Huang CC, Hasegawa T. The characteristics of patient safety culture in Japan, Taiwan and the United States. BMC Health Serv Res. 2013;13:20. DOI: 10.1186 / 1472-6963-13-20.
Wagner C, Smit M, Sorra J, Huang CC. Assessing patient safety culture in hospitals across countries. International Journal for Quality in Health Care. 2013;25(3):213–221. DOI: 10.1093/intqhc/mzt024
Costa TM. Cultura de segurança do paciente: percepção da equipe de enfermagem de um hospital pediátrico. Niterói: [s.n.] 104 f. Dissertação (Mestrado Acadêmico em Ciências do Cuidado em Saúde) - Universidade Federal Fluminense. 2016. Available from < https://app.uff.br/riuff/bitstream/1/6147/1/DISSERTA%c3%87%c3%83O%20FINAL.pdf>
Carmo JMA. Cultura de segurança do paciente em serviços de atenção obstétrica. Belo Horizonte. Dissertação [Mestrado] - Universidade Federal de Minas Gerais, Escola de Enfermagem. 2018. Available from: http://www.enf.ufmg.br/pos/defesas/947M.PDF
Moretão DIC. A cultura de segurança do paciente em unidades cirúrgicas de um hospital de ensino da rede pública de saúde. Belo Horizonte. Dissertação [Mestrado] - Universidade Federal de Minas Gerais,Escola de Enfermagem. 2019. Available from https://repositorio.ufmg.br/bitstream/1843/ENFC-BBTR7U/1/diene_in_s_carvalho_moret_o.pdf
Baratto MAM, Pasa TS, Cervo AS, Dalmolin GL, Pedro CMP, Magnago TSBS. Culture of patient safety in the hospital setting: an integrative review. J Nurs UFPE online. 2016;10(11):4126-36. DOI: 10.5205/1981-8963-v10i11a11500p4126-4136-2016 .
Elmontsri M, Almashrafi A, Banarsee R, Majeed A. Status of patient safety culture in Arab countries: a systematic review. BMJ Open. 2017;24;7(2):e013487. DOI: 10.1136/bmjopen-2016-013487.
Okuyama JHH, Galvao TF, Silva MT. Healthcare Professional's Perception of Patient Safety Measured by the Hospital Survey on Patient Safety Culture: A Systematic Review and Meta-Analysis. ScientificWorldJournal. 2018;19:9156301. DOI: 10.1155/2018/9156301.
Pumar-Méndez MJ, Attree M, Wakefield A. Methodological aspects in the assessment of safety culture in the hospital setting: a review of the literature. Nurse Educ Today. 2014;34(2):162-170. DOI: 10.1016/j.nedt.2013.08.008.
Dunstan E, Cook JL, Coyer F. Safety culture in intensive care internationally and in Australia: A narrative review of the literature. Aust Crit Care. 2019;32(6):524-539. DOI: 10.1016/j.aucc.2018.11.003.
Tarling M, Jones A, Murrells T, McCutcheon H. Comparing safety climate for nurses working in operating theatres, critical care and ward areas in the UK: a mixed methods study. BMJ Open. 2017;30;7(10):e016977. DOI: 10.1136/bmjopen-2017-016977.
Santos CMP, Lopes RGC, Rocha MLTLF, Santos BPdos, Sousa MGde, Nascimento CC. Patient safety culture: health professional's perspective. Rev enferm UFPE online. 2019;13:e241435. DOI: 10.5205/1981-8963.2019.241435.
Karademirler Y, Manav G. Perceptions and Factors Affecting Patient Safety Culture of Employees in Pediatric Services. The Journal of Pediatric Research. 2020;7:301-308. DOI: 10.4274 / jpr.galenos.2019.77699.
Raftopoulos V, Pavlakis A. Safety climate in 5 intensive care units: a nationwide hospital survey using the Greek-Cypriot version of the safety attitudes questionnaire. J Crit Care. 2013;28(1):51-61. DOI: 10.1016/j.jcrc.2012.04.013.
Teleş M, Kaya S. Staff perceptions of patient safety culture in general surgery departments in Turkey. Afr Health Sci. 2019;19(2):2208-2218. DOI: 10.4314/ahs.v19i2.46.
