Investigating Patient Safety Culture of Nurses at Cheng Ching General Hospital: A Correspondent Analysis

Document Type : Original Article

Authors

1 Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 40704, Taiwan

2 School of Business, Embry-Riddle Aeronautical University, Prescott, Arizona

3 Department of Business Administration, National Changhua University of Education, Changhua 500, Taiwan

4 School of Business Administration, Hubei University of Economics, Jiangxia District,Wuhan City, Hubei Province, China 430205

5 Department of Statistics, Tunghai University, Taichung 40704, Taiwan

6 6Department of Medical Quality Management, Cheng Ching General Hospital, Taichung City 40799

10.22038/psj.2025.89232.1475

Abstract

Introduction:
This study focuses on nurses' perspectives to explore the relationships among safety characteristics, aiming to understand how age, gender, and workplace factors should be incorporated to enhance patient safety. Data were collected from Cheng Ching General Hospital in Taiwan, with 446 valid respondents. Participants were classified into three age groups and six departments to form two mixed variables: gender-age and workplace-age.
Materials and Methods:
The Safety Attitudes Questionnaire (SAQ), supplemented with three additional safety characteristics, was utilized. Correspondence Analysis was then applied to generate two-dimensional diagrams illustrating the relationships between the mixed variables and nine safety characteristics.
Results:
Female respondents demonstrated a less positive attitude toward team-to-team safety characteristics. Additionally, the older age group exhibited a higher level of positive attitude regarding managerial support-related characteristics and stress recognition compared to their younger counterparts. Finally, no age group within the emergency department showed a positive association with teamwork across departments.
Conclusions:
Key recommendations include: 1) Encouraging greater involvement of younger staff in developing safety policies; 2) Monitoring and managing the workload of older staff; and 3) Establishing structured monitoring procedures for patient transfers between the emergency department and other units.

