NO SUBJECT AUTHOR VARIABLE DESIGN RESULT CONCLUSION

1 International Margarida Eiras Dimensions/composites
Journal of Health Ana Escoval 1. Teamwork within units
Care Quality Isabel Monteiro 2. Supervisor/manager
Assurance Grillo Carina expectations and actions
The hospital Silva-Fortes , promoting patient safety
survey on patient (2014) 3. Management support for
safety culture in patient safety
Portuguese 4. Organizational learning –
hospitals: continuous improvement
Instrument validity 5. Overall patient-safety
and perceptions
reliability 6. Feedback and
communication about error
7. Communication openness
8. Frequency of events
reported
9. Teamwork across units
10. Staffing
11. Handoffs and transitions
12. Non-punitive response to
errors
Empiric The dimension Safety culture assessments can
study management support empower hospital staff and help
for patient safety was them to work on
answered differently by quality and safety improvement
respondents in all strategies to achieve safer
hospitals. There are environments. This project,
large differences which started with
between hospital communicating survey results to
characteristics (type staff and managers,
and size) and encompasses
management setting priorities for action,
commitment to quality making changes to improve
and safety healthcare delivery and
issues. measuring their effect on patient
safety. We believe that the
information we acquire
from hospital culture
assessment tools is vital to
developing effective patient
safety
strategies and projects in
specific healthcare systems.

2 Educational Reece P. Swart educational background of Cross- Both the registered- From the results it was evident
background of Ronel Pretorius nurses sectinal and enrolled nurses that perceptions of RNs and
nurses and their Hester Klopper, perceptions of quality of care descriptive seemed satisfied with ENs related to the quality of
perceptions of the (2015) study the quality of care and care and patient safety differed.
quality and safety patient safety patient safety in the There seemed to be a
of patient care units were they work. statistically-significant difference
Enrolled nurses (ENs) between RNs and ENs
indicated that current perceptions of the prevention of
efforts to prevent errors errors in the unit, losing patient
are adequate, whilst information between shifts and
the registered nurses patient incidents related to
(RNs) obtained high medication errors, pressure
scores in reporting ulcers and falls with injury.
incidents in surgical
wards. Nurses play a major role as
primary patient contact and
have a vital role in ensuring the
quality and safety of patient
care. The results of this study
suggest that nurses (both
registered and enrolled) have
favourable perceptions of the
quality and safety of patient care
delivered in surgical units in
private hospitals in Gauteng. It
is strongly suggested that
several of the findings that can
affect the quality and safety of
patient care, such as recording
of medication errors, be
addressed by management. To
that end, the findings provide a
glimpse of one of the critical
professions’ perceptions on the
safety and quality of care in
surgical units in private hospitals
3 Impacts of Job Young-Mi Park , Job stress Cross- Of the hospital nurses In conclusion, this study was
Stress and Souk Young Kim Cognitive failure sectinal who participated in this aimed at exploring the impact of
Cognitive Failure (2013) Patient safety incidents descriptive study, 72.1% hospital nurses’ job stress and
on Patient Safety Personality type study responded that they cognitive failure on patient
Incidents had never made an safety incidents and ultimately
among Hospital error causing harm to using the result as basic data for
Nurses patients in the past 6 preventing and managing
months. The remaining patient safety incidents. This
27.9% of all those who study showed that 27.9% of the
experienced patient participants had experienced
safety incidents were such incidents in the past 6
divided as follows: months. Factors affecting
“Once in 6 months” incidents were found to be shift
(24.7%), “Once in a work, cognitive failure, job
month” (2.5%), “Once instability, and lack of job
 in a week” (0.7%), and autonomy. Therefore, what we
“More than once in a need to prepare is many
day” (none). It is hard countermeasures to reduce
to apply this result for patient safety incidents caused
hospital nurses in by shift workers and plans to
general, but it still has reduce job stress to reduce
significance in the workers’ cognitive failure.
sense of a general Further, it is necessary to
understanding of the reduce job instability and clearly
current condition of define the scope and authority
patient safety incidents for duties that are directly
among Korea’s hospital related to patient safety
nurses. Considering
their occupation deals
with the life of patients,
this is not to be
overlooked; rather, it
calls on the
development of
preventive solutions for
the safety of patients.
