PATIENT SAFETY CULTURE

Presentación del tema: "PATIENT SAFETY CULTURE"— Transcripción de la presentación:

1 PATIENT SAFETY CULTURE
RELATIONSHIP BETWEEN JOB SATISFACTION AND PATIENT SAFETY CULTURE MJ Merino-Plaza, FJ Carrera-Hueso, MR Roca-Castello, MD Morro-Martin, A Martinez-Asensi , N Fikri-Benbrahim 1

2 Professional competence
Introduction Objectives Methods Results Conclusions Professional competence Professional competence depends basically on three elements:  Knowledge: the ability to give knowledge and professional skills related to what ”must be done“ Power to do: related to the availability of means for an effective and adequate realization of the tasks, which means the availability of adequate material, technological and human resources. Desire to do: related to the degree of motivation and involvement of professionals with organizational goals.  This last aspect is achieved through the effort to reach a good working environment or "organizational climate".

3 Introduction Objectives Methods Results Conclusions Job Satisfaction How should organizations and job positions be designed in order to be satisfactory to those who hold them?

4 Introduction Objectives Methods Results Conclusions Job Satisfaction Work climate is the set of characteristics that define the work environment of an organization and that exerts effect on behavior, relations and attitudes of the individuals Job satisfaction is a subjective perception of the individuals when facing their work that can guide the person for or against their work activity. 4

5 Introduction Objectives Methods Results Conclusions Job Satisfaction The organizational climate and job satisfaction are strategic tools that contribute to the continuous improvement of the organization. Analyzing them, key elements are identified that allow raising workers’ life quality and quality of services provided, due to their influence on the motivation and the performance of the professionals. Recently, more importance has been given to the human factor and the organizational climate due to their influence on the motivation of the professionals and the improvement of performance. Some studies indicate that job satisfaction may be related to patient safety. 5

6 Job satisfaction is a necessary element but not enough to guarantee
Introduction Objectives Methods Results Conclusions Job satisfaction is a necessary element but not enough to guarantee the quality of care Quality of the patient relationship Quality in decision making

7 Burnout Job Satisfaction Patient Safety
Introduction Objectives Methods Results Conclusions Job Stress Burnout Job Satisfaction Patient Safety

8 Patient Safety Culture
Introduction Objectives Methods Results Conclusions Patient Safety Culture Flexible Organization Information Teamwork Learning RELIABILITY Risk management is an Integral part of what we do Creative: We are alert to risks that may occur Proactive: National Patien Safety Agency (UK) We have systems for risk management Calculator We act only when an incident occurs Reactive: Security is a waste of time Pathologic: Parker D. Patient Safety. NPSA 2006, Birmingham, 2006 8

9 Introduction Objectives Methods Results Conclusions Patient Safety Patient Safety is an essential objective of health systems and is a transversal dimension of Quality Healthcare. This reality evidence the need to know those organizational factors that originate the existing deficiencies in health institutions. A positive patient safety culture is an essential requirement to prevent the occurrence of adverse events. It is necessary to evaluate the perceptions of both, users and workers, to find improvement areas in the management of health services 9

10 Introduction Objectives Methods Results Conclusions Objectives To evaluate the relationship between Safety Culture and Job Satisfaction in a medium-stay hospital Relationships between dimensions that define Job Satisfaction and Safety Culture were analyzed. Dimensions with the greatest impact on both variables were identified. to design alternatives that allow us to optimize the quality of the service. 10

11 Methods Design: Two Cross-sectional studies conducted in 2013 and 2015
Introduction Objectives Methods Results Conclusions Methods Design: Two Cross-sectional studies conducted in 2013 and 2015 Basque Health Service Job Satisfaction survey and Spanish version of the «Hospital Survey on Patient Safety» questionnaire (Agency for Healthcare Research and Quality). were applied to the health staff of the hospital. Sampling: Consecutive non-probabilistic Data analysis: spss 19.0 Agency for Health Care Research and Quality

12 Introduction Objectives Methods Results Conclusions Methods Variables Predictor Variables: socio-demographic characteristics and perception of the evaluated dimensions. In order to analyze the influence of each of the considered dimensions on job satisfaction and on the degree of perceived safety, a new variable called "High satisfaction with the dimension" was codified for each of them It was considered that this level was reached when people answered 5 (maximum score) to all the questions that evaluate the considered dimension These new variables were used in the bivariate analysis of the results

13 Introduction Objectives Methods Results Conclusions Methods Variables Result Variables: High Job Satisfaction and High Perceived Patient Safety Degree (score ≥75th percentile). The association between variables was quantified by adjusted Odds Ratio and the 95% confidence interval. We also considered the degree of job satisfaction and the degree of perceived security with respect to each of the 12 dimensions considered in each of the surveys The adjusted analysis was performed by binary logistic regression, including in the model potentially confounding variables and those variables for which a statistically significant relationship was found in the bivariate analysis.

