Safety culture in the Neonatal Intensive Care Unit: contributions from the multiprofessional team

Ventura, Maria Williany Silva; Façanha, Ana Paula Melo; Néri, Eugenie Desirèe Rabelo; Diógenes, Mariana da Silva; Lopes, Emeline Moura

doi:10.1590/1806-9304202200020007

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 22 (2) • Apr-Jun 2022 • https://doi.org/10.1590/1806-9304202200020007 copy

Safety culture in the Neonatal Intensive Care Unit: contributions from the multiprofessional team

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to analyze the patient safety culture with the multidisciplinary team in a neonatal ICU at a Brazilian maternity.

Methods:

the safety culture was evaluated by the Hospital Survey on Patient Safety Culture (HSOPSC), with a sample of 117 professionals. The questions were divided into 12 domains, classifying them as areas of strength when the percentage was higher than 75% of positive responses. For inferential analysis, Kruskal-Wallis and Chi-square tests were used, considering significant p<0.05 values.

Results:

the domains ‘organizational learning- continuous improvement’ and ‘teamwork’ were considered as areas of strength in establishing security. Those who needed improvement were: ‘non-punitive response to error’ and ‘staffing’. There was no significant relevance between the crossings of the numbers of positive responses with the professional data, thus showing that the factors did not interfere in the answers given.

Conclusions:

in view of the results presented, changes are suggested mainly in the aspects related to punitive culture and evaluation of possible reduction of work overload. However, we cannot fail to praise the positive aspects found, such as teamwork, the concern of professionals and managers to bring improvements to promote patient safety.