In this study, variables
that have a significant
effect on incidents are
shift work, cognitive
failure, job instability,
and lack of job
autonomy.
4 Nursing workload, Lisbeth As a result of this, the observational We find that the odds Several factors affect the
patient safety Fagerström,,Mari findings fell study for a patient safety reporting of incidents, for
incidents and na Kinnunen, naturally into four key incident were 10%– example, staff’s lack of
mortality: an Jan Saarela categories: 30% higher, and for motivation or knowledge, nurse
observational (2018) 1. the need for clear and patient mortality about staff shortage, stressful
study from unambiguous care 40%. higher, if the situations or burn-out. A
Finland pathways NWL as measured by reasonable argument is
2. positive relationships with the RAFAELA system therefore that a very high NWL
staff (OPC/nurse) was indicates a working situation
3. continuity of care and above the assumed where the nurse staff resources
4. good communication. optimal level, as are too low. Still, too few
compared with if it was resources can result in the
at this level. If deprioritisation of the
OPC/nurse was below registration of adverse events
the level, the odds for a and thus the under-reporting of
patient safety incident incidents connected to high
and for mortality were NWL, which may affect the
approximately 25% results of our study and the
lower. The latter conclusions.
situation would mean
that nurses have more This study has showed that a
time for work situation above the
caring and observing assumed optimal level
each patient, which increases the risk for adverse
may reduce the risk for events and patient mortality.
adverse events and However, the resources for
accordingly prevent the nursing staff are limited in all
patient’s health organisations. Nurse managers,
condition from therefore, have to use available
deteriorating. resources in the most optimal
way. This study provided some
As compared with the new evidence to suggest that
patients/nurse the traditional nurse staffing
classification, models method, the patient-to-nurse
estimated on basis of ratio, is not necessarily
the RAFAELA preferable when it comes to
classification system controlling for patients’ severity
generally provided and casemix
larger effect sizes,
greater statistical
power and better
model fit, although the
difference was not very
large. Net benefits as
calculated on the basis
of decision analysis did
not provide any clear
 evidence on which
measure to prefer.

5 Professional Pierfrancesco Dimensions/composites observational Our main findings The nurses’ strong commitment
attitudes toward Tricarico, Luigi study relate to our novel to procedures seems to drive
incident Castriotta, Incident reporting forms approach in which we the first phases of IR
reporting: can we Claudio Inpatients attendance combined the IR and implementation, with prompt
measure and Battistella, Day hospital/day surgery FTE data, and present involvement in the system and
compare Fabrizio attendance a new perspective on consistent behavior. The
improvements in Bellomo, Ambulatory care attendance professionals’ attitudes attitudes of doctors may
patient safety Giovanni Nurses full-time equivalent toward IR. We found represent the growing safety
culture? Cattani, Doctors full-time equivalent that doctors, whose IR culture within the hospital,
Lucrezia Other full-time equivalent rates increased starting from initial skepticism
Grillone, Complaints significantly during the before increasing their
Stefania Degan, Praises 6-year period, were involvement, particularly
Daniela De Corti, Work accidents more likely to report regarding their reporting of near
And Silvio AEs than nurses, but misses, which are particularly
Brusaferro the proportion of self- important in safety improvement
(2017) reporting was higher initiatives. However, the
for nurses. Both nurses selfreporting data suggest that
and doctors were more doctors, in particular, have not
likely to report AEs fully accepted the IR system as
than near misses. We an opportunity for their own
also found significant improvement.
decreases in the rates While IR systems offer
of patient complaints opportunities related to their
and work accidents original
that helped us to purpose of highlighting critical
interpret the trends in situations inside hospitals, our
IRs. The rate of IRs data shows that they are useful
filed by professionals for other applications. The
tended to increase trends in IRs, once expressed in
during the study period, rates, can be compared over
although not time and represent a reliable
significantly. In prior estimate of the penetration of a
studies, higher safety culture. It is also clear
reporting rates were that alternative proxy indicators
associated with should be used to support the
improvements in interpretation of trends in IR
surveymeasured rates. We believe that new
safety culture and indicators and different
negatively associated combinations of trends could be
with litigation used to provide more complete
claims, but were not understanding of the
related to patient phenomenon.
