Patient safety through the lens of human factors system approach : qualitative exploratory-descriptive study of public and private tertiary care hospitals of Karachi

Patient safety is an integral component of high quality service delivery but despite this, annually, worldwide there are around 42.7 million adverse events. Medical errors are also one of the major issues in Neonatal Intensive Care Unit (N ICUs) and it estimated that 27% of reported errors result in harm to patient and increases the mortality and morbidity of neonates. Worldwide 98% of 5 million global neonatal deaths occur in developing countries. Those occurring due to neonatal infections are about 1.6 million deaths. Health care associated infections constitute a major portion of it and those occurring in the Neonatal Intensive Care Unit (NICU) are the most significant cause of morbidity and mortality among critically ill neonates. Lack of infection control policies in developing countries causes the hospital-born babies to be at a 30-20 times at a greater risk of getting neonatal infections as compared to those born in developed countries. Objectives: The study aimed to assess the patient safety climate and identify the factors which influence the patient safety in the NICU of a public and private tertiary care hospital. Method: It was a qualitative exploratory-descriptive study with concurrent data collection. The study was conducted from July to August\u2718 at the NICU of one public and one private tertiary care level hospital of Karachi, Sindh. The study participants were the health care professionals of the NICU from the respective hospitals. It included management personnel, doctors, nurses and technicians. The data collection was concurrent with qualitative data being collected along with the quantitative data collection. The purposive sampling technique was used for the qualitative data collection whereas convenience sampling was used for the quantitative data collection. In the first phase of the study qualitative and quantitative data was collected simultaneously. Qualitative data comprised of in-depth interviews with different cadres of healthcare professionals and observation of study sites. The quantitative data was collected by using a self-administrated safety attitude questionnaire. In the second phase of the study we analyzed the quantitative data using IBM SPSS version 19. The qualitative data which included IDIs verbatim was translated and transcribed. It was then coded and emerging themes were then • identified and analyzed using N-Vivo 10. In phase three of the study triangulation of the quantitative and qualitative data was done which provided rigor and integrity to the study Results: The perceptions regarding patient safety climate in the NICU of public as well private hospital were not high as the general mean score of both was lower than the recommended score of \u3e75. In the domains analysis there was no significant variation in the means of the scores of both of the hospitals. All of the six domains of patient safety climate scored lower than 75 in the NICU of the public sector hospital while in private hospital except job satisfaction all of the remaining domains scored less than 75. In positive percent agreement the NICU of public sector hospital scored lower than the private hospital in all of the domains except stress recognition. The key barriers of limited resources, shortage of personnel, lack of proper error reporting system, inadequate monitoring systems and lack of policies regarding infection control practices were identified from the N1CU of public sector hospital. Stress due to workload, lack of stress management and cultural were identified in both of the hospitals. Conclusion: The patient safety climate was perceived as inferior in the NICUs of both of the hospitals. There was no significant variation in the scores of the domains of the patient safety climate survey. The proportion of positive respondents was higher in the N1CU of private hospital as compared to the public one. The major barriers identified were resource limitation, lack of policies regarding infection control, shortage of trained staff, unorganized task distribution, cultural and social challenges in work place and lack of adequate error repoiting and monitoring system. They main facilitators that emerged were the presence of an active infection control committee along with a biomedical department, proper error reporting system with root cause analysis, using of standardized tools (International patient safety goals and SBAR) and monitoring through proper key performance indicators and statistics