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      The impact of patient safety culture and the leader coaching behaviour of nurses on the intention to report errors: a cross-sectional survey

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          Abstract

          Background

          There is growing interest in examining the factors affecting the reporting of errors by nurses. However, little research has been conducted into the effects of perceived patient safety culture and leader coaching of nurses on the intention to report errors.

          Methods

          This cross-sectional study was conducted amongst 256 nurses in the emergency departments of 18 public and private hospitals in Tabriz, northwest Iran. Participants completed the Hospital Survey on Patient Safety Culture (HSOPSC), Coaching Behavior Scale and Intention to Report Errors’ questionnaires and the data was analyzed using multiple linear regression analysis.

          Results

          Overall, 43% of nurses had an intention to report errors; 50% of respondents reported that their nursing managers demonstrated high levels of coaching. With regard to patient safety culture, areas of strength and weakness were “teamwork within units” (PRR = 66.8%) and “non-punitive response errors” (PRR = 19.7%). Regression analysis findings highlighted a significant association between an intention to report errors and patient safety culture (B = 0.2, CI 95%: 0.1 to 0.3, P < 0.05), leader coaching behavior (B = 0.2, CI 95%: 0.1 to 0.3, P < 0.01) and nurses’ educational status (B = 0.8, 95% CI: − 0.1 to 1.6, P < 0.05).

          Conclusions

          Further research is needed to assess how interventions addressing patient safety culture and leader coaching behaviours might increase the intention to report errors.

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          Most cited references34

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          Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project.

          To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Nine teaching and community hospital EDs. A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p = .012). Subjective workload was not affected by the intervention (p = .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p = .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p = .047) and staff assessments of institutional support showed a significant increase (p = .040). Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.
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            Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture

            Background The Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture was designed to assess staff views on patient safety culture in hospital settings. The purpose of this study was to examine the multilevel psychometric properties of the survey. Methods Survey data from 331 U.S. hospitals with 2,267 hospital units and 50,513 respondents were analyzed to examine the psychometric properties of the survey's items and composites. Item factor loadings, intraclass correlations (ICCs), design effects, internal consistency reliabilities, and multilevel confirmatory factor analyses (MCFA) were examined as well as intercorrelations among the survey's composites. Results Psychometric analyses confirmed the multilevel nature of the data at the individual, unit and hospital levels of analysis. Results provided overall evidence supporting the 12 dimensions and 42 items included in the AHRQ Hospital Survey on Patient Safety Culture as having acceptable psychometric properties at all levels of analysis, with a few exceptions. The Staffing composite fell slightly below cutoffs in a number of areas, but is conceptually important given its impact on patient safety. In addition, one hospital-level model fit indicator for the Supervisor/Manager Expectations & Actions Promoting Patient Safety composite was low (CFI = .82), but all other psychometrics for this scale were good. Average dimension intercorrelations were moderate at .42 at the individual level, .50 at the unit level, and .56 at the hospital level. Conclusions Psychometric analyses conducted on a very large database of hospitals provided overall support for the patient safety culture dimensions and items included in the AHRQ Hospital Survey on Patient Safety Culture. The survey's items and dimensions overall are psychometrically sound at the individual, unit, and hospital levels of analysis and can be used by researchers and hospitals interested in assessing patient safety culture. Further research is needed to study the criterion-related validity of the survey by analysing the relationship between patient safety culture and patient outcomes and studying how to improve patient safety culture.
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              What is patient safety culture? A review of the literature.

              To organize the properties of safety culture addressed by many studies and to develop a conceptual culture of safety model.
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                Author and article information

                Contributors
                z.cheginy@gmail.com
                edriskakemam@gmail.com
                masghari862@gmail.com
                janati1382@gmail.com
                Journal
                BMC Nurs
                BMC Nurs
                BMC Nursing
                BioMed Central (London )
                1472-6955
                21 September 2020
                21 September 2020
                2020
                : 19
                : 89
                Affiliations
                [1 ]GRID grid.412606.7, ISNI 0000 0004 0405 433X, Social Determinants of Health Research Center, , Qazvin University of Medical Sciences, ; Shahid Bahonar Blvd, Zip code, Qazvin, 1531534199 Iran
                [2 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, National Institute for Health Research, Tehran University of Medical Sciences, ; Tehran, Iran
                [3 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, Department of Health Management and Economics, , School of Public Health, Tehran University of Medical Sciences, ; Tehran, Iran
                [4 ]GRID grid.412888.f, ISNI 0000 0001 2174 8913, Road Traffic Injury Research Center, , Tabriz University of Medical Sciences, ; Tabriz, Iran
                [5 ]GRID grid.412888.f, ISNI 0000 0001 2174 8913, Department of Statistics and Epidemiology, , Faculty of Health, Tabriz University of Medical Sciences, ; Tabriz, Iran
                [6 ]GRID grid.412888.f, ISNI 0000 0001 2174 8913, Tabriz Health Services Management Research Center, , Tabriz University of Medical Sciences, ; Tabriz, Iran
                Author information
                http://orcid.org/0000-0001-9125-9453
                Article
                472
                10.1186/s12912-020-00472-4
                7504664
                32973398
                44028f62-8e5c-435a-8365-df1e20c32f3c
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 6 January 2020
                : 18 August 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004366, Tabriz University of Medical Sciences;
                Award ID: 59002
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Nursing
                coaching,patient safety culture,medical error,cross-sectional studies,iran
                Nursing
                coaching, patient safety culture, medical error, cross-sectional studies, iran

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