satisfaction
6 Attitudes of Marilyn J Topic guide for the focus qualitative Cultural differences Our study has identified, in an
doctors and Kingston, Sue M groups study between doctors and Australian
nurses towards Evans, Brian J • What comes to mind when nurses, identified using context, that innovations to
incident reporting: Smith and Jesia you hear the word “incident Triandis’ improve patient
a qualitative G Berry (2004) reporting”? theory of social safety, such as incident
analysis • What is the current reporting behaviour, were found reporting, require
process in your organisation? to underpin attitudes to cultural change. A climate that
• Can you think of any incident reporting. does not
positive things that have Nurses reported more foster disclosure and
occurred as a result of habitually than doctors investigation of errors
completing an incident due to a culture which has been found to be pervasive
report? Can you think of any provided in healthcare
negative things? directives, protocols systems both locally and
• How would you rate the and the notion of overseas, and is
current reporting system? security, whereas the clearly detrimental to patients’
• If you were in charge of the medical culture was best interests.
incident reporting system, less Cultural change is possible,
what changes, if any, would transparent, favoured even if it is a
you make? dealing with incidents slow process. Further research
• How many times a year, on “in-house” and was is required to
 average, do people in your less reliant on test whether facilitating
position fill out incident directives. Common conditions for incident
reports? barriers to reporting reporting alters reporting
• Why do people decide to incidents included time behaviour.
complete an incident report? constraints, However, this in itself is unlikely
• How do you think people unsatisfactory to lead to
feel when they complete an processes, deficiencies any change without the support
incident report? in knowledge, cultural and
• Based on your experience, norms, inadequate involvement of top-level
how many times a year feedback, beliefs about management in the
should people in your position risk, and a perceived promotion of a culture of safety.
fill out an lack of value in the
incident report? process.
• What makes people in your
position decide not to
complete a report?
• Does the seriousness of the
situation have any bearing on
whether an incident report is
made,
or not?
• On the sheet, I have listed
some of the obstacles to
reporting.* Do you have any
comments?
Which of these do you regard
as the really big issues? Are
there any other obstacles?
• Would having a form with
the option of not identifying
the reporter make a
difference?
• Is there anything else we
should have discussed that
we haven’t touched on yet?
7 Factors affecting Ari Mwachofi Age Descriptive Most nurses held Our research provides insight
nurses' Stephen L. Gender study positive perspectives into IT’s effect on patient safety.
perceptions of Walston Badran Salary regarding service Technology has long
patient safety A. Al-Omar, Error-Seen quality. their patient promised to significantly
(2011) Resolve safety perceptions at improve patient quality and
Safe-Suggest department and safety
Tech-Check hospital level. Data
E-Interface indicate that only 7.6 The need to provide quality,
IT-Proficient per cent viewed patient cost-effective healthcare has
MicroMedex safety in their caused most nations to
Updated-Medex department poorly or closely examine how their
Private-HIS acceptable. The rest healthcare can be better
perceived patient provided. Leaders are now
Patient Safety safety as good to seeking
excellent. At the to improve hospital patient
hospital level, just 10.6 safety and are looking at
per cent perceived methods to change their
patient safety poorly or systems
acceptable. The rest and cultures. Our research
perceived patient provides a glimpse of one
safety at the hospital critical professional group’s
level ranging from good perceptions and suggests
to excellent. Thus, various means by which hospital
nurses perceive staff can improve patient
relatively good patient quality and safety.
safety in their hospitals.
Probing further into
nurse perceptions, we
asked if they would be
safe being treated as
patients in their
respective hospitals.
Responses are Over
three-quarters (77.4
per cent) agreed or
strongly agreed that
they would feel safe as
patients. Responses
indicate a slightly
diminished patient
 safety view that was
indicated by their
responses to the earlier
two questions.

