Patient safety in hospitals - Research Paper Example

Patient Safety in Hospitals What is the difference between a research question and a hypothesis? The research process consists of several steps. The research question is a critical starting step in the research process. It reflects the idea that is the basis of the research paper. The hypothesis is the attempt of answering the research question or questions at the outset. The hypothesis is the anticipated result of the author or authors. There may be only one such prediction or there may be more than one. 2. Critique of a research articleAbbas, A. E. A.

, Bassiuni, N. A. & Baddar, F. M. (2008). Perception of Front-line Healthcare Providers Toward Patient Safety: A Preliminary Study in the University of Egypt. Topics in Advanced Practice Nursing, 8(2). Retrieved October 19, 2011, from Web Site: http://www.medscape.com/viewarticle/570921_2 is the article taken up for a critique. Abbas, A. E. A., PhDN is an Assistant Professor in the Nursing Administration and Education Department, King Saud University, Saudi Arabia. Bassiuni, N. A., PhDN, MSN, BScN is also an Assistant Professor in the Nursing Administration Department, Alexandria University, Alexandria, Egypt.

Baddar, F. M., PhDN, MSN, BScN is an Assistant Professor in the Nursing Administration and Education Department, King Saud University, Saudi Arabia. The review of literature (ROL) conducted by the study shows that in the healthcare field there is growing realization that under the influence of several factors the culture in healthcare organizations is not conducive to patient safety. The factors involved are productivity, efficiency, and cost controls. Though a universal agreement on what constitutes a safety culture for health organizations is yet to emerge, there are clear indications of what these dimensions should be.

The safety culture of an organization involves individual and group values, attitudes, perceptions, and behavioural patterns of commitment towards safety management in the organization. Most of the efforts in providing an understanding safety culture have been focused on healthcare systems and patient engagement within these systems, with particular emphasis on such understanding in the Middle-East. There has been limited research into the handling of patient safety issues in terms of the perceptions of the front-line healthcare providers, leaving a gap in the body of knowledge on the subject.

The authors justify this study on the basis of attempting to reduce this gap in the body of knowledge. The difference in perceptions on patient safety of frontline healthcare providers in a clinical and the whether there was any association between these perceptions and the variables of job category, years of experience, and work setting were the research questions. The hypothesis was that there would be a difference in perception on patient safety between the different categories and work settings, and that there would be an association between the variables of job category, years of experience, and work setting.

The study used a quantitative methodology, with the “Safety Climate Survey” used as the study instrument. The categories of frontline healthcare workers selected in the purposive sampling were nurses, physicians, and paramedics. The findings of the study were that there was a significantly higher perception of patient safety among physicians over nurses and paramedics. The study also found that the work setting had an influence on the perception of patient safety. For instance, participants from ICU settings demonstrated the highest perception for patient safety.

The study also found that the number of years of experience had an influence on perception of patient safety. During the early years of experience there was a higher perception of patient safety, which diminished as the years of experience increased. The study also found an overall low perception of patient across all categories of frontline healthcare providers. Literary References Abbas, A. E. A., Bassiuni, N. A. & Baddar, F. M. (2008). Perception of Front-line Healthcare Providers Toward Patient Safety: A Preliminary Study in the University of Egypt.

Topics in Advanced Practice Nursing, 8(2). Retrieved October 19, 2011, from Web Site: http://www.medscape.com/viewarticle/570921_2 http://www.medscape.com/viewarticle/570921From Topics in Advanced Practice Nursing eJournal > Articles Perception of Front-line Healthcare Providers Toward Patient Safety: A Preliminary Study in a University Hospital in Egypt Hanan Abdullah Ezzat Abbas, PhDN, MScN; Nora Ahmed Bassiuni, PhDN, MSN, BScN; Fatma Mostafa Baddar, PhDN, MSN, BScNAuthors and Disclosures Posted: 04/16/2008; Topics in Advanced Practice Nursing eJournal.

 2008;8(2) © 2008  Medscape Authors and DisclosuresHanan Abdullah Ezzat Abbas, PhDN, MScN, Assistant Professor, Nursing Administration and Education Department, King Saud University, Riyadh, Saudi ArabiaNora Ahmed Bassiuni, PhDN, MSN, BScN, Assistant Professor, Nursing Administration Department, Alexandria University, Alexandria, EgyptFatma Mostafa Baddar, PhDN, MSN, BScN, Assistant Professor, Nursing Administration and Education Department, King Saud University, Riyadh, Saudi ArabiaDisclosure: Hanan Abdullah Ezzat Abbas, PhDN, MScN, has disclosed no relevant financial relationships.

