15
PATIENT SAFETY CULTURE ANALYSIS IN THE STAFF OF
A SPECIALTY HOSPITAL IN ECUADOR: A CROSS SECTIONAL STUDY.
Francisco Cueva1,2*, Kathy Bustamante1
Abstract
Background
There are millions of deaths attributable to low levels of quality and
patient safety in healthcare. One of the rst steps in the journey to high
reliability is to establish a solid patient safety culture. This study sought
to determine the level of patient safety culture in the personnel of a
specialty Hospital in Ecuador.
Methods
A cross-sectional study was conducted with a descriptive phase
comprising the presentation of results of the patient safety culture level
in the staff, and an analytical phase to determine conditioning factors
of this aspect.
Results
344 hospital staff answers were included in the study. The most signicant
group of personnel who responded to the survey corresponded to
medical staff (39.83%). An overall patient safety culture level of 63.86%
was determined, with higher scores observed in leadership positions
(73,55%) and among the medical staff (69,90%), followed by support
positions (60,97%), Other staff positions (60,44%), and nursing (56,74%).
The dimensions of patient safety culture identied as strengths were
teamwork and hospital management support in patient safety, and
as improvement areas gured response to error, and stafng and work
pace. Signicant differences were found between the results of the
patient safety culture domains and: staff position, working time in the
hospital, working time in the current area or unit, weekly working hours,
and typical contact with patients during daily activities (p < 0.05).
Conclusions
The patient safety culture level in the Ecuadorian context was
determined, as well as its strengths and improvement areas. In this study,
the support of hospital management support in patient safety stands
out as a strength. Additionally, aspects of the staff were found to be
signicantly associated with the results of the patient safety culture
dimensions indicating potential areas of focus for efforts to improve
patient safety culture.
Palabras clave: Patient safety, Safety culture, Organizational culture,
Quality improvement.
ESTUDIO TRANSVERSAL ARTÍCULO ORIGINAL
Citation: Cueva F. Bustamante K. PATIENT
SAFETY CULTURE ANALYSIS IN THE
STAFF OF A SPECIALTY HOSPITAL IN
ECUADOR: A CROSS SECTIONAL STUDY.
Rev Med Vozandes. 2024; 35 (1): 15 - 27
1 Universidad Internacional del Ecuador, Maestría de
Gerencia en Salud. Quito – Ecuador.
2 Hospital Vozandes, Unidad de Experiencia y Seguridad
del Paciente. Quito – Ecuador.
ORCID ID:
Francisco Cueva
orcid.org/0000-0001-9573-5090
Kathy Bustamante
orcid.org/0009-0007-7448-3032
*Corresponding author: Francisco Cueva
E-mail: fcueva@hospitalvozandes.com
Este artículo está bajo una
licencia de Creative Com-
mons de tipo Reconocimien-
to – No comercial – Sin obras
derivadas 4.0 International.
Received: 20 – May – 2024
Accepted: 27 – Jun – 2024
Publish: 01 – Jul – 2024
Article history
DOI: 10.48018/RMVv35i12
STROBE 2008 Check List statement: The
author has real the STROBE 2008 Check List and the
manuscript was prepared and revised according to the
STROBE 2008 Checklist.
Conflict of interest: The authors have full freedom
of manuscript preparation, and there were no potential
conicts of interest.
Financial disclosure: : The authors have no nan-
cial relationships relevant to this article to disclose.
CRediT – Contributor Roles Taxonomy: : Conceptualización, Metodología, Curación de datos, Análisis for-
mal: FC – KB, Supervisión, Validación: KB, Redacción – borrador original: FC, Redacción – revisión y edición: FC – KB.
Revista Médica Vozandes
Volumen 35, Número 1, 2024
16
PATIENT SAFETY CULTURE ANALYSIS IN THE STAFF
OF A SPECIALTY HOSPITAL IN ECUADOR (...)
