Introduction
Patient safety is a major component and objective of health care quality in the world. In the recent past, many health care organizations across the world have made patient safety a central tenet of their activities. In this process, the organizations are keen on ensuring a clear understanding of what patient safety involves. As such, to understand and implement activities towards healthcare improvement, it is important to understand the principles, attitudes, and standards that are specific to an organization. Besides, it is crucial to recognize the attitudes and behaviors that influence patient safety.
Patient safety is a term that is used to refer to the lack of avertable impairment to a sick person during health care practices (WHO, 2008). The definition indicates the group of efforts and actions that health facilities and healthcare providers undertake to avoid patient harm during the process of providing health care. In this case, patient safety concerns arise due to medical errors that cannot be pinned down on a simple factor. For example, a study on the National Health Service (NHS) hospitals in Britain found that medical errors resulted from poor communication between professional providers, poor medical records, misdiagnosis by inexperienced clinicians, lack of adequate evaluate before discharging patients from hospitals, and insufficient input by consultant physicians in the daily care of patients.
On the other hand, the World Health Organization (2008) identifies the patient safety issues according to the level of country development as represented in the table below:
Another research by Leape (2009) brings the medical and public attention to medical errors by concluding making a mistake is part of human life. The research links patient safety issues to the failure in organizational systems and procedures. Further, the research recommends more focus on system errors as compared to human errors. To address the concerns about patient safety, Leape (2009) suggests six principles, which include focusing on errors because of poorly designed systems, the adoption of safety culture in the place of punitive environment, patient-focused attention, intelligibility, joint effort, and collaboration. Further, he recommends the sharing of accountability by all stakeholders in the organization. Concisely, it is evident that patient safety is a major global issue in the healthcare sector. The subject is highly controversial. Different scholars and medical professionals provide different approaches to addressing the issue effectively.
Problem Statement
In developing countries, patient safety is an issue of greater concern as compared to developed nations. The United Arab Emirates is a country in transition. It has one of the most elaborate healthcare systems in the Middle East. However, just like any other country, patient safety is an important issue when it comes to ensuring an effective healthcare system. Patient safety is a global issue and that no region can pride itself as not facing this challenge in its healthcare system. As such, the only way healthcare organizations can ensure that they have the best patient safety outcomes for their patients is through the continuous review of the existing patient safety programs and making the necessary adjustments to guarantee progressive improvement towards the best healthcare outcomes for health care seekers (Wagner, Smits, Sorra, & Huang, 2013).
Based on this recognition, this study seeks to investigate the patient safety conditions in one of the Al Noor Hospitals in Abu Dhabi, the United Arab Emirates. The hospital that will be used will be the Airport Campus, Al Noor Hospitals Group in Abu Dhabi. Al Noor Hospitals form a large part of the available healthcare facilities in the country. Consequently, they serve many patients. The patient safety conditions in the selected hospital will be an important indicator of the patient safety conditions in the whole of the Al Noor Hospitals conglomerate and the whole of Abu Dhabi. The study will also focus on the identification of the various steps that the health facility has undertaken to learn from previous cases of concern on patient safety. Such information will be obtained from the Airport Campus, Al Noor Hospitals Group to highlight changes in patient safety outcomes, both negative and positive, and consequently make important conclusions on whether the implemented patient safety programs, if any, have had positive or negative outcomes for the patients at Al Noor Hospitals Group.
Literature Review
The emphasis or importance that is placed on patient safety has taken root in the periods of modern medicine. However, it is worth noting that patient safety has existed even before contemporary medicine. It can be traced to the ancient Greek civilians, or possibly, earlier. For instance, Hippocrates acknowledges the harm that patients often receive from well-intended actions of their healers or doctors. In 4 BC, the Hippocratic Oath, which indicated the commitment of the healers to the good of their patients, was written (Tabrizchi & Sedaghat, 2012). The oath required healers to do the best of their ability and judgment concerning what seemed good for the patients without harming them. Such records from the civilization of thousands of years ago show that patients were often harmed in the process of getting medical care.