Key words:
Patient safety; Intensive care units neonatal; Patient care team

	Positive Responses		Neutral Responses		Negative Responses		Total
	n	%	n	%	n		N	%
DOMAIN 1 (Teamwork within units)
A1 - In this unit, people support each other.	90	76.9	18	15.4	9	7.7	117	100.0
A3 - When there is a lot of work to be done quickly, we work together as a team to complete it properly.	88	75.2	21	17.9	8	6.9	117	100.0
A4 - In this unit, people treat each other with respect.	102	87.2	9	7.7	6	5.1	117	100.0
A11 - When an area of this unit becomes overloaded, the other professionals in this unit help.	75	64.6	19	16.4	22	19.0	116	100.0
Total overall	355	76.0	67	14.3	45	9.7	467	100.0
DOMAIN 2 (Supervisor expectations and actions to promote patient safety)
B1 - My supervisor/boss praises when he/she sees work performed in accordance with established patient safety procedures.	76	64.9	18	15.4	23	19.7	117	100.0
B2 - Does my supervisor/boss really consider the professionals' suggestions for improving patient safety.	81	69.2	21	17.9	15	12.9	117	100.0
B3 -Whenever the pressure builds, my supervisor/boss wants us to work faster, even if it means ‘skipping steps’.	77	66.4	26	22.4	13	11.2	116	100.0
B4 - My supervisor/boss does not pay enough attention to patient safety issues that happen over and over again.	96	83.5	11	9.7	8	7.0	115	100.0
Total	330	71.0	76	16.3	59	12.7	465	100.0
DOMAIN 3 (Organizational learning - continuous improvement)
A6 - We are actively doing things to improve patient safety.	108	92.3	6	5.1	3	2.6	117	100.0
A9 - Errors have led to positive change around here.	83	71.6	18	15.5	15	12.9	116	100.0
A13 - After implementing changes to improve patient safety, we evaluated the effectiveness.	86	74.2	20	17.2	10	8.6	116	100.0
Total	277	79.4	44	12.6	28	8.0	349	100.0
DOMAIN 4 (Feedbackand communication about errors)
C1 - We receive information about implemented changes from the event reports.	52	45.6	37	32.5	25	21.9	114	100.0
C3 - We are informed about errors that happen on this unit.	59	51.3	36	31.3	20	17.4	115	100.0
C5 - In this unit, we discuss ways to prevent errors from happening again.	81	70.4	25	21.8	9	7.8	115	100.0
Total	192	55.8	98	28.5	54	15.7	344	100.0
DOMAIN 5 (Openness for Communication)
C2 - Professionals are free to say when they see something that could negatively affect patient care.	89	78.1	19	16.7	6	5.3	114	100.0
C4 - Professionals feel free to question the decisions or actions of their superiors.	36	31.3	47	40.9	32	27.8	115	100.0
C6 - Professionals are afraid to ask when something appears to be not right.	57	50.4	44	38.9	12	10.7	113	100.0
Total	182	53.2	110	32.2	50	14.6	342	100.0
DOMAIN 6 (Staffing)
A2 - We have enough staff to handle the workload.	10	8.6	6	5.2	100	86.2	116	100.0
A5 - The professionals in this unit work longer hours than would be best for patient care.	34	29.3	33	28.4	49	42.4	116	100.0
A7 - We use more temporary and outsourced professionals than is desirable for patient care.	92	80.0	16	13.9	7	6.1	115	100.0
A14 - We work in a ‘crisis situation’, trying to do too much, too fast.	26	22.2	29	24.8	62	53.0	117
Total	162	34.9	84	18.1	218	47.0	464	100.0
DOMAIN 7 (Nonpunitive response to error)
A8 - Professionals feel that their mistakes can be used against them.	21	18.1	20	17.2	75	64.7	116	100.0
A12 - When an event is reported, it appears that the focus is on the person rather than the issue.	40	34.5	25	21.5	51	44.0	116	100.0
A16 - Professionals are concerned that their mistakes are registered on their job records.	18	15.5	23	19.8	75	64.7	116	100.0
Total	79	22.7	68	19.5	201	57.8	348	100.0
DOMAIN 8 (Hospital management support for patient safety)
F1 - Hospital management provides a working climate that promotes patient safety.	53	45.3	41	35.0	23	19.7	117	100.0
F8 - Hospital management actions demonstrate that patient safety is a top priority.	74	63.8	21	18.1	21	18.1	116	100.0
F9 - Hospital management only seems interested in patient safety when an adverse event occurs.	66	56.4	27	23.1	24	20.5	117	100.0
Total	193	55.1	89	25.4	68	19.5	350	100.0
DOMAIN 9 (Teamwork among hospital units)
F2 - Hospital units are not well coordinated with each other.	51	43.6	36	30.8	30	25.6	117	100.0
F4 - There is good cooperation between hospital units that need to work together.	72	61.5	30	25.6	15	12.9	117	100.0
F6 - It is often unpleasant to work with professionals from other hospital units.	69	59.0	29	24.8	19	16.2	117	100.0
F10 - Hospital units work well together to provide the best care for patients.	79	67.5	32	27.4	6	5.1	117	100.0
Total	271	57.9	127	27.1	70	15.0	468	100.0
DOMAIN 10 (Hospital handoffs and shift changes)
F3 - The care process is compromised when a patient is transferred from one unit to another.	65	55.6	24	20.5	28	23.9	117	100.0
F5 - It is common for important information about patient care to be lost during shift changes or shifts.	58	50.0	26	22.4	32	27.6	116	100.0
F7 - Problems often occur in the exchange of information between hospital units.	55	50.0	29	26.4	26	23.6	110	100.0
F11 - In this hospital, shift or shift changes are problematic for patients.	83	71.6	22	19.0	11	9.4	116	100.0
Total	261	56.9	101	22.0	97	21.1	459	100.0
DOMAIN 11 (General perception of patient safety)
A10 - It is just by chance that more serious mistakes do not happen around here.	67	58.8	27	23.7	20	17.5	114	100.0
A15 - Patient safety is never compromised due to the greater amount of work to be completed.	16	13.9	22	19.1	77	67.0	115	100.0
A17 - In this unit we have patient safety issues.	24	20.5	22	18.8	71	60.7	117	100.0
A18 - Our procedures and systems are adequate to prevent errors from occurring.	63	53.9	24	20.5	30	25.6	117	100.0
Total	170	36.7	95	20.5	198	42.8	463	100.0
DOMAIN 12 (Frequency of event reporting)
D1 - When an error occurs, but it is noticed and corrected before it affects the patient, how often is it reported?	46	40.7	29	25.7	38	33.6	113	100.0
D2 - When an error occurs but there is no risk of harm to the patient, how often is the patient notified?	37	33.0	40	35.7	35	31.3	112	100.0
D3 - When an error occurs, which could cause harm to the patient, but does not, how often is the patient notified?	56	50.0	39	34.8	17	15.2	112	100.0
Total	139	41.3	108	32.0	90	26.7	337	100.0
Total Overall	2.611	53.8	1.067	22.0	1.178	24.2	4.856	100.0

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[1] Authors’ contribution

Ventura MWS and Lopes EM were responsible for the conception and study design, writing the article, analysis and interpretation of data, critical review of the intellectual content and final approval of the version to be submitted. Diógenes MS contributed to data collection and critical review of the article. Façanha APM and Néri EDR performed the critical review and writing of the article. All authors approved the final version of the article and declare no conflict of interest.