Resumen
ANÁLISIS DE LA CULTURA DE SEGURIDAD DEL
PACIENTE EN EL PERSONAL DE UN HOSPITAL
DE ESPECIALIDADES EN ECUADOR:
UN ESTUDIO TRANSVERSAL.
Palabras clave: Seguridad
del paciente, Cultura de
seguridad, Cultura organiza-
cional, Mejora de la calidad.
Antecedentes
Existen millones de muertes atribuibles a los bajos niveles de calidad y seguridad del paciente en
la atención sanitaria. Uno de los primeros pasos en el camino hacia la alta abilidad es establecer
una sólida cultura de seguridad del paciente. Este estudio buscó determinar el nivel de cultura de
seguridad del paciente en el personal de un Hospital de especialidades en Ecuador.
Métodos
Se realizó un estudio transversal con una fase descriptiva que comprendió la presentación de
resultados del nivel de cultura de seguridad del paciente en el personal, y una fase analítica
para determinar los condicionantes de este aspecto.
Resultados
Se incluyeron en el estudio 344 respuestas del personal hospitalario. El grupo más signicativo de
personal que respondió a la encuesta correspondió al personal médico (39,83%). Se determinó
un nivel global de cultura de seguridad del paciente del 63,86%, observándose puntuaciones
más altas en los puestos de liderazgo (73,55%) y entre el personal médico (69,90%), seguidos
de los puestos de apoyo (60,97%), Otros puestos de personal (60,44%) y enfermería (56,74%).
Las dimensiones de la cultura de seguridad del paciente identicadas como fortalezas fueron
el trabajo en equipo y el apoyo a la gestión hospitalaria en la seguridad del paciente, y como
áreas de mejora guraron la respuesta al error, y la dotación de personal y el ritmo de trabajo. Se
encontraron diferencias signicativas entre los resultados de los dominios cultura de seguridad
del paciente y: puesto de personal, tiempo de trabajo en el hospital, tiempo de trabajo en el
área o unidad actual, horas de trabajo semanales y contacto típico con los pacientes durante
las actividades diarias (p < 0,05).
Conclusiones
Se determinó el nivel de cultura de seguridad del paciente en el contexto ecuatoriano, así
como sus fortalezas y áreas de mejora. En este estudio, el apoyo a la gestión hospitalaria en la
seguridad del paciente se destaca como una fortaleza. Además, se encontró que los aspectos
del personal estaban signicativamente asociados con los resultados de las dimensiones de la
cultura de seguridad del paciente, lo que indica posibles áreas de enfoque para los esfuerzos
para mejorar la cultura de seguridad del paciente.
Cueva F, et al.
Revista Médica Vozandes
Volumen 35, Número 1, 2024
17
In 2018, it was estimated that in low and middle-income
countries there were between 5.7 and 8.4 million deaths occur
each year due to poor quality health services, approximately
60% of these are directly attributable to deciencies in the
quality of care (1). Furthermore, in February 2023, the Fifth World
Ministerial Summit on Patient Safety was held, one of the main
messages was to consider patient safety as a global public
health priority and Dr. Tedros Adhanom Ghebreyesus, stated in
reference to healthcare: “If it’s not safe, it’s not care” (2).
Many leaders have initiated changes to improve healthcare
quality without signicant progress; however, those who have
succeeded attribute their success to the application of the
theory of Highly Reliability Organizations (HRO) (3), which are
those who constantly succeed in avoiding disastrous incidents
while operating in a context where accidents can be expected
due its complexity of processes and technologies, along with
specic risk factors(4). The structure of an HRO is based on
the fusion of indicators that together constitute a collective
mindfulness that allow its staff members to be constantly aware
of minimal changes in their operations and environment that
could potentially lead to harm. These determine the safety
culture of the personnel of an HRO and are: Preoccupation
with failure, Reluctance to simplify, Sensitivity to operations,
Commitment to resilience and Deference to expertise (4,5).
