Application of the hospital survey on patient safety culture (HSOPSC) to dentistry

Eun Suk An; Ho Sung Shin

doi:10.11149/jkaoh.2013.37.4.216

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An and Shin: Application of the hospital survey on patient safety culture (HSOPSC) to dentistry

Original Article

J Korean Acad Oral Health 2013;37(4):216-223.

Published online: 12 December 2013

DOI: https://doi.org/10.11149/jkaoh.2013.37.4.216

Application of the hospital survey on patient safety culture (HSOPSC) to dentistry

Eun Suk An, Ho Sung Shin

Department of Humanity & Social Dentistry, Wonkwang University College of Dentistry, Iksan, Korea

Corresponding Author: Ho Sung Shin Department of Humanity & Social Dentistry, Wonkwang University College of Dentistry, 460 Iksan-dearo, Iksan 570-749, Korea Tel: +82-63-850-6995 Fax: +82-63-850-6915 E-mail: shinhosung@gmail.com

Received 22 August 2013 Revised 9 October 2013 Accepted 9 December 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The topic of patient safety has recently gained attention across healthcare institutes. Building a broad awareness of patient safety issues among dental care personnel, thus establishing a sound patient safety culture, has beneficial prophylactic effects on the quality assurance of dental care services. This study examines the adequacy and validity of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire developed by the Agency for Healthcare Research and Quality (AHRQ) for application to Korean dental care institutes.

Methods

The HSOPSC, which is a self-administered questionnaire survey, was administered to dental care workers who participated in the 2011 Dental Care Quality Assurance Symposium. The reliability and construct validity of the questionnaire were tested using STATA 11.0; factor, reliability, and correlation analyses were performed.

Results

Awareness of patient safety was dealt with in 10 subareas comprising 38 items. The 10 subareas were included patient safety policy at the institute level, open communication, patient safety-related expectations and behaviors of managers, frequency of reporting on patient safety-related incidents, and teamwork within the department. Both the construct validity and internal consistency of each factor were confirmed to be adequate.

Conclusions

The results of the adequacy test for the application of this questionnaire to dental care institutes revealed that most items had a certain level of validity and reliability. However, it is necessary to reflect upon the specificity of dental care services to assess patient safety culture within dental care institutes more accurately.

Keywords: Dental care institutes, HSOPS, Patient safety culture, Reliability, Validity

References

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Table 1.

Demographic characteristics of respondents

	Variable	Frequency	Percent
Type of dentalhospital	Dental school affiliatedhospital	198	79.52
	Medical school affiliateddental hospital	3	1.20
	Large private dentalhospital	31	12.45
	Small private dentalhospital	17	6.83
Work experience(yrs)
Hospital	≤1	30	12.00
	≤2-5	77	30.80
	≤6-10	60	24.00
	≤11-15	41	16.40
	≤16-20	23	9.20
	≥21	19	7.60
Unit	≤1	57	22.80
	≤2-5	104	41.60
	≤6-10	61	24.40
	≤11-15	18	7.20
	≤16-20	6	2.40
	≥21	4	1.60
Specialty	≤1	23	9.24
	≤2-5	57	22.89
	≤6-10	69	27.71
	≤11-15	50	20.08
	≤16-20	19	7.63
	≥21	31	12.45
Working hours	<20	3	1.20
	20-39	16	6.40
	40-59	206	82.40
	60-79	20	8.00
	80-99	5	2.00
Job title	Dentist	7	2.81
	Dental hygienist	188	75.50
	Dental technician	5	2.01
	Nurse	7	2.81
	Adminstration worker	20	8.03
	Other	22	8.84
Job position	Manager	20	8.06
	Unit manager	45	18.15
	Unit member	157	63.31
	Other	26	10.48
Direct contactwith patient	Contacted	216	87.10
Direct contactwith patient	Non contacted	32	21.74

Table 2.

