An evaluation 0 a patient afety culture tool in Saudi Arabia

417 Pages·2015·51.57 MB·English

An evaluation a patient afety culture
0
tool in Saudi Arabia
amd oh hri r
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June 2 11
IMAGING SERVICES NORTH
Boston Spa, Wetherby
West Yorkshire, LS23 7BQ
www.bl.uk
PAGE NUMBERING AS
ORIGINAL
IMAGING SERVICES NORTH
Boston Spa, Wetherby
West Yorkshire, LS23 7BQ
www.bl,uk
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Summary
Background
Safety culture is considered to be an essential element of patient safety. Several tools are
available to assess patient safety culture in hospitals. One of the most common methods of
assessing safety culture is the use of safety climate questionnaires.
Research question
Is there an existing patient safety culture measure that can be demonstrated to be a valid and
reliable tool for use with the workforce in hospitals in Saudi Arabia?
Aim and objectives
This study aims to identify whether there is an existing English language tool that would be
suitable for assessing patient safety culture in Saudi context. The objectives of the study are:
1. To select an appropriate questionnaire to assess hospital patient safety culture.
2. To evaluate the face validity of the selected patient safety climate questionnaire.
3. To assess the psychometric properties of the selected patient safety climate
questionnaire in hospitals in Saudi Arabia.
4. To develop the most appropriate measure for assessing patient safety culture for use
in hospitals in Saudi Arabia.
Methods
Qualitative methods were used to evaluate face validity (n=12 hospital staft). Quantitative
methods were used to assess psychometric properties (n=862 doctors and nurses in three
hospitals in Saudi Arabia).
Findings
Evaluation of face validity identified a need for minor changes to the Hospital Survey on
Patient Safety Culture (HSOPSC) questionnaire wording before it was used to collect data for
psychometric assessment. The results of Confirmatory Factor Analysis (CF A) and reliability
analysis showed an unsatisfactory fit for the factor structure of the original HSOPSC
questionnaire to the Saudi data. Exploratory Factor Analysis (EF A) was used on one half of
the Saudi dataset to produce an optimal model(s). This was followed by CFA of the resulting
measurement model on the second (validation) half of the data to test the fit of the resulting
optimal factor structure. The result of EF A showed that eight factors (23 safety climate
items) is the optimal model to the Saudi data.
I
All factors consisted of two to four items. The items loading were between 0.43 and 0.97.
The result of CFA confirmed the eight factors solution (CF A=O.94, RMSEA=0.045,
SRMR=O.040, TLI=O.97). The results of EFA, CFA, correlation and reliability analysis
(Cronbach's alpha) showed that the optimal model for the Saudi data consists of eight patient
safety culture dimensions (23 safety climate items).
Conclusion
This is one of very few studies to provide an assessment of an American patient safety culture
tool using data from Saudi Arabia. The results indicate the importance of appropriate
validation of patient safety climate questionnaires prior to applying them to populations
outside contexts in which they were developed. The validated Saudi English language
version of the HSOPSC questionnaire is an appropriate patient safety climate questionnaire to
assess patient safety culture in Saudi hospitals.
II
Acknowledgments
Firstly, all praise to Allah almighty who enabled me to accomplish this task. I am thankful
for all his blessings showering me and his unlimited beneficence in my life.
I would like to express my sincere gratitude to my supervisors, Professor Allen Hutchinson,
Dr. Rachel O'Hara and Dr. Jenny Freeman for their invaluable advice, guidance and
encouragement throughout the duration of this project.
I want to express my great appreciation to my parents (to my late father's memory) who
supported and encouraged me to continue my study. I would like to express my sincere
gratefulness to my mother who unendingly prays, offers advice and encouragement, and her
endless love and carrying. I must admit that without my brothers (Gaze, Saleh, Farhan, Naif
and Mosab and their children), my wife (am Zaid) and my children (Zaid, Remas, Tareq and
Nout) for their continuous love, encouragement and support I would not have reached this
point.
I would like to thank my uncle and his family (Abo Hadi) for their encouragement and
support. I would like to thank my sisters and my aunt for their love and support.
I gratefully acknowledge the people who they helped me in data collection. I would like to
thank Dr. Chris Stride for his help and advice in data analysis. I would like to thank the
course instructor (Charlotte McClelland) for the statistical analysis training and support
course.
I would like to thank my government for providing me financial support during this research
work. A special thanks for Dr. Tariq Mashhour for his support in this work.
Finally, I would like to thank my relatives (uncles, aunts and their children) and friends back
home (Mohamed, Mamdouh, Jaber, Ouied, Abduallah and Nassar) who have helped me in
any way during this work. Special thanks for Abdul Rauf for his help and support.