Although these principles outlined by Weick and Sutcliffe (6)
have been widely diffused and proven to be successful in
different scenarios, it is challenging to achieve high reliability
in an industry where key safety practices tend to fail as in the
case of healthcare, as the aforementioned precepts have
been signicantly less investigated and implemented (4,7,8).
Indeed, one of the major barriers to the implementation of HRO
practices in the healthcare industry is a culture in which, rather
than addressing failures, hospitals and healthcare professionals
tend to act as if they accept failures as inevitable events in
their daily practice. This phenomenon has been proposed as
a potential explanation for common scenarios, such as the
coexistence of high rates of hospital-acquired infections with
low rates of compliance to hand hygiene practices (9,10).
To make progress on the journey to high reliability, it is essential to
establish a solid safety culture within the staff of an organization,
since it is a conditioning factor of its results, and considered one
major change needed to make substantial progress toward
high reliability (4,11). Patient safety culture can be dened as “the
product of individual and group values, attitudes, perceptions,
competencies and behavioral patterns that determine the
characteristics and management of the organization’s health
and safety” (12,13). A safety culture compatible with an HRO is
characterized by three core attributes: trust, reporting and
improvement. Trust is obtained once intimidating or punitive
behaviors that suppress fault reporting are eliminated in
the organization, timely action is taken on reports, and
improvements to the system are periodically socialized, resulting
in the emergence of a just culture (4,9,14).
Recognizing that the establishment of a patient safety culture
is a key step on the journey to high reliability, it is fundamental
to rst measure and evaluate it to establish a baseline, identify
areas for improvement, generate awareness of patient
safety among staff, evaluate patient safety
interventions and monitor change over time;
perform internal and external benchmarking;
and comply with guidelines or regulatory
requirements such as the standards of a given
accreditation, all of this being especially
particular in countries with limited resources (15,16).
Once patient safety culture has been measured,
it is essential to analyze the data in order to
identify potential areas for improvement within
the hospital. These ndings should then be used
to inform the focus of improvement efforts and,
in last instance, patient safety culture metrics
and goals to improve them should be included
in the strategic planning programmes, in line
with a view of zero harm preventable harm as
a mainstay in the leadership perspectives (4,10,14).
A tool for measuring organizational culture that is
widely used is the Hospital Survey of Patient Safety
Culture (HSOPSC) (17) . This tool was developed in
the United States by the Agency for Healthcare
Research and Quality Improvement (AHRQ) in
2004 and updated to its second version in 2019 (17).
The rst version of the HSOPSC survey has been
validated and used in several Latin American
publications; however, version 2.0 has not been
subjected to academic studies in the region (1,18).
Taking into account this theoretical basis,
the evidence that the levels of patient safety
culture of the personnel are scarcely known
in Latin American health institutions (1), added
to the absence of analogous studies in the
country, the present study sought to determine
the level of patient safety culture in the
personnel of a specialty hospital in Ecuador as
measured by the HSOPSC 2.0 survey (17), as well
as the presence of organizational factors that
inuence these outcomes.
METHODS
A cross-sectional study was performed at
Hospital Vozandes Quito, a tertiary health
facility located in Quito, Ecuador that offers
multispecialty healthcare. The study data were
provided in an anonymized database by the
Patient Safety Unit in accordance with current
local regulations (19), which measures patient
safety culture using HSOPSC 2.0 survey (17) as an
internal management indicator based on the
recommendations provided by AHRQ (20). For this
reason, a sample was not calculated, instead a
census was conducted by sending this voluntary
response survey to all the hospital staff, which
constitute the universe. All complete records
were included in the study, and incomplete and
ESTUDIO TRANSVERSAL ARTÍCULO ORIGINAL
Revista Médica Vozandes
Volumen 35, Número 1, 2024
18
duplicate records were excluded. After cleaning the database
provided, the results were coded to facilitate the analysis of
the data in electronic platforms. The platforms used for data
analysis were Microsoft Excel for univariate analysis and R 4.3.1
for bivariate analysis, in which statistically signicant differences
were sought between the patient safety culture domains and
the sociodemographic and organizational characteristics of
the staff, by calculating the chi-squared test or Fisher’s exact
test, The answers comprised in the “don’t know” and “does not
apply” categories were excluded from bivariate analysis.