Keywords

Main Subjects


  1. Vincent C, Taylor-Adams S, Stanhope N. Framework for analyzing risk and safety in clinical medicine. BMJ. 1998;316(7138):1154–7.
  2. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. PMID: 25057539.
  3. Williamson AM, Feyer A, Cairns D, Biancotti D. The development of a measure of safety climate: The role of safety perceptions and attitudes. Saf Sci. 1997;25(1–3):15–27.
  4. Lee W, Wung H, Liao H, Lo C, Chang F, Wang P, et al. Hospital safety culture in Taiwan: a nationwide survey using Chinese version safety attitude questionnaire. BMC Health Serv Res. 2010;10:234.
  5. Tabrizchi N, Sedaghat M. The First Study of Patient Safety Culture in Iranian Primary Health Centers. Acta Med Iran. 2012;50(7):505–10.
  6. Nie Y, Mao X, Cui H, He S, Li J, Zhang M. Hospital survey on patient safety culture in China. BMC Health Serv Res. 2013;13:228.
  7. Kuriakose R, Aggarwal A, Sohi RK, Goel R, Rashmi NC, Gambhir RS. Patient safety in primary and outpatient health care. J Fam Med Prim Care. 2020;9(1):7.
  8. American Association of Colleges of Nursing. Nursing Fact Sheet. Available from: http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-fact-sheet (accessed 10 May 2022).
  9. Buerhaus P, Donelan K, Ulrich B, Norman L, Dittus R. State of the Registered Nurse Workforce in the United States. Nurs Econ. 2006;24(1):6–12.
  10. Friesen M, Farquhar M, Hughes R. The Nurse's Role in Promoting a Culture of Patient Safety. Am Nurses Assoc. 2005.
  11. Nyberg A, Olofsson B, Fagerdahl A, Haney M, Otten V. Longer work experience and age associated with safety attitudes in operating room nurses: an online cross-sectional study. BMJ Open Qual. 2024;13(1).
  12. Hadad ES, Abd Elrhmaan SM, Ahmad FA, Ali HD. Perceptions of Staff Nurses about Patient Safety Culture at Minia General Hospital. Minia Sci Nurs J. 2021;10(1):68–77.
  13. Ahmed N, Adam S, Al-Moniem I. Patient safety: Assessing nurses' perception and developing an improvement plan. Life Sci J. 2011;8(2):53–64.
  14. Cliff B. The Evolution of Patient-Centered Care. J Healthc Manag. 2012;57(2):86–8.
  15. Albalawi A, Kidd L, Cowey E. Factors contributing to the patient safety culture in Saudi Arabia: a systematic review. BMJ Open. 2020;10(10):e037875.
  16. Zuniga F, Schwappach D, De Geest S, Schwendimann R. Psychometric properties of the Swiss version of the nursing home survey on patient safety culture. Saf Sci. 2013;55:88–103.
  17. Mardon R, Khanna K, Sorra J, Dyer N, Famolaro T. Exploring relationships between hospital patient safety culture and adverse events. J Patient Saf. 2010;6(4):226–32.
  18. Rosen A, Zhao S, Rivard P, Lovel S, Montez-Rath M, Elixhauser A, Romano P. Tracking rates of patient safety indicators over time: Lessons from the veterans administration. Med Care. 2006;44(9):850–61.
  19. Agnew C, Flin R, Mearns K. Patient safety climate and worker safety behaviours in acute hospitals in Scotland. J Safety Res. 2013;45:95–101.
  20. Dunlap R, Van Liere K, Mertig A, Jones R. Measuring endorsement of the new ecological paradigm: a revised NEP scale. J Soc Issues. 2000;56(3):425–42.
  21. Abdou H, Saber K. A baseline assessment of patient safety culture among nurses at Student University Hospital. World J Med Sci. 2011;6(1):17–26.
  22. Shie H, Lee W, Hsiao H, Lin H, Yang L, Jung F. Patient safety attitudes among respiratory therapists in Taiwan. Respir Care. 2011;56(12):1924–9.
  23. Kitch B. Patient safety culture: a review of survey instruments. Presented at: National Patient Safety Congress, Orlando; 2005.
  24. Altinpinar I, Başar E. Investigation of the effect of vessel type on seafarers’ safety culture. Int J Occup Saf Ergon. 2022;28(3):1618–23.
  25. Gambashidze N, Hammer A, Wagner A, Rieger MA, Brösterhaus M, Van Vegten A, Manser T, WorkSafeMed Consortium. Influence of gender, profession, and managerial function on clinicians’ perceptions of patient safety culture: a cross-national cross-sectional study. J Patient Saf. 2021;17(4):e280–7.
  26. Singer S, Lin S, Falwell A. Relationship of safety climate and safety performance in hospitals. Health Serv Res. 2009;44:399–421.
  27. Azimi L, Tabibi S, Maleki M, Nasiripour A, Mahmoodi M. Influence of training on patient safety culture: a nurse attitude improvement perspective. Int J Hosp Res. 2012;1(1):51–6.
  28. Göras C, Wallentin F, Nilsson U, Ehrenberg A. Swedish translation and psychometric testing of the safety attitudes questionnaire. BMC Health Serv Res. 2013;13(1):104.
  29. Aziminasab N, Amini S, Morovatdar N. Validation of the Persian Version of the Safety Attitudes Questionnaire. J Patient Saf Qual Improv. 2020;8(3):139–43.
  30. Asi S, Calsbeek H, Kangasniemi MK, Vähi M, Põlluste K. Patient Safety Culture and Safety Attitudes in the Estonian Context: Simultaneous Bilingual Cultural Adaptation and Validation of Instruments. Int J Public Health. 2024;69:1607392.
  31. Alqahtani AS, Evley R. Application of Safety Attitudes Questionnaire (SAQ) in adult intensive care units: a cross-sectional study. MedRxiv. 2020 Jul.