However, following a report by the Institute of Medicine in the 21st century, the issue gained international attention. In the report, the Institute of Medicine reported that between 44000 and 98000 deaths in the US were because of medical errors and negligence (Leape, 2009). In 2000, following the report, the President of the United States, Bill Clinton, established a nationwide system of reporting medical errors. It is from this point that patient safety has expanded to become a central tenet of the healthcare system in the world.
Research on Patient Safety
Leape (2009) studied the patient safety and identified key areas that imply a positive patient safety environment or culture in healthcare institutions. These characteristics of patient safety culture include transparent and open communication about safety issues, support by local and organizational leaders, and effective teamwork. In this research, the emphasis was on the personnel as key determinants of safety culture in health organizations. The study used observational cross-sectional study. The strength of the research was evident in its focus on primary observational data, which ensured that it obtained first-hand information on the behavior of medical practitioners. The major weakness of the study was its narrow focus on only observational evidence, which fails to capture other important factors that may influence the findings. Further, its focus on the local hospital setting means that the findings of the study cannot be generalized. However, the study is different from others that show that personnel are not the only determining factors for patient safety. As such, there is a need for more research on other factors such as resources and the setting on the patient safety outcomes.
Patient Safety Assessments
Another study by Broughton, Ikram, and Sahak, (2013) used the cross-sectional observation study in a maternity hospital to record the patient safety culture and efforts in Afghanistan. To determine the healthcare risk that patients are exposed to when receiving health care in hospitals, the study reveals the importance of having clear measurement systems to identify such risks. During the early days of the concept of patient protection, patient safety assessment approaches were blurred and highly contestable. In other words, despite the general agreement that health care providers often harmed their patients, no consensus was reached concerning the indicators of patient safety in health care facilities. The research found that medical records were poor. The condition had a significant influence on patient safety. However, no specific pattern could predict patient safety. Since then, a parallel study by Palmieri et al. (2008) confirms the major developments that have been aimed at streamlining patient safety assessment strategies to guarantee across-board understanding of what patient safety implies.
In 2004, the Medical Errors Workgroup of the Quality Interagency Coordination Task Force (QuIC) recognized the need for a measurement tool to assess patient safety culture in hospitals and healthcare-related organizations. In response to its recommendations, QuIC funded the development of a hospital survey tool on patient safety culture. The survey, which was developed by an organization contracted by the Agency for Healthcare Research and Quality (AHQR), has become a common and accepted instrument among health practitioners and researchers in patient safety. The tool has gained prominence due to its simplicity and ability to be applied in different institutions and contexts. For instance, the tool can be applied at the institutional level as whole or in specific departments or units in a given healthcare or non-healthcare context.
Another study by Wagner et al. (2013) shows how the effectiveness of the tool has been further strengthened by its ability to compare and contrast between previous and future patient safety outcomes in hospitals. It has been used in many countries to compare their patient safety outcomes in the world. For example, the tool was used to compare the patient safety culture between Netherlands, the United States, and Taiwan. The study involved 45, 622, 74 hospitals in Netherlands, the United States, and Taiwan respectively (Wagner et al., 2013). The results indicated that the three countries had high teamwork within units in hospitals where the findings were 92% for Netherlands, 88% for Taiwan, and 85% for the United States.
However, major differences were witnessed in terms of communication openness between the three countries. Overall, the research found that although there were high levels of teamwork, other areas such as openness and commitment were lagging behind and hence a cause for worry. Netherlands scored highly on patient safety while the USA emerged the last. From such study, it is evident that comparing patient safety outcomes across different countries is an important way of identifying defects and areas of improvement in the current patient safety programs in a health care facility, department, or a whole nation.
The United Arab Emirates Patient Safety Situation
The study by Aw (2012) reveals how the healthcare system has grown tremendously over the years since the country discovered oil in the 1970s. With robust economic growth and the rapid development of a least developed country to a developing country in transition, the country’s healthcare system has also been in the process of development (Aw, 2012). Currently, out of more than 8.3 million people, Aw (2012) asserts that 11% of them are natives while the rest are expatriates. The UAE healthcare has expanded tremendously to cover this large population. One of the largest healthcare providers in the country is the Al Noor Hospitals, which will be part of the research since the study will be undertaken at the Airport Campus, Al Noor Hospitals Group.
