FACTOR ANALYSES THE IMPLEMENTATION OF THE PATIENT

SAFETY CULTURE IN THE HOSPITAL : SYSTEMATIC REVIEW

RESEARCH IN THE HEALTH CONCERN

Lilik Wijayati¹, Djazuly Chalidyanto²

1
Departement of Administration and Health Policy,Universitas Airlangga, Surabaya
Jalan Dr. Ir. H. Soekarno, Mulyorejo, 60115
E-mail:lilik.wijayati-2018@fkm.unair.ac.id
2
Lecturer on Departement of Administration and Health Policy, Universitas Airlangga, Surabaya
Jalan Dr. Ir. H. Soekarno, Mulyorejo, 60115
djazulych@fkm.unair.ac.id

ABSTRACT

Background: Patient safety is a global issue of health care in hospital. It is a system to make patient
care safer include risk assessment, identification and management of matters relating to the risk of the
patient, reporting and analyzing of incident, the ability to learn form the incident, and follow up
implementation of solution to reduce risks and to prevent injuries caused by errors due to carry out an
act that should be done. WHO (World Health Organization) 2014 collected hospital research in
various countries such as Denmark and Australia. It be found 3.2% - 16.6%. That be triggered in
different countries to conduct research and development of patient safety system.

Aim: The purpose of this study is to analyze factors that affect implementation of patient safety in the
hospital and to give recommendation of monitoring and evaluation patient safety as well.

Method : the Journal had searched towards multiple database : DOAJ, Sage, Proquest, Medline,
Google Scholar, Science Direct. It used limited time in January 2013 to august 2018. From 1797
article, only 15 articles that suitable with the inclusion criteria.

Results : from the 15 literature had acquired factors that affect the implementation of patient safety
such as : economics aspect, leadership, culture, health care system, knowledge, attitudes, and actions
of professional, analysis of the situation and workplace conditions, the risk management system, the
duration of nurse’s working hours, mentoring program, nursing supervision, and evaluation of the
patient safety implementation. The instrument used to measure the implementation of patient safety
include questionnaires, checklists observation form, and interview form. The instruments are often by
the environmental practice scale of the nursing work index (PES-NWI) and the hospital survey of
patient safety culture.

Conclusion : these factors can provide positive support in the hospital to implement management
system and excellent health services by optimalizing the implementation of patient safety to reduce the
risk malpractice or undesirable events. In the implementing patient safety expected to have good
cooperation and collaboration of hospital’s to be run optimally. It can provide a positive impact on
improving the quality of health service.

