EFFECT OF THE ADMINISTRATIVE TRANSITION OF HOSPITAL MANAGEMENT ON THE SAFETY CULTURE IN SURGICAL UNITS

Batista, Josemar; Cruz, Elaine Drehmer de Almeida; Lopez, Evelyn da Costa Martins Silva; Sarquis, Leila Maria Mansano; Seiffert, Leila Soares; Wolff, Lillian Daisy Gonçalves

doi:10.1590/1980-265X-TCE-2019-0012

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Original Article • Texto contexto - enferm. 29 • 2020 • https://doi.org/10.1590/1980-265X-TCE-2019-0012 copy

EFFECT OF THE ADMINISTRATIVE TRANSITION OF HOSPITAL MANAGEMENT ON THE SAFETY CULTURE IN SURGICAL UNITS

EFECTO DE LA TRANSICIÓN ADMINISTRATIVA DE LA GESTIÓN HOSPITALARIA SOBRE LA CULTURA DE SEGURIDAD EN UNIDADES QUIRÚRGICAS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the safety culture in surgical units of a teaching hospital in different periods of hospital management.

Method:

this is a descriptive and analytical study developed with health professionals working at a surgical center and at five surgical inpatient units in two different periods of hospital management in southern Brazil. The Hospital Survey on Patient Safety Culture questionnaire was answered by 73 professionals in period I (2014/2015) and by 158 professionals in period II (2017). The analysis was based on descriptive statistics and on inferential analysis and reliability analysis using Cronbach's alpha coefficient; the dimensions were considered strong when the percentage of positive answers was ≥75%.

Results:

the administrative transition had a positive influence on the “Staffing” and “Handoffs and transitions” dimensions and a negative influence on “Teamwork within units” (p<0.001), with no difference in the remaining nine dimensions. In both periods, no dimension was considered strong; there were no changes with regard to the notification of adverse events and to the overall safety assessment; and the overall reliability of the instrument was satisfactory (0.89).

Conclusion:

the administrative transition of hospital management had little impact on the dimensions of the organizational safety culture, and there are still challenges in the progressive development of this predictor of patient safety.

DESCRIPTORS:
Organizational culture; Hospital administration; Quality management; Patient safety; Nursing

Contract	Period
Contract	10/30/2014	2015	12/31/2016	12/27/2017
Legal Regime of the Union	1,951	-	1,805	1,761
Brazilian Company of Hospital Services	0	-	557	902
Support Foundation for the Federal University of Paraná	883	-	828	768
Total	2,834	-	3,190	3,431

Variables	Period I		Period II		p-value ^*
Variables	n	%	n	%	p-value ^*
Gender					0.003^†
Female	57	78.1	91	57.6
Male	16	21.9	67	42.4
Title/Function
Clinical body physician/Assistant physician	06	8.2	41	26	0.002^‡
Resident physician/Physician in training	13	17.8	31	19.6
Nurse	18	24.7	15	9.5
Nursing technician	10	13.7	24	15.2
Nursing assistant	26	35.6	47	29.7
Schooling
Complete high school	13	17.8	26	16.5	0.443^‡
Incomplete higher education	07	9.6	12	7.6
Complete higher education	19	26	35	22.2
Post-graduation (specialization level)	28	38.4	59	37.3
Post-graduation (MS or PhD level)	05	6.8	25	15.8
Unknown	01	1.4	01	0.6
Working time in the hospital
Less than 1 year	16	21.9	22	13.9	0.007^‡
1 to 5 years	10	13.7	43	27.2
6 to 10 years	10	13.7	06	3.8
11 to 15 years	06	8.2	23	14.6
16 to 20 years	08	11.0	10	6.3
≥ 21 years	23	31.5	54	34.2
Working time in the unit
Less than 1 year	23	31.5	31	19.6	0.005^‡
1 to 5 years	14	19.2	55	34.8
6 to 10 years	11	15.1	06	3.8
11 to 15 years	06	8.2	15	9.5
16 to 20 years	03	4.1	11	7.0
≥ 21 years	16	21.9	40	25.3
Weekly workload
Between 20 and 39 hours	35	48.0	111	70.2	0.001^‡
Between 40 and 59 hours	12	16.4	17	10.8
Between 60 and 79 hours	23	31.5	17	10.8
Between 80 and 99 hours	03	4.1	07	4.4
≥ 100 hours	00	0.0	06	3.8
Interaction/Direct contact with the patient
Yes	71	97.3	158	100	0.313^†
No	02	2.7	00	0.0	0.313^†
Total	73	100	158	100