However, the study does not focus on patient safety in the country. Although the country has focused more resources on fighting against major ailments such as obesity, cardiovascular diseases, injury, and cancers, this move does not mean that the country has no patient safety issues in its healthcare system. The common patient safety concerns include medication and blood labeling mistakes among others. Besides, the study confirms the lack of comprehensive studies that have focused on identifying the patient safety situation in the healthcare system in the country. It is for this reason that there is a high need for studies to focus on the identification of patient safety conditions in the country.
Challenges in Implementing Patient Safety Programs
According to Palmieri et al. (2008), despite the recognition of the importance of patient safety, there are still many challenges that health institutions and countries face in the quest of ensuring safe health care for all people. The study relied on the existing literature to formulate its findings. Based on the findings, several campaigns that have been implemented to improve patient safety have raised controversies.
Firstly, concerns have been raised that the various patient safety-reporting programs in the United States have resulted in actionable plans that can reduce such cases. In other words, even with the identification of concerns on patient safety in some countries or states as evident in the USA, Palmieri et al. (2008) confirm that many hospitals or healthcare systems are reluctant to implement programs to reduce the identified cases of patient safety.
Secondly, in the reporting process or the identification of patient safety issues, concerns have been raised that the introduction of new technologies and their impact on patient safety are not well reported. Such lack of reporting fails to address or identify any negative or positive impact that such technologies can bring to a healthcare facility. It is for this reasons that QuIC recommends the sharing of information on new technologies and methods in understanding safety conditions in hospitals and consequently informing future practices and programs on patient safety (Palmieri et al., 2008).
Another major issue is on the legal dilemmas such reporting or patient safety programs may generate. For instance, when healthcare practitioners are required to report adverse outcomes of their practice such as death or serious damages to patients, then accountability concerns are likely to arise. In such a situation, not only can malpractices increase but also healthcare practitioners may be unwilling to report such mistakes if they feel that they are likely to receive litigation for their actions.
Thus, the study concurs with Tabrizchi and Sedaghat’s (2012) finding that it is important for healthcare facilities to analyze and investigate medical errors without the fear of litigation. The above challenges are a major hindrance to ensuring the success of patient safety programs in the developing nations, countries in transition, and developed countries.
Research Questions/Hypotheses
The research questions will be as follows:
- What are the major patient safety issues in Al Noor Hospitals, Airport Campus?
- How has the hospital responded to patient safety issues?
- What are the concerns and challenges in the hospital among the healthcare providers in ensuring the success of patient safety programs?
The research hypotheses will be as follows:
- Al Noor Hospital faces major patient safety issues
- The hospital has adequately responded to patient safety issues and incidents in the past
- There are concerns and challenges in the hospital among the healthcare in ensuring success of patient safety programs
Study Rationale, Justification, and Benefits
The study on patient safety is a major part of promoting good health care outcomes for all patients. In this case, it is important for modern health care systems and institutions to put in place good measures that can promote positive healthcare outcomes. Patient safety is part of the process of ensuring the best healthcare outcomes for those who seek healthcare services. In the United Arab Emirates, very few studies have been undertaken towards understanding patient safety in the hospitals in the country. It is important to undertake this study, which will highlight and bring forward the patient safety conditions in the hospitals in the UAE.
The findings of the study will also be important in informing future programs and activities that can improve patient safety and outcomes in the country. Further, the study will identify gaps in research that future studies should focus on to expand the knowledge of patient safety in the healthcare sector. As revealed in the literature review, previous studies have not elaborately addressed whether the availability of resources or lack thereof has a direct impact on patient safety. This research will seek to fill the gap in the knowledge area.