Keyword : patient safety, health, helath worker, hospital

1
BACKGROUND
Patient safety is a system to make
patient care safer include risk assessment,
identification and management of matters
relating to the risk of the patient, reporting and
analysing of incident, the ability to learn form
the incident, and follow up implementation of
solution to reduce risks and to prevent injuries
caused by errors due to carry out an act that
should be done (ministry oh helath 2011). The
hospitals always tried to increase the level of
patient safety. Patient safety incidents at the
hospital will give negative impact on hospital,
staff, and patient, because they are recipient of
the service. The impact was decreased the
level of public trust to the health service. Low
quality of care provided for patient safety was
part of quality service (Flynn, 2002 in cahyono
2008).
Safety is a global issue, it summarized
in five important issues related to hospital such
as patient safety, hospital safety, environment
safety, building safety and hospital business
safety. It was important to be implementation,
but it must be recognized hospital activities be
operated there was patients. Patient safety is
key priority for implementation issues related
to the quality and image of hospitalization
(Moh 2011). WHO (World Health
Organization) 2014 collected hospital research
in various countries such as Denmark and
Australia. It be found 3.2% - 16.6%. That be
triggered in di in different countries to conduct
research and development of patient safety
system (Moh 2011).
The hospital has an important role to realize
optimal level of public health. Therefore, the
hospitals are required to be able to manage
activities by emphasis responsibilities of
health professionals, especially medical and
nursing staff in official dutty. Not always
medical service not often provided health
profesionals workers to get results as aepected
by all people. Because of many accident of
malpractice cases, so must be applied to
patient safety rpograms.
The phenomenon of patient safety
incidents in Indonesia still happen until 2015,
it has been published in kompas daily about
patient safety incidents such as happened for
patient. Martin (7th) died after received wound
care post accident in kefamenamu hospital.
The other happened for swelling and open
wasted on the femur of that injected by nurse
citama bogor hospital, Mrs sutiah (43th) has
urticarial swelling in in the leg blistered post
operative hernia in Kasih Ibu hospital North
Aceh nad other patient safety incidents. It
describe patient safety culture in hospitals that
required special attention in the
implementation. Though patient safety based
on priority in hospital, but in the fact is not as
comfortable as possible.
Nurse is the important health worker
in the process of provided health sevices to
patients. Nurses tried to maintain and to
improve the health client toward provided
health care information that is clear and easily
understood by client nad family, while they not
cured at the hospital. In the nursing
intervention that do not suitable with Standar
Operasional Procedure get risk of decreasing
implementation of patient safety goals.
Based on this phenomenon, the
authors are interested to analyzed factors that
affect the implementation of the patient safety
in hospital.
METHOD
A literature searching towards samo
major databases such as PROQUEST,
SCIENCEDIRECT, DOAJ,SAGEPUB,
MEDLINE, and GOOGLE SCHOLAR by
with input keywords patient safety, health,
health worker. The limited time in January
2011 to august 2016. From 1797 article, only
15 article that suitable inclusion criteria. It
contain were 1) the study design RCT, 2)
variable factors that affect patient safety goals,
3) samples of heatlh workers in hospitals, and
4) parameter that assessed the intensity of the
implementation of patient safety goal.
From the fiveteen literature has
acquired variety of factors that affect the
implementation of patient safety goals, there
are economics aspect, leadership, culture,
health care systems, knowledge, attitudes and
professionals interventions, analysis of the
situation and workplace conditions, the risk
management system, the duration of nurses
working, mentoring programs, nursing
supervision, and evaluation of the
implementation patient safety. While the
parameters used to measure the
implementation of patient safety to get data
from the instrument are questionnaires,
observation sheets and sheets intervies
checklist. The instrument are often used by
2
environmental practice scale of the Nursing
Work Index (PES-NWI) and the hospital
survey of patient safety culture.
RESULTS AND DISCUSSION
Economic aspects
Research Jackson (2009) showed the
influence of the economics aspects of the
implementation of patient safety goals. In the
fact patient of lower economic class got
nosocomial infections beacause of bad
implementation of patient safety in hospital.
The economics aspects impacted care unit
level includes the availability of facilities,
supporting facilities, health care and patient
comfort during hospitalized.
Leadership
Research Kessler (2014) aims to
evaluate theories, models, and empirical
evidence on function, rules and independence
leadership, safety culture and the patient safety
in hospital. Result of the research is the
development framework based on Evidence
Based Nursing which define the relationship
between leadership, safety culture, and patient
safety.
Research setowati (2013) aims to
determine the relationship effective leadership
from head room with the implementation of
patient safety culture. The analysis showed
negative relationship between effective
leadership from head room with the
implementation of patient safety culture.
Effective leadership style from head nurse
such as : effective leadership, knowledge, self-
awareness, communication, energy, passion,
and take action.
Leadership style had great influence on
the implementation of patient safety goals. A
good leader will be a role model for teamwork
in implementation of patient safety, so it can
improve the quality of health service.
Culture
Research bouafia (2015) aims to
determine obediencs staff level towards
implementation of patient safety culture in
hospital education center Tunisia. The results
showed that 68.8% health worker had made
the application of patient safety culture was
low. The cultural factors are very influence in
the implementation of patient safety, because
