Safety culture and systems thinking for predicting safety competence and safety performance among registered nurses in Saudi Arabia: a cross-sectional study
Restricted accessResearch articleFirst published online March, 2021
Safety culture and systems thinking for predicting safety competence and safety performance among registered nurses in Saudi Arabia: a cross-sectional study
Medical errors are a worldwide concern and the contribution of nurses’ safety competence and performance to these errors is a high priority. It has been over 20 years since the first report of the need to address medical errors. New approaches are needed for enhancing safety competence and performance.
Aims
This study explored the relationships among systems thinking, educational level, safety culture, safety competence and safety performance among registered nurses working in medical and surgical units in Saudi Arabia.
Methods
A correlational cross-sectional design with a convenience sample of 84 registered nurses was used.
Results
Systems thinking predicted 16% of safety knowledge (F[2, 81] = 7.61, P = 0.001), while safety culture, baccalaureate education and completion of safety training predicted 19% of safety skill (F[3, 78] = 2.80, P = 0.001). A safety culture that promoted learning from mistakes predicted 15% of safety performance measured based on nurses’ self-report of the number of errors in the past 3 months (F[3, 75] = 2.86, P = 0.008).
Conclusions
Professional development including systems thinking and safety training are the necessary next steps for nurses. In addition, policy changes facilitating organisations to support learning from mistakes will contribute to reducing medical errors.
AboumatarHJThompsonDWuA, et al.(2012) Development and evaluation of a 3-day patient safety curriculum to advance knowledge, self-efficacy and system thinking among medical students. BMJ Quality & Safety21(5): 416–422.
2.
Agency for Healthcare Research and Quality (2017) Root cause analysis, Patient safety network. Available at: https://www.psnet.ahrq.gov (accessed 2 May 2020).
3.
Al-HomayanAMShamsudinFMSubramaniamC, et al.(2013) Analysis of health care system-resources and nursing sector in Saudi Arabia. Advances in Environmental Biology7(9): 2584–2592.
4.
AlMadaniNA (2015) Degree education as an entry requirement for qualified nurses in Saudi Arabia: An overview. The Journal of MacroTrends in Health and Medicine3(1): 142–155.
5.
Al MutairAA (2015) Quality of nursing care in Saudi Arabia: Needs for improvement. Journal of Nursing Care4(6): 1000309.
6.
AlonaziNAAlonaziAASaeedE, et al.(2016) The perception of safety culture among nurses in a tertiary hospital in Central Saudi Arabia. Sudanese Journal of Pediatrics16(2): 51.
7.
AlquwezNCruzJPAlmoghairiAM, et al.(2018) Nurses’ perceptions of patient safety culture in three hospitals in Saudi Arabia. Journal of Nursing Scholarship50(4): 422–431.
8.
AlshammariMHMitalDP (2016) Medical errors in Saudi Arabia: Understanding the pattern and associated financial cost. International Journal of Medical Engineering and Informatics8(1): 41–48.
9.
AlswatKAbdallaRAMTitiMA, et al.(2017) Improving patient safety culture in Saudi Arabia (2012–2015): Trending, improvement and benchmarking. BMC Health Services Research17(1): 516–529.
ArmstrongGEDietrichMNormanL, et al.(2017) Development and psychometric analysis of a nurses’ attitudes and skills safety scale: Initial results. Journal of Nursing Care Quality32(2): E3.
12.
CronenwettLSherwoodGBarnsteinerJ, et al.(2007) Quality and safety education for nurses. Nursing Outlook55(3): 122–131.
13.
D’AmourDDuboisC-ATchouaketE, et al.(2014) The occurrence of adverse events potentially attributable to nursing care in medical units: Cross sectional record review. International Journal of Nursing Studies51(6): 882–891.
14.
DiCuccioMH (2015) The relationship between patient safety culture and patient outcomes: A systematic review. Journal of Patient Safety11(3): 135–142.
15.
Dillon-Bleich K (2018) Keeping patients safe: the relationships among structural empowerment, systems thinking, level of education, certification and safety competency. Doctoral dissertation, Cleveland, OH, USA: Case Western Reserve University.
16.
DolanskyMAMooreSM (2013) Quality and safety education for nurses (QSEN) – the key is systems thinking. OJIN: The Online Journal of Issues in Nursing18(3): 1–12.
17.
Dolansky MA, Moore SM, Palmieri PA, et al. (2020) Development and validation of the Systems Thinking Scale. Journal of General Internal Medicine 35(8): 2314–2320.
18.