RESULTS
The database provided contained 344 complete responses
that were included in the study. Considering that this was a
voluntary survey, and that it was sent to 875 staff
members, a response rate of 39.31% was obtai-
ned. Medical staff was the most signicant group
who responded to the survey (137; 39.83%) and of
these, attending physicians (108; 31.39%). In last
place is the group corresponding to leadership
positions (14; 4.06%) (Table 1).
The group that has been working in the hospital
for one to ve years is the most representative,
accounting for 37.79%. The second group in fre-
quency corresponds to staff members who have
been part of the institution for 11 or more years,
comprising 27.90% of respondents. These values
were to the tenure in the current unit/area of
work. 281 of 344 staff members (81.68%) work at
PATIENT SAFETY CULTURE ANALYSIS IN THE STAFF
OF A SPECIALTY HOSPITAL IN ECUADOR (...) Cueva F, et al.
Revista Médica Vozandes
Volumen 35, Número 1, 2024
Table 1: Staff members who responded to the survey classied by position.
Position N°
Medical 137
Physician, Attending, Hospitalist 108
Resident, Intern 29
Nursing 78
Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN) 31
Registered Nurse (RN) 22
Patient Care Aide, Hospital Aide, Nursing Assistant 13
Advanced Practice Nurse (NP, CRNA, CNS, CNM) 12
Support 72
Unit Clerk, Secretary, Receptionist, Ofce Staff 37
Housekeeping, Environmental Services 30
Information Technology, Health Information Services, Clinical Informatics 3
Transporter 1
Facilities 1
Other Staff Position 43
Technologist, Technician (e.g., EKG, Lab, Radiology) 25
Physical, Occupational, or Speech Therapist 6
Respiratory Therapist 4
Dietitian 3
Psychologist 2
Pharmacist, Pharmacy Technician 2
Social Worker 1
Supervisor, Manager, Clinical Leader, Senior Leader 14
Supervisor, Manager, Department Manager, Clinical Leader, Administrator, Director 13
Senior Leader, Executive, C-Suite 1
Total 344
Source: Authors
19
least 30 hours per week, and of these group, 133
(38.66%) claim to work more than 40 hours worked
per week (gure 1). Finally, the vast majority of par-
ticipants (288; 83.72%) interact with patients in the
course of their daily activities.
An overall patient safety culture level of 63.86% was
determined, with higher scores observed in leaders-
hip positions (73,55%) and among the medical staff
(69,90%), followed by support positions (60,97%),
Other staff positions (60,44%), and nursing (56,74%).
The staff members belonging to the leadership
groups exhibited the highest levels of patient safe-
ty culture in all domains, exceeding the institutional
average, with exception of those pertaining to or-
ganizational learning and continuous improvement;
and handoffs and information exchange. In these
domains, the highest level of culture was attributed
to the medical staff with 79.05% and 63.36% of posi-
tive responses respectively. Conversely, the nursing
service presents the lowest levels of positive respon-
ses in eight of the ten patient safety culture doma-
ins. In the remaining two, which pertain to teamwork
and communication about error, the lowest values
correspond to the support positions, with 67.97% and
59.11% of positive responses respectively (gure 2).
A Pareto diagram was created to identify the nega-
tive responses (gure 3). This revealed that 51.59% of
the negative responses correspond to the domains
of stafng and work rhythm, response to error, and
information transfer and exchange.
With regard to the nal two questions of the survey, 54.94%
of staff members have not reported any security events
over the past year. Of those who have, 29.65% have repor-
ted between one and two security events over the same
period. Finally, the perception of the level of patient safety
according to staff criteria shows that 65.40% rate this area
of management in their unit as very good or excellent.
