Hana Brborović

Development of a Croatian version of the US Hospital Survey on Patient Safety Culture questionnaire: dimensionality and psychometric properties

Background The Hospital Survey on Patient Safety Culture (HSOPSC), originally developed in the USA, is used worldwide to assess patient safety culture in hospitals. A limited number of studies have provided data on psychometric properties outside of the US healthcare system. Our aim was to determine if all 12 dimensions of the US HSOPSC were applicable, valid and reliable to Croatian healthcare workers. Methods The study was conducted from September 2010 to April 2011. Questions were translated into Croatian and then translated back into English. The questionnaires (ie, the Croatian translation of the US HSOPSC) were distributed in unmarked envelopes along with a consent form to all the doctors and nurses in four Croatian hospitals. The responses were analysed using explorative factor analyses, reliability testing, and confirmatory factor analyses. Results The study included 561 healthcare workers in four Croatian hospitals—a response rate of 32.69%. Our results are similar to the original US sample, but with some differences: 11 dimensions with acceptable reliability scores were identified by exploratory factor analysis compared with the original 12 in the US sample; five of 12 dimensions had a Cronbachs α higher than 0.7, suggesting a reasonable fit to the original US HSOPSC; the dimensions ‘Staffing’ and ‘Organisational learning—continuous improvement’ were found to have a Cronbachs α <0.6. The use of confirmatory factor analysis confirmed a good fit to the original US model. Conclusions Results show that the Croatian translation of the US HSOPSC is compatible in 11 of the original 12 dimensions. Results suggest that for the purposes of research in Croatia, the dimensions ‘Staffing’, ‘Communication openness’, and ‘Organisational learning—continuous improvement’ should be revised. For example, the use of question A7 (‘We use more agency/temporary staff than is best for patient care’) in the context of European healthcare systems should be adapted or removed for the Croatian version of the US HSOPSC questionnaire.

Are nurse presenteeism and patient safety culture associated: a cross-sectional study

Abstract Working as a nurse involves great dedication and sacrifice: working night shifts, working overtime, and coming to work sick. The last is also known as presenteeism. Research has shown that poor nurse performance can affect both caregiver’s and patient’s safety. The aim of this cross-sectional study was to investigate whether nurse presenteeism affected patient safety culture and to look deeper into the characteristics of nurse presenteeism and patient safety culture in Croatia. The study was conducted in one general hospital in Croatia over April and May 2012 and specifically targeted medical nurses as one of the largest groups of healthcare professionals. They were asked to fill two questionnaires: the six-item Stanford Presenteeism Scale (SPS-6) and the Hospital Survey on Patient Safety Culture (HSOPSC). We found no association between presenteeism and patient safety culture. Overall positive perception of safety was our sample’s strength, but other dimensions were positively rated by less than 65 % of participants. The lowest positive response concerned “nonpunitive response to error”, which is consistent with previous studies. Presenteeist nurses did not differ in their characteristics from nurses without presenteeism (gender, age, years of experience, working hours, contact with patients and patient safety grades). Our future research will have to include a broader healthcare population for us to be able to identify weak spots and suggest improvements toward high-quality and cost-effective health care. Sažetak Zanimanje medicinske sestre uključuje veliku predanost i požrtvovnost: medicinske sestre rade noćne smjene, rade prekovremeno i dolaze na posao i kada su bolesne. Naziv za ovu zadnju pojavu je prezentizam. Neka su istraživanja pokazala da smanjena radna sposobnost medicinskih sestara zbog bolesti može ugroziti sigurnost pružatelja zdravstvene usluge i bolesnika. Cilj ovog presječnog istraživanja bio je ispitati obilježja prezentizma i kulture bolesničke sigurnosti u medicinskih sestara u Hrvatskoj te utječe li njihov prezentizam na kulturu bolesničke sigurnosti. Istraživanje je provedeno u jednoj općoj bolnici u Hrvatskoj tijekom travnja i svibnja 2012., i bilo je posebno ciljano prema medicinskim sestrama s obzirom na to da čine jednu od najvećih skupina zdravstvenih djelatnika. Ispitanici su zamoljeni da ispune dva upitnika: Stanfordsku ljestvicu prezentizma (SPS-6) i Upitnik o kulturi bolesničke sigurnosti u bolnici (HSOPSC). Nije nađena povezanost između prezentizma i kulture bolesničke sigurnosti. Najveći broj pozitivnih odgovora imala je dimenzija “Opća percepcija bolesničke sigurnosti”; ostale dimenzije imale su pozitivne odgovore ispod 65 %. Najmanji broj pozitivnih ocjena imala je dimenzija “Nekažnjavajući pristup neželjenom događaju”, što je u skladu s prethodnim istraživanjima. U pogledu spola, dobi, godina iskustva, radnih sati, kontakata s bolesnicima i njihove sigurnosti, medicinske sestre s prezentizmom nisu se nimalo razlikovale od medicinskih sestara bez prezentizma.

