The Critical Role of Leadership in Patient Safety Culture: A Mediation Analysis of Management Influence on Safety Factors.

Purpose: This research aims to investigate the role of management leadership in promoting a culture of patient safety within healthcare organizations. Through a comprehensive mediation analysis of the Chinese version of the safety attitudes questionnaire (CSAQ) and patient safety culture, the study examines the interplay between these critical factors and their combined influence on healthcare outcomes. Patients and Methods: In a medical center located in Taiwan, a cross-sectional survey was carried out utilizing the CSAQ. Among the 1500 distributed surveys, 1037 were returned and deemed valid, resulting in a return rate of 69.13%. To investigate the main measures, Structural Equation Modeling with mediation analysis was employed to scrutinize the direct and indirect effects of factors including teamwork climate, job satisfaction, stress recognition, perceptions of management, working conditions, and emotional exhaustion on safety climate. Results: The findings reveal that effective management leadership plays a pivotal role in shaping safety attitudes and fostering a robust patient safety culture. The study identifies three critical facets of patient safety that are entirely mediated by management perceptions: teamwork climate, working conditions, and stress recognition. The results highlight the importance of enhancing these dimensions to advance the patient safety culture within healthcare organizations. Moreover, stress recognition is identified as a critical factor influencing the organizational culture of patient safety. Conclusion: This research offers valuable insights for healthcare organizations seeking to prioritize patient safety and improve overall quality of care. By enhancing our understanding of the critical factors that shape safety attitudes and patient safety culture, this study provides a roadmap for effective management leadership and a culture of patient safety within healthcare organizations. The study underscores the significance of management leadership in promoting patient safety culture and highlights the importance of enhancing teamwork climate, working conditions, and stress recognition to advance patient safety culture.

Medical staff's emotional exhaustion and its relationship with patient safety dimensions.

PURPOSE: Medical staff's emotional exhaustion increases cynical attitudes and behaviors about work and patients and leads medical staff to become detached from work. This may decrease patients' trust and satisfaction and even endanger patients' lives. There is a need to examine the critical factors affecting the medical staff's emotional exhaustion by investigating its relationship with the patient-safety dimensions based on the safety attitudes questionnaire (SAQ). DESIGN/METHODOLOGY/APPROACH: A case study is conducted from the viewpoints of physicians and nurses to examine the relationship between emotional exhaustion and six dimensions of the SAQ from 2016 to 2020 from a regional teaching hospital in Taiwan. Linear regression with forward selection is employed. Six dimensions of the SAQ are the independent variables, whereas emotional exhaustion is the dependent variable for each year. FINDINGS: Stress recognition is the most important variable to influence emotional exhaustion negatively, while job satisfaction is the second important variable to affect emotional exhaustion positively from 2016 to 2020. On the contrary, working conditions do not influence emotional exhaustion in this hospital from medical staff's viewpoints. ORIGINALITY/VALUE: This study uses longitudinal data to find that both stress recognition and job satisfaction consistently influence emotional exhaustion negatively and positively, respectively, in this five-year period. The third dimension to impact emotional exhaustion varies from time to time. Thus, the findings from a cross-sectional study might be limited. The authors' findings show that reducing stress recognition and enhancing job satisfaction can lead to the improvement of emotional exhaustion from medical staff's viewpoints, which should be monitored by hospital management.

A comparative study on patient safety culture among high-risk hospital staff in the context of the COVID-19 and non-COVID-19 pandemic: a cross-sectional study in Taiwan.

The study aimed to compare the evolution of patient safety culture perceived by high-risk hospital staff in the context of the COVID-19 pandemic and non-COVID-19 pandemic and to examine the variations in patient safety culture across demographic variables. The study found that the COVID-19 pandemic has significantly impacted patient safety culture in healthcare settings, with an increased focus on safety climate, job satisfaction, teamwork climate, stress recognition, and emotional exhaustion. Safety culture and work stress vary among medical professionals of different age groups. To reduce stress, workload should be minimized, work efficiency improved, and physical and mental health promoted. Strengthening safety culture can reduce work-related stress, improve job satisfaction, and increase dedication towards work. The study recommends interventions such as psychological and social support, along with emotional management training, to reduce emotional exhaustion. Healthcare institutions can set up psychological counseling hotlines or support groups to help medical professionals reduce stress and emotional burden.