Disclosure: Nora Ahmed Bassiuni, PhDN, MSN, BScN, has disclosed no relevant financial relationships.Disclosure: Fatma Mostafa Baddar, PhDN, MSN, BScN, PhD, has disclosed no relevant financial relationships.AbstractObjective: Increasing focus on improving patient safety in healthcare organizations makes it crucial to first create a positive safety climate. The current study targeted the perceptions of front-line healthcare providers toward safety climate, and management and clinical staff commitment to patient safety.

Methods: This study was conducted at Alexandria Main University Hospital, Alexandria University, Egypt, during the period from March, 2006 to December, 2006. Subjects were a convenience sample of 400 front-line clinical staff members working in the general medical and surgical wards, intensive care units (ICUs), and paramedical departments at Alexandria Main University Hospital. The "Safety Climate Survey" was used to gain information about the front-line health care providers perceptions toward patient safety in the clinical settings.

Results: The majority of participants conveyed negative perceptions toward patient safety. Physicians perceptions about patient safety were high compared to those of nurses and paramedical personnel. Respondents perceived a significantly stronger commitment to patient safety from their managers and surrounding safety climate than from clinical personnel. Perceptions of subjects working in the general wards reflected a significantly poorer commitment to safety from their managers compared with those working in the ICUs and paramedical departments.

Moreover, negative correlations were found between subjects years of experience and perceptions about patient safety climate and management commitment to patient safety.Conclusion: Achieving an acceptable standard of patient safety requires that all healthcare settings develop patient safety systems that include both a positive culture of safety and organizational support for safety processes. This will not be possible unless the perceptions of the front-line health care providers and management are positively managed and directed.

IntroductionSafety in healthcare has received substantial attention worldwide since the late 1990s.[1] Rapid change in healthcare has mandated greater attention to safety, which is essential for quality patient care, employee welfare, and morale.Safety is a condition or state of being resulting from the modification of human behavior and/or designing of the physical environment to reduce hazards, thereby reducing the chance of accidents (Khatab M, unpublished data, 2005). The Institute of Medicine (IOM) report, "To Err Is Human,"[2] described the magnitude of the patient safety problem in some detail, yet it provided only a high level view of how organizations might change in order to improve care delivery.

The IOM report also highlighted an actionable conclusion that "the biggest challenge to moving toward a safer health system is changing the culture from one of blaming individuals for errors to one in which errors are treated not as personal failures, but as opportunities to improve the system and prevent harm."[2] The IOM estimated that 98,000 preventable deaths occur each year due to medical errors, with no significant improvement in 5 years due to failure to improve patient safety.[3,4] Since the IOM report, organizations have struggled to develop effective programs for improving safety.

[2] A study conducted by Khatab in 2005 (personal communication) in a teaching hospital affiliated with Alexandria University assessed the facilitys safety management system and developed a manual for safety practices for nurses in critical care units. This study concluded that the hospital safety management system was insufficient. Only 36% of safety measures to prevent susceptibility to hospital-acquired infection were followed. None of the safety measures that applied to the physical structures of the studied units were followed.

Moreover, Khatab learned that needle-stick injuries were the main source of hazard for both technical and professional nurses, while insufficient equipment, medication errors, improper preparation of the patient for procedures, and nursing malpractice were identified as frequent hazards for patients in the ICUs.Promoting a culture of safety has become a pillar of the patient safety movement. Patient safety was defined by Batcheller and colleagues[5] as "the avoidance and prevention of patient injuries or adverse events resulting from the processes of health care delivery.

Patient safety also means prevention of harms to patients."In recent years, there has been increasing understanding within the healthcare field that various factors create a culture that contradicts the requirements of patient safety. These factors include the emphasis on production, efficiency, and cost controls;[6] organizational and individual failure to acknowledge fallibility;[7] and professional norms for perfectionism among healthcare providers.[8] Increasingly, the culture of healthcare organizations is regarded as a potential risk factor that threatens the patients for whom they provide care.