Antecedents and associations of sickness presenteeism and sickness absenteeism in nurses: A systematic review

AIMS This study comprehensively analysed and systemized the elements associated with nursing sickness presenteeism (SP) and sickness absenteeism (SA). BACKGROUND Both behaviours represent a real challenge to nursing departments because they can increase costs, cause health care adverse events, and impact the quality of health care. DESIGN The systematic review of cohort studies was designed to be consistent with the PRISMA guidelines. DATA SOURCES PubMed, ProQuest, and Emerald were systematically searched for peer-reviewed articles published from the 1950s to December 2016. REVIEW METHODS Cohort studies were included (12 SA and 1 SP) in the review if they examined the association between one or more exposures and SP and/or SA in nurses. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. RESULTS Twenty-three antecedents were associated with SA and grouped as work and organizational, mental and physical health, and demographic; 3 antecedents were associated with SP (job demands, burnout, and exhaustion). Exhaustion (fatigue) and job demands were associated with SA and SP. Depersonalization was an outcome of SP over time. CONCLUSION The ability to predict presenteeism and absenteeism in nursing is useful to constrain costs and ensure that quality care is delivered.

Patient safety culture shapes presenteeism and absenteeism: a cross-sectional study among Croatian healthcare workers

Abstract Healthcare workers have high rates of injuries and illnesses at the workplace, and both their absence from work due to illness (absenteeism) or working ill (presenteeism) can compromise patient safety and the quality of health care delivered. Following this premise, we wanted to determine whether presenteeism and absenteeism were associated with patient safety culture (PSC) and in what way. Our sample consisted of 595 Croatian healthcare workers (150 physicians and 445 nurses) who answered the short-form WHO Health and Work Performance Questionnaire and the Hospital Survey on Patient Safety Culture. The results have confirmed the association with both presenteeism and absenteeism in several PSC dimensions, but not as we expected based on the premise from which we started. Opposite to our expectations, lower job performance (as a measure of presenteeism) was associated with higher PSC instead of lower PSC. Absenteeism, in turn, was associated with lower PSC, just as we expected. These findings suggest that it is the PSC that shapes presenteeist and absenteeist behaviour and not the other way around. High PSC leads to presenteeism, and low PSC to absenteeism. We also believe that the presenteeism questionnaires should be adjusted to health care and better define what lower performance means both quantitatively and qualitatively in a hospital setting

HOW TO IMPROVE PATIENT SAFETY CULTURE IN CROATIAN HOSPITALS

Patient safety culture (PCS) has a crucial impact on the safety practices of healthcare delivery systems. The purpose of this study was to assess the state of PSC in Croatian hospitals and compare it with hospitals in the United States. The study was conducted in three public general hospitals in Croatia using the Croatian translation of the Hospital Survey of Patient Safety Culture (HSOPSC). A comparison of the results from Croatian and American hospitals was performed using a T-square test. We found statistically significant differences in all 12 PSC dimensions. Croatian responses were more positive in the two dimensions of Handoff s and Transitions and Overall Perceptions of Patient Safety. In the remaining ten dimensions, Croatian responses were less positive than in US hospitals, with the most prominent areas being Nonpunitive Response to Error, Frequency of Events Reported, Communication Openness, Teamwork within Units, Feedback & Communication about Error, Management Support for Patient Safety, and Staffing. Our findings show that PSC is significantly lower in Croatian than in American hospitals, particularly in the areas of Nonpunitive Response to Error, Leadership, Teamwork, Communication Openness and Staffing. This suggests that a more comprehensive system for the improvement of patient safety within the framework of the Croatian healthcare system needs to be developed. Our findings also help confirm that HSOPSC is a useful and appropriate tool for the assessment of PSC. HSOPSC highlights the PSC components in need of improvement and should be considered for use in national and international benchmarking.