Results of factor analysis

Item F1	F1	F2	F3	F4	F5	F6	F7	F8	F9	F10
F2. Hospital units do not coordinate well with each other	063
F3. Things “fall between the cracks”when transferring patients from one unit to another	0.76
F4. There is good cooperation among hospital units that need to work together	0.57
F5. Important patient care information is often lost during shift changes	0.67
F6. It is often unpleasant to work with staff from other hospital units	0.44
F7. Problems often occur in exchange of information across hospital units	0.66
F9. Hospital management seems interested in patient safety only after an adverse event happens	0.44
F10. Hospital units work well together to provide the best care for patients	0.46
C1. We are given feedback about changes put into place based on event reports		0.57
C2. Staff will freely speak up if they see something. that may negatively affect patient care		0.72
C3. We are informed about errors that happen in this unit		0.66
C4. Staff feel free to question the decisions or actions of those with more authority		0.57
C5. In this unit, we discuss ways to prevent errors from happening again		0.65
B1. My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures			0.77

B2. My supervisor/manager seriously considers staff suggestions for improving patient safety			0.79
B4. My supervisor/manager overlooks patient safety problems that hap- pen over and over			0.58
D1. When a mistake is made, but is caught and corrected before af- fecting the patient, how often is this reported?				0.82
D2. When a mistake is made, but has no potential to harm the patient, how often is this reported?				0.90
D3. When a mistake is made that could harm the patient, but does not, how often is this reported?				0.92
A1. People support one another in this unit					0.77
A2. We have enough staff to handle the workload					0.52
A3. When a lot of work needs to be done quickly, we work together as a team to gets the work done					0.66
A4. In this unit, people treat each other with respect					0.75
A5. Staff in this unit work longer hours than is best for patient care						0.51
A6. We are actively doing things to improve patient safety						0.52
A12. When an event is reported, it feels like the person in being writ- ten up, not the problem						0.56
A13. After we make changes to improve patient safety, we evaluate their effectiveness						0.39
A14. We work in “crisis mode” trying to do too much, too quickly						―0.55
A18. Our procedures and systems are good at preventing errors from happening						0.36
A9. Mistakes have led to positive changes here							0.80
A10. It is just by chance that more serious mistakes don’t happen around here							0.78
C6. Staff are afraid to ask question the when something does not seem right								0.70
F1. Hospital management provides a work climate that promotes patient safety								0.49
F8. The actions of hospital management show that patient safety is a top priority								0.47
A8. Staff feel like their mistakes are held against them									0.75
A16. Staff worry that mistakes they make are kept in their personnel file									0.60
A15. Patient safety is never sacrificed to get more work done										0.61
B3. Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts										0.72
Explorative factor analysis
Number of items	8	5	3	3	4	6	2	2	3	2
Chronbach alpha	0.82	0.83	0.78	0.90	0.75	0.67	0.71	0.45	0.58	0.21

F1, patient safety policy across hospital units; F2, feedback and openness of communication for patient safety; F3, supervisor/manager democrati expectations/actions; F4, frequency of event reporting; F5, teamwork within units for patient safety; F6, system and procedure for patient safety F7, organizational training & response; F8, strict manager response to error; F9, concern for errors; F10, burden of workload.

Table 3.

Comparison of patient safety culture between AHRQ 12 dimensions and 10 dimensions (this study)