[9,10] Although there is no firm consensus on the definition of safety culture, the Advisory Committee on the Safety of Nuclear Institutions provides the following definition that can easily be adapted to the context of patient safety in healthcare: "The safety culture of an organization is the product of individual and group values, attitudes, perceptions, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organizations health and safety management.

Organizations with a positive safety culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of safety, and by confidence in the efficacy of preventive measures."[11] Two important concepts affect the culture of safety: error reporting and disclosure of errors. The acceptance of and means by which errors are identified, reported, and communicated to those involved or affected, have much to do with how well safety is ingrained in the healthcare organizations culture.

[12] Increasing the focus on improving patient safety in healthcare organizations made it crucial to first create a positive safety climate. According to Flin and colleagues,[13] a climate of safety can be regarded as the surface features of the safety culture, discerned from the workforce attitudes and perceptions at a given point in time.In 2004, the Center of Excellence for Patient Safety Research and Practice at the University of Texas established a conceptual framework to transform patient safety.

[14] They believe that most medical errors result not from the errors of individuals, but from numerous latent errors that exist within complicated systems of care delivery. This approach to medical error is well supported and consistent with historical efforts in healthcare quality improvement.Medical errors can be caused by factors at several different levels of a system.[11] On one level, individual processes may trigger errors. However, an individual who triggers an error at the "sharp end" may not be the root cause of that error.

Instead, the error may be related to the interactions of individuals with inadequately designed medical devices, for example. Factors related to the functioning of teams reflect a third, even wider level that can also lead to errors, as can organizational policies and structures (eg, resource allocation, staffing and scheduling, and training). Finally, societal laws and regulations influence all the other levels and may affect the frequency and types of errors.[14] The current study targeted the individual level; it focused on studying perceptions of front-line healthcare providers toward safety culture, and management and clinical staff commitment to patient safety.

Safety culture surveys are useful for measuring organizational conditions that can lead to adverse events and patient harm in the healthcare organization. In addition, these surveys can be used to raise awareness about patient safety issues and track changes over time. The ultimate goal, to develop a positive culture of safety, has tremendous potential to benefit patients.[12] In the Middle East, efforts to transform the healthcare system are ongoing. These efforts require health administrators to consider the role of front-line care providers perceptions about safety, since these can both positively and negatively affect efforts to improve safety.

In March 2007, the Eastern Mediterranean Regional Office (EMRO) of the World Health Organization (WHO) planned and conducted a "Regional Patients for Patient Safety" workshop in Cairo for all 6 of the WHO geographic regions.[15] This event brought together 30 participants from 8 countries within the Eastern Mediterranean region. The event created a network of consumer champions in the Eastern Mediterranean who are actively engaged in contributing their experience, wisdom, and knowledge to improving patient safety.

The meeting culminated in several discussions around the topic of patient safety with particular emphasis on the engagement of patients in shaping the healthcare system.Moreover, in Egypt, various studies in the patient safety field have been conducted.[16] However, less attention has been focused on handling patient safety issues from the front-line healthcare providers perception. Furthermore, in order to advance patient safety in healthcare organizations, collaborative efforts must begin with an assessment of the current culture to identify the positive and negative perceptions and attitudes toward the safety environment and relationships that promote or hinder safe patient care.

Thus, this study was carried out to identify perceptions of front-line healthcare providers toward patient safety, in order to propose actions that can be implemented to improve behaviors, attitudes, and policies that support patient safety culture, and to reinforce and sustain a commitment to safer care.Study AimsOur study had 3 aims:1. Gather information about:a. The perceptions of front-line clinical staff about patient safety;b. The commitment of management staff to patient safety; andc. The commitment of healthcare personnel to patient safety.2. Identify how perceptions varied across different departments.3. Identify the association between the front-line healthcare providers perceptions about patient safety and variables such as job category, years of experience, and work setting.

Materials and MethodsSettingThis study was conducted in a 1724-bed government teaching hospital affiliated with Alexandria University in Egypt. Six general medical and surgical units, 6 ICUs, and 5 paramedical departments were randomly selected to participate. Paramedical departments included 2 pharmacies, 2 general laboratories, and the physiotherapy department.SubjectsA purposive sampling technique was used to select the study sample. Four hundred front-line clinical staff members, from those available in the selected settings at the time of data collection and meeting the inclusion criteria, joined the study.

