Assessment of Attitude of Primary Care Medical Staff Toward Patient Safety Culture in Primary Health-care Centers–—Al-Ahsa, Saudi Arabia

Figures & data

Table 1 Demographics Characteristic for Study Participants in PHCs

	Frequency	Percent
Gender
Female	175	60.8
Male	113	39.2
Job category
Nurse	102	35.4
Technologist/technician	62	21.5
Physician	54	18.8
Pharmacist/pharmacy tech.	36	12.5
Other	34	11.8
Years in the center
Less than 3 years	38	13.2
3–10 years	168	58.3
More than 10 years	82	28.5
Job title
Nurse in charge	9	3.1
Manager	7	2.4
Nonsupervisory	272	94
Age
Less than 30	80	27.8
30 to 40 years	131	45.5
More than 40 years	77	26.7
Education level
Diploma	202	70.1
Bachelor	78	27.1
Board	8	2.8
Nationality
Saudi	261	90.6
Non-Saudi	27	9.4

Table 2 Internal Consistency of the Scale

Subscale	Cronbach’s α	Item Numbers
Teamwork	0.75	1–6
Safety climate	0.76	7–13
Job satisfaction	0.83	15–19
Stress recognition	0.77	20–23
Perception of management	0.85	24–28
Work condition	0.73	29–32
Total	0.86	All items

Table 3 Validity of the Scale Using Pearson’s Correlation Coefficients

	Teamwork	Job Satisfaction	Stress Recognition	Perception of Management	Work Condition	Safety Climate	Total Score
Teamwork	1
Job satisfaction mean	0.409*	1
Stress recognition	0.097	0.069	1
Perception of management	0.352*	0.669*	0.094	1
Work condition mean	0.287*	0.497*	0.231*	0.557*	1
Safety climate	0.552*	0.613*	0.096	0.584*	0.453*	1
Total score	0.598*	0.773*	0.428*	0.788*	0.739*	0.757*	1

Note: *p<0.01 significance level.

Table 4 Total and Subscale Scores of Medical Staff Attitudes Towards Patient Safety in PHCs

Subscale	N	Minimum	Maximum	Mean	SD	Score
Teamwork	288	1.17	5.00	4.11	0.595	77.5
Safety climate	288	1.50	5.00	3.74	0.778	68.5
Job satisfaction	288	1.20	5.00	4.20	0.720	80
Stress recognition	288	1.00	5.00	3.01	1.130	50
Perception of management	288	1.00	5.00	3.75	0.859	68.6
Work condition	288	1.00	5.00	3.50	0.797	62.6
Total score	288	1.85	4.89	3.72	0.521	68

Table 5 Participant’s Responses for Each Item in the Six Subscales of SAQ

Subscales, Item Number, and Text	Disagree (%)	Neutral (%)	Agree (%)	Missing (%)	Mean (SD)
1. Nurse input is well received in this center	18 (6.25)	31 (10.75)	235 (81.6)	4 (1.38)	75.0 (22.5)
2. In this PHC center, it is difficult to speak up if I perceive a problem with patient care^a	239 (83)	17 (5.9)	27 (9.4)	5 (1.73)	74.9 (24.8)
3. Disagreements in this center are resolved appropriately	28 (9.7)	20 (6.9)	234 (81.3)	6 (2.1)	74.8 (24.3)
4. I have the support I need from other personnel to care for patient	22 (7.6)	2 (6.9)	242 (84)	4 (1.4)	77.5 (23.3)
5. It is easy for personnel here to ask questions when there is something that they do not understand	14 (4.8)	5 (1.7)	264 (92)	5 (1.73)	81.8 (19.3)
6. The physicians and nurses here work together as well coordinated team	15 (5.2)	21 (7.3)	24 3(84)	9 (3.1)	81.2 (20.9)
7. I would feel safe being treated here as a patient	31 (10.8)	30 (10.4)	223 (77.4)	4 (1.4)	74.1 (25.5)
8. Medical errors are handled appropriately in this center	75 (26)	14 (4.9)	196 (68)	3 (1.0)	64.8 (31.6)
9. I know the proper channels to direct questions regarding patient safety	67 (23.3)	30 (10.4)	186 (64.6)	5 (1.7)	63.6 (30.2)
10. I received appropriate feedback about my performance	29 (10.1)	31 (8.7)	226 (78.5)	2 (0.7)	75.0 (24.4)
11. In this center it is difficult to discuss errors^a	194 (67.4)	35 (12.2)	55 (19.1)	4 (1.4)	66.1 (29.2)
12. I am encouraged by my colleagues to report any patient safety concerns I may have	52 (18.1)	26 (9.0)	156 (54)	5 (1.7)	69.0 (27.7)
13. The culture in this center makes it easy to learn from the errors of others	50 (17.4)	4 0(13.9)	191 (66.3)	7 (2.4)	66.5 (26.4)
15. I like my job	5 (1.73)	17 (5.9)	262 (90.9)	4 (1.4)	88.9 (17.9)
16. Working here is like being part of a large family	21 (7.3)	29 (10.1)	232 (80.5)	6 (2.1)	79.7 (23.9)
17. This is a good place to work	31 (10.8)	36 (12.5)	218 (75.7)	2 (0.7)	75.0 (26.4)
18. I am proud to work in this center	17 (5.9)	35 (12.2)	232 (80.5)	4 (1.4)	80.6 (23.3)
19. Morale in this center is high	17 (4.9)	50 (17.4)	216 (75)	5 (1.7)	76.4 (22.8)
20. When my workload becomes excessive my performance is impaired	129 (44.8)	37 (12.8)	124 (43)	8 (2.8)	48.1 (32.8)
21. I am less effective at work when fatigued	123 (42.7)	35 (12.2)	122 (42.4)	4 (1.4)	50.2 (33.2)
22. I am more likely to make errors in tense or hostile situations	139 (48.2)	34 (11.8)	113 (46.2)	2 (0.7)	51.1 (33.9)
23. Fatigue impairs my performance during emergency situations	129 (44.8)	51 (17.7)	102 (35.4)	6 (2.1)	51.2 (31.9)
24. Management supports my daily efforts	41 (14.2)	55 (19.1)	189 (65.6)	3 (1.0)	67.9 (25.9)
25. Management does not knowingly compromise patient safety	67 (23.2)	47 (16.3)	169 (58.7)	5 (1.7)	62.8 (29.5)
26. Management is doing a good job	28 (9.7)	38 (13.2)	218 (75.7)	4 (1.4)	73.6 (24.4)
27. Problem personnel are dealt with constructively by the center management	35 (12.1)	52 (18.1)	194 (67.4)	7 (2.4)	70.2 (26.8)
28. I get adequate timely information about events that might affect my work	41 (14.2)	50 (17.4)	195 (67.7)	2 (0.7)	68.4 (26.1)
29. The levels of staffing in this center are sufficient to handle the number of patients	134 (46.5)	49 (17)	103 (35.8)	2 (0.7)	45.9 (32.1)
30. This center does a good job of training new personnel	42 (14.6)	33 (11.5)	208 (72.2)	5 (1.7)	68.8 (24.3)
31. All the necessary information for diagnostic and therapeutic decisions is routinely available to me	36 (12.5)	56 (19.4)	188 (65.3)	8 (2.8)	68.1 (23.8)
32. Trainees in my discipline are adequately supervised in this center	32 (11.1)	64 (22.2)	183 (63.5)	9 (3.1)	68.0 (23.7)