Statistically signicant differences were found for each do-
main of patient safety culture with respect to the charac-
teristics of the individuals, these included: position, tenure
in the hospital, tenure in the current area or unit, weekly
working hours, and typical contact with patients during
daily activities (table 2). It should be noted that organiza-
tional learning – continuous improvement and reporting
patient safety events were dimensions that did not show
statistically signicant differences with the aforementioned
aspects of the staff. Conversely, the dimensions of patient
safety culture that are most associated with staff factors are
response to error and supervisor, manager, or clinical lea-
der support for patient safety. In regard to response to error,
positive answers are signicantly higher in leadership posi-
tions, staff working in the hospital for less than a year, staff
with a workload of less than 30 working hours per week and
those who did not interact with patients in regular basis (p
<,001). Concomitantly, the dimension of leader support for
patient safety showed higher positive answers in the same
aspects, with exception of tenure in the current area/ser-
vice, in which staff with less than a year have the higher
positive answers rate (p <,001), and typical interaction with
patients, in which no statistically differences were found for
this dimension.
ESTUDIO TRANSVERSAL ARTÍCULO ORIGINAL
Revista Médica Vozandes
Volumen 35, Número 1, 2024
Figure 1: Staff by tenure in hospital and in current unit/ work area.
Source: Authors
20
PATIENT SAFETY CULTURE ANALYSIS IN THE STAFF
OF A SPECIALTY HOSPITAL IN ECUADOR (...) Cueva F, et al.
Revista Médica Vozandes
Volumen 35, Número 1, 2024
Figure 2: Distribution of positive answers to staff safety culture domains by position and in relation to institutional
average.
Source: Hospital Vozandes Quito
Figure 3: Pareto chart of negative answers corresponding to each of the patient safety culture
domains.
Source: Authors
21
ESTUDIO TRANSVERSAL ARTÍCULO ORIGINAL
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Volumen 35, Número 1, 2024
Table 2 (Part 1): Relationship of variables between patient safety culture domains and general
and sociodemographic data of the staff.
Teamwork Negative Neutral Positive X2p
Position
Support N 9 14 49 24,5 0,002
%12,5% 19,4% 68,1%
Nursing N2 19 57
%2,6% 24,4% 73,1%
Medical N 2 15 120
%1,5% 10,9% 87,6%
Other Clinical Position N 28 33
% 4,7% 18,6% 76,7%
Supervisor, Manager, Clinical Lea-
der, Senior Leader
N0 1 13
%0,0% 7,1% 92,9%
Hours Worked per Week
in Hospital
Less than 30 hours per week N09 54 11,3 0,020
%0,0% 14,3% 85,7%
30 to 40 hours per week N 9 17 122
%6,1% 11,5% 82,4%
More than 40 hours per week N 6 31 96
% 4,5% 23,3% 72,2%
Supervisor, Manager, or Clinical Leader Support for Patient
Safety
Negative Neutral Positive X2p
Position
Support N 5 12 51 42,5 <,001
% 7,4% 17,6% 75,0%
Nursing N18 24 36
%23,1% 30,8% 46,2%
Medical N 5 20 108
% 3,8% 15,0% 81,2%
Other Clinical Position N 1 10 32
%2,3% 23,3% 74,4%
Supervisor, Manager, Clinical Lea-
der, Senior Leader
N0 1 11
%0,0% 8,3% 91,7%
Tenure in Hospital
Less than 1 year N0 10 48 26,4 <,001