The front-line clinical staff included nurses (n = 266), physicians (n = 80), and paramedical personnel (n = 54). The inclusion criteria for nurses were: working in the selected settings for at least 6 weeks prior to the data collection period and regularly working at least 20 hours per week in the selected settings. For physicians, the inclusion criteria were: treating, on average, at least 3 patients per week in any of the selected inpatient settings. For the paramedical personnel, the inclusion criteria were: assigned either primarily to the selected settings or assigned to do work at least 3 days a week in the selected settings.

Study InstrumentOur tool, the "Safety Climate Survey," was developed and validated by The Center of Excellence for Patient Safety Research and Practice, University of Texas.[17] The tool was translated to Arabic and used to gain information about the perceptions of the front-line healthcare providers about patient safety in the clinical settings. The tool consisted of 3 parts:Part 1: "Safety Climate" included 8 statements related to perception of front-line clinical staff about safety in their clinical areas.

Part 2: "Management Commitment" included 5 statements related to managements commitment to patient safety.Part 3: "Personnel Commitment" included 6 statements related to health personnels commitment to patient safety.The responses were measured with a 5-point Likert scale and ranged from (1) "Strongly Disagree" to (5) "Strongly Agree." A reverse scoring was devised for question 18 due to its negative wording, so that (1) reflects "Strongly Agree" and (5) indicates "Strongly Disagree".In addition, targeted characteristics were added to the tool and included questions related to job categories, age group, years of experience, and work setting.

A cover letter, providing instructions for completing and returning sheets to researchers, and a statement of information confidentiality were attached to the survey sheet.MethodsFollowing institutional approval, the Arabic tool was tested by 5 experts in the field of study for its content relevance, and necessary modifications were made. A pilot study was carried out on 10% of the subjects to assess the clarity of the statements and time required to complete the survey. After giving consent, subjects completed the surveys while they were in their work settings.

Completing the survey took about 15 minutes. Data collection, review, and coding were completed during the period from March 2006 to December 2006.Statistical AnalysisAfter data were collected and coded, they were transferred into a specially designed format for computer entry. Frequency analysis, cross-tabulation, and manual revision were all used to detect and manage errors. The Expanded Program for Immunization (EPI INFO 3.2, 2006) was used for both data analysis and presentation.Statistical measures included descriptive measures (count, percentage, arithmetic mean, standard deviation, minimum, and maximum) and Chi-square for analysis of qualitative variables.

The level of significance used was P ≤ .05.To calculate the 100-point scale score (teamwork climate) for an individual respondent, we performed the following:Reverse scored all negatively worded items;Calculated the mean of the set of items from the scale;Subtracted 1 from the mean; andMultiplied the result by 25.The equation looked like this:Patient Safety Climate Scale Score for a Respondent = {(Mean of the safety climate items)-1) x 25}To calculate the percent of respondents who had positive perception (ie, percent agreement), the percent of respondents with a scale score of 75 or higher was identified.

A score of 75 on the scale indicates the same thing as "agree slightly" on the original 5-point Likert scale (1=Disagree Strongly, 2=Disagree Slightly, 3=Neutral, 4=Agree Slightly, 5=Agree Strongly). With the conversion to the 100 point scale, 1 = 0, 2 = 25, 3 = 50, 4 = 75, and 5 = 100.ResultsFour hundred respondents completed the survey. Nearly half of the participants (48.5%) were in their thirties and 59% of the targets were working in ICUs. Ten percent of the subjects were newly hired, and 14% had been working for more than 13 years ( Table 1 ).

Table 2 presents the relationship between front-line healthcare providers perceptions toward patient safety and their job categories. Mean scores for perception of patient safety climate were significantly higher for physicians (3.69 ± 0.42) than for nursing personnel (3.47 ± 0.36) and paramedical personnel (3.51 ± 0 .25); the difference was statistically significant (X2 = 6.65, P < .05). Moreover, there was a statistically significant difference between perception of the 3 categories of respondents toward management commitment to patient safety, with scores of 3.93 ± 0.52, 3.68 ± 0.53, and 3.97 ± 0.29 for physicians, nursing personnel, and paramedical personnel, respectively (P < .05). The same was observed in relation to safety climate.