8 Influence from Espen Olsen, Safety climate at the hospital Cross- Generally, the results Conclusively, unit leaders must
organisational (2018) level sectinal support the work to improve organisational
factors on patient safety descriptive measurement concepts learning and
safety and safety leadership study applied in the current continuous improvement, which
behaviour among safety study. All items had aims at developing learning
nurses and climate at the unit level. satisfactory statistical cultures at unit levels. It
hospital safety variation, and is also crucial that unit leaders
staff outcomes. correlations among ensure and maintain staffing
concepts were adequacy, or, when
adequate, illustrating possible, adjust workload
discriminant validity. according to staffing levels. Unit
With the exception of leaders should motivate
Organizational hospital staff to engage in safety
learning—continuous behaviour, and to be mindful of
improvement, which expected and
had a marginally lower unexpected risk
reliability score,
reliability coefficients,
assessed by
Cronbach’s alphas,
were satisfactory. The
cross validation
approach using
confirmatory factor
analysis revealed that
measurement concepts
generally fit the data
within recommended
criteria among both
nurses and other
hospital staff as well as
in the total sample. As
such, the psychometric
properties supported
the use of
measurement
concepts.
9 Applying Yii-Ching Lee 1. Teamwork climate Case study Patient safety culture Cooperation among hospital
importance- Hsin-Hung Wu 2. Safety climate has become an units should be improved to
performance Wan-Lin Hsieh 3. Job satisfaction essential issue for establish a positive patient
analysis to patient Shao-Jen Weng 4. Stress recognition healthcare staff. In our safety culture. Nine questions
safety culture Liang-Po Hsieh 5. Perceptions of study, the Chinese were minor weaknesses and
Chih-Hsuan management SAQ version, based on when major weaknesses have
Huang , 6. Working conditions the Taiwan Joint been addressed, minor
(2015) 7. Hospital management Commission on weaknesses could be improved.
support for patient safety Hospital Accreditation Overall, five factors (teamwork
8. Teamwork across instrument, is used to climate, safety climate, job
hospital units assess staff attitudes satisfaction, stress
9. Hospital handoffs and towards patient safety. recognition and working
transitions Physicians, nurses and conditions) are identified as
senior managers were essential strengths to improve
patient safety culture asked to answer 41 competitiveness. We suggest
questions categorized that attention to essential
under nine dimensions. weakness, hospital handoffs
The IPA normally and transitions, which represent
assumes an transferring patients and
independent correlation information between units
between and shifts, should improve
importance and patient safety culture.We reveal
performance. that hospital handoffs and
Surveying two different transitions were assessed as
groups (hospital staff the lowest construct among nine
and senior managers) dimensions.
 to assess their
importance and
performance
perceptions should
minimize the
importance-
performance response
function and obtain
different patient safety
perceptions. An IPA
plot was conducted to
classify nine
dimensions and 41
questions into four
major importance and
performance groups to
diagnose essential
factors that enhance
the patient safety
culture. Nine patient
safety culture
dimensions were
assessed. Results
show that five
dimensions (teamwork
climate, safety climate,
job satisfaction, stress
recognition and
working conditions) are
considered to be major
patient safety culture
strengths. One
dimension (perceptions
of management) is a
major weakness.
10 Incident Reporting Eshetu Infrastructure Cross- This study showed that The study identified that training
Behaviours and Haileselassie Personnel quality sectinal the overall proportion on incident reporting, reporting
Associated Engeda (2016) Process of clinical care descriptive of nurses who reported of incidents to help a patient,
Factors Administrative procedures study incidents was very low. fear of administrative sanctions,
among Nurses Safety indicators Better incident fear of legal penalty, and fear of
Working in Hospital image reporting behaviour loss of prestige as significant
Gondar University Social responsibility was demonstrated predictors of nurses’ incident
Comprehensive Trustworthiness of the when the incident had reporting behaviour. When
Specialized hospital no potential harmto the health institutions are able to
Hospital, patient. Training on establish a successful
Northwest patient satisfaction. incident reporting, incident reporting system,
Ethiopia reason to report (to patient safety could be improved
help a patient), fear of and the system would allow
administrative nurses and other clinicians to
sanctions, fear of legal have easy access to reporting
penalty, and fear of an incident with an
loss of prestige understanding that their report
among colleagues could be handled in a
were the factors nonpunitive manner. Moreover,
significantly associated the reported incidents would be
with the incident used in a positive way in that
reporting behaviour of health professionals could learn
nurses. It is from their mistakes and improve
recommended that the healthcare system and service
hospital needs to train without fear of administrative
its nurses about the and/or legal consequences. On
benefits of incident top of that, such kind of system
reporting with regard to fosters enhanced learning
ensuring and regarding the causes of
promoting patient incidents and helps health
safety. institutions effectively design a
sustainable mechanism to
prevent incidents from recurring.
