Beyond medical errors : patient safety culture in a Maltese obstetrics department

Abstract

The World Health Organisation (2016a) defines patient safety as the absence of preventable harm to a patient during the delivery of healthcare. Evidence from several scholars and researchers has shown the high incidence of patient harm and subsequent high cost of medical errors in hospitals in general and within Obstetric Units. This research study tests a moderated mediated relationship between patient safety friendly working environment and perceived unsafe performance in the Maltese Obstetrics department with burnout as the mediator variable and management support as the moderator. A cross-sectional descriptive and analytical research study was conducted. The target population includes the three Obstetric wards, the Central Delivery Suite, the Breastfeeding clinic and the Neonatal Intensive Care Unit. A sample of 184 healthcare professionals, who fit the eligibility criteria, participated in the research study, achieving a response rate of 73.6%. The research tool in this study was adapted from the ‘Safety Attitudes Questionnaire- Labour and Delivery version’ (Appendix B), from Sexton et al., (2006). Overall, the findings support the theoretical framework. Findings support the hypothesis: the higher the extent to which a patient safety friendly working environment is perceived as favourable to the obstetric team, the lower the obstetric team’s perceived unsafe performance. Findings also support the hypothesis: burnout mediates the relationship between a patient safety friendly working environment and perceived unsafe performance. Moreover, findings support the hypothesis: management support has a negative relationship on perceived unsafe performance. Essentially managers should be seen as supportive and as leaders who act safely, work safely, speak of safety and engage others in safety standards and initiatives. The present research study sheds light on the fact that managers should not focus on safety in isolation, but should implement safety management systems where threats and disturbances that may destabilize the system are identified, monitored and controlled as recommended by Carayon et al., (2006). Health service managers are recommended to create a working environment which fosters staff wellbeing that protects against burnout by finding a balance between job demands and job resources. Future research should adopt a longitudinal design, so as to be able to measure independent variable mediator and moderator at T1 and dependent variable at T2, while controlling for T1. Furthermore a mixed methods approach would have given more depth to the research study. Further research should identify and investigate other safety culture dimensions, develop level-specific subscale perceptions and analyse data at the work group level. In addition, further research should extend the present research study to other healthcare settings, focus on the effectiveness of strategies aimed at improving a patient safety friendly working environment and management support and how these strategies can be adapted to specific units and to hospital subcultures.