Xie J-F, Ding S-Q, Zhong Z-Q, Zeng S-Q, Qin C-X, YI Q-F, Gong L-N, Zhou J-D. Safety culture training program enhanced perceptions of patient safety culture of nursing managers, Nurse Education in Practice. 2017;27:128-133. DOI: 10.1016/j.nepr.2017.08.003.
Santiago THR, Turrini RNT. Organizational culture and climate for patient safety in Intensive Care Units. Rev. esc. enferm. USP [Internet]. 2015;49(spe):123-130. DOI: 10.1590/S0080-623420150000700018.
Listyowardojo TA, Nap RE, Johnson A. Variations in hospital worker perceptions of safety culture. Int J Qual Health Care. 2012;24(1):9-15. DOI: 10.1093/intqhc/mzr069.
El-Jardali F, Jaafar M, Dimassi H, Jamal D, Hamdan R. The current state of patient safety culture in Lebanese hospitals: a study at baseline. Int J Qual Health Care. 2010;22(5):386-395. DOI: 10.1093/intqhc/mzq047.
Macedo TR, Rocha PK, Tomazoni A, Souza S, Anders JC, Davis K. A cultura de segurança do paciente na perspectiva da equipe de enfermagem de emergência pediátrica. Rev. esc. enferm. USP. 2016;50(5):756-762. DOI: https://doi.org/10.1590/s0080-623420160000600007.
Notaro KAM, Corrêa AR, Tomazoni A, Rocha PK, Manzo BF. Safety culture of multidisciplinary teams from neonatal intensive care units of public hospitals. Rev. Latino-Am. Enfermagem. 2019;27:e3167. DOI: 10.1590/1518-8345.2849.3167 .
Oliveira ICL, Cavalcante MLS, Aires SF, Freitas RJM, Silva BV, Marinho DMF. Safety culture: perception of health professionals in a mental hospital. Rev. Bras. Enferm. 2018;71(Suppl 5):2316-2322. DOI: 10.1590/0034-7167-2018-0125.
Al Ma'mari Q, Sharour LA, Omari OA. Predictors of perceptions of patient safety culture and frequency of event reporting by critical care nurses in Oman: a model-building approach. Critical Care and Shock. 2020;22:230-242. Available from: https://criticalcareshock.org/files/2019/08/predictors-of-perceptions-of-patient-safety-culture-and-frequency-of-event-reporting-by-critical-care-nurses-in-oman-a-model-building-approach.pdf
Bahar S, Önler E. Turkish surgical nurses' attitudes related to patient safety: A questionnaire study. Niger J Clin Pract. 2020;23(4):470-475. DOI: 10.4103/njcp.njcp_677_18.
Mir-Abellán R, Falcó-Pegueroles A, Puente-Martorell ML. Actitudes frente a la cultura de seguridad del paciente en el ámbito hospitalario y variables correlacionadas. Ac Sanit. 2017;31(2):145-149. DOI: 10.1016/j.gaceta.2016.07.019.
Beck MK, Loro MM, Casali VAB, Schmidt CR, Pai SD, Bandeira LR, Kolankiewicz ACB. Weaknesses in patient safety culture from the perspective of workers in a general hospital. O Mundo da Saúde. 2018;42(4): 1062-1081. DOI: 10.15343/0104-7809.2018420410621081
Silva ACAB, Rosa DOS. Cultura de segurança do paciente em organização hospitalar. Cogitare Enfermagem [online]. 2016;21(5). DOI: 10.5380/ce.v21i5.4558.
Fujita S, Seto K, Kitazawa T, Matsumoto K, Hasegawa T. Characteristics of unit-level patient safety culture in hospitals in Japan: a cross-sectional study. BMC Health Serv Res. 2014;22:14:508. DOI: 10.1186/s12913-014-0508-2.
Gasparino RC, Bagne BM, Gastaldo LS, Dini AP. Perception of nursing regarding patient safety climate in public and private institutions. Rev. Gaúcha Enferm. [Internet]. 2017;38(3):e68240. DOI: 10.1590/1983-1447.2017.03.68240.
Akologo A, Abuosi AA, Anaba EA. A cross-sectional survey on patient safety culture among healthcare providers in the Upper East region of Ghana. PLoS One. 2019;20:14(8):e0221208. DOI: 10.1371/journal.pone.0221208.
Alahmadi HA. Assessment of patient safety culture in Saudi Arabian hospitals. Qual Saf Health Care. 2010;19(5):e17. DOI: 10.1136 / qshc.2009.033258.