11 Health care Indre Brasaite, Teamwork climate Cross- The results of this Attitudes related to patient
professionals’ Marja Kaunonen, Safety climate sectinal study were partly in- safety issues are positive
attitudes Arvydas Job satisfaction descriptive line with earlier results, among health care
regarding patient Martinkenas and Stress recognition study there were also professionals in Lithuania, which
safety: Tarja Suominen Perceptions of management contradictory elements. helps to open the door for the
cross‑sectional (2016) Working conditions As such, further study open discussion of patient
survey is needed to establish safety and adverse events.
 Patient safety attitudes links between However, in future we also need
these areas, and the to investigate the knowledge
attitudes and and skills professionals have in
background factors of relation to patient safety, in
individual respondents, order to gain a deeper
and this may prove understanding of the present
important in developing situation.
our clinical practices.
Age seemed to be
associated
with many safety
attitudes scales, and it
has previously been
reported that the
highest positive safety
score when comparing
younger and older age
groups
was to be found to be
in the 30–35 year age
group. In our study
however, safety
attitudes were found to
be higher
in older age groups.
This may be explained
by the linked years of
work experience which
indicates that health
care professionals who
know their job very
well, may also hold
enhanced safety
attitudes. It was
interesting to find that
physicians had higher
safety attitudes
towards teamwork
climate than nurses
and nurse assistants.
12 The influence of Carien W. Competitive mechanisms qualitative Although the formal In conclusion, patient safety
environmental Alingh, Jeroen Experienced room to study responsibility rests with management requires a
conditions D. H. van manoeuvre the board of directors, balanced approach in which
on safety Wijngaarden, Strategic responses all hospitals in this hospitals are encouraged to
management in Robbert Safety management study established a combine both control- and
hospitals: a Huijsman and approach structure of shared commitment-based
qualitative study Jaap Paauwe responsibilities and management practices.
(2018) joint decision-making Institutional and competitive
on hospital-wide safety pressures as well as strategic
policies and practices: choices that hospitals make,
“Together with the result in various
board of directors, the combinations of the safety
medical advisory board management approaches. The
takes decisions on dominant coalition tends to
many organisational prefer a control-based approach
issues. For all topics when they experience little room
related to the national to manoeuvre
programme ‘Prevent and when they expect
Harm, Work Safely’, an healthcare professionals to lack
action plan is, for intrinsic motivation. The
example, presented adoption of a commitment-
which is approved by based management approach is
both of them” . Medical generally chosen if the dominant
specialists have a coalition expects safety
powerful voice in these requirements to generate
decision-making intrinsic motivation in healthcare
processes, especially professionals of when they
in case of care-related experience plenty of room to
matters such as patient manoeuvre. External pressures
safety. “There is no mainly steer managers towards
board of directors of a a control-based safety
Dutch hospital who management approach, which
does something that generates extrinsic motivation in
doctors don’t want to, employees but may, at the
because then your same time, undermine or even
 days as a board diminish intrinsic motivation to
member are simply work on patient
numbered”. safety.
Remarkably, nurses,
who have a central role
in care delivery and
who form a significant
part of the hospital
staff, are not closely
involved in shaping
hospital wide safety
policies and practices.
With regard to
departmental safety
issues, a similar
pattern of shared
responsibilities was
found. “Together with
the medical manager,
as a duo we are
responsible for taking
care of and ensuring
patient safety [in our
department]”.
Departmental safety
policies and practices
are deeply influenced
by choices made at the
hospital level.
Nonetheless, business
unit managers, medical
managers and nurse
managers still have
some leeway for
shaping safety
management within
their own department.