Table 2 shows that physicians had the highest mean scores regarding safety climate (3.59 ± 0.52) and personnel commitment (3.61 ± 0.63). Table 3 illustrates the relationship between front-line healthcare providers perceptions toward patient safety and their work settings. It was observed that the participants in the ICUs had the highest overall mean score on patient safety items (3.57 ± 0.34), and there was no statistically significant difference between perceptions of the participants in the 3 work settings (P < .05). Table 3 also illustrates that a statistically significant difference was found among participants work settings in relation to their perceptions of management commitment to patient safety (X2 = 17.233, P < .05).

Regarding the relationship between participants years of experience and their perceptions toward patient safety, Table 4 points out that the total mean score of the participants perceptions about patient safety decreased as their years of experience increased. Participants perceptions of clinical staff commitment to patient safety fluctuated up and down as their years of experience increased. Those who worked in their jobs for less than a year recorded the highest overall mean scores (3.68 ± 0.41) compared with the groups with more years of job experience.

Specifically, those who had worked less than 1 year showed the highest mean score in relation to all 3 items of patient safety: safety climate (3.41 ± 0.53), management commitment to patient safety (3.95 ± 0.47), and personnel commitment to patient safety (3.75 ± 0.61). In contrast, participants with more than 13 years of job experience showed the lowest overall mean scores related to patient safety (3.43 ± 0.57). Participants whose experience ranged from 3 to less than 8 years had the lowest total mean score on perception toward patient safety climate (3.30 ± 0.51).

Table 5 indicates the number and percent of front-line healthcare providers who perceived "patient safety" positively and negatively, as distributed by targeted variables. There were statistically significant differences among participants perceptions among the 3 job categories (X 2 = 20.341, P < .05) and the 5 groups of years of job experiences (X 2 = 10.088, P < .05). Table 5 also shows that only 10.5% of participants had a positive perception toward patient safety compared with 89.5% with a negative perception.

DiscussionPatient safety is moving up the list of priorities for hospitals and healthcare delivery systems, but improving safety across a large organization is challenging.[4] Quality and patient safety management systems are based on the same principles. They are both planned and managed and depend on measurement, monitoring, and improvement efforts.[2] In the healthcare environment, organizational culture has been associated with several elements of organizational experience that contribute to quality, such as nursing care, job satisfaction, communication, standard of practice, and commitment to patient safety.

[12] We found that the majority of participants conveyed negative perceptions toward patient safety. This finding is in line with the findings of Aspden and colleagues,[18] who advocated that a key aspect of a patient safety system is a culture that encourages clinicians, patients, and others to be vigilant in facilitating learning and redesign of care processes.Safety culture assessment provides an organization with a basic understanding of safety-related perceptions and attitudes of both managers and staff.

[19] The assessment communicates what is important to the organization, as well as the desirable end states.[9,19,20] Pronovost and Sexton[21] advocated that in a safe culture, employees are guided by an organization-wide commitment to safety in which each member upholds his/her own safety norms and those of his/her coworkers. Moreover, within a healthcare context, safety culture influences patient safety by motivating healthcare professionals to choose behaviors that enhance, rather than reduce, patient safety.

Safety culture also aims to improve performance rather than blame individuals.[12] McKesson[22] concluded that as healthcare organizations develop patient safety strategies, it is vital to understand concerns and opportunities from the front-line nurses perspectives.Our study also indicates that the relationship between overall mean scores of the front-line healthcare providers perceptions toward patient safety and their job categories was statistically significant, and physicians reported the highest mean scores compared with other front-line healthcare providers.

This could be explained by the lack of communication and collaboration between nursing and medicine, which has a profound effect on workplace environment and patient care.In healthcare organizations, communication is a process for sharing information, thoughts, beliefs, and feelings that influence the individuals health-directed behaviors, and creating support for individual or collective action that directly affects professional-professional and professional-client interactions. Moreover, differences between the 2 professions perceptions can interfere with shared meaning, and the rules of the process of communication can be changed with inappropriate responses.