Methodology
Research Design
The research will use a modification of the AHRQ Hospital Survey on patient safety culture where staff members will be questioned on medical errors, patient safety issues, and reporting at Al Noor Hospitals Airport Campus. The survey will constitute 20 questions, which will assess 12 dimensions of patient safety and culture as follows:
- Teamwork within units
- Supervisor/manager expectation and actions promoting patient safety
- Communication openness
- Non-punitive response to error
- Organizational learning-continuous improvement
- Feedback and communication about error
- Frequency of events reported
- Hospital handoffs and transitions
- Overall perceptions of safety
- Teamwork across hospital units
- Hospital management support for patient safety
- Staffing
The respondents will be required to rate the various dimensions that are represented in the questionnaire on a five-point Likert scale of frequency (never, rarely, sometimes, most of the time, always) or agreement (strongly disagree, disagree, neutral, agree, strongly agree). The survey will place much emphasis on the patient safety culture at the unit level since the sample population will include nurses and doctors who are aware of safety programs at the unit levels where they work. The survey will also be designed in a manner that will allow the respondents to write additional comments where necessary. Such comments will be important in providing direct quotes on the views of respondents on various issues that the research survey will seek to answer.
Population and Sampling
The study will be carried at the Al Noor Hospital, Airport Campus, and the United Arab Emirates. The use of Al Noor Hospital Airport Campus is of great significance since the hospital is part of the Al Noor Hospitals, which form one of the biggest hospital groups in the country. As such, it will be better placed to provide findings, which can be generalized to other hospitals under the same name and consequently throughout the country. The study will include lab technicians, nurses, physicians, doctors, and management staff members from all the various units of the hospital. Further, all participants will be required to be permanent employees with more than one year working at the facility.
To ensure little disruption to the running of the hospital, it will be important to liaise with the management who will provide a list of the staff members who will participate in the study. To ensure that the research team knows the participants better, the management will be required to provide the names of the participants and their respective departments or units at the hospital. The sample population targeted will be 40 people drawn from the various departments in the hospital to ensure better representation in the survey.
Variables and Measurement
It is important to understand the variables that will guide the determination of the level of patient safety in the hospital under this study. Patient safety is a function of the number of errors or negative outcomes from medical procedures on patients and the efforts that have been dedicated to ensuring patient safety. In the case of the Al Noor Hospital, patient safety will be the dependent variable that will be measured in terms of the number of errors that have been reported in the hospital. The seriousness of the errors will be an independent variable in the research. The errors will be measured against the relevant corrective measures, or lack thereof, with a view of understanding the outcomes of such efforts.
Data Collection
The survey implementation can be carried either online or in paper format. In this study, the paper format will be preferred to the online format. This strategy will be in line with AHRQ recommendation that advocates paper format to obtain the highest possible response rate. The surveys will be delivered to the hospital’s management, which will then distribute them to the relevant units and people who will have been selected for the study. The management will also work closely with a research assistant who will be readily available to clarify any issues that may have ambiguity in the research. Each survey will have a unique study ID, which will be important in tracking non-respondents in the study. After distributing the surveys, respondents will be given enough time of five working days to fill the survey questions.
Data Analysis
The data analysis is an important part of the research since it will help in converting the collected data into meaningful information. The data analysis will utilize various tools to provide important patient safety indicators that will be used to understand the situation in Al Noor Hospital. Some of the tools that will be used will include graphs, pie charts, and descriptive analysis to make sense of the feedback that will be collected from the survey questions. The use of percentages will also be important in making sense of various statistics that the research will reveal. Where applicable, data analysis software such as the SPSS will be used to code or arrange the data into formats that can easily be understood and interpreted for the purpose of this research.
Potential Limitations
Undertaking the research will require will have several limitations. Firstly, obtaining the relevant permissions to undertake the survey may be a problem in the country whose laws are very strict. Secondly, obtaining the right information from the participants may be a challenge, especially since they may fear the repercussions of providing the information sought by the paper. Lastly, the resources needed for the research may present a challenge in terms of ensuring timely and adequate completion of the research.
Schedule
The estimated time for the completion of the study will be six months. The following is the planned timescale for the completion of the study:
Research Ethics
Studies that focus on health care are highly sensitive due to the possible implications they may bring to the sector, as well as on patients. As such, such studies are highly regulated and formalized. Further, they have high ethical expectations, which must be considered. Firstly, the safety and rights of participants must be respected at all times. In this case, participants at the Al Noor Hospital, Airport Campus will not be involved in activities that may jeopardize their rights and safety. Secondly, the research will uphold the rights to privacy of the participants at all times. The study will have the approval of the health ministry and the participating hospital to ensure that it does not violate any laws of the country concerning medical research. Further, to advance the rights of the participants, the research will be voluntary. In this case, participants will not be forced to participate or respond to all questions. The survey will not request participants to record any personal information concerning their identity. This strategy will ensure that the right to privacy and confidentiality is guaranteed.