%0,0% 17,2% 82,8%
1 to 5 years N 5 22 100
% 3,9% 17,3% 78,7%
6 to 10 years N 7 16 33
%12,5% 28,6% 58,9%
11 or more years N17 19 57
%18,3% 20,4% 61,3%
Table 2 (Part 2)
Supervisor, Manager, or Clinical Leader Support for
Patient Safety
Negative Neutral Positive X2p
Tenure in Unit/Work
Area
Less than 1 year N1 14 62 14,9 0,021
%1,3% 18,2% 80,5%
1 to 5 years N 9 27 94
% 6,9% 20,8% 72,3%
6 to 10 years N11 13 36
%18,3% 21,7% 60,0%
11 or more years N 8 13 46
%11,9% 19,4% 68,7%
Hours Worked per
Week in Hospital
Less than 30 hours per week N25 54 14,8 0,004
% 3,3% 8,2% 88,5%
30 to 40 hours per week N14 26 103
% 9,8% 18,2% 72,0%
More than 40 hours per week N13 36 81
%10,0% 27,7% 62,3%
Communication Openness Negative Neutral Positive X2p
Position
Support N 7 23 41 18,2 0,020
% 9,9% 32,4% 57,7%
Nursing N 9 25 44
%11,5% 32,1% 56,4%
Medical N 7 24 101
% 5,3% 18,2% 76,5%
Other Clinical Position N 1 11 31
%2,3% 25,6% 72,1%
Supervisor, Manager, Clinical
Leader, Senior Leader
N0 1 12
%0,0% 7,7% 92,3%
Tenure in Hospital
Less than 1 year N2 11 45 14,4 0,026
% 3,4% 19,0% 77,6%
1 to 5 years N 7 27 95
% 5,4% 20,9% 73,6%
6 to 10 years N 3 21 33
% 5,3% 36,8% 57,9%
11 or more years N12 25 56
%12,9% 26,9% 60,2%
22
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Table 2 (Part 3)
Communication About Error Negative Neutral Positive X2p
Tenure in Hospital
Less than 1 year N1650 22,8 <,001
%1,8% 10,5% 87,7%
1 to 5 years N14 31 85
%10,8% 23,8% 65,4%
6 to 10 years N 3 19 35
% 5,3% 33,3% 61,4%
11 or more years N17 25 54
%17,7% 26,0% 56,3%
Tenure in Unit/Work Area
Less than 1 year N 3 15 60 12,6 0,050
% 3,8% 19,2% 76,9%
1 to 5 years N15 26 91
%11,4% 19,7% 68,9%
6 to 10 years N 8 17 36
%13,1% 27,9% 59,0%
11 or more years N 9 23 37
%13,0% 33,3% 53,6%
Hospital Management Support for Patient Safety Negative Neutral Positive X2p
Position
Support N 2 13 57 17,3 0,027
%2,8% 18,1% 79,2%
Nursing N1 22 55
%1,3% 28,2% 70,5%
Medical N 0 24 112
%0,00% 17,6% 82,4%
Other Clinical Position N 0 13 30
%0,0% 30,2% 69,8%
Supervisor, Manager, Clinical
Leader, Senior Leader
N1 0 13
%7,1% 0,0% 92,9%
Response to Error Negative Neutral Positive X2p
Position
Support N 15 28 29 32,4 <,001
%20,8% 38,9% 40,3%
Nursing N29 29 20
%37,2% 37,2% 25,6%
Medical N 15 46 70
%11,5% 35,1% 53,4%
Other Clinical Position N 6 20 17
%14,0% 46,5% 39,5%
Supervisor, Manager, Clinical
Leader, Senior Leader
N1310
%7,1% 21,4% 71,4%
24
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Table 2 (Part 4)
Response to Error Negative Neutral Positive X2p
Tenure in Hospital
Less than 1 year N12 18 28 15,4 0,017
%20,7% 31,0% 48,3%
1 to 5 years N13 58 55
%10,3% 46,0% 43,7%
6 to 10 years N18 17 23
%31,0% 29,3% 39,7%
11 or more years N23 33 40
%24,0% 34,4% 41,7%
Hours Worked per Week in
Hospital
Less than 30 hours per week N2 19 37 24,0 <,001
% 3,4% 32,8% 63,8%
30 to 40 hours per week N26 55 67
%17,6% 37,2% 45,3%
More than 40 hours per week N 38 52 42
%28,8% 39,4% 31,8%
Interaction With Patients
No N 5 18 33 8,18 0,016
% 8,9% 32,1% 58,9%
Sí N61 108 113
%21,6% 38,3% 40,1%
Handoffs and Information Exchange Negative Neutral Positive X2p
Hours Worked per Week in
Hospital
Less than 30 hours per week N1 19 35 24,2 <,001