14 Hospital human resources
Introduction Objectives Methods Results Conclusions Hospital human resources 3 managers, 22 doctors 180 Nursing staff: nurses, assistants, speech therapists, physiotherapists, technicians 113 Non-health personnel: caretakers, administrative, social workers, pricks, maintenance … Los RRHH con los que contamos

15 Sample characteristics
Introduction Objectives Methods Results Conclusions Sample characteristics The surveys were applied to the health staff of Doctor Moliner Hospital SAMPLING: The questionnaires were distributed through the middle management and collected in suggestion boxes SAMPLE SIZE The sample size was not predetermined, since the questionnaires Were sent by mail to the entire health staff The remaining 48 Did not receive the survey for different reasons (absentisme, etc.) Year Template Distributed Answers Participation rate 2013 206 158 66 (55 valid) 34,8% 2015 92 (75 valid) 47,5% 15

16 Dimensions evaluated in the Safety Culture Survey
Introduction Objectives Methods Results Conclusions Dimensions evaluated in the Safety Culture Survey Frequency of events reported Overall perceptions of Patient Safety Expectations and actions of the supervision of the Unit promoting Patient Safety Organizational learning / continuous improvement Teamwork within Units Communication openness Feed-back and communication about errors Non-punitive response to errors Staffing Management support for patient safety Teamwork across units Problems in shift changes and transitions between units Perceived Patient Safety Degree

17 Dimensions evaluated in the Job Satisfaction Survey
Introduction Objectives Methods Results Conclusions Dimensions evaluated in the Job Satisfaction Survey Working Conditions Training Promotion and Development Recognition Job definition Relationship with supervisor Participation Change management Working environment Communication Knowledge of the objectives Hospital management perception Job Satisfaction Dimensions of the Osakidetza survey

18 Introduction Objectives Methods Results Conclusions Safety Culture Mean Perception of Patient Safety Degree was similar in both studies: 7.8 in 2013 (N2013=55) 7.5 in 2015 (N2015=75) 75th percentile of the distribution in both cases was 9. The best evaluated dimension in the 2 studies was 3 (Expectations and actions of the supervision of the Unit promoting Patient Safety) The worst-evaluated dimensions were 9 and 10 (Staffing and management support). Sociodemographic variables had little significance An excellent perception of some of the dimensions, was associated with high Perceived Patient Safety Degree Regarding stratified analysis: In 2015, the dimensions most associated with the effect were: 3, 6 and 12 (actions of supervision, communication openness and problems in shift changes) with OR >10.

19 Introduction Objectives Methods Results Conclusions Evolution of perceived Safety Degree with respect to each of the dimensions considered 19

20 Introduction Objectives Methods Results Conclusions Job Satisfaction Mean Job Satisfaction was 7.10 in 2013 and 7.04 in 2015 75th percentile of the distribution in both cases was 9 points The best evaluated aspect in both studies was the quality of the assistance provided The worst evaluated dimensions were the perception of hospital management and recognition There were no significant differences in the mean perception with respect to each of the dimensions considered. Socio-demographic variables showed little influence on Job Satisfaction Only were significant seniority in the hospital and direct contact with patients. Six dimensions related to organizational characteristics showed strong association with high Job Satisfaction, with OR >10 In both surveys, job satisfaction was higher among professionals without direct contact with patients, probably because of the emotional overload of care for chronic patients, in many cases with a high degree of dependence or in a terminal situation. Another interesting fact is that professionals with less than 10 years of age in the hospital showed greater job satisfaction, which decreased in the interval between 10 and 14 years old in the center. These results coincide with those of the Burnout study carried out in 2012, which also showed a higher degree of affectation between 10 and 14 years of age. 20

21 Introduction Objectives Methods Results Conclusions Evolution of perceived job satisfaction with respect to each of the dimensions considered 21