  32. Tocco Tussardi I, Moretti F, Capasso M, Niero V, Visentin D, Dalla Barba L, Tardivo S. Improving the culture of safety among healthcare workers: Integration of different instruments to gain major insights and drive effective changes. Int J Health Plann Manag. 2022;37(1):429–51.
  33. Pevec T, Albreht T, Turk E. Safety culture in the operating room: translation, validation of the safety attitudes questionnaire–operating room version. BMC Health Serv Res. 2023;23(1):491.
  34. Malinowska-Lipień I, Brzyski P, Gabryś T, Gniadek A, Kózka M, Kawalec P, et al. Cultural adaptation of the safety attitudes questionnaire–short form (SAQ-SF) in Poland. PLoS One. 2021;16(2):e0246340.
  35. Hair J, Black W, Babin B, Anderson R. Multivariate data analysis. 5th ed. Upper Saddle River, NJ: Prentice-Hall; 2010. Hatch DJ, Freude G, Martus P, Rose U, Müller G, Potter GG. Age, burnout and physical and psychological work ability among nurses. Occup Med. 2018;68(4):246–54.
  36. Kudlats J, Money A Jr. Correspondence analysis: A promising technique to interpret qualitative data in family business research. J Fam Bus Strategy. 2014;5:30–40.
  37. Hoffman D, Franke G. Correspondence analysis: Graphical representation of categorical data in marketing research. J Mark Res. 1986;23(3):213–27.
  38. Agresti A. Categorical data analysis. Hoboken: John Wiley & Sons; 2002.
  39. San Augustine A, Long W, Pantzallis J. Hospital Positioning: A Strategic Tool for the 1990s. J Health Care Mark. 1992;12(1):15–23.
  40. Beh E. Correspondence analysis of aggregate data: The 2×2 table. J Stat Plan Inference. 2008;138:2941–52.
  41. Ivy J. Higher education institution image: A correspondence analysis approach. Int J Educ Manag. 2001;15(6):276–82.
  42. Lu S, Mei P, Wang J, Zhang H. Fatality and influence factors in high-casualty fires: A correspondence analysis. Saf Sci. 2012;50(4).
  43. Kakai H, Maskarinec G, Shumay D, Tatsumura Y, Tasaki K. Ethnic differences in choices of health information by cancer patients using complementary and alternative medicine: An exploratory study with correspondence analysis. Soc Sci Med. 2003;56:851–62.
  44. Whipple T. Mapping focus group data. Mark Res. 1994;6(1):16–21.
  45. Atilgan E, Akinci S, Aksoy S. Mapping service quality in the tourism industry. Manag Serv Qual. 2003;13(5):412–22.
  46. Lee M, Atkins K, Kim Y, Park S. Competitive analyses between regional malls and big-box retailers: A correspondence analysis for segmentation and positioning. J Shopping Cent Res. 2006;13(1):81–98.
  47. Méjean C, Traissac P, Eymard-Duvernay S, Ati J, Delpeuch F, Maire B. Influence of socio-economic and lifestyle factors on overweight and nutrition-related diseases among Tunisian migrants versus non-migrant Tunisians and French. BMC Public Health. 2007;7:265.
  48. Pineda-Vargas C, Prozesky V, Przybylowicz W, Mayer J. Correspondence analysis evaluation of linear nutrient distribution in root tips of the tropical forage Brachiaria brizantha. Nucl Instrum Methods Phys Res B. 2001;181:493–8.
  49. Cakir H, Khorram S, Nelson S. Correspondence analysis for detecting land cover change. Remote Sens Environ. 2006;102:306–17.
  50. Wagner C, Smits M, Sorra J, Huang C. Assessing patient safety culture in hospitals across countries. Int J Qual Health Care. 2013;25(3):213–21.
  51. Lee L, Hsu C, Hong J. Explore the impact of hospital restructuring medical practitioners of patient safety culture attitudes. J Health Manag. 2012;10(2):189–99.
  52. Sexton J, Helmreich R, Neilands T, Rowan K, Vella K, Boyden J, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res. 2006;6(1):44.
  53. Rigobello M, Carvalho R, Cassiani S, Galon T, Capucho H, Deus N. The climate of patient safety: perception of nursing professionals. Acta Paul Enferm. 2012;25(5):728–35.
  54. Tang YT, Wu HH, Lee YC, Huang CH. Evaluating the psychometric properties of the Chinese version of the Safety Attitudes Questionnaire among medical staff in Taiwan. J Health Organ Manag. 2022;37(1):84–95.
  55. Yan M, Shi Z, Zhou A, Zeng S. Analysis and interpretation of organizational silence behavior of male nurses from the perspective of phenomenology. BMC Nurs. 2025;24(1):864.
  56. Hatch DJ, Freude G, Martus P, Rose U, Müller G, Potter GG. Age, burnout and physical and psychological work ability among nurses. Occup Med. 2018;68(4):246–54.
  57. Milton J, Erichsen Andersson A, Åberg ND, Gillespie BM, Oxelmark L. Healthcare professionals’ perceptions of interprofessional teamwork in the emergency department: a critical incident study. Scand J Trauma Resusc Emerg Med. 2022;30(1):46.
  58. World Health Organization. State of the World's Nursing 2020: Investing in education, jobs and leadership. Available from: https://www.who.int/publications/i/item/9789240003279 (Accessed 16 Dec 2024).
  59. Zeng D, Shimosaka M, Wu X, Anagnostou D, Asakura K, Kinoshita A. Why do male nurses choose to work in foreign countries? A qualitative study on Chinese male nurses working in Japan. Heliyon. 2024;10(1).