Perception of safety climate among Indonesian nurses: A cross-sectional survey

  • Evi Harwiati Ningrum | sue.evans@monash.edu.au School of Nursing, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
  • Sue Evans Monash University, Melbourne, Australia.
  • Sze-Ee Soh Monash University, Melbourne, Australia.
  • Arul Ernest Monash University, Melbourne, Australia.

Abstract

Background: The measurement of nurse perception on safety, and the factors associated to safety climate, direct the development of effective strategies in reducing adverse events, and patient safety improvement.
Design and Method: This research was quantified, using the teamwork and safety climate domains of an Indonesian translated version of the Safety Attitudes Questionnaire (SAQ-INA). The teamwork and safety climate domain scores were calculated, using the published SAQ-INA scoring algorithm. The univariate and multivariate median regression models were performed to examine the association between potential predictors and safety climate.
Result: The results showed that 279 nurses responded to the survey (82% response rate). While most of them had a positive attitude towards teamwork (n= 170, 61%), fewer possessed the same mentality towards safety climate (n=109, 39%).  The lowest level of teamwork was perceived by nurses working in the emergency department (median 71, interquartile range 12.5), and safety climate (median 64, interquartile range 14.2). Furthermore, those that worked in the private hospitals, also reported lower levels of safety climate, compared to nurses in the public health centres (median difference=-3.571, p=0.009).
Conclusion: Ward and hospital type were associated with the level of safety climate, perceived by nurses. Understanding the key areas, the intervention is best directed to target hospital wards with poor safety climate, in a bid to reduce adverse events, and improve patient safety.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Indonesian Ministry of Health. Ministry of Health Regulation about Health Services under Indonesia Universal Health Coverage. No. 71 Year 2013. Jakarta: Indonesian Ministry of Health; 2013.

Indonesian Government. Indonesian presidential regulation about JKN implementation. No. 12 year 2013. Jakarta: Indonesian Government; 2013.

Indonesian Ministry of Health. Minister of Health Regulation about hospital accreditation. No. 012 Year 2012. Jakarta: Indonesian Ministry of Health; 2012.

Broughton E, Achadi A, Latief K, et al. Indonesia hospital accreditation process impact evaluation: Midline report. Bethesda: University Research Co LLC (URC); 2015.

Health and Safety Commission. Organising for safety: Third report of the ACSNI (Advisory Committee on the Safety of Nuclear Installations) study group on human factors. Sudbury: HSE Books; 1993.

Nieva V, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Health Care 2003;12:ii17-ii23. DOI: https://doi.org/10.1136/qhc.12.suppl_2.ii17

Wallace J, Hunt J, Richards C. The relationship between organisational culture, organisational climate and managerial values. Int J Public Sector Manage 1999;12:548-64. DOI: https://doi.org/10.1108/09513559910305339

Brand CA, Jolley DJ, Cameron P, et al. Advice on methodology for patient safety culture survey. NHMRC Centre of Research Excellence in Patient Safety. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Faculty of Medicine Nursing and Health Science: Monash University; 2010.

Huang DT, Clermont G, Kong L, et al. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care 2010;22:151-61. DOI: https://doi.org/10.1093/intqhc/mzq017

Hansen LO, Williams MV, Singer SJ. Perceptions of hospital safety climate and incidence of readmission. Health Serv Res 2011;46:596-616. DOI: https://doi.org/10.1111/j.1475-6773.2010.01204.x

Haynes AB, Weiser TG, Berry WR, et al. Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention. BMJ Qual Saf 2011;20:102-7. DOI: https://doi.org/10.1136/bmjqs.2009.040022

Patient Safety Committee for Indonesian Hospital. [Tingkat Kejadian Tidak Diharapkan di Rumah Sakit Indonesia (Unexpected incidence rate in Indonesian hospitals)].[in Indonesian]. Jakarta: Patient Safety Committee for Indonesian Hospital; 2010.

Sexton J, Helmreich B, Robert L, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 2006;6:1. DOI: https://doi.org/10.1186/1472-6963-6-44

Ningrum E, Evans S, Soh SE. Validation of the Indonesian version of the Safety Attitudes Questionnaire: A rasch analysis. PloS One 2019;14:e0215128. DOI: https://doi.org/10.1371/journal.pone.0215128

Barker AL, Morello RT, Ayton DR, et al. Development of an implementation plan for the 6-PACK falls prevention programme as part of a randomised controlled trial: protocol for a series of preimplementation studies. Inj Prev 2016;22:446-52. DOI: https://doi.org/10.1136/injuryprev-2015-041915

Koenker R. Quantile regression for longitudinal data. J Multivar Anal 2004;91:74-89. DOI: https://doi.org/10.1016/j.jmva.2004.05.006

Gong Z. Estimation of sample size and power for quantile regression. Degree Dissertation. Kingston: Queens University; 2016.

Iriviranty A, Ayuningtyas D, Misnaniarti M. Evaluation of patient safety culture and organizational culture as a step in patient safety improvement in a hospital in Jakarta, Indonesia. J Patient Saf Qual Improv 2016;4:394-9.

Irwandy S, Noer Bahry Noor AFA, Andi Silviyah N, et al. Patient safety culture across hospital in South Sulawesi Province, Indonesia: Comparing between urban, sub urban and rural areas. Int J Sci Res Publ 2015;26:1.