Bohomol E, Melo EF. Cultura de segurança do paciente em centro cirúrgico: percepção da equipe de enfermagem. Revista SOBECC, São Paulo. 2019;24(3):132-138. DOI: 10.5327/Z1414-4425201900030004.
Schmidt CR, Loro MM, Aozane F, Soares JH, Toso GL, Kolankiewicz AC. Cultura de segurança do paciente na percepção de profissionais técnicos de enfermagem. Rev Cubana Enferm [Internet] 2017;33(4). Available from: http://www.revenfermeria.sld.cu/index.php/enf/article/view/1202.
Toso GL, Golle L, Magnago TSBS, Herr EGG, Loro MM, Aozane F. Patient safety culture in hospitals within the nursing perspective. Rev. Gaúcha Enferm. [Internet]. 2016;37(4):e58662. DOI: 10.1590/1983-1447.2016.04.58662.
Fassarella CS, Silva LD, Camerini FG, Figueiredo MCAB. Nurse safety culture in the services of a university hospital. Rev. Bras. Enferm. [Internet]. 2019;72(3): 767-773. DOI: 10.1590/0034-7167-2018-0376
Granel N, Domínguez JMM, Watson CE, Ibáñez RG, Tamayo, MDB. Nurses’ perceptions of patient safety culture: a mixed-methods study. BMC Health Serv Res. 2020;29(2):283-293. DOI: 10.1186/s12913-020-05441-w.
Bump GM, Coots N, Liberi CA, Minnier TE, Phrampus PE, Gosman G, Metro DG, McCausland JB, Buchert A. Comparing Trainee and Staff Perceptions of Patient Safety Culture. Acad Med. 2017;92(1):116-122. DOI: 10.1097/ACM.0000000000001255.
Tomazoni A, Rocha PK, Souza S, Anders JC, Malfussi HFC. Cultura de segurança do paciente em unidades de terapia intensiva neonatal: perspectivas da equipe de enfermagem e médica. Rev. Latino-Am. Enfermagem [Internet]. 2014;22(5):755-763. DOI: 10.1590/0104-1169.3624.2477.
Alzahrani N, Jones R, Abdel-Latif ME. Attitudes of Doctors and Nurses toward Patient Safety within Emergency Departments of a Saudi Arabian Hospital: A Qualitative Study. Healthcare (Basel). 2019;18;7(1):44. DOI: 10.3390/healthcare7010044.
Göras C, Unbeck M, Nilsson U, Ehrenberg A. Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey. BMJ Open. 2017;7(9):e015607. DOI: 10.1136/bmjopen-2016-015607.
Hamdan M. Measuring safety culture in Palestinian neonatal intensive care units using the Safety Attitudes Questionnaire. J Crit Care. 2013;28(5):886.e7-14. DOI: 10.1016/j.jcrc.2013.06.002.
Kawano T, Taniwaki M, Ogata K, Sakamoto M, Yokoyama M. Improvement of teamwork and safety climate following implementation of the WHO surgical safety checklist at a university hospital in Japan. J Anesth. 2014;28(3):467-70. DOI: 10.1007/s00540-013-1737-y.
Russo GM. Diagnóstico da cultura organizacional: o impacto dos valores organizacionais no desempenho das terceirizações. Rio de Janeiro: Alta Books, 2017.
Carvalho PA, Gottems LBD, Pires MRGM, Oliveira MLC. Cultura de segurança no centro cirúrgico de um hospital público, na percepção dos profissionais de saúde. Rev. Latino-Am. Enfermagem [online]. 2015;23(6):1041-1048. DOI: 10.1590/0104-1169.0669.2647.
Giménez-Marín A, Rivas-Ruiz F, García-Raja AM, Venta-Obaya R, Fusté-Ventosa M, Caballé-Martín I, Benítez-Estevez A, Quinteiro-García, AI, Bedini JL, León-Justel A, Torra-Puig M. Assessment of patient safety culture in clinical laboratories in the Spanish National Health System. Biochem Med (Zagreb). 2015;25(3):363-76. DOI: 10.11613/BM.2015.036.
Schein EH. Guia de sobrevivência da Cultura corporativa. Rio de Janeiro: José Olympio, 2001.
Carvalho REFL, Arruda LP, Nascimento NKP, Sampaio RL, Cavalcante MLSN, Costa ACP. Avaliação da cultura de segurança em hospitais públicos no Brasil. Rev. Latino-Am. Enfermagem [Internet]. 2017;25:e2849. DOI: 10.1590/1518-8345.1600.2849.
