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


Patient safety is moving up the list of priorities for hospitals and healthcare delivery systems, but improving safety across a large organization is challenging.[4] Quality and patient safety management systems are based on the same principles. They are both planned and managed and depend on measurement, monitoring, and improvement efforts.[2]

In the healthcare environment, organizational culture has been associated with several elements of organizational experience that contribute to quality, such as nursing care, job satisfaction, communication, standard of practice, and commitment to patient safety.[12] We found that the majority of participants conveyed negative perceptions toward patient safety. This finding is in line with the findings of Aspden and colleagues,[18] who advocated that a key aspect of a patient safety system is a culture that encourages clinicians, patients, and others to be vigilant in facilitating learning and redesign of care processes.

Safety culture assessment provides an organization with a basic understanding of safety-related perceptions and attitudes of both managers and staff.[19] The assessment communicates what is important to the organization, as well as the desirable end states.[9,19,20] Pronovost and Sexton[21] advocated that in a safe culture, employees are guided by an organization-wide commitment to safety in which each member upholds his/her own safety norms and those of his/her coworkers. Moreover, within a healthcare context, safety culture influences patient safety by motivating healthcare professionals to choose behaviors that enhance, rather than reduce, patient safety. Safety culture also aims to improve performance rather than blame individuals.[12] McKesson[22] concluded that as healthcare organizations develop patient safety strategies, it is vital to understand concerns and opportunities from the front-line nurses' perspectives.

Our study also indicates that the relationship between overall mean scores of the front-line healthcare providers' perceptions toward patient safety and their job categories was statistically significant, and physicians reported the highest mean scores compared with other front-line healthcare providers. This could be explained by the lack of communication and collaboration between nursing and medicine, which has a profound effect on workplace environment and patient care.

In healthcare organizations, communication is a process for sharing information, thoughts, beliefs, and feelings that influence the individual's health-directed behaviors, and creating support for individual or collective action that directly affects professional-professional and professional-client interactions. Moreover, differences between the 2 professions' perceptions can interfere with shared meaning, and the rules of the process of communication can be changed with inappropriate responses. In a survey conducted by Kitch[23] to determine characteristics of patient safety culture, it was concluded that teamwork within units; honest and open communication among physicians, administrators, and healthcare workers; as well as open communication with patients and their families are considered the principal characteristics of a culture of safety.

The results of our study contradict those of Carayon and co-authors,[24] who examined the elements of the work system, employees' outcomes, and care processes by comparing various safety measures applied across 3 categories: nurses, physicians, and other staff. In this study, they found that there was no difference between the 3 job categories on the measures of perceptions toward safety performance.

We found statistically significant differences between the 3 job categories of participants, as well as among their work settings, and in perceptions of management commitment to patient safety. These findings corroborate those of Singer and colleagues,[25] who concluded that safety culture may not be as strong as desired by high reliability organizations, and that safety culture differs significantly, not only between hospitals but also by clinical status and job class within individual hospitals.

Furthermore, Singer and coauthors[25] and Sexton and colleagues[26] identified safety culture elements such as leadership and management commitment to safety, safety climate (ie, organizational resources for patient safety), and staff elements such as overconfidence. Pronovost and Sexton[21] described employees in a safe culture as being guided by an organization-wide commitment to safety. Safety culture includes the commitment of the leadership to discuss and learn from errors, documenting and improving patient safety, and using systems for reporting.[27,28,29,30] Similarly, Singer and colleagues[25] found that commitment to safety is articulated at the highest levels of the organization, and claim that this must be translated into shared values, beliefs, and behavioral norms at all levels.

According to Singer and Tucker,[28] nurses must accept their role accountability and move forward with concrete evidence of commitment toward participating in shaping a culture of safety. Loss of trust in hospital administration is widespread among nursing staff. This loss of trust stems, in part, from a perception that initiatives in patient care and nursing work redesign have emphasized efficiency over patient safety. Poor communication practices have also led to mistrust, which has serious implications for the ability of hospitals to provide safer patient care.[31] Furthermore, management practices are essential to the creation of safety within the organization, and these practices include creating and sustaining trust throughout the organization.[31]

Our study found no significant differences between front-line healthcare providers' perceptions toward patient safety according to their work settings, although the management commitment to patient safety among paramedical departments reflected a more positive perception. This may be because managers consider themselves to be part of the organization so they exert more effort to help it to be successful. Also, managers have to monitor quality of care, make decisions related to the work safety environment, utilize the resources, and participate in conferences and meetings, so they are more likely to get the job done and to achieve organizational goals. This achievement depends on the manager's sense of obligation and commitment to the organization. These findings are supported by Chandler,[32] who concluded that employees who have high access to resources are more likely to achieve organizational goals with precision and to be more committed to their organizations. Singer and Tucker[28] and Wong[33] advanced that perceptions differ between senior leadership and front-line staff regarding patient safety, with leaders having a more optimistic view than front-line staff. This difference suggests that some leaders do a better job than others in their efforts to communicate their commitment to patient safety.[34]


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