Assessment of doctors and nurses attitudes toward patient safety in emergency departments of Australian and Saudi Arabian hospitals

Abstract Introduction: Within the context of addressing the high number of medical errors in hospitals, the overall aim of this thesis was to investigate and assess the attitudes of doctors and nurses towards the patient safety in Saudi Arabian and Australian hospitals emergency departments. Methods: A mixed method research design was employed to address this aim. The quantitative study was conducted among doctors and nurses working in the emergency departments of Saudi Arabian and Australian hospitals. The qualitative part was conducted among doctors and nurses working in the emergency department of Saudi Arabian hospital. It was hypothesised that doctors will have more positive safety attitudes than nurses (H1). It was also hypothesised that patient safety attitudes amongst nurses and doctors will be comparatively more negative on the dimensions of management and working conditions (H2). Moreover, it was hypothesised that positive safety attitudes would be correlated with fewer reported clinical errors (H3). This thesis also compared the difference in patient safety attitudes between Saudi doctors and nurses and non-Saudi doctors and nurses. In addition, the differences in patient safety attitudes between doctors and nurses in Australian hospital were compared. Finally, the study compared the differences in safety attitudes between the two countries: Saudi Arabian and Australian sampled hospitals. Results: In the quantitative phase of the research in this thesis, Saudi doctors and nurses (N = 503) and Australian doctors and nurses (N = 51) working in hospital emergency departments completed the safety attitudes questionnaire (SAQ). The safety attitudes questionnaire measured the safety attitudes of doctors and nurses on the dimensions of teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions, and stress recognition. In the qualitative phase of this research, Saudi doctors and nurses (N = 20) engaged in semi-structured interviews to provide comprehensive and rich data on their attitudes towards patient safety climate. Whereas the data from the quantitative studies was analysed with inferential statistics. In support of expectations, the findings showed patient safety attitudes amongst nurses and doctors were comparatively more negative on the dimensions of management and working conditions (H1). The findings also confirmed the expectation (H2) that doctors working in hospital emergency departments would report more positive attitudes toward the patient safety than nurses. Moreover, the findings also showed nurses reported lower teamwork climate and collaboration attitudes on the SAQ than doctors in both the Saudi and Australian hospital contexts. Even though there was evidence of under-reporting of medical errors by doctors and nurses, the findings provided qualified evidence to support the expectation (H3) that positive safety attitudes would be related to fewer reported clinical errors. Conclusion: These main findings and others in the thesis raise several empirical, theoretical and practical implications that centre on considering the impact of cultural and status differences on patient safety attitudes of doctors and nurses working in hospital emergency departments. The findings suggest that interventions to improve management support and engagement would lead to more positive patient safety attitudes among doctors and nurses. The findings of this thesis are also consistent the view that safety training interventions (during and post-medical school) are an important remedy to improve the engagement of doctors and nurses in patient safety in hospitals and to impact positively on the patient safety climate of hospital staff more broadly. In conclusion, the findings of this thesis provide one of the few research contributions to knowledge on the differential of doctors and nurses attitudes toward patient safety in hospital emergency departments