22 Job Satisfaction Dimensions
Introduction Objectives Methods Results Conclusions Association of Job Satisfaction dimensions with outcome variables Job Satisfaction Dimensions High Job Satisfaction High Perceived Safety OR adjusted (IC del 95%) OR adjusted (IC del 95%) Working conditions Excellent dimension assessment 2,9 (0,4-19)1 10,4 (1,2-92,5)*a Rest of professionals 1 Training 5,0 (1,1-24)*2 5,8 (1,2-28)*b Promotion and Development No ajustable Recognition 10,4 (1,8-60)*3 6,6 (1,0-45,3) c Job definition 12,2 (12,2-67)*4 4,8 (1,1-20.4)* d Relationship with supervisor 12,3 (2.3-66,8)*5 6,7 (2,0-22,1)* e Participation Excellent dimension assessment 15,5 (1,5-172)*6 8,6 (1,1-71)* f Rest of professionals 1 Change management 6,0 (1,1-50)*7 6,5 (1,1-35,7)* g Working environment 11,1 (2,2-56,8)*8 7,4 (1,6-35,3)* h Communication 6,5 (1,2-34,7)*9 0,4 (0,1-3,3) i Knowledje of objectives No ajustable10 6,3 (0,7-54) j Hospital Management Perception 14,1 (1,9-106)*9 10,4 (1,9-57,1)* k Degree of association between the dimensions that define job satisfaction and outcome variables 1 Ajustado edad, contacto directo con el paciente, definición del puesto y relación con el mando a Ajustado para antigüedad en el hospital, trabajo de noches, participación y gestión del cambio 2 Ajustado para antigüedad en el hospital, contacto directo con pacientes, reconocimiento y gestión del cambio b Ajustado para categoría profesional antigüedad en el hospital, reconocimiento y definición del puesto 3 Ajustado para edad, contacto directo con pacientes, condiciones de trabajo y comunicación c Ajustado para antigüedad en el hospital, contacto directo con pacientes, condiciones de trabajo y comunicación 4 Ajustado para edad, antigüedad en el hospital, condiciones de trabajo y comunicación d Ajustado para categoría profesional antigüedad en el hospital, formación y reconocimiento 5 Ajustado para edad, contacto directo con los pacientes, condiciones de trabajo y participación e Ajustado para categoría profesional, contacto directo con los pacientes, condiciones de trabajo y comunicación 6 Ajustado para fármacos para dormir, contacto directo con pacientes, condiciones de trabajo, y ambiente de trabajo f Ajustado para categoría profesional, tipo de contrato, condiciones de trabajo y comunicación 7Ajustado para antigüedad en el hospital, contacto directo con pacientes, formación y reconocimiento g Ajustado para antigüedad en el hospital, contacto directo con pacientes, condiciones de trabajo y formación 8 Ajustado para fármacos para dormir, contacto directo con pacientes, condiciones de trabajo y participación h Ajustado para sexo, contacto directo con los pacientes, condiciones de trabajo y formación 9Ajustado para antigüedad laboral, contacto directo con pacientes, condiciones de trabajo y promoción y desarrollo i Ajustado para categoría profesional, contacto directo con pacientes, participación y ambiente de trabajo 10No ajustable j Ajustado para categoría profesional, antigüedad en el hospital, relación con el mando y comunicación 11 Ajustado para edad, antigüedad en el hospital, formación y reconocimiento k Ajustado para categoría profesional, antigüedad en el hospital, formación y gestión del cambio 22

