Factors affecting patient safety culture in a university hospital under the universal health insurance system: A cross-sectional study from Japan

Abstract

We conducted a cross-sectional study of patient safety culture aimed at examining the factors that influence patient safety culture in university hospitals under a universal health insurance system. The Hospital Survey on Patient Safety Culture developed by the Agency for Healthcare Research and Quality was used. The survey was distributed to 1066 hospital employees, and 864 responded. The confirmatory factor analysis showed a good fit of the results to the 12-composites model. The highest positive response rates were for “(1) Teamwork within units” (81%) and “(2) Supervisor/manager expectations and actions promoting patient safety” (80%), and the lowest was for “(10) Staffing” (36%). Hayashi’s quantification theory type 2 revealed that working hours per week had the greatest negative impact on patient safety culture. Under a universal health insurance system, workload and human resources might have a significant impact on the patient safety culture.

Safety culture survey among medical residents in Japan: a nationwide cross-sectional study

“…It is believed that because residents are in training and, therefore, are at the bottom of the physician hierarchy, they may be less likely to express their opinions or take part in various medical discussions 12 25 28. University hospital residents may be significantly more likely to feel punished and emotionally burdened by the act of filing an incident report, according to previous studies that found results that are similar to ours regarding reluctance to submit incident reports 12 21 22 25 28. Despite the aforementioned cultural context, other studies on registered nurses, physicians, managers and other healthcare professionals have found that managers’ opinions of patient safety culture vary widely, even in the same institutional healthcare setting 29.…”

“…Furthermore, university hospitals employ more specialised staff such as quality-improvement and patient-safety experts than community hospitals as they have more resources to handle safety activities and medical errors methodically and carefully 20 21. Additionally, Japanese university hospitals are required to employ three to four full-time patient safety specialised staff members, which fosters a highly trained and educated workforce that likely impacts safety culture positively 21 22. Surprisingly, our results indicate the opposite, which implies that the general theory of patient safety does not apply to Japanese medical residents 21.…”

“…This potential bias is further compounded by inherent subjectivity. Fourth, studies on safety culture vary according to facility type and settings, which limits generalisability to other clinical settings across countries, healthcare systems, and cultural and ethnic backgrounds 22 29 31. Despite these limitations, our study is the first nationwide cross-sectional survey that focuses on resident safety culture in Japan.…”

“…Residents who do not wish to be in those situations may be working at university hospitals 18. Third, although the safety culture measurement index,19 21 22 which was validated initially in Japanese, could not be used for all questions in this survey due to the limitation of the number of questions in the questionnaire, those that were consistent with the Japanese training background were extracted and included 18 19 21 29. Furthermore, there may be potential for response bias, considering that residents rely on self-reported data based on their individual training experiences at the respective institution.…”

“…To ascertain the accuracy of residents’ perceptions and potential causes for this situation, it is imperative that university hospitals be further investigated by various types of healthcare professionals in Japan. Furthermore, as previous international studies have demonstrated,14–16 20–22 identification of the causes for low perceived safety culture and proposal of activities and strategies to improve it could play an essential role in the reduction of medical errors and promotion of higher productivity of medical staff.…”