Evaluating the psychometric properties of the Chinese version of the Safety Attitudes Questionnaire among medical staff in Taiwan.

PURPOSE: The rapid changes that the healthcare services industry is undergoing pose a challenge to obtaining accurate measurements of the delivery of medical services to patients. Current Chinese measures of patient safety culture may not adequately capture how medical staff perceives the promotion of patient safety. This study aims to construct a valid and applicable patient safety culture instrument by re-estimating the Chinese version of the Safety Attitudes Questionnaire (SAQ) with medical staff in Taiwan. DESIGN/METHODOLOGY/APPROACH: Exploratory factor analysis (EFA) was conducted on data collected from a sample of 448 medical workers at a regional teaching hospital in Taiwan, and data from 804 participants at a medical center were subjected to confirmatory factor analysis (CFA). The distribution of the questions among the dimensions was different from that in the Chinese version of the SAQ. FINDINGS: The authors' results confirm that 3 correlated first-order factors, including 11 items, can be used to measure collaboration and safety, stress recognition and emotional exhaustion (EE). The authors' data suggest that the cooperation mechanism, patient safety promotion, stress management and emotional management are drivers of patient safety and should be prioritized when seeking to evaluate the perceptions of hospital staff toward patient safety culture in hospitals in Taiwan. ORIGINALITY/VALUE: To improve the quality and safety of patient care, the measurement scale should be revisited and modified as the industry changes over time and to take account of cultural variation. The authors restructured the current Chinese version of the SAQ developed by the Joint Commission of Taiwan (JCT) to offer more precise measures that increase the sensitivity of the measurement of the level of care in items of patient safety and that serve as a diagnostic instrument to review patient safety management.

Patient safety in Work Environments: Perceptions of Pediatric Healthcare Providers in Taiwan.

BACKGROUND: Extensive research on the link between the organizational characteristics of the work environment and patient safety in a healthcare organization has been conducted; yet, only a few studies have concentrated on care providers in a pediatric unit. OBJECTIVES: To determine the correlation between different work environment factors impacting patient safety in a pediatric care unit from the perspective of registered nurses working in these units. DESIGN: Cross-sectional design. DATA SOURCES AND METHODS: The study was conducted with 155 registered nurses from a pediatric unit in a medical center in Taiwan with the Chinese version of the Safety Attitudes Questionnaire (SAQ) 2014-2017. RESULTS: Teamwork climate, higher job satisfaction, and better working conditions are linked to positive perceptions of patient safety culture. Emotional exhaustion is negatively related to most dimensions of patient safety. CONCLUSION: Teamwork climate, job satisfaction, working conditions, and emotional exhaustion were identified as critical factors impacting the patient safety climate. IMPLICATIONS FOR NURSING OR HEALTH POLICY: Investments to improve teamwork climate, job satisfaction, and working conditions and reduce emotional exhaustion may have a positive effect on patient safety in pediatric care units.

What Role Does Patient Gratitude Play in the Relationship Between Relationship Quality and Patient Loyalty?

The environment in health care organizations is becoming increasingly competitive. Therefore, to improve patient return rates, health care organizations need to examine how to enhance the physician-patient relationship. In particular, the role of patient gratitude on the physician-patient relationship in health care organizations is still ambiguous. The specific role of patient gratitude in the medical service industry needs to be identified. Therefore, this study aimed to investigate physician-patient interactions with reference to relationship marketing and to further understand the relationships among relationship quality, patient gratitude, and patient loyalty. The potential effects of patient gratitude on the physician-patient relationship were examined by testing mediation effect. The results demonstrated that patient gratitude had a notable effect on the association between relationship quality and patient loyalty. To improve the physician-patient relationship in the medical service industry, health care managements should not ignore the 3 relationship quality tactics perceived by patients, specially the role of the potential effect of patient gratitude on relational building.