23 Safety Culture Dimensions
High Perceived Safety High Job Satisfaction OR adjusted (IC del 95%) Frequency of events reported Excellent dimension assessment 6,5 (1,3-33,3)1 12,3 (2,0-74,1)a Rest of professionals 1 Overall perceptions of patient safety 6,6 (1,6-26)*2 7,2 (1,3-40,5)*b Actions of the supervision 22,5 (1,5-344)*3 0,5 (0,6-4,7)*c Organitational learning 8,9 (1,9-41)* 4 12,1 (2,5-58)* d Teamwork within units 6,3 (1,3-31,1)* 5 6,3 (1,4-28,2)* e Communication openness 14,2 (2,4-83,8)* 6 14,3 (1,8-116,2)* f Feed-back about errors Excellent dimension assessment 5,7 (1,2-27,4)*7 10,4, (2,2-49,7)* g Rest of professionals 1 Non-punitive response 0,2 (0,003-11,3) 8 0,4 (0,03-6,0) h Staffing Non- adjustable 19,7 (1,3-291,1)* i Management support Teamwork across units 0,3 (0,04-2,6) 11 3,5 (0,7-17,1) k Problems in shift changes 13,9 (1,1-181,7)*12 19,4 (1,7-222,2)* l Degree of association between the dimensions that define safety culture and outcome variables 1Ajustado para categoría profesional, antigüedad en el hospital, respuesta no punitiva y dotación de personal a Ajustado para categoría profesional, antigüedad en el hospital, respuesta no punitiva y dotación de personal 2Ajustado para antigüedad en el hospital, responsabilidad sobre dirección de equipos, trabajo en equipo entre unidades y problemas al cambio de turno b Ajustado para antigüedad en el hospital, responsabilidad sobre dirección de equipos, trabajo en equipo entre unidades y problemas al cambio de turno 3Ajustado para categoría profesional, tipo de contrato, mejora continua y trabajo en equipo en la unidad c Ajustado para categoría profesional, tipo de contrato, franqueza en la comunicación y respuesta no punitiva 4Ajustado para antigüedad en el hospital, fármacos para dormir, feed back comunicación de errores y problemas al cambio de turno d Ajustado para tipo de contrato, categoría profesional, acciones de la supervisión en pro de la seguridad del paciente y dotación de personal 5Ajustado para categoría profesional, tipo de contrato, respuesta no punitiva a los errores y acciones de la supervisión en pro de la seguridad del paciente e Ajustado para categoría profesional, tipo de contrato, respuesta no punitiva a los errores y trabajo en equipo entre unidades 6Ajustado para categoría profesional, responsabilidad sobre dirección de equipos, feed back comunicación de errores y respuesta no punitiva f Ajustado para categoría profesional, responsabilidad sobre dirección de equipos, feed back comunicación de errores respuesta no punitiva 7Ajustado para categoría profesional, responsabilidad sobre dirección de equipos, franqueza en la comunicación y respuesta no punitiva a los errores g Ajustado para categoría profesional, tipo de contrato, franqueza en la comunicación y respuesta no punitiva a los errores 8Ajustado para edad, antigüedad en el hospital, mejora continua y feed back comunicación de errores h Ajustado para categoría profesional, fármacos ansiolíticos, acciones de la supervisión en pro de la seguridad del paciente y trabajo en equipo en la unidad 9 No ajustable i Ajustado para categoría profesional, antigüedad en el hospital, notificación (trabajo en equipo en la unidad en 2013) y respuesta no punitiva 10No ajustable j No ajustable 11Ajustado para responsabilidad sobre dirección de equipos, contacto directo con pacientes, franqueza en la comunicación y problemas al cambio de turno k Ajustado para fármacos ansiolíticos, contacto directo con pacientes, mejora continua y respuesta no punitiva 12Ajustado para antigüedad en el hospital, fármacos para dormir, trabajo en equipo entre unidades y respuesta no punitiva l Ajustado para responsabilidad sobre dirección de equipos, contacto directo con pacientes, franqueza en la comunicación y trabajo en equipo entre unidades 23

24 Correlations between dimensions
Introduction Objectives Methods Results Conclusions Job satisfaction dimensions 1 2 3 4 5 6 7 8 9 10 11 12 1: Working conditions 2: Training 0,48** 3: Promotion and Development 0,55** 4: Recognition 0,53** 0,46** 0,66** 5: Job definition 0,49** 0,42** 0,60** 0,72** 6: Relationship with supervisor 0,38** 0,37** 0,47** 0,54** 0,67** 7: Participation 0,44** 0,32** 0,51** 0,68** 0,79** 8: Change management 0,73** 0,74** 0,59** 0,50** 9: Working environment 0,64** 0,65** 0,58** 10: Communication 11: Knowledje of objectives 0,29* 0,32* * 0,57** 0,40** 0,45** 0,61** 12: Hospital Management Perception 0,36** 0,39** 0,27* Job Satisfaction 0,62** 0,63** 0,56** 0,31**