Rigobello MCG, Carvalho REFLd, Cassiani SHDB, et al. The climate of patient safety: perception of nursing professionals. Acta Paul Enferm 2012;25:728-35. DOI: https://doi.org/10.1590/S0103-21002012000500013

Soh SE, Morello R, Rifat S, et al. Nurse perceptions of safety climate in Australian acute hospitals: a cross-sectional survey. Australian Health Rev 2018;42:203-9. DOI: https://doi.org/10.1071/AH16172

Mearns K, Yule S. The role of national culture in determining safety performance: Challenges for the global oil and gas industry. Safety Sci 2009;47:777-85. DOI: https://doi.org/10.1016/j.ssci.2008.01.009

Schwendimann R, Zimmermann N, Küng K, et al. Variation in safety culture dimensions within and between US and Swiss Hospital Units: an exploratory study. BMJ Qual Saf 2013;22:32-41. DOI: https://doi.org/10.1136/bmjqs-2011-000446

Nordén-Hägg A, Sexton JB, Kälvemark-Sporrong S, et al. Assessing safety culture in pharmacies: the psychometric validation of the safety attitudes questionnaire (SAQ) in a national sample of community pharmacies in Sweden. BMC Clin Pharmacol 2010;10:8. DOI: https://doi.org/10.1186/1472-6904-10-8

Samsuri SE, Lin LP, Fahrni ML. Safety culture perceptions of pharmacists in Malaysian hospitals and health clinics: a multicentre assessment using the safety attitudes questionnaire. BMJ Open 2015;5:e008889. DOI: https://doi.org/10.1136/bmjopen-2015-008889

Singer SJ, Gaba DM, Falwell A, et al. Patient safety climate in 92 US hospitals: differences by work area and discipline. Med Care 2009;47:23-31. DOI: https://doi.org/10.1097/MLR.0b013e31817e189d

Khademian Z, Sharif F, Tabei SZ, et al. Teamwork improvement in emergency trauma departments. Iranian J Nurs Midwifery Res 2013;18:333.

Burström L. Patient safety in the emergency department, culture, waiting, and outcomes of efficiency and quality. Sweden: Uppsala University; 2014.

Vieth TL, Rhodes KV. The effect of crowding on access and quality in an academic ED. Am J Emerg Med 2006;24:787-94. DOI: https://doi.org/10.1016/j.ajem.2006.03.026

Cowan RM, Trzeciak S. Clinical review: emergency department overcrowding and the potential impact on the critically ill. Crit Care 2004;9:291.

The Economist [Internet]. Universal health coverage in Indonesia - one year on. 2015. Accessed: 2020 Nov 26. Available from: https://www.eiu.com/public/topical_report.aspx?campaignid=indonesiahealthcare

Raftopoulos V, Pavlakis A. Safety climate in 5 intensive care units: a nationwide hospital survey using the Greek-Cypriot version of the safety attitudes questionnaire. J Crit Care 2013;28:51-61. DOI: https://doi.org/10.1016/j.jcrc.2012.04.013

Sahebalzamani M, Mohammady M. A study of patient safety management in the framework of clinical governance according to the nurses working in the ICU of the hospitals in the East of Tehran. Iran J Nurs Midwifery Res 2014;19:295.

Guidet B, González-Romá V. Climate and cultural aspects in intensive care units. Crit Care 2011;15:312. DOI: https://doi.org/10.1186/cc10361

Colla J, Bracken A, Kinney L, et al. Measuring patient safety climate: a review of surveys. Qual Saf Health Care 2005;14:364-6. DOI: https://doi.org/10.1136/qshc.2005.014217

College of Intensive Care Medicine of Australia and New Zealand. Minimum Standards for Intensive Care Units Australia 2010. Accessed: 2020 Nov 20. Available from: https://www.cicm.org.au/CICM_Media/CICMSite/CICM-Website/Resources/Professional%20Documents/IC-1-Minimum-Standards-for-Intensive-Care-Units.pdf

The Directorat General of Health Efforts Development (MoH). Technical guidance for the implementation of intensive care unit service. Jakarta: Ministry of Health; 1966.

Indonesian Hospital Association. Consultation paper. Indonesian Hospital Association role and response to ministry of health regulation no. 64/2016 to prevent hospital bankruptcy. Surabaya: Indonesian Hospital Association Press; 2016.

Indonesian Ministry of Health. Ministry of Health Regulation No. 12 year 2013, Rate pattern of hospital as a public entity. Jakarta: Ministry of Health; 2013.

Indonesian Ministry of Health. Ministry of Health Regulation No. 27 year 2014 About technical guidance for INA CBGs implementation. Jakarta: Indonesian Ministry of Health; 2014.

Australian Institute of Health and Welfare. AIHW national health workforce. Canberra: Australian Institute of Health and Welfare; 2014.

Mayer CM, Cluff L, Lin W-T, et al. Evaluating efforts to optimize TeamSTEPPS implementation in surgical and pediatric intensive care units. Jt Commn J Qual Patient Saf 2011;37:365-74. DOI: https://doi.org/10.1016/S1553-7250(11)37047-X

Thomas L, Galla C. Building a culture of safety through team training and engagement. BMJ Qual Saf 2013;22:425-34. DOI: https://doi.org/10.1136/bmjqs-2012-001011

Stein J, Payne C, Methvin A, et al. Reorganizing a hospital ward as an accountable care unit. J Hospital Med 2015;10:36-40. DOI: https://doi.org/10.1002/jhm.2284

Published
2021-04-14
Ethics Approval
Ethical approval obtained through the Human Research Ethic Committee, at Monash University (MUHREC 2016-1409)
Keywords:
Nurses, perception on safety, safety attitudes, teamwork climate, safety climate
Statistics
  • Abstract views: 79

  • PDF: 36
How to Cite
Ningrum, E. H., Evans, S., Soh, S.-E., & Ernest, A. (2021). Perception of safety climate among Indonesian nurses: A cross-sectional survey. Journal of Public Health Research, 10(2). https://doi.org/10.4081/jphr.2021.2182