Reference List
Aw, T. (2012). Lost in transition? Challenges and Opportunities for raising health and safety awareness among a multinational workforce in the United Arab Emirates. Safety and Health at Work, 3(1), 298-304.
Broughton, E., Ikram, A., & Sahak, I. (2003). How accurate are medical record data in Afghanistan’s maternal health facilities? An observational validity study. BMJ Open, 3(4), 24-31.
Leape, L. (2009). Errors in medicine. Clinica Chimica Acta, 404(1), 2-5.
Palmieri, P., DeLucia, P., Peterson, L., Ott, T., & Green, A. (2008). The anatomy and physiology of error in adverse health care events. Advances in Health Care Management, 7(1), 33-68.
Tabrizchi, N., & Sedaghat, M. (2012). The first study of patient safety culture in Iranian primary health centers. Acta Medica Iranica, 50(7), 505-510.
Wagner, C., Smits, M., Sorra, J., & Huang, C. (2013). Assessing patient safety culture in hospitals across countries. International Journal for Quality in Health Care, 25(3), 213-221.
WHO. (2008). Global Priorities for Research in Patient Safety. Web.
Appendix 1: Survey
Survey for the Patient Safety Research in Al Noor Hospital, Airport Campus, UAE
This survey is part of the research on the patient safety at the Al Noor Hospital, Airport Campus. The main aim of the study is to investigate patient safety at the hospital. The survey will take 10-15 minutes to complete. As a participant, you will be asked about your opinion on different areas of patient safety at the hospital. Please read carefully and respond to the survey to the best of your ability. The survey will be collected after 5 working days from the time you receive the questionnaire.
Instructions
- You are not required to write your name on the questionnaire
- Answer each question to the best of your knowledge and ability to represent your opinion
- You are not obliged to answer all questions
- Please note that the survey is highly confidential and that no one in your organization will be allowed access to your questionnaire
Thank You for Your Participation in Advance
Survey Questions
Please Answer the Questions Appropriately
- Teamwork within Units
[Strongly disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree]- People support each other in this unit
- When there is a need to perform a task fast, we work as a team to complete the work.
- Others help out when an area of the unit gets busy
- People treat each other with respect at the unit
- Supervisor/Managers’ Expectations and Promotion of Patient Safety
[Strongly disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree]- My supervisor appreciates and acknowledges work that has been done according to established patient safety procedures
- When there is pressure at work, supervisor/ manager is willing to take shortcuts to complete tasks
- Supervisor overlooks patient safety issues that happen at the unit
- Organizational Learning-Continuous Improvement
[Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree]- We are progressively and actively dedicated to improving patient safety
- We evaluate the effectiveness of changes towards patient safety
- Management Support for Patient Safety
[Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree]- Hospital management is dedicated to providing good work environment that is safe for patients
- Overall Perceptions of Patient Safety
[Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree]- Patient safety is a top priority at the unit
- Feedback and Communication
[Never, Rarely, Sometimes, Most of the Time, Always]- We give feedback on initiatives and changes implemented based on event reports
- Communication Openness
[Never, Rarely, Sometimes, Most of the Time, Always]- Staff members are free to communicate or speak up in the case of anything that can have potential risk to patient care
- Frequency of events reported
[Never, Rarely, Sometimes, Most of the Time, Always]- How often are events that have the potential of harming the patient reported?
- Team Work Across Units
[Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree]- Units in the hospital work together collaboratively to ensure best patient care
- There is no coordination between units in the hospital
- Staffing
[Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree]- There is adequate number of staff members to handle workload
- Hand offs and Transitions
[Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree]- There is smooth transition when transferring a patient to another unit
- Non-punitive response to errors
[Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree]- Staff members worry that mistakes will be held against them
- Staff members worry that mistakes will be kept in their personal files