Carvalho PA, Laundos CAS, Juliano JVS, Casulari LA, Gottems LBD. Avaliação da cultura de segurança em um hospital público do Distrito Federal, Brasil. Rev. Bras. Enferm. [Internet]. 2019;72 (Suplemento 1):252-258. DOIoi: 10.1590/0034-7167-2017-0716.
Cauduro F, Sarquis L, Sarquis L, Cruz E. Safety culture among surgical center professionals. Cogitare Enfermagem. 2015;20(1):128-37. DOI: 10.5380/ce.v20i1.36645.
Fermo VCRV, Rosa LM, Marinho MM. Professional attitudes toward patient safety culture in a bone marrow transplant unit. Rev. Gaúcha Enferm. [Internet]. 2016;37(1):e55716. DOI: 10.1590/1983-1447.2016.01.55716
Kolankiewicz ACB, Loro MM, Schmidt CR, Santos FP, Bandeira VAC, Magnago TSBS. Clima de segurança do paciente na equipe de enfermagem: fatores contribuintes. Acta paul. Enferm. 2017;30(5):531-537. DOI: https://doi.org/10.1590/1982-0194201700076.
Gama ZAS, Oliveira ACS, Hernández PJS. Patient safety culture and related factors in a network of Spanish public hospitals. Cad. Saúde Pública [Internet]. 2013;29(2):283-293. DOI: 10.1590/S0102-311X2013000200015.
Galvão TF, Lopes MCC, Oliva CCC, Araújo MEA, Silva MT. Patient safety culture in a university hospital. Rev. Latino-Am. Enfermagem [Internet]. 2018;26: e3014. DOI: 10.1590/1518-8345.2257.3014
Knihs NS, Cabral AS, Magalhães ALP, Barra DCC, Lanzoni GMM, Silva OM. Assessment of safety culture in organ donation. Rev. Bras. Enferm. 2020;73(2): e20180514. DOI: 10.1590/0034-7167-2018-0514.
Lopez ECMS, Cruz EDA, Alpendre FT, Batista J. Culture of patient safety in surgical units of teaching hospitals. REME - Rev Min Enferm. 2020;24:e1298. DOI: http://www.dx.doi.org/10.5935/1415-2762.20200027
Alves DFS, Guirardello EB. Ambiente de trabalho da enfermagem, segurança do paciente e qualidade do cuidado em hospital pediátrico. Rev Gaúcha Enferm. 2016;37(2):e588171. DOI: http://dx.doi.org/10.1590/1983-1447.2016.02.58817.
Ramos RR, Calidgid CC. Patient safety culture among nurses at a tertiary government hospital in the Philippines. Appl Nurs Res. 2018;44:67-75. DOI: 10.1016/j.apnr.2018.09.007
Pavan NF, Magalhães AL, Poncio DF, Ascari RA, Zanini PD, Knihs NS. Patient safety culture in kidney transplant patients in western Santa Catarina. Acta paul. enferm. [Internet]. 2019;32( 4 ):398-405. DOI: 10.1590/1982-0194201900055.
Deilkås E, Hofoss D. Patient safety culture lives in departments and wards: multilevel partitioning of variance in patient safety culture. BMC Health Serv Res. 2010;31;10:85. DOI: 10.1186/1472-6963-10-85.
Matiello R, Lima E, Rezende CM, Araújo OE, Leite F, Primo C. A cultura de segurança do paciente na perspectiva do enfermeiro. Cogitare Enferm. 2016;21(esp):01-09. DOI: 10.5380/ce.v21i5.45408.
Gil AC. Métodos e técnicas de pesquisa social. São Paulo: Atlas. 2008. Available from: https://ayanrafael.files.wordpress.com/2011/08/gil-a-c-mc3a9todos-e-tc3a9cnicas-de-pesquisa-social.pdf
Flick U. Uma introdução à pesquisa qualitativa. Porto Alegre: Artmed. 2004. Available from: https://www.ets.ufpb.br/pdf/2013/2%20Metodos%20quantitat%20e%20qualitat%20-%20IFES/Bauman,%20Bourdieu,%20Elias/Livros%20de%20Metodologia/Flick%20-%20Introducao%20%C3%A0%20Metodologia%20da%20Pesquisa.pdf
