Patient safety culture in oncology healthcare settings in Malta

Abstract

Background: In recent decades, there has been a significant increase in patient safety, safety culture and incident reporting publications as well as commitments and efforts to reduce patient harm. A safety culture that can be measured, understood and improved is considered a pillar to the patient safety movement. This is especially emphasised in the realm of oncology healthcare, given its inherent complexity and toxicity of the treatment modalities involved. Aim: This research study aimed to explore the perceptions of different healthcare professionals of patient safety culture in oncology healthcare settings in Malta. Moreover, this research study aimed to investigate the relationship between safety culture dimensions and safety-related behaviour, specifically reporting of patient safety events. Design: A retrospective, descriptive and analytical cross-sectional research study was conducted. A mixed-method, concurrent triangulation strategy was employed, following pragmatism principles. Data was collected through a self-administered quantitative questionnaire and a semi-structured focus group interview. Participants: A total population sampling strategy was employed to recruit participants in the questionnaire-part of the study. Specifically, all full-time and part-time healthcare professionals and management who had been working in Sir Anthony Mamo Oncology Centre for at least 6 months were asked to participate. Out of the 239 questionnaires distributed, 129 questionnaires were returned, achieving a total response rate of 53.97%. On the other hand, maximum variation sampling was employed to recruit participants in the focus group interview. Specifically, the focus group interview comprised of four nursing, two allied healthcare professionals and one health carer working in Sir Anthony Mamo Oncology Centre for at least six months. Results: Findings from the present research study highlight a number of gaps in the perceptions of safety culture among healthcare professionals working in oncology healthcare settings in Malta, namely in the following components: hospital management support for patient safety (M=2.92, SD=0.784), response to error (M=2.81, SD=0.714), and staffing and work pace (M=2.72, SD=0.833). In addition, findings revealed statistically significant differences in responses across different healthcare professional groups, highlighting the need for adaptivity and individualised approach in prioritising and implementing strategies among diverse healthcare professional groups. Furthermore, higher levels of communication about error and higher levels of response to error were identified as significant predictors of higher frequency of patient safety event reporting, explaining 38.4% of the total variation in the responses (r= 0.384). Overall, quantitative and qualitative findings aligned. However, qualitative findings indicated mixed findings with regards to communication about error and organisational learning as participants in the focus group interview expressed frustration regarding the effectiveness of incident reporting stating that they often felt that their concerns were met with inaction in terms of feedback and learning from errors. Furthermore, differences in perceptions across healthcare professional groups did not emerge in the qualitative insights gathered. Finally, in addition to the dimensions explored by the quantitative questionnaire, the qualitative insights obtained from the focus group interview revealed a noteworthy component of safety culture, that had not been encapsulated and explored by the questionnaire – that of training and continuous professional development. Participants emphasised its importance in oncology healthcare setting, shedding light on a previously overlooked dimension. Conclusion: This research study gave an insight into healthcare professionals’ perceptions of safety culture as well as the impact of safety culture on incident reporting in the local oncology healthcare settings. The study indicated various deficiencies inherent in the local safety culture. Furthermore, findings highlighted the significance of feedback systems as well as the significance of just culture in error management and their contribution to safety behaviour, specifically incident reporting.