A time-trend analysis of intended career choice for family medicine among croatian medical students

Abstract Aim: To gain insight into the trend of career choice for family medicine in Croatia in recent years. Methods: Six surveys were performed in the academic years 2006/07-2011/12 at the University of Zagreb, School of Medicine. Altogether, 1140 6th year students participated. They anonymously completed a questionnaire containing questions on desired future specialisation as well as other selected characteristics (e.g. gender, desired area and place of work, motivation to study medicine, etc.). Binary logistic regression was used to determine unadjusted and adjusted trends. Results: After adjustment for selected factors, the relationship between observed outcome and the year of observation showed an evident decreasing trend. The odds for intention to specialise in family medicine were in the academic year 2006/2007 1.43-times higher than in the year 2007/2008 (p=0.412), 1.85-times higher than in the year 2008/2009 (p=0.168), 2.38-times higher than in the year 2009/2010 (p=0.051), 2.63-times higher than in the year 2010/2011 (p=0.027) and 3.85-times higher than in the year 2011/2012 (p=0.003). Conclusions: The results of the present study offer evidence that Croatia is experiencing a constantly decreasing trend of career choice for family medicine in recent years. It is obvious that final year medical students are not very much interested in working as family practitioners. At the same time, demand for family practitioners in Croatia is increasing. Both academic and professional societies have a social responsibility to reorient the health care system and medical curricula towards comprehensive primary health care in which family medicine has a key role. Izvleček Izhodišče: Pridobitev vpogleda v trend izbire poklica zdravnik specialist družinske medicine na Hrvaškem v zadnjih letih. Metode: V študijskih letih 2006/7-2011/12 je bilo na Medicinski fakulteti Univerze v Zagrebu opravljenih šest raziskav, v katerih je skupaj sodelovalo 1.140 študentov 6. letnika. Ti so anonimno izpolnili vprašalnik z vprašanji o želeni prihodnji specializaciji in drugih izbranih karakteristikah (npr. spol, želeno področje in kraj dela, motivi za študij medicine itn.). Za določitev neprilagojenih in prilagojenih trendov je bila uporabljena binarna logistična regresija. Rezultati: Po prilagoditvi izbranih dejavnikov je bil pri povezavi med opazovanim rezultatom in letom opazovanja ugotovljen jasen padajoči trend. Verjetnost izbire specializacije iz družinske medicine je bila v študijskem letu 2006/2007 1,43-krat večja kot v letu 2007/2008 (p = 0,412), 1,85-krat večja kot v letu 2008/2009 (p = 0,168), 2,38- krat večja kot v letu 2009/2010 (p = 0,051), 2,63-krat večja kot v letu 2010/2011 (p = 0,027) in 3,85-krat večja kot v letu 2011/2012 (p = 0,003). Zaključki: Rezultati te raziskave dokazujejo, da je v zadnjih letih na Hrvaškem prisoten stalno padajoči trend pri izbiri poklica zdravnik specialist družinske medicine. Očitno je, da študenti zadnjega letnika medicine niso preveč zainteresirani za delo zdravnika družinske medicine. Hkrati pa se na Hrvaškem povečuje potreba po tovrstnih zdravnikih. Tako akademska kot strokovna združenja so družbeno odgovorna za preoblikovanje sistema zdravstvenega varstva in študijskih programov medicine v celovito primarno zdravstveno varstvo, v katerem ima družinska medicina ključno vlogo.