The Perceptions of Physicians and Nurses Regarding the Establishment of Patient Safety in a Regional Teaching Hospital in Taiwan.

BACKGROUND: Physicians and nurses are core staff who are the first points of contact in care provision to patients. We aimed to examine physicians' and nurses' perceptions of patient safety in a case hospital by administering the Chinese Safety Attitude Questionnaire (CSAQ), developed from the Taiwan Joint Commission on Hospital Accreditation, in order to provide the patients with a safe environment and excellent medical service. METHODS: An intra-organizational online survey was conducted. Confirmatory factor analysis (CFA) was first performed on the assessment of the measures for patient safety culture and seven dimensions with 33 items were identified. Pearson correlation analysis was subsequently used to examine the strength and direction of the relationships between seven dimensions of patient safety culture. RESULTS: A total of 800 questionnaires were issued and 405 valid questionnaires were collected, the effective response rate being 50.6%. The findings highlighted that safety climate (SC) was positively and significantly related to teamwork climate (TC) and perception of management (PM), whereas stress recognition (SR) was negatively related to burnout (BUR). CONCLUSION: Patient safety culture in healthcare organizations has been considered a critical issue for improving the quality of healthcare. This study further focused on the contribution of a better patient safety culture for healthcare organizations in Taiwan.

Causal Relationship Analysis of the Patient Safety Culture Based on Safety Attitudes Questionnaire in Taiwan.

This study uses the decision-making trial and evaluation laboratory method to identify critical dimensions of the safety attitudes questionnaire in Taiwan in order to improve the patient safety culture from experts' viewpoints. Teamwork climate, stress recognition, and perceptions of management are three causal dimensions, while safety climate, job satisfaction, and working conditions are receiving dimensions. In practice, improvements on effect-based dimensions might receive little effects when a great amount of efforts have been invested. In contrast, improving a causal dimension not only improves itself but also results in better performance of other dimension(s) directly affected by this particular dimension. Teamwork climate and perceptions of management are found to be the most critical dimensions because they are both causal dimensions and have significant influences on four dimensions apiece. It is worth to note that job satisfaction is the only dimension affected by the other dimensions. In order to effectively enhance the patient safety culture for healthcare organizations, teamwork climate, and perceptions of management should be closely monitored.

The perceptions of patient safety culture: A difference between physicians and nurses in Taiwan.

AIMS: In order to pursue a better patient safety culture and provide a superior medical service for patients, this study aims to respectively investigate the perceptions of patient safety from the viewpoints of physicians and nurses in Taiwan. BACKGROUND: Little knowledge has clearly identified the difference of perceptions between physicians and nurses in patient safety culture. Understanding physicians and nurses' attitudes toward patient safety is a critical issue for healthcare organizations to improve medical quality. METHODS: Confirmatory factor analysis (CFA) is used to verify the structure of data (e.g. reliability and validity), and Pearson's correlation analysis is conducted to demonstrate the relationships among seven patient safety culture dimensions. RESULTS: Research results illustrate that more teamwork is exhibited among team members, the more safety of a patient is committed. Perceptions of management and emotional exhaustion are important components that contribute to a better patient safety. More importantly, working conditions and stress recognition are found to be negatively related from the perceptions of nurses. Compared to physicians, nurses reported higher stress and challenges which result from multi-task working conditions in the hospital. CONCLUSIONS: This study focused on the contribution of a better patient safety culture from different viewpoints of physicians and nurses for healthcare organizations in Taiwan. A different attitudes toward patient safety is found between physicians and nurses. The results enable the hospital management to realize and design appropriate implications for hospital staffs to establish a better patient safety culture.

Analyzing Patient Safety Culture From Viewpoints of Physicians and Nurses-A Case of a Regional Teaching Hospital in Taiwan.

