Patient safety culture in Irish healthcare: a mixed-methods investigation

Abstract

Introduction: Medical error is a leading cause of preventable harm worldwide. Patient safety culture has been described as the way in which members of a healthcare organisation think about and prioritise safety. The patient safety culture in a healthcare organisation can be affected by numerous factors including staff perceptions of teamwork, patient safety, working conditions and support from management in their clinical area. A positive patient safety culture has been reported to have a positive impact on patient safety. Various instruments have been used to measure patient safety culture in healthcare organisations around the world over the past two decades, however there is a lack of research on the patient safety culture in Irish healthcare organisations. Over the past decade, the Irish healthcare system has suffered from the after effects of the global financial crisis and historic underfunding, which has led to understaffing and overcrowding in hospitals. The aim of this thesis was to investigate the patient safety culture in Ireland and to explore methods to improve patient safety in Irish healthcare organisations.

Methods: A mixed-methods approach was adopted throughout this thesis. First, a mixed-methods survey study using the Safety Attitudes Questionnaire was carried out to investigate the safety culture in a number of healthcare organisations in the south-west of Ireland. The study involved quantitative analysis of survey results as well as qualitative analysis of data gathered in the comments section of the survey. The results of this mixed methods study informed the development of the topic guide for a qualitative interview study, which aimed to further explore staff perceptions of the safety culture in a large Irish teaching hospital. The results of the survey and interview studies led to the conduction of two systematic reviews: 1) a quantitative systematic review on interventions to improve medication error reporting in hospitals, and 2) a qualitative systematic review on healthcare professionals’ experiences of interprofessional communication.

Results: The mixed methods survey study and qualitative interview study found that Irish healthcare professionals generally have positive attitudes towards the patient safety culture in their clinical area. A number of potential areas for improvement were identified including working conditions, interprofessional communication, education, support from management and medication error reporting. The quantitative systematic review on medication incident reporting identified a lack of intervention studies of strong methodological quality. Anonymity, reporting system format, education and a non-punitive culture were identified as important factors to consider when designing an intervention to improve medication error reporting. The qualitative systematic review on interprofessional communication found that personal factors, such as strong working relationships and an interprofessional ethos can act as facilitators, while organisational factors such as hierarchy and stressful working conditions can act as barriers to interprofessional communication.

Conclusions: This thesis has made a significant contribution to patient safety research and to the knowledge available regarding patient safety culture in Irish healthcare. This thesis makes three novel contributions to the literature on patient safety: 1) An insight into safety culture in Irish healthcare organisations, 2) A novel systematic review of interventions to improve medication incident reporting and 3) A novel systematic review of healthcare professionals’ experiences of interprofessional communication. This thesis therefore lays the groundwork for two future studies to improve patient safety in Irish healthcare organisations, and should therefore be used as a guide for future patient safety research.