Perception of Front-line Healthcare Providers Toward Patient Safety: A Preliminary Study in a University Hospital in Egypt

Hanan Abdullah Ezzat Abbas, PhDN, MScN; Nora Ahmed Bassiuni, PhDN, MSN, BScN; Fatma Mostafa Baddar, PhDN, MSN, BScN


Topics in Advanced Practice Nursing eJournal. 2008;8(2) 

In This Article

Study Aims

Our study had 3 aims:

  1. Gather information about:

    1. The perceptions of front-line clinical staff about patient safety;

    2. The commitment of management staff to patient safety; and

    3. The commitment of healthcare personnel to patient safety.

  2. Identify how perceptions varied across different departments.

  3. Identify the association between the front-line healthcare providers' perceptions about patient safety and variables such as job category, years of experience, and work setting.

Materials and Methods

This study was conducted in a 1724-bed government teaching hospital affiliated with Alexandria University in Egypt. Six general medical and surgical units, 6 ICUs, and 5 paramedical departments were randomly selected to participate. Paramedical departments included 2 pharmacies, 2 general laboratories, and the physiotherapy department.

A purposive sampling technique was used to select the study sample. Four hundred front-line clinical staff members, from those available in the selected settings at the time of data collection and meeting the inclusion criteria, joined the study. The front-line clinical staff included nurses (n = 266), physicians (n = 80), and paramedical personnel (n = 54). The inclusion criteria for nurses were: working in the selected settings for at least 6 weeks prior to the data collection period and regularly working at least 20 hours per week in the selected settings. For physicians, the inclusion criteria were: treating, on average, at least 3 patients per week in any of the selected inpatient settings. For the paramedical personnel, the inclusion criteria were: assigned either primarily to the selected settings or assigned to do work at least 3 days a week in the selected settings.

Our tool, the "Safety Climate Survey," was developed and validated by The Center of Excellence for Patient Safety Research and Practice, University of Texas.[17] The tool was translated to Arabic and used to gain information about the perceptions of the front-line healthcare providers about patient safety in the clinical settings. The tool consisted of 3 parts:

Part 1: "Safety Climate" included 8 statements related to perception of front-line clinical staff about safety in their clinical areas.

Part 2: "Management Commitment" included 5 statements related to management's commitment to patient safety.

Part 3: "Personnel Commitment" included 6 statements related to health personnel's commitment to patient safety.

The responses were measured with a 5-point Likert scale and ranged from (1) "Strongly Disagree" to (5) "Strongly Agree." A reverse scoring was devised for question 18 due to its negative wording, so that (1) reflects "Strongly Agree" and (5) indicates "Strongly Disagree".

In addition, targeted characteristics were added to the tool and included questions related to job categories, age group, years of experience, and work setting. A cover letter, providing instructions for completing and returning sheets to researchers, and a statement of information confidentiality were attached to the survey sheet.

Following institutional approval, the Arabic tool was tested by 5 experts in the field of study for its content relevance, and necessary modifications were made. A pilot study was carried out on 10% of the subjects to assess the clarity of the statements and time required to complete the survey. After giving consent, subjects completed the surveys while they were in their work settings. Completing the survey took about 15 minutes. Data collection, review, and coding were completed during the period from March 2006 to December 2006.

After data were collected and coded, they were transferred into a specially designed format for computer entry. Frequency analysis, cross-tabulation, and manual revision were all used to detect and manage errors. The Expanded Program for Immunization (EPI INFO 3.2, 2006) was used for both data analysis and presentation.

Statistical measures included descriptive measures (count, percentage, arithmetic mean, standard deviation, minimum, and maximum) and Chi-square for analysis of qualitative variables. The level of significance used was P ≤ .05.

To calculate the 100-point scale score (teamwork climate) for an individual respondent, we performed the following:

  • Reverse scored all negatively worded items;

  • Calculated the mean of the set of items from the scale;

  • Subtracted 1 from the mean; and

  • Multiplied the result by 25.

The equation looked like this:

Patient Safety Climate Scale Score for a Respondent = {(Mean of the safety climate items)-1) x 25}

To calculate the percent of respondents who had positive perception (ie, percent agreement), the percent of respondents with a scale score of 75 or higher was identified. A score of 75 on the scale indicates the same thing as "agree slightly" on the original 5-point Likert scale (1=Disagree Strongly, 2=Disagree Slightly, 3=Neutral, 4=Agree Slightly, 5=Agree Strongly). With the conversion to the 100 point scale, 1 = 0, 2 = 25, 3 = 50, 4 = 75, and 5 = 100.


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