Designing a Model of Patient Participation in Promoting Patient Safety Culture

Patient safety in the health care system is a worrying issue and one of the biggest threats in the health system is related to medical errors. Efforts to minimize these problems lead to progress and development in patient safety in hospitals and subsequently lead to prevention, reduction of accidents and injuries caused by providing patient care. From injuries caused by providing patient care, medication errors, surgical complications, incorrect diagnoses, delay in diagnosis, non-diagnosis, failure of devices and equipment leading to wrong diagnosis and other cases such as hospital infections, patient falls, bedsores and others. The cases can be named. It is important to improve the culture of patient safety in organizations according to the model of patient participation. This research was conducted with the aim of designing a model of patient participation in improving the culture of patient safety. The results showed that the designed model has a good fit. In this research, based on the research findings, an attempt was made to provide a comprehensive model for patient participation in promoting patient safety culture. The components and stages of the proposed model were designed using the results of a field review study and findings from semi-structured interviews with experts in this field and after statistical analysis. The presented model is the model of patient participation in promoting patient safety culture, which consists of 3 main factors: organizational factors, environmental and perceptual factors, and decision-making factors. In this model, each of the main factors includes several sub-components. Organizational factors (giving a sense of control and responsibility, heavy tasks and the number of manpower, management and leadership, response to errors) environmental and perceptual factors (communication in the field of safety, patient empowerment, teamwork, evaluation) decision-making in treatment (characteristics patient, patient cooperation and collaboration, raising awareness) were categorized. Finally, each of the sub-components will find objectivity and measureability by one or more items. A total of 58 items were considered for the model.

The current research was a description of structural equations. The statistical population included the employees of educational hospitals of Mashhad and Torbat Heydarieh universities of medical sciences, 536 people were selected as a sample by stratified random sampling method. The researcher-made questionnaire of patients' participation was used in improving the culture of patient safety. A reliability of 0.93 was obtained. LIZREL version 10 software and alpha level of 0.05 were considered for data analysis.

According to the results of this study, in the context of implementing patient participation in improving the patient safety culture in hospitals, first of all, attention should be paid to strengthening the dimension of "being accountable for mistakes", which, from the perspective of hospital staff, has the greatest impact on realizing patient participation. In promoting patient safety culture. After that, strengthening the dimensions of "ethics and ethical leadership", "organization and organizational control", "characteristics of the patient", "giving a sense of control and cooperative activities to the patient", "team work", "management and leadership" ", "manpower planning", "doctor-patient interaction" and then "patient evaluation" are in the next level of importance. The strengths show that the employees and managers of the departments have the necessary potential to promote the safety culture, but it is necessary to modify the procedures and policies at the level of hospitals. Today, examining and strengthening the patient safety culture has been widely considered by healthcare organizations. And the first step of improving patient safety is to evaluate patient safety culture; Team work and interaction between doctor and patient was a positive point, the strength of the patient safety culture. Non-punitive responses to errors were weaknesses of the patient safety culture. The results of this finding were consistent with other studies. This research has faced limitations. The statistical population of the research was limited to the employees of the medical departments of the selected hospitals of Razavi Khorasan province, so caution should be exercised in generalizing the results to other groups and cities. Another limitation of this research was the difficulty in communicating with some of the employees of the treatment department and determining the time required for the interview, and the time-consuming administrative bureaucracies to conduct the research, as well as the low accuracy of some people in studying the questions and answering them. According to the research results, it is suggested to carry out this research in other cities and geographical regions. Also, a model comparison of Iran with other countries is made.

The results showed that the value of t in all paths between the research factors was equal to and greater than 1.96. Also, the results showed that the fit of the general research model is appropriate and strong.