Measuring Patient Safety Culture in Riyadh's Hospitals: A Comparison between Public and Private Hospitals.
BACKGROUND
The issue of patient safety has received an increasing attention worldwide. In Saudi Arabia, policy makers and health organizations continually strive to substantially reduce medical errors and improve quality of health care. The aim of this research was to explore the perceptions of Riyadh hospitals' staff on patient safety and error reporting and to identify factors that influence the levels of frequency of events reported.


METHODS
A cross-sectional survey, using Hospital Survey on Patient Safety Culture (HSPSC), was carried out in 2008. The questionnaire was distributed to all hospitals' staff in Riyadh, which included nine public hospitals and two private hospitals. A total of 1224 questionnaires were returned over a six-month period, giving a response rate of 47.4%.


RESULTS
Organizational learning was the safety culture dimension with the highest positive response (75.9%), while the non-punitive response to error received the lowest positive response (21.1%). The key areas that need improvement in public hospitals include handoffs and transitions, communication openness, staffing, and non-punitive response to error. The private hospitals need an improvement in two aspects; staffing and non-punitive response to error. The results show that all types of mistakes were reported more frequency in private hospitals than in public hospitals. Most respondents reported "no events" in the twelve months preceding the survey, with the percentage of not reporting being higher in private sector compared to public hospitals. The high percent of "no event" reports may represent under-reporting in all hospitals. Regression analysis indicated that event reporting was influenced by feedback and communication about error, staff position, teamwork across units, non- punitive response to error, supervisor/managers expectations and actions promoting patients safety, and type of hospital.


CONCLUSIONS
Areas needs improvement in Riyadh hospitals includes handoffs and transitions, communication openness, staffing and non-punitive response to error. Healthcare organizations should reduce the fear of blame culture and create a climate of open communication and continuous learning.
Al-Ahmadi
Talal A
TA
Health Administration, Institute of Public Administration, Riyadh, Saudi Arabia. ahmadit@ipa.edu.sa.