title: Barriers to and facilitators of the implementation of a positive patient safety culture in Saudi Arabia from multiple perspectives (healthcare professionals and patients/families)
Creators: name: Al Balawi, Abdulmajeed
Publisher: name: University of Glasgow
Year: 2022

description: Background: Concern over patient safety has been a serious healthcare issue and an international priority facing healthcare organisations globally. The risk of harm and unsafe practice in healthcare organisations has received great attention from both healthcare providers and patients. Patient safety culture has been acknowledged as a crucial element of healthcare organisations as it prevents patient harm and maintains safe, high-quality healthcare. Therefore, investigating the patient safety culture in Saudi Arabia is central to understanding the factors that contribute to patient safety from a broad perspective (healthcare professionals and patients/families). Understanding the safety culture in healthcare organisations may enable a robust and successful implementation of safe practice during medical care. Moreover, patient participation in patient safety is growing internationally, and is regarded in many healthcare systems globally as beneficial in raising awareness of adverse events and monitoring, and detecting any mistakes that were made during patients’ own care. It is evident that in the patient safety literature, patients act as vigilant monitors over safety issues including use of medication, falls prevention, and infection control at the hospital so that they can ensure their own safety. Therefore, it is worth exploring patient perspectives and experiences of safety culture along with healthcare professionals in Saudi Arabia, where patient perspectives and experiences are unknown. Study aim: The aim of this thesis is to obtain an understanding of the status of patient safety culture in Saudi Arabia, and the barriers to and facilitators of the implementation of a positive patient safety culture in Saudi Arabia from multiple perspectives (healthcare professionals and patients/families). Study objectives: To identify the factors contributing to the patient safety culture in Saudi Arabia; To explore healthcare professionals' perceptions of the current patient safety culture in their workplace and the impact of perceived barriers and facilitators on the implementation of a positive patient safety culture; To explore the experiences and perceptions of patients and families towards patient safety culture and the impact of perceived barriers and facilitators on the implementation of a positive patient safety culture. Study design and methods: This study adopted an explanatory sequential mixed method approach to provide a comprehensive and accurate picture of patient safety culture in Saudi Arabia from multiple perspectives. Phase I utilised systematic review to identify factors contributing to patient safety culture in Saudi Arabia. Phase II utilised a cross sectional survey design using the pre-validated Hospital Survey on Patient Safety Culture (HSOPSC) tool with multidisciplinary healthcare professionals (n=363: RR: 30%) in three hospital sites in one Saudi Arabian city. Phase III used a qualitative approach (case study design) which gathered data from healthcare professionals (n=35) through focus groups and patients/ families (n=12) through semi-structured interviews. Convenience sampling was used with the survey participants, and purposive sampling was used with qualitative methods; both descriptive statistical analysis and thematic analysis were used in this mixed methods approach. Findings: The findings from the systematic review (Phase I) identified a variety of factors that contribute to a patient safety culture in the Saudi context, with both strengths and weaknesses being reported. The findings from the survey (Phase II) showed that patient safety culture in the three participating hospitals is weak as all the 12 dimensions of patient safety culture across the three hospitals failed to meet the HSOPSC tool for a strength criterion. The findings from the qualitative study (Phase III) revealed that both patients/family members and healthcare professionals had negative perceptions towards patient safety culture and highlighted many aspects that they believed contribute to patient safety culture. A broad range of factors were identified in Phase III that act as barriers and facilitators to patient safety culture, and these are categorised under four themes: communication, work conditions, organisational factors, and patient empowerment and centeredness. The findings of the three studies undertaken in this thesis revealed that patient safety culture in Saudi Arabia is compromised by several factors, related to different dimensions of patient safety culture including staff issues, communication, blame culture, leadership, reporting systems, work conditions, organisational factors, and person-centred care. The findings reveal that patients/family members observe tasks and activities of safety issues and actively are willing to participate in safety initiatives. They also offer the richest source of information related to safety issues as many of them witness details of individuals, organisation, and systems failures that pose a threat to patient safety. In the current research, healthcare professionals and patients both perceived that patient/family participation in patient safety initiatives can lead to positive outcomes because patients/families are able to identify factors that trigger errors and threaten patient safety. Conclusion: This study revealed that patient safety culture is significantly exposed to many aspects that could represent threats to patient safety. Excessive communication breakdown, heavy workload, blame culture, poor leadership, inappropriate working conditions, and deficits in the organisational environment remain the most described issues that hinder the implementation of a positive patient safety culture. Although the findings provide insight to the barriers and facilitators, it should be noted that the number of barriers outweigh the facilitators, indicating an obvious deficit in the status of patient safety culture in Saudi Arabia. Policy makers in the healthcare system should take these into consideration to reduce barriers and to facilitate improvements to patient safety and quality of healthcare. Moreover, consideration should be given to the factors that may help to support the implementation of a positive patient safety culture, especially establishing a blame-free culture, improving communications and leadership capacity, learning from errors and involving patient perspectives in safety initiatives. This thesis demonstrates the advantages of combining surveys with qualitative methods to study safety culture, which are useful in identifying the key factors that may hinder the implementation of a safety culture. This study concludes that understanding patient safety culture from healthcare professionals’ and patient/families’ perspectives can benefit individuals and organisations in maintaining the safe delivery of healthcare.