%1,8% 34,5% 63,6%
30 to 40 hours per week N13 45 70
%10,2% 35,2% 54,7%
More than 40 hours per week N24 60 40
%19,3% 48,34% 32,3%
Stafng and Work Pace Negative Neutral Positive X2p
Position
Support N 15 35 22 21,2 0,007
%20,8% 48,6% 30,6%
Nursing N19 39 20
%24,4% 50,0% 25,6%
Medical N 12 60 64
% 8,8% 44,1% 47,1%
Other Clinical Position N 8 21 14
%18,6% 48,8% 32,6%
Supervisor, Manager, Clinical
Leader, Senior Leader
N14 9
%7,1% 28,6% 64,3%
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Table 2 (Part 5)
Stafng and Work Pace Negative Neutral Positive X2p
Hours Worked per Week in Hospital
Less than 30 hours per week N 4 28 31 20,2 <,001
% 6,3% 44,4% 49,2%
30 to 40 hours per week N16 74 58
%10,8% 50,0% 39,2%
More than 40 hours per week N 35 57 40
%26,5% 43,2% 30,3%
Number of Events Reported in the last year Negative Neutral Positive X2p
Position
Support N 56 12 415,7 0,047
% 77,8% 16,7% 5,6%
Nursing N 64 12 2
%82,1% 15,4% 2,6%
Medical N 123 7 7
% 89,8% 5,1% 5,1%
Other Clinical Position N 39 3 1
%90,7% 7,0% 2,3%
Supervisor, Manager, Clinical
Leader, Senior Leader
N 9 4 1
% 64,3% 28,6% 7,1%
Patient Safety Rating Negative Neutral Positive X2p
Position
Support N 5 23 44 31,8 <,001
% 6,9% 31,9% 61,1%
Nursing N 6 39 33
% 7,7% 50,0% 42,3%
Medical N 3 27 107
%2,2% 19,7% 78,1%
Other Clinical Position N 1 12 30
%2,3% 27,9% 69,8%
Supervisor, Manager, Clinical
Leader, Senior Leader
N1 2 11
%7,1% 14,3% 78,6%
Hours Worked per Week in Hospital
Less than 30 hours per week N27 54 14,6 0,006
%3,2% 11,1% 85,7%
30 to 40 hours per week N 8 49 91
% 5,4% 33,1% 61,5%
More than 40 hours per week N 6 47 80
% 4,5% 35,3% 60,2%
Source: Authors
26
DISCUSSION
This study reports the level of patient safety culture at a specialty
hospital in Ecuador according to the HSOPSC 2.0 tool. Camacho-
Rodríguez et al. (1) published a systematic review with the aim of
determining the state of patient safety culture in Latin American
hospitals using the HSOPSC tool. The analysis included 30
studies, and the authors report that the scientic literature on
this subject is limited to ve countries: Brazil, Mexico, Colombia,
Peru and Argentina. Furthermore, they found that all the studies
used version 1.0 of the HSOPSC tool, and none used the most
recent version. This is consistent with the ndings of Pedroso et al.
(18), who conducted a multicenter study in four South American
hospitals, including the Chilean setting. Their results corroborate
the assertion that patient safety culture is a phenomenon that
has been scarcely studied in the region.
In our study, a response rate of 39.31% was obtained, while the
annual report of the AHRQ agency (21) mentions an average
response rate of 48%. Conversely, Pedroso et al. (18) published
this year a multicenter cross-sectional study in South America
using version 1.0 of the HSOPSC survey, in which they obtained
a response rate of 30.1% (25 - 55%). Our study reveals that the
institutional average level of patient safety culture of 63.86%.
The highest values are observed in leadership positions and
medical staff, with 73.55% and 69.90% respectively, while the
lowest values are attributed to nursing positions, with 56.74%.