In a survey conducted by Kitch[23] to determine characteristics of patient safety culture, it was concluded that teamwork within units; honest and open communication among physicians, administrators, and healthcare workers; as well as open communication with patients and their families are considered the principal characteristics of a culture of safety.The results of our study contradict those of Carayon and co-authors,[24] who examined the elements of the work system, employees outcomes, and care processes by comparing various safety measures applied across 3 categories: nurses, physicians, and other staff.

In this study, they found that there was no difference between the 3 job categories on the measures of perceptions toward safety performance.We found statistically significant differences between the 3 job categories of participants, as well as among their work settings, and in perceptions of management commitment to patient safety. These findings corroborate those of Singer and colleagues,[25] who concluded that safety culture may not be as strong as desired by high reliability organizations, and that safety culture differs significantly, not only between hospitals but also by clinical status and job class within individual hospitals.

Furthermore, Singer and coauthors[25] and Sexton and colleagues[26] identified safety culture elements such as leadership and management commitment to safety, safety climate (ie, organizational resources for patient safety), and staff elements such as overconfidence. Pronovost and Sexton[21] described employees in a safe culture as being guided by an organization-wide commitment to safety. Safety culture includes the commitment of the leadership to discuss and learn from errors, documenting and improving patient safety, and using systems for reporting.

[27-30] Similarly, Singer and colleagues[25] found that commitment to safety is articulated at the highest levels of the organization, and claim that this must be translated into shared values, beliefs, and behavioral norms at all levels.According to Singer and Tucker,[28] nurses must accept their role accountability and move forward with concrete evidence of commitment toward participating in shaping a culture of safety. Loss of trust in hospital administration is widespread among nursing staff.

This loss of trust stems, in part, from a perception that initiatives in patient care and nursing work redesign have emphasized efficiency over patient safety. Poor communication practices have also led to mistrust, which has serious implications for the ability of hospitals to provide safer patient care.[31] Furthermore, management practices are essential to the creation of safety within the organization, and these practices include creating and sustaining trust throughout the organization.[31] Our study found no significant differences between front-line healthcare providers perceptions toward patient safety according to their work settings, although the management commitment to patient safety among paramedical departments reflected a more positive perception.

This may be because managers consider themselves to be part of the organization so they exert more effort to help it to be successful. Also, managers have to monitor quality of care, make decisions related to the work safety environment, utilize the resources, and participate in conferences and meetings, so they are more likely to get the job done and to achieve organizational goals. This achievement depends on the managers sense of obligation and commitment to the organization. These findings are supported by Chandler,[32] who concluded that employees who have high access to resources are more likely to achieve organizational goals with precision and to be more committed to their organizations.

Singer and Tucker[28] and Wong[33] advanced that perceptions differ between senior leadership and front-line staff regarding patient safety, with leaders having a more optimistic view than front-line staff. This difference suggests that some leaders do a better job than others in their efforts to communicate their commitment to patient safety.[34] Conclusion and Recommendations for ActionPatient safety is an integral part of the delivery of quality patient care, and achieving an acceptable standard of patient safety requires that all healthcare settings develop patient safety systems including both a positive culture of safety and an organizational support for safety processes.

This will not be possible unless the perceptions of the front-line healthcare providers and management are positively managed and directed. Based on our findings, we recommend that an effective safety culture should be initiated, supported, and maintained organization-wide, among both front-line personnel and senior leaders, to improve safety and quality. This can be achieved through specific actions and behaviors that embody a commitment to safety:Provide safety education to front-line staff, managers, and physicians that includes team training and education in communication techniques.

Advocate safety as everyones responsibility and incorporate a safety culture initiative into the overall organizational patient safety plan; ensure that patient safety initiatives, action plans, and results, as well as interventions to improve safety, are periodically reported to the board of directors.Empower staff to identify and ameliorate hazards and risks by allocating adequate safety resources and establishing a nonpunitive system for reporting errors and events.Implement a reward-based reporting system and ensure timely feedback to staff on how reports are used to improve patient safety.

Healthcare leaders and researchers should develop a "code of safe health settings and practices" to keep health practices much safer and up to the required standards.Healthcare organizations should conduct conferences, seminars, and discussions about how to initiate and maintain safety culture among all working teams while providing patient care.Further ResearchThis study was a first step upon which to build future research. The negative perceptions about commitment to patient safety reflected in this study need further investigation to clarify the attitudes of front-line healthcare providers and leadership staff toward patient safety.

