No abstract

We developed the LPPSq questionnaire to measure patient satisfaction with perioperative care, of which anaesthesia care is an important element. In this study, information provision and the relationship between staff and patient were the major determinants of patient satisfaction.

The person-centred analysis and prevention approach has long dominated proposals to improve patient safety in healthcare. In this approach, the focus is on the individual responsible for making an error. An alternative is the systems-centred approach, in which attention is paid to the organizational factors that create precursors for individual errors. This approach assumes that since humans are fallible, systems must be designed to prevent humans from making errors or to be tolerant to those errors. The questions raised by this approach might, for example, include asking why an individual had specific gaps in their knowledge, experience, or ability. The systems approach focuses on working conditions rather than on errors of individuals, as the likelihood of specific errors increases with unfavourable conditions. Since the factors that promote errors are not directly visible in the working environment, they are described as latent risk factors (LRFs). Safety failures in anaesthesia, in particular, and medicine, in general, result from multiple unfavourable LRFs, so we propose that effective interventions require that attention is paid to interactions between multiple factors and actors. Understanding how LRFs affect safety can enable us to design more effective control measures that will impact significantly on both individual performance and patient outcomes.

Background: The current awareness of the potential safety risks in healthcare environments has led to the development of largely reactive methods of systems analysis. Proactive methods are able to objectively detect structural shortcomings before mishaps and have been widely used in other high-risk industries. Methods: The Leiden Operating Theatre and Intensive Care Safety (LOTICS) scale was developed and evaluated with respect to factor structure and reliability of the scales. The survey was administered to the staff of operating rooms at two university hospitals, and intensive care units (ICUs) of one university hospital and one teaching hospital. The response rate varied between 40-47%. Data of 330 questionnaires were analysed. Safety aspects between the different groups were compared. Results: Factor analyses and tests for reliability resulted in nine subscales. To these scales another two were added making a total of 11. The reliability of the scales varied from 0.75 to 0.88. The results clearly showed differences between units (OR1, OR2, ICU1, ICU2) and staff. Conclusion:The results seem to justify the conclusion that the LOTICS scale can be used in both the operating room and ICU to gain insight into the system failures, in a relatively quick and reliable manner. Furthermore the LOTICS scale can be used to compare organisations to each other, monitor changes in patient safety, as well as monitor the effectiveness of the changes made to improve the level of patient safety.

LRFs are important correlates of the well-being of anaesthesia staff. Important differences between the different members of the anaesthesia team emerged in the set of LRFs that affect their well-being. These differences should be taken into account both in research and intervention projects.