of providers and users of health survice have a
unique character management. Management
and good cooperation are required by staff at
the hospital. Effort to promote patient safety
program to all people there in hospital
Risk Management Systems and Health
Service
World research 2015 showed that 90%
of health workers in Kinshasa knowed about
risk management infection control, while 89%
health worker do not know about patient
safety. Oyourou OA research and Adeoti 2013
showed the percentage of influence service
management aspect such as : leadership
development (64%), the target document
completeness of patient safety and risk
management (60%), medical technology
(63.6%), human resources (42%), medical
information (40%). Evaluation nursing practice
(20%), finance (16%) and health research
(33%). Djibo study (2013) on the effect of risk
management in the implementation of patient
safety showed the results : 60 % experienced
health professionals provided health service to
patient during hospitalized, 65,7 % are
exposed blood products, 45% do hand hygiene
procedures, 25,7% frequently use medical
equipment, 14.3% of health workers have not
immunize hepatitis-B, and 37.1% had attended
training hand hygiene and patient safety.
The results of three studies showed that
the risk management system and health
services that appropriate can give a positive
influence of optimization in implementation of
patient safety. Completeness of facilities and
staff training will facilitated the
implementation of patient safety in hospital.
Knowledge, attitudes, and actions
Research gebru (2013) aims to identify
knowledge, attitudes, and action in conducted
injection by health worker professionals. The
results showed 161 people (85%) have
knowledge about of injection unsafe or rsky,
135 people (71%) know the way of
administration with a single dose. Other data
showed 149 (79%) know the inaccuracies in
delivery drug that infection, whereas 50 (26%)
of health workers professionals do not apply
aseptic technique, 80 (42%) did not receive
training on injection. Proceduces safety 40% of
health workers experienced needle stick injury
incident.
3
 Research Bernadetta (2015) aims to
determine the relationship knowledge of nurses
about patient safety in the implementation
Standart Operation Procedures of patient safety
related operating procedures in panti waluya
sawahan malang hospital.
The results showed a significant
ralatioship between the knowledge of nurses at
the panti waluya hospital with the
implementation of patient safety in hospital.
Based on spearman correlation statistic value
of it have 0.420 with a significance of 0.001
(P<0.05). 49 responden (81.7%) have
sufficient knowledge, 68.3% are still lacking in
implementation standar operation procedures
of patient safety.
Knowledge, attitudes, and action are
required by health workers who better to
avoid mistakes or malparactice in the provided
of health services. The precision of action by
staff will support the achievement of
optimizing the implementation of patient
safety, so it can improve the quality of health
services.
Situation Analysis and Environmental
Condition Work
Research kirwan (2012) aims to
determine the relationship between the work
environment of nurses towards the
implementation of patient safety. The results
showed that the workload of nurses in each
care unit and the education level of nurses in a
work environment significantly influence the
implementation of patient safety. The
percentage of influence of the workload (76%)
and education (51%). Positive work
environment and workload calculation
according to human resources and staff
education level can support optimal
implementation of patient safet.
Duration working hours nurse
We yinghui research (2013) aims to
determine the effect of the working hours of
nurses towards patient safety. The results
showed that working hours duration of ners per
week divided into three groups, that are <40
hours, 40-60 hours, and >60 hours. The longer
duration of the working hours of nurses can
improve for low implementation safety culture.
The effectiveness of working hours can affect
the quality of performance will support the
implementation of patient safety maximally.
Mentoring program
Research Nurmalia (2013) aims to
determine the effect of implementation of a
mentoring program patient safety culture in
unit at one private hospital in Semarang. The
results show there is influence between the
cultural implication of the control group after
the intervention group mentoring program (p=
0.056, x2=4.5 α = 0.1) and RR 2.5. The
analysis showed group that did not get the
mentoring program will be at risk of decline in
the implication of patient safety culture at 2.5
times greater than the group receiving
mentoring nursing program.
Research suggests new methods of
optimizing the implication of patient safety is
by mentoring. The discussion involves the
principles and theory of four dimensions of
openness, fairness, reporting, and learning
implications for service and nursing education
to develop methods directives in accordance
with the needs of nurses in hospitals.
Nursing Supervision and Patient Safety
Evaluation
Research Suparna (2015) aims to
determine the evaluation of implication of
patient safety: the risk falls the emergency
room at the Panti Rini Kalasan Sleman
Hospital. The results showed that the risk falls
by standard operating procedures, aspects of
which carried 100%, that is writing on
documentation, while 50% falls risk
assessment, aspects of the mounting pins fall
risk, obtained only 51% of its appropriateness.
Research Rasdini (2015) show the relationship
between supervision of nursing services with
the implication of patient safety in the Sanglah
Denpasar, Government Hospital. The results
show that significant correlation between the
supervision of nursing services (normative,
formative, and restorarif) with the application
of patient safety by nurses (p = 0.000).
Supervision of nursing and patient
safety evaluation had given a positive impact
on implementation of patient safety in
hospitals. Supervision of nursing is a form of
supervision and assistance in the intervention
of nurses. Periodic evaluation do to determine
the achievement of implementation of patient
safety. If there is not suitable aspect have done,
better strategies that target the implementation
of patient safety can be optimized for
improving the quality of health care in
hospitals.
4
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