While, the average value reported by Alaska and Alkutbe (22)
is 66.58%, and the AHRQ (21) reports an average level of patient
safety culture of 70% in the American context.
STRENGTHS
At our study, the domains of teamwork (77.46%) and the
support of hospital management support for patient safety
(77.33%) were identied as strengths. Teamwork is considered a
strength among the staff included in this study and in available
publications (21–23). With regard to this dimension, studies have
indicated that up to 68% of adverse events may be attributed
to failures in teamwork. Consequently, several programs and
approaches scoping to improve this skill among health team
members have been proposed in different scenarios (24). A
comparison of the answers of personnel in our study revealed
that in leadership and medical roles, as well as those working
less than 30 hours per week, exhibited signicantly higher levels
of positivity regarding to teamwork.
Hospital management support for patient safety is a strength to
be highlighted in the present study, since it is one of the most
discussed dimensions in the scientic literature (24–26). Respecting
to this, Segura-García et al. (23) found signicantly high negative
responses in attending physicians (16.92%), while the value of
this item in our study comprised 82.4% of positive responses (p
< 0,005).
In our study, 65.4% of personnel reported a positive rating
of patient safety to their perception, a gure similar to that
reported by the AHRQ agency (21), which reports 67%, and
lower in comparison with Segura-García et al, (23) who report
91.71% positive responses. Moreover, Camacho-
Rodríguez et al. (1) reported an average of 48.86%
for the Latin American region.
IMPROVEMENT AREAS
Within the staff included in this study, response to
error and stafng and work pace were identied
as areas for improvement, as these dimensions
presented positive response rates of 43.62% and
43.05%, respectively. These aspects correspond
to the lowest values reported in the available
literature, except that in some cases they are
not considered improvement areas, since the
gures are slightly above 50%(21). The exception
is in the Spanish and Saudi contexts, where the
stafng and work rate gures are 39.07% and
46.86%, respectively (22,23). The second area of
improvement analyzed in this study is response
to error. This dimension is related to the concept
of “punitive culture” (14,24), that sets out several
possible explanations for the deterioration in
patient safety that occurs in an organizational
culture in which healthcare professionals are
punished for making errors, which is an inherent
aspect of human nature (1,14).
Furthermore, the report on patient safety
incidents in the staff of our study revealed that
84.59% of respondents had reported fewer than
two incidents in the previous year. This gure is
higher than the data published in Saudi Arabia (22),
which indicate a value of 73.37%, and the gures
reported by the AHRQ (21), which show a negative
response rate of 82%. The present study has
demonstrated that, in relation to the reporting of
patient safety events, the proportion of negative
responses is signicantly higher among medical
professionals and other clinical position.
It is important to note as a limitation that, in the
local context of this study, staff members are
responsible for fullling various roles in different
areas of the hospital, which made it challenging to
accurately record their responses on the HSOPSC
2.0 survey and subsequently analyze them.
CONCLUSIONS
This study analyzed the patient safety culture at a
specialty hospital in Ecuador, gathering information
on a fundamental aspect of patient safety in the
path of healthcare organizations seeking high
reliability. The level of patient safety culture in the
Ecuadorian context was determined, as well as
its strengths and improvement areas. In our study,
the support of the hospital management in patient
safety was highlighted as a strength.
PATIENT SAFETY CULTURE ANALYSIS IN THE STAFF
OF A SPECIALTY HOSPITAL IN ECUADOR (...) Cueva F, et al.
Revista Médica Vozandes
Volumen 35, Número 1, 2024
27
Furthermore, the study identied signicant
associations between staff characteristics and the
results of the patient safety culture dimensions, which
can guide future efforts to improve the patient safety
culture. Finally, more robust studies on the characteristics and
determinants of patient safety culture in the Latin American
setting are encouraged.
ESTUDIO TRANSVERSAL ARTÍCULO ORIGINAL
Revista Médica Vozandes
Volumen 35, Número 1, 2024
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