To create a positive culture of safety, the current organizational environment must be assessed, including organizational structure and willingness to initiate, support, and maintain a positive work environment rather than a destructive, punitive system.[ CLOSE WINDOW ]Table 1. Targeted Characteristics of the ParticipantsTargeted CharacteristicsN (400)Percent (%)Job Category Medical personnelNursing personnelParamedical personnelAge Group < 30 years30-40 years> 40 yearsWork Setting General wardsICUsParamedical deptsJob Experience < 1 year1-3 years3-8 years8-13 years> 13 years8026654741941321142365040102102100562066.513.518.548.533.028.559.012.510.025.525.525.014.0Table 2. Relationship Between Front-line Healthcare Providers Perception Toward Patient Safety and Job CategoriesItems of Patient SafetyJob CategoriesX2 (P)*Medical PersonnelX ± SDNursing PersonnelX ± SDParamedical PersonnelX ± SDTotalX ± SDSafety Climate. 3.59 ± 0.523.28 ± 0.493.30 ± 0.443.34 ± 0.5010.51*(.005)Management Commitment 3.93 ± 0.523.68 ± 0.533.97 ± 0.293.77 ± 0.5211.96*(.003)Health Personnel Commitment 3.61 ± 0.633.51 ± 0.593.36 ± 0.513.51 ± 0.591.84(.399)Overall Mean Score of Patient Safety Climate 3.69 ± 0.423.47 ± 0.363.51 ± 0.253.52 ± 0.376.65*(.036)SD = standard deviation*P < 0.05Table 3. Relationship Between Front-line Healthcare Providers Perceptions Toward Patient Safety and Their Work SettingsItems of Patient SafetyWork SettingsX2 (P)*General WardsX ± SDICUsX ± SDParamedical Depts.

X ± SDTotalX ± SDSafety Climate 3.26 ± 0.523.40 ± 0.503.27 ± 0.443.34 ± 0.502.419(.298)Management Commitment 3.52 ± 0.603.85 ± 0.473.95 ± 0.243.77 ± 0.5217.233*(.002)Health Personnel Commitment 3.51 ± 0.653.54 ± 0.583.34 ± 0.523.51 ± 0.592.177(.337)Overall Mean Score of Patient Safety Climate 3.42 ± 0.453.57 ± 0.343.48 ± 0.233.52 ± 0.372.953(.228)SD = standard deviation*P < .05Table 4. Relationship Between Front-line Healthcare Providers Perception Toward Patient Safety and Their Range of Job ExperienceItems of Patient SafetyRange of Job ExperienceX2 (P)*0-1 yearX ± SD1-3 yearsX ± SD3-8 yearsX ± SD8-13 yearsX ± SD13+ yearsX ± SDTotalX ± SDSafety Climate 3.41 ± 0.533.36 ± 0.453.30 ± 0.513.35 ± 0.473.34 ± 0.613.34 ± 0.501.142(.888)Management Commitment 3.95 ± 0.473.80 ± 0.423.78 ± 0.433.77 ± 0.523.56 ± 0.763.77 ± 0.523.553(.470)Health Personnel Commitment 3.75 ± 0.613.35 ± 0.523.56 ± 0.523.56 ± 0.633.43 ± 0.703.51 ± 0.598.127(.087)Overall Mean Score of Patient Safety Climate 3.68 ± 0.413.48 ± 0.263.52 ± 0.273.54 ± 0.373.43 ± 0.573.52 ± 0.372.069(.723)SD = standard deviation*P < .05Table 5. Number and Percent of Front-line Healthcare Providers Who Are Positively and Negatively Perceiving "Patient Safety" as Distributed by Targeted VariablesTargeted VariablesFront-line Care ProvidersPerception N (400)X2 (P)*PositiveN %NegativeN %Job Category Medical personnelNursing personnelParamedical personnelWork Setting General wardsICUsParamedical deptsJob Experience < 1 year1-3 years3-8 years8-13 years> 13 years24 614 3.54 16 1.534 8.5 2 0.512 36 1.

58 212 34 156 14252 6350 12.5108 27202 50.548 1224 696 2494 23.588 2252 1320.341*(.00004)4.7039(.952)10.088*(.0389)Overall Perception42 10.5358 89.5---*P < .05