Assessment of patient safety culture in Palestinian public hospitals

Objective. To assess the prevalent patient safety culture in Palestinian public hospitals. Design. A cross-sectional design, Arabic translated version of the Hospital Survey on Patient Safety Culture was used. Setting. All the 11 general public hospitals in the West Bank. Participants. A total of 1460 clinical and non-clinical hospital staff. Intervention(s). No. Main Outcome Measures. Twelve patient safety culture composites and 2 outcome variables (patient safety grade and events reported in the past year) were measured. Results. Most of the participants were nurses and physicians (69.2%) with direct contact with patients (92%), mainly employed in medical/surgical units (55.1%). The patient safety composites with the highest positive scores were teamwork within units (71%), organizational learning and continuous improvement (62%) and supervisor/manager expectations and actions promoting patient safety (56%). The composites with the lowest scores were non-punitive response to error (17%), frequency of events reported (35%), communication openness (36%), hospital management support for patient safety (37%) and staffing (38%). Although 53.2% of the respondents did not report any event in the past year, 63.5% rated patient safety level as 'excellent/very good'. Significant differences in patient safety scores and outcome variables were found between hospitals of different size and in relation to staff positions and work hours. Conclusions. This study highlights the existence of a punitive and blame culture, under-reporting of events, lack of communication openness and inadequate management support that are key challenges for patient safe hospital care. The baseline survey results are valuable for designing and implementing the patient safety program and for measuring future progress.