III
Table of Contents '
Summary .................................................................................................................................. I
Acknowledgments ................................................................................................................. III
List of Tables ........................................................................................................................ VII
List of Figures ......................................................................................................................... X
List of Appendices .................................................................................................................X I
Abbreviations ...................................................................................................................... XIII
Glossary ................................................................................................................................ XV
Chapter one: Introduction ...................................................................................................... 1
1.1 Background ............................................................................................................... 1
1.2 Research problem .................................................................................................... 3
1.3 Research question ................................................................................................... 3
1 4 Research al'm and obiectl'ves .................................................... 3
• J •••••••••••••••••••••••••••••
1 5 SI'gnl'fl'cance of the study .................................................. 4
1'6 The Saudi health care Sy~t~·~ .. ·. ......... ·. . ·. . ·. ... ·. ... · ............................................ .4
· 1.6.1 Patient safety in hospitals ·i·~. . S·~~di·A~~·bi·~:::::: .. :. .......................................... 5
1 7 Thesis structure ................................................................... 6
1:8 Summary ............ ::::::::::::::::::::::::::::::::::::: ................................................................... 6
Chapter two'. Ll'terature rev'lew .. ............................... .. ........................................................... 7
2 ·1 Introduct'lon .................................. .. ............................................................................ 7
2.2 Organisational safety ............................................................................................... 7
2.2.1 Safety in organisations ..................................................................................... 7
2.2.2 Safety in healthcare organisations ............................................................... 11
2.2.3 Patient safety in healthcare ........................................................................... 12
2.3 Safety culture .......................................................................................................... 15
2.3.1 Overview of safety culture ............................................................................. 15
2.3.2 Safety culture and safety climate .................................................................. 23
2.3.3 Patient safety culture ...................................................................................... 33
2.4 Measurement of patient safety climate ............................................................... 38
2.4.1 Existing patient safety climate questionnaires ............................................ 39
2.4.2 Development and validation of patient safety climate questionnaires .... 51
2.4.3 Selecting a suitable questionnaire for measuring patient safety climate67
2.5 Overall summary of chapter two .......................................................................... 69
Chapter Three: Methodology ............................................................................................... 72
3.1 Introduction .............................................................................................................. 72
3.2 Research aim and objectives ............................................................................... 72
3.3 Study design ............................................................................................................ 73
3.4 Study setting and sample ...................................................................................... 78
3.5 Research Ethics Review ....................................................................................... 78
3.6 The fieldwork and plan ........................................................................................... 79
3.7 Summary .................................................................................................................. 80
Chapter 4: Choosing an appropriate patient safety climate questionnaire for use in'
Saudi hospitals ...................................................................................................................... 81
4.1 Introduction .............................................................................................................. 81
4.2 Selection of appropriate patient safety climate questionnaires ....................... 81
4.2.1 Step1: Identifying existing patient safety culture questionnaires ............. 82
N
4.2.2 Step 2: Assessment of psychometric properties (validity and reliability)
and dimensionality of patient safety climate questionnaires .................................. 84
4.2.3 Step 3: Assessment of general characteristics of patient safety climate
questionnaires ................................................................................................................ 85
4.2.4 Step 4: Select appropriate patient safety climate questionnaires ........... 87
4.2.5 Comparison of the two questionnaires ........................................................ 96
4.3 Face validity testing of two patient safety climate questionnaires .................. 98
4.3.1 Introduction ....................................................................................................... 98
4.3.2 Objectives of interviews .................................................................................. 99
4.3.3 Setting of interviews ........................................................................................ 99
4.3.4 Sample of interviews ....................................................................................... 99
4.3.5 Recruitment (interview process) ................................................................... 99
4.3.6 The structure of the interview ...................................................................... 10 1
4.3.7 Analysis of interviews data .......................................................................... 103
4.3.8 Characteristics of participants ..................................................................... 104
4.3.9 Results of the face validity testing of the Hospital Survey on Patient
Safety Culture (HSOPSC) .......................................................................................... 105
4.3.10 Results of the face validity testing of the Teamwork and Safety Climate
Survey 115
4.3.11 Results of the comparison of the two patient safety climate
questionnaires .............................................................................................................. 123
4.3.12 Decision and changes (making a choice of questionnaire and changes
to questionnaire's language and structure) ............................................................. 128
4.4 Overall summary ................................................................................................... 132
Chapter Five: Data collection: Using the Hospital Survey on Patient Safety Culture
questionnaire. ....................................................................................................................... 133
5.1 Introduction ... :. ....................................................................................................... 133
5.2 Study setting .......................................................................................................... 133
5.3 Population of study ............................................................................................... 134
5.4 Sample size ........................................................................................................... 134
5.5 Data collection ....................................................................................................... 135
5.5.1 King Fahad National Guard hospital at King Abdul-Aziz Medical City. 137
5.5.2 King Fahad Medical City .............................................................................. 139
5.5.3 King Faisal Specialist Hospital and Research Centre ............................. 141