The Chinese version of safety attitudes questionnaire is used to evaluate patient safety culture from the viewpoints of physicians and nurses of a regional teaching hospital in Taiwan in 2014. This study applies Mann-Whitney U test for two independent samples test and analysis of variance to observe if different demographic variables are perceived differently in patient safety culture in terms of eight dimensions. In addition, linear regression models are applied to take into account the confounding effects of demographic variables in eight dimensions. The results show that none of the eight dimensions is more important. Besides, supervisor/manager and experience in position are the two critical demographic variables to influence the patient safety culture. The results imply that the hospital management needs to pay much attention to the employees who are not supervisors/managers and/or more experienced in position because they are less satisfied in patient safety culture.

A New Approach to Identify High Burnout Medical Staffs by Kernel K-Means Cluster Analysis in a Regional Teaching Hospital in Taiwan.

This study uses kernel k-means cluster analysis to identify medical staffs with high burnout. The data collected in October to November 2014 are from the emotional exhaustion dimension of the Chinese version of Safety Attitudes Questionnaire in a regional teaching hospital in Taiwan. The number of effective questionnaires including the entire staffs such as physicians, nurses, technicians, pharmacists, medical administrators, and respiratory therapists is 680. The results show that 8 clusters are generated by kernel k-means method. Employees in clusters 1, 4, and 5 are relatively in good conditions, whereas employees in clusters 2, 3, 6, 7, and 8 need to be closely monitored from time to time because they have relatively higher degree of burnout. When employees with higher degree of burnout are identified, the hospital management can take actions to improve the resilience, reduce the potential medical errors, and, eventually, enhance the patient safety. This study also suggests that the hospital management needs to keep track of medical staffs' fatigue conditions and provide timely assistance for burnout recovery through employee assistance programs, mindfulness-based stress reduction programs, positivity currency buildup, and forming appreciative inquiry groups.

Applying importance-performance analysis to patient safety culture.

PURPOSE: The Sexton et al.'s (2006) safety attitudes questionnaire (SAQ) has been widely used to assess staff's attitudes towards patient safety in healthcare organizations. However, to date there have been few studies that discuss the perceptions of patient safety both from hospital staff and upper management. The purpose of this paper is to improve and to develop better strategies regarding patient safety in healthcare organizations. DESIGN/METHODOLOGY/APPROACH: The Chinese version of SAQ based on the Taiwan Joint Commission on Hospital Accreditation is used to evaluate the perceptions of hospital staff. The current study then lies in applying importance-performance analysis technique to identify the major strengths and weaknesses of the safety culture. FINDINGS: The results show that teamwork climate, safety climate, job satisfaction, stress recognition and working conditions are major strengths and should be maintained in order to provide a better patient safety culture. On the contrary, perceptions of management and hospital handoffs and transitions are important weaknesses and should be improved immediately. Research limitations/implications - The research is restricted in generalizability. The assessment of hospital staff in patient safety culture is physicians and registered nurses. It would be interesting to further evaluate other staff's (e.g. technicians, pharmacists and others) opinions regarding patient safety culture in the hospital. ORIGINALITY/VALUE: Few studies have clearly evaluated the perceptions of healthcare organization management regarding patient safety culture. Healthcare managers enable to take more effective actions to improve the level of patient safety by investigating key characteristics (either strengths or weaknesses) that healthcare organizations should focus on.

Model construction for the intention to use telecare in patients with chronic diseases.

Objective. This study chose patients with chronic diseases as study subjects to investigate their intention to use telecare. Methods. A large medical institute in Taiwan was used as the sample unit. Patients older than 20 years, who had chronic diseases, were sampled by convenience sampling and surveyed with a structural questionnaire, and a total of 500 valid questionnaires were collected. Model construction was based on the Health Belief Model. The reliability and validity of the measurement model were tested using confirmatory factor analysis (CFA), and the causal model was explained by structural equation modeling (SEM). Results. The priority should be on promoting the perceived benefits of telecare, with a secondary focus on the external cues to action, such as promoting the influences of important people on the patients. Conclusion. The findings demonstrated that patients with chronic diseases use telecare differently from the general public. To promote the use and acceptance of telecare in patients with chronic diseases, technology developers should prioritize the promotion of the usefulness of telecare. In addition, policy makers can strengthen the marketing from media and medical personnel, in order to increase the acceptance of telecare by patients with chronic diseases.