EdwardsMT (2017) An organizational learning framework for patient safety. American Journal of Medical Quality32(2): 148–155.
19.
ElmontsriMAlmashrafiABanarseeR, et al.(2017) Status of patient safety culture in Arab countries: A systematic review. BMJ Open7(2): e013487.
20.
GibsonRArmstrongATillA, et al.(2017) Learning from error: Leading a culture of safety. British Journal of Hospital Medicine78(7): 402–406.
21.
HammoudiBMIsmaileSAbu YahyaO (2018) Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences32(3): 1038–1046.
22.
HwangJI (2015) What are hospital nurses’ strengths and weaknesses in patient safety competence? Findings from three Korean hospitals. International Journal for Quality in Health Care27(3): 232–238.
23.
HwangJIParkHA (2017) Nurses’ systems thinking competency, medical error reporting, and the occurrence of adverse events: A cross-sectional study. Contemporary Nursing53(6): 622–632.
24.
Institute of Medicine (2012) Best care at lower cost: The path to continuously learning health care in America, Washington, DC: The National Academies Press.
25.
Kohn LT, Corrigan JM and Donaldson MS (eds) (2000) To Err is Human: building a safer health system. Committee on Quality of Health Care in America, Institute of Medicine. Washington DC: National Academies Press.
26.
MardonREKhannaKSorraJ, et al.(2010) Exploring relationships between hospital patient safety culture and adverse events. Journal of Patient Safety6(4): 226–232.
27.
Ministry of Health (2017) Medical malpractice complaints up by 37%. Saudi Gazette. Available at: http://saudigazette.com.sa/article/180099/Medical- malpractice-complaints-up-by-37 (accessed 2 May 2020).
28.
MitchellP (2008) Defining patient safety and quality care. In: HughesRG (eds) Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Rockville, MD: Agency for Healthcare Research and Quality (AHRQ) Publication no. 08-0043, pp. 1-1–1-6.
29.
NajjarSNafouriNVanhaechtK, et al.(2015) The relationship between patient safety culture and adverse events: A study in Palestinian hospitals. Safety in Health1(1): 16.
30.
RockvilleWSorraJGrayL, et al.(2016) AHRQ hospital survey on patient safety culture: User’sguide, Rockville, MD: Agency for Healthcare Research and Quality.
31.
SalehAABarnardA (2019) Barriers facing nurses in reporting medication administration errors in Saudi Arabia. American Journal of Nursing7(4): 598–625.
32.
SammerCELykensKSinghKP, et al.(2010) What is patient safety culture? a review of the literature. Journal of Nursing Scholarship42(2): 156–165.
33.
Sanko JS, Gattamorta K, Young J, et al. (2020) A multisite study demonstrates positive impacts to systems thinking using a table-top simulation experience. Nurse Educator. Epub ahead of print. DOI: 10.1097/nne.0000000000000817.
34.
SchnallRStonePCurrieL, et al.(2008) Development of a self-report instrument to measure patient safety attitudes, skills, and knowledge. Journal of Nursing Scholarship40(4): 391–394.
35.
ShojaniaKGDuncanBWMcDonaldKM, et al.(2001) Making health care safer: A critical analysis of patient safety practices. Evidence Report/Technology Assessment (Summ)43(1): 668.
36.
SingerSJVogusTJ (2013) Reducing hospital errors: Interventions that build safety culture. Annual Review of Public Health34: 373–396.
37.
SorraJSDyerN (2010) Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture. BMC Health Services Research10(1): 199.
38.
Sorra JS and Nieva VF (2004) Hospital survey on patient safety culture. (Prepared by Westat, under contract no. 290-96-0004). AHRQ publication no. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality.
39.
StalterAMMotaA (2018) Using systems thinking to envision quality and safety in healthcare. Nursing Management49(2): 32–39.
40.
StalterAMPhillipsJMRuggieroJS, et al.(2017) A concept analysis of systems thinking. Nursing Forum52(4): 323–330.
41.
TchouaketEDuboisC-AD’AmourD (2017) The economic burden of nurse-sensitive adverse events in 22 medical-surgical units: Retrospective and matching analysis. Journal of Advanced Nursing73(7): 1696–1711.
42.
TetuanTOhmRKinzieL, et al.(2017) Does systems thinking improve the perception of safety culture and patient safety?Journal of Nursing Regulation8(2): 31–39.
43.
World Health Organization (2009) WHO Patient Safety Research: Better Knowledge for Safer Care, Geneva, Switzerland: WHO.