13 Improving patient Johan Hellings Work environment Cross- Overall limited We used a quantitative
safety culture Ward Schrooten Professional background sectinal progress was realised. approach to measure safety
Niek S. Klazinga Direct patient interaction descriptive Although much needs culture. With this approach there
Arthur Vleugels, Professional experience study to be done on the road is a risk that one selects and
(2010) towards hospital measures dimensions that are
patient safety, this not relevant or important in
study can present terms of organisation’s cultural
lessons from various dynamics. There are doubts
perspectives. First, it whether our questionnaire is
illustrates that hospital actually reliable and valid, since
staff are highly validating something as deep
motivated to participate and complex as cultural
in measuring patient assumptions is intrinsically
safety culture. Second, difficult. It would be interesting,
it identifies safety therefore, to explore more in-
domains that urgently depth specific topics that were
need improvement in revealed by the survey using
these hospitals; that is, qualitative approaches, like
hospital transfers and interviews or focus groups.
transitions, non- From a qualitative perspective, it
punitive response to would be interesting to
errors. Third, it investigate specific safety
confirms how complex culture issues in different wards
realising patient safety and departments, and also
culture progress can interaction between professional
be, demonstrating at cultures
the same time that it is
possible to improve
management patient
safety support.
14 Implementation of Kathleen L. 1. Patient safety initiative Cross- We hypothesized that Therefore, it appears that an
patient safety McFadden Importance sectinal the greater the effective strategy for increasing
initiatives in US Gregory N. 2. Patient safety initiative descriptive perceived importance the level of implementation at
hospitals Stock Charles R. Barriers study of PSIs, the higher the hospitals is to have an
Gowen III, 3. Patient safety initiative level of enthusiastic patient safety
(2006), Implementation implementation. The leader who buys into the various
results from our initiatives. This is an important
Hospital Benefits regression model finding for more senior hospital
 supported this administrators who want to
hypothesis. create change in their
Specifically, our organization. Approaches for
findings suggest that getting hospital administrators
the more emphasis the and employees to realize the
patient safety leader importance of the PSIs could
places on these PSIs involve increased education
the more likely the through research efforts as well
hospital is to actually as through professional
implement them. conferences and seminars on
this issue. Given that the level of
PSI implementation at the
hospitals surveyed
15 Factors affecting Stephen L. Management support Cross- Our findings provide Patient safety continues to be a
the climate of Walston Badran Good reporting systems sectinal practice implications critical healthcare factor in all
hospital patient A. Al-Omar organizational climate descriptive and suggest that three countries. There is a
safety: A study of Faisal A. Al- Adequate resources study dimensions need need to provide better and safer
hospitals in Saudi Mutari, (2010) highlighting: care. Our research provides an
Arabia (1) Management international perspective on how
Patient safety. support. staff can differ in their patient
(2) Reporting systems. safety focus and demonstrates
(3) Resource adequacy how managerial support, proper
significantly affect reporting systems and adequate
patient safety climates. resources can affect hospital
Patient safety is a patient safety climate. Hospitals
critical component in that address these issues are
the quality of patient likely to provide better and safer
care. Yet, many patient care.
organizations ignore
the underlying factors
that contribute to
improved patient
safety. Healthcare
organizations,
especially hospitals,
need to allocate the
time and resources to
assure that these
conditions exist in their
facilities that create not
only monitors to
measure quality but
processes,
encouragement, and
resources that produce
a climate and
eventually a culture
that becomes self-
regulating and
promotes patient
safety.
16 Attitudes of Marilyn J Habit qualitative Our qualitative study Cultural differences between
doctors and Kingston, Sue M Social factors study has improved doctors and nurses, identified
nurses towards Evans, Brian J Intention understanding of the using Triandis’ theory of social
incident reporting: Smith and Jesia Affect attitudes of medical behaviour, were found to
a qualitative G Berry (2004) and nursing health underpin attitudes to incident
analysis professionals towards reporting. Nurses reported more
reporting incidents, and habitually than doctors due to a
identified process culture which provided
disincentives to directives, protocols and the
reporting within a notion of security, whereas the
context of cultural medical culture was less
variation.Understandin transparent, favoured dealing
g the culture of an with incidents “in-house” and
organisation is critical was less reliant on directives.
to Common barriers to reporting
making sense of the incidents included time
behaviour observed in constraints, unsatisfactory
it, and values,beliefs processes, deficiencies in
and assumptions form knowledge, cultural norms,
the core of inadequate feedback, beliefs
organisational culture. about risk, and a perceived lack
The focus-group of value in the process.
commentary suggested
a division of cultures, in
which hierarchies may
impede
communication,
particularly across
professional groups.