الفهرس 
Patient SafetyOnly 14 pages are availabe for public view
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Abstract
Medical interventions are, by their nature, high risk procedures.
Recent researches suggests that levels of harm range from 3 – 25% in
acute care (Health Foundation, 2011 A), and the number of patient
deaths associated with hospital care is more than 400,000 a year. The
toll is estimated to be much higher in developing countries (James,
2013). Many researchers concluded that 80% of errors result from
system failures rather than individual errors (Reason, 2000). Good
clinical practice means providing care that is safe and effective
without doing harm. This requires proper identification and
acceptance of errors through sound safety culture. Safety culture has
become a significant issue for healthcare organizations striving to
improve patient safety (Kennedy, 2001). Dr. James Reason identified
four components for safety culture, namely; just culture which
balances between no blame and accountability, reporting culture,
flexibility culture and learning culture. Other elements include
leadership, communication and teamwork (Reason, 1998).
Accreditation is defined by Joint Commission International
(JCI) as “a process in which an entity, separate and distinct from the
healthcare organization, usually non-governmental, assesses the
healthcare organization to determine if it meets a set of standards
requirements designed to improve quality of care” (JCI, 2011).
Accreditation standards offer healthcare organizations a systematic
way of organizing operations for optimal efficiency and effectiveness
(Haakstad, 2001).
Does accreditation improve patient safety culture? In one study,
staff participation in an accreditation process was found to have promoted a quality and safety culture by better integrating different
professional groups e.g., doctors, nurses and allied health
professionals. Researchers also found that accreditation focused all
staffs attention on a common quality improvement goal (Greenfield
et al., 2011; Hinchcliff et al., 2013). However, researches focused on
the impact of accreditation on patient safety and quality of care as a
whole yet little attention was given to measuring its impact on patient
safety culture directly.
The Objective of the current study is to:
Compare patient safety culture between an accredited and nonaccredited
hospital.
Identify factors affecting patient safety culture in both hospitals.
The current study is a comparative descriptive study carried out
in two hospitals; one accredited “Dar Al Shefaa” and one nonaccredited
“Al Qahira Al Fatimya”. The two hospitals were matched
regarding administrative type, bed capacity and provided level of
care. The study included healthcare providers working in the two
selected hospitals excluding administrative staff and laborers. The
sample size was estimated to be 182 subjects in each hospital to
detect a difference up to at least 15%. Study tool was an Arabic
version of the validated self-administrated questionnaire; Hospital
Survey on Patient Safety Culture designed by the Agency for
Healthcare Research and Quality (AHRQ) to assess hospital staff
opinions about patient safety issues, medical errors and event
reporting. It was pilot tested, revised and then released in November
2004. It consists of 12 dimensions of patient safety culture in addition
to outcome variables (Sorra and Nieva, 2004).
The collected sample was 312 questionnaires from both
hospitals, the sample included physicians, nurses, pharmacists,technicians and chemists. Different departments were represented in
the sample.
Main study findings show that accreditation is the only
significant independent variable, with the accredited hospital having
odds of 3.83 higher than the non-accredited to have 50% or more
total score of safety culture (95% CI 2.1-6.9). More than 75% of
respondents from the accredited hospital scored ≥50% total safety
culture versus only 43.8% from the non-accredited hospital, with
difference of 32.2% (p<0.001).Also respondents working in
accredited hospital were more likely to report an Excellent/ very good
grade accounting for 93% versus 57.6% in the non-accredited
hospital (p<0.001). The accredited hospital scores are significantly
higher than those of the non-accredited hospital regarding all
dimensions of patient safety culture except for the dimension
“Staffing” where both hospitals scores are low. Also both hospital
scores are low regarding “Non Punitive Response to Errors” although
the statistical difference between them is highly significant
(p<0.001). There is no statistical significant difference between the
studied hospitals regarding the outcome measure “Number of Events
Reported”.
Areas of strengths (score in the accredited hospital are
“Teamwork within Units” (82.9), “Organizational Learning and
Continuous Improvement” (78.4) and “Feedback and Communication
about Error” (76.1), while areas of improvement (score ≤ 50%) are
“Staffing” (41.4) and “Non Punitive Response to Errors” (35.3). The
non-accredited hospital shows no areas of strengths while areas of
improvement are 8 out of 12 namely; “Non Punitive Response to
Errors” (19.1), “Staffing” (42.2), “Management Support for Patient.