25 Correlations between dimensions
Introduction Objectives Methods Results Conclusions Safety Culture Dimensions 1 2 3 4 5 6 7 8 9 10 11 12 1: Frequency of events reported 2: Overall perceptions of patient safety ,33* 3: Actions of the supervision ,56** 4: Organitational learning ,49** ,41** 5: Teamwork within units ,24* ,46** 6: Communication openness ,55** ,59** ,50** ,27* ,48** 7: Feed-back about errors ,54** ,64** 8: Non-punitive response ,66** ,35* ,31* 9: Staffing ,26* ,24** ,44 ** 10: Management support ,37* ,44** ,28* ,25* 11: Teamwork across units ,45** ,33** 12: Problems in shift changes ,38* ,34* Perceived Safety ,47**

26 Correlations between dimensions
Introduction Objectives Methods Results Conclusions Job Satisfaction Dimensions 1 Work Conditions 2 Trai-ning 3 Promo-tion 4 Recog-nition 5 Job Defini-tion 6 Relati supervisor 7 Participation 8 Change Man 9 Work envi-ronm 10 Comuni-cation 11 Know Objectives 12 Manageme Perce Job Satis-faction Safety Culture Dimensions 1: Frequency of events reported ,38* ,36* ,34* ,33* ,39* ,49** 2: Overall perceptions of patient safety ,29* ,28* ,48** ,50** ,51** ,53** ,43** ,60** ,37* ,25* 3: Actions of the supervision ,45** ,70** ,63** ,35* ,56** 4: Organitational learning ,57** ,47** ,32* ,55** ,44** ,42** 5: Teamwork within units ,61** ,27* 6: Communication openness 7: Feed-back about errors ,31* ,58** ,69** ,52** ,59** 8: Non-punitive response ,41** 9: Staffing 10: Management support ,46** 11: Teamwork across units ,26* ,45* 12: Problems in shift changes Perceived Safety ,67** In addition, there are strong correlations between the dimensions that define Job Satisfaction and those that define the Safety Culture of the patient, which seems to indicate that all of them are part of the same construct and that both concepts, Job Satisfaction and Safety Culture, are strengthened with each other. 26

27 job satisfaction and patient safety
Introduction Objectives Methods Results Conclusions Influence of the degree of satisfaction regarding the dimensions considered on the high perception of job satisfaction and patient safety a Leyenda del gráfico Dimensiones que definen la satisfacción laboral 1: Condiciones de trabajo; 2: Formación; 3: Promoción y desarrollo; 4: Reconocimiento; 5: Definición del puesto; 6: Relación con el mando; 7: Participación; 8: Gestión del cambio; 9: Clima de trabajo; 10: Comunicación; 11: Conocimiento de objetivos; 12: Percepción de la Dirección Dimensiones que definen la cultura de seguridad del paciente 1: Notificación de Eventos Adversos; 2: Percepción global de seguridad; 3: Acciones de la supervisión en apoyo de la seguridad; 4: Mejora continua; 5: Trabajo en equipo en la Unidad; 6: Franqueza en la comunicación; 7: Feed-back y comunicación sobre errores; 8: Respuesta no punitiva a los errores; 9: Dotación de personal; 10: Apoyo de la Dirección a la seguridad del paciente; 11: Trabajo en equipo entre unidades; 12: Problemas en cambios de turno y transiciones entre servicios 27

28 Introduction Objectives Methods Results Conclusions

29 Patient Satisfaction and Burnout
Introduction Objectives Methods Results Conclusions Patient Satisfaction and Burnout Patient satisfaction Low EE % Low DP % Low PA % Patient Satisfaction and low % of professionals with affected subescales Patient Satisfaction Burnout (%) EE (Mean) DP (Mean) PA (Mean)

30 Introduction Objectives Methods Results Conclusions Conclusions The results of this study indicate that there is a relationship between the dimensions that define Job Satisfaction and Safety Culture. Indicators based on the individual dimensions are more sensitive than the overall perceived safety or job satisfaction index. The adjusted OR helps to identify the variables most strongly associated with the effect and to select those areas where improvement plans can be more effective. This information can be useful to design improvement plans that allow us to increase the Job Satisfaction and optimize the quality of the service. In our organization, staffing, participation and communication, especially to avoid problems in shift changes, seem to be the dimensions most associated with the effects wanted.

31 Thank you very much SMALL ACTIONS X MANY PROFESSIONALS = BIG RESULTS
Introduction Objectives Methods Results Conclusions SMALL ACTIONS X MANY PROFESSIONALS = BIG RESULTS Thank you very much