5.6 Data management .................................... :. .......................................................... 145
5.6.1 Introduction ..................................................................................................... 145
5.6.2 Data Preparation ........................................................................................... 145
5.6.3 Data entry ....................................................................................................... 146
5.6.4 Data editing (validation and checking) ....................................................... 147
5.6.5 Double entry: .................................................................................................. 149
5.6.6 Incomplete questionnaires ........................................................................... 150
5.7 Summary ................................................................................................................ 151
Chapter 6: Assessing the psychometric properties of the Hospital Survey on Patient
Safety Culture ...................................................................................................................... 152
6.1 Introduction ............................................................................................................ 152
6.2 Descriptive Analysis ............................................................................................. 153
6.2.1 Demographic information ............................................................................. 153
6.2.2 Items analysis ................................................................................................ 156
6.3 psychometric Analysis of the Hospital Survey on Patient Safety Culture ... 168
6.3.1 Introduction ..................................................................................................... 168
v
6.3.2 Assessment of the Suitability of the data for factor analysis .................. 168
6.3.3 Psychometric Data Analysis Strategy ........................................................ 172
6.4 Testing the original USA HSOPSC modeL ....................................................... 173
6.4.1 Confirmatory Factor Analysis ...................................................................... 173
6.4.2 Reliability Analysis of the original USA HSOPSC model ........................ 176
6.5 Identifying optimal modeL .................................................................................. 178
6.5.1 Exploratory Factor Analysis (EFA) ............................................................. 179
6.5.2 Testing the fit of the optimal model: CFA .................................................. 212
6.5.3 Construct validity (factor correlations of the optimal model) .................. 214
6.5.4 Reliability analysis (internal consistency) .................................................. 215
6.6 Proposed optimal model ...................................................................................... 216
6.7 Summary of overall findings ............................................................................... 217
Chapter Seven: Discussion ............................................................................................... 218
7.1 Introduction ............................................................................................................ 218
7.2 Face validity findings ............................................................................................ 218
7.3 Testing the original model findings .................................................................... 224
7.4 Developing the optimal model ............................................................................ 234
7.5 Methodological issues ......................................................................................... 250
7.6 Study Strengths and Iimitations .......................................................................... 252
7.7 Summary of the main findings and impact of the study ................................. 254
Chapter eight: Conclusion .................................................................................................. 256
8.1 Introduction ............................................................................................................ 256
8.2 Implications of the study ...................................................................................... 257
8.3 Conclusion ............................................................................................................. 259
References ........................................................................................................................... 260
VI
List of Tables
Table 2-1 Differences and similarities between safety culture and safety climate ..... 32
Table 2- 2 Patient safety culture dimensions .................................................................... 35
Table 2- 3 Dimensions of patient safety climate questionnaires .................................. .44
Table 2-4 A comparison of the common patient safety climate dimensions that are
mentioned in four review papers ......................................................................................... 46
Table 2- 5 Psychometric properties of Hutchinson et aI's study (2006) ....................... 54
Table 2- 6 The original analysis of the HSOPSC (Sorra and Nieva, 2004) ................. 57
Table 2- 7 Psychometric properties of Waterson et aI's study (2009) .......................... 59
Table 2- 8 Psychometric properties of Bodur and Filiz's study (2010) ......................... 61
Table 2- 9 Psychometric properties of Smits et aI's (2008) study ................................. 63
Table 2-10 Psychometric properties of Pfeiffer and Masner's study (2010) ............... 65
Table 3- 1 Fieldwork timetable ............................................................................................. 80
Table 4- 1 Steps of selecting appropriate patient safety climate questionnaires ........ 82
Table 4- 2 Excluded patient safety climate questionnaires in step2 ............................. 84
Table 4- 3 Excluded patient safety climate questionnaires in step 3 ............................ 86
Table 4- 4 Characteristics of the original Hospital Survey on Patient Safety Culture 88
Table 4- 5 Characteristics of Safety Climate Survey ....................................................... 90
Table 4- 6 Characteristics of Teamwork and safety climate survey ............................. 91
Table 4- 7 Characteristics of Safety Attitude Questionnaire .......................................... 93
Table 4- 8 Characteristics of Patient Safety Culture Survey on Health Care
Organisations ......................................................................................................................... 94
Table 4- 9 Steps of selection of an appropriate questionnaire for assessing patient
safety culture .......................................................................................................................... 96
Table 4- 10 Demographic information of participants (n=12) ....................................... 104
Table" 4- 11 Clarity and understanding of the HSOPSC ............................................... 106
Table 4- 12 Number of participants identifying unclear items ...................................... 107
Table 4- 13 General comments of the respondents about HSOPSC ......................... 114
Table 4- 14 Clarity and understanding of Teamwork and Safety Climate Survey .... 116
Table 4- 15 Number of participants identifying unclear items ...................................... 117
Table 4- 16 General comments of the respondents about Teamwork and Safety
Climate Survey .................................................................................................................... 122
Table 4- 17 Comparison of the questionnaires (12 interviews) ................................... 124
Table 4- 18 Comparison of the questionnaires in terms of clarity (n=12) .................. 126
Table 4- 19 Advantages and disadvantages of questionnaires ................................... 127
Table 4- 20 Changes made on the HSOPSC questionnaire ........................................ 129
Table 4- 21 Patient safety culture dimensions of the HSOPSC questionnaire ......... 131
Table 5- 1 data collection of KFNGH ............................................................................... 139
Table 5- 2 Data collection of KFMC ................................................................................. 140
Table 5- 3 Data collection of the KFSH&RC ................................................................... 143
Table 5- 4 Duplicate cases ................................................................................................ 147
Table 5- 5 Outliers ............................................................................................................... 148
VII