12 Dimension	Item	10 Dimension
Hospital handoffs and transitions	F3. Things “fall between the cracks”when transferring patients from one unit to another	F1
	F5. Important patient care information is often lost during shift changes	F1
	F7. Problems often occur in exchange of information across hospital units	F1
	F11. Shift changes are problematic for patients in this hospital	-
Teamwork within units	A1. People support one another in this unit	F5
	A3. When a lot of work needs to be done quickly, we work together as a team to gets the work done	F5
	A4. In this unit, people treat each other with respect	F5
	A11. When one area in this unit gets really busy, others help out	-
Organizational learning: continuos improvement	A6. We are actively doing things to improve patient safety	F6
	A9. Mistakes have led to positive changes here	F7
	A13. After we make changes to improve patient safety, we evaluate their effectiveness	F6
Frequency of event reporting	D1. When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported?	F4
	D2. When a mistake is made, but has no potential to harm the patient, how often is this reported?	F4
	D3. When a mistake is made that could harm the patient, but does not, how often is this reported?	F4
Nonpunitive response to error	A8. Staff feel like their mistakes are held against them	F9
	A12. When an event is reported, it feels like the person in being written up, not the problem	F6
	A16. Staff worry that mistakes they make are kept in their personnel file	F9
Supervisor/manager perception promoting patient safety	B1. My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures	F3
	B2. My supervisor/manager seriously considers staff suggestions for improving patient safety	F3
	B3. Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts	F10
	B4. My supervisor/manager overlooks patient safety problems that happen over and over	F3
Feedback and communication about error	C1. We are given feedback about changes put into place based on event reports	F2
	C3. We are informed about errors that happen in this unit	F2
	C5. In this unit, we discuss ways to prevent errors from happening again	F2
Communication openess	C2. Staff will freely speak up if they see something that may negatively affect patient care	F2
	2 C4. Staff feel free to question the decisions or actions of those with more authority	F2
	C6. Staff are afraid to ask question the when something does not seem right	F8
Teamwork across hospital units	F2. Hospital units do not coordinate well with each other	F1
	F4. There is good cooperation among hospital units that need to work together	F1
	F6. It is often unpleasant to work with staff from other hospital units	F1
	F10. Hospital units work well together to provide the best care for patients	F1
Hospital management support for patient safety	F1. Hospital management provides a work climate that promotes patient safety	F8
	F8. The actions of hospital management show that patient safety is a top priority	F8
	F9. Hospital management seems interested in patient safety only after an adverse event happens	F1
Staffing	A2. We have enough staff to handle the workload	F5
	A5. Staff in this unit work longer hours than is best for patient care	F6
	5 A7. We use more agency/temporary staff than is best for patient care	-
	7 A14. We work in “crisis mode” trying to do too much, too quickly	F6
Overall perceptions of safety	A10. It is just by chance that more serious mistakes don’t happen around here	F7
	A15. Patient safety is never sacrificed to get more work done	F10
	A17. We have patient safety problems in this unit	-
	A18. Our procedures and systems are good at preventing errors from happening	F6

F1, patient safety policy across hospital units; F2, feedback and openness of communication for patient safety; F3, supervisor/manager democratic expectations/actions; F4, frequency of event reporting; F5, teamwork within units; F6, system and procedure for patient safety; F7, organizational training & response; F8, strict manager response to error; F9, concern for errors; F10, burden of workload.

Table 4.

Mean and correlation coefficients of factor scores

Variable	mean	SD	1	2	3	4	5	6	7	8	9	10
1 Patient safety policy across hospital units	2.33	0.70	1.00
2 Feedback and openness of communication for patient safety	2.68	0.79	0.59	1.00
3 Supervisor/manager democratic expectations/actions	2.33	0.74	0.52	0.63	1.00
4 Frequency of event reporting	2.83	0.89	0.28	0.35	0.30	1.00
5 Teamwork within units for patient safety	2.25	0.59	0.47	0.55	0.47	0.23	1.00
6 System and procedure for patient safety	2.70	0.49	0.46	0.50	0.50	0.40	0.58	1.00
7 Organizational training & response	2.48	0.76	0.43	0.44	0.42	0.27	0.41	0.45	1.00
8 Strict manager response to error	2.31	0.72	0.66	0.60	0.52	0.35	0.46	0.48	0.34	1.00
9 Concern for errors	3.25	0.79	0.44	0.39	0.37	0.27	0.31	0.30	0.35	0.38	1.00
10 burden of workload	2.67	0.80	0.27	0.30	0.32	0.21	0.28	0.26	0.23	0.28	0.27	1.00

All over significant P<0.01.

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