	Period	Cronbach's Alpha	Percentage of answers			p-value*
	Period	Cronbach's Alpha	Negative	Neutral	Positive	p-value*
1. Teamwork within units	I	0.62	27.3	9.7	63.0
1. Teamwork within units	II	0.75	23.4	20.6	56.0	<0.001^†
2. Supervisor/Manager expectations and actions that promote patient safety	I	0.62	21.6	13.9	64.5
	II	0.70	24.8	18.8	56.4	0.057^†
3. Organizational learning - continuous improvement	I	0.62	25.0	13.4	61.6
3. Organizational learning - continuous improvement	II	0.59	20.3	20.3	59.5	0.066^†
4. Management support for patient safety	I	0.79	42.1	26.6	31.3
4. Management support for patient safety	II	0.70	36.8	32.5	30.8	0.256^†
5. Overall perceptions of patient safety	I	0.46	41.8	11.1	47.0
5. Overall perceptions of patient safety	II	0.46	35.4	18.9	45.8	0.009^†
6. Feedback and communication about error	I	0.58	31.8	32.7	35.5
6. Feedback and communication about error	II	0.76	30.4	31.8	37.8	0.840^†
7. Communication openness	I	0.71	23.3	23.3	53.4
7. Communication openness	II	0.55	26.1	23.1	50.8	0.722^†
8. Frequency of events reported	I	0.74	30.5	25.4	44.1
8. Frequency of events reported	II	0.82	31.9	22.8	45.3	0.758^†
9. Teamwork across units	I	0.53	51.7	22.7	25.5
9. Teamwork across units	II	0.74	42.4	26.8	30.7	0.033^†
10. Staffing	I	0.47	54.7	12.9	32.4
10. Staffing	II	0.26	40.2	20.6	39.2	<0.001^†
11. Handoffs and transitions	I	0.73	61.3	10.5	28.2
11. Handoffs and transitions	II	0.74	41.5	26.0	32.5	<0.001^†
12. Nonpunitive response to error	I	0.50	56.7	16.7	26.5
12. Nonpunitive response to error	II	0.10	64.5	16.3	19.3	0.082^†

Dimensions and items/questions	Percentage of positive answers
Dimensions and items/questions	Period I	Period II
Supervisor/Manager expectations and actions that promote patient safety	64.5	56.4
My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures.	47.9	43.9
My supervisor/manager seriously considers staff suggestions for improving patient safety.	63.9	51.6
Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means “taking shortcuts”.	63.9	63.9
My supervisor/manager overlooks patient safety problems that happen over and over.	81.9	66.2
Management support for patient safety	31.3	30.8
Hospital management provides a work climate that promotes patient safety.	37.5	31.6
The actions of hospital management show that patient safety is a top priority.	25.0	33.8
Hospital management seems interested in patient safety only after an adverse event happens.	22.2	26.9

Variables	Period I		Period II
Variables	n	%	n	%
Patient safety grade
Excellent	02	2.7	09	5.7
Very good	37	50.7	94	59.5
Acceptable	29	39.7	50	31.6
Bad/Very bad	04	5.5	05	3.2
Unknown	01	1.4	00	0.0
Number of events notified in the last twelve months
None	36	49.3	86	54.4
1-2	18	24.7	42	26.6
3-5	07	9.6	20	12.7
6 or more	10	13.7	09	5.7
Unknown	02	2.7	01	0.6
Total	73	100	158	100

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Josemar Batista josemar.batista@hotmail.com