Notes: ^aIndicates that the question was reversed. SAQ subscale items adapted from Sexton JB, Helmreich RL, Neilands TB, et al. The Safety Attitudes Questionnaire: Psychometric Properties, Benchmarking Data, and Emerging Research. BMC Health Services Research. 2006;6:44.⁷ © 2006 Sexton et al; licensee BioMed Central Ltd. Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0).

Table 6 Comparison Between Participant’s Characteristic and Their Attitude Scores Toward Patient Safety

Sub-Scales	TW	SC	JP	SR	PM	WC	Overall Score
Mean (SD)	77.5 (15.1)	68.5 (19.4)	80 (18.0)	50 (28.3)	68.6 (21.5)	62.6 (19.9)	68.0 (13.1)
Sectors of the PHC
Al Hofuf	75.3 (17.6)	67.5 (20.9)	79.7 (19.7)	47.6 (28.6)	68.6 (23.9)	59.6 (21.4)	66.4 (14.4)
Al Mubarraz	79.3 (14.7)	68.3 (19.3)	77.3 (17.6)	50.0 (26.0)	65.9 (20.4)	61.9 (18.4)	67.1 (11.9)
Al Omran	77.9 (11.7)	69.8 (17.7)	84.3 (15.9)	53.5 (30.6)	72.2 (19.6)	66.9 (19.7)	70.8 (12.3)
F	1.857	0.328	3.654	0.993	2.078	3.095	2.916
p-value	0.158	0.721	0.027	0.372	0.127	0.047	0.056
CBAHI accreditation
Yes	77.0 (14.1)	68.6 (18.9)	79.5 (18.8)	47.6 (28.5)	67.7 (22.6)	62.1 (20.1)	67.1 (12.7)
No	78.1 (15.8)	68.4 (19.9)	80.6 (17.4)	52.5 (27.9)	69.3 (20.5)	63.1 (19.8)	68.7 (13.4)
t-value	0.593	0.078	0.527	1.459	0.624	0.412	1.016
p-value	0.553	0.938	0.599	0.146	0.533	0.681	0.310
Gender
Male	74.7 (18.5)	69.1 (19.6)	81.6 (17.4)	38.9 (25.8)	73.2 (19.3)	62.0 (18.6)	66.6 (14.0)
Female	79.4 (12.1)	68.1 (19.0)	79.2 (18.4)	57.5 (27.5)	65.7 (22.3)	63.0 (20.7)	68.8 (12.3)
t-value	2.539	0.455	1.103	5.714	2.907	0.382	1.390
p-value	0.012	0.650	0.271	0.000	0.004	0.703	0.166
Years in the PHC Center
Less than 3 years	80.8 (14.0)	72.8 (19.9)	82.9 (16.4)	47.6 (30.5)	71.6 (24.2)	70.3 (21.2)	70.9 (16.7)
3–10 years	78.8 (11.3)	68.1 (19.8)	82.3 (16.5)	53.1 (27.3)	70.6 (19.5)	62.3 (18.9)	69.2 (10.7)
More than 10 years	73.3 (20.7)	67.2 (20.4)	73.9 (20.5)	45.5 (28.8)	62.8 (23.1)	59.5 (20.5)	63.7 (14.5)
F	4.797	1.243	6.782	2.158	4.044	4.080	6.266
p-value	0.009	0.290	0.001	0.117	0.019	0.018	0.002
Age
Less than 30 years	76.3 (11.8)	63.1 (20.4)	77.3 (16.9)	49.4 (28.1)	64.3 (23.6)	59.6 (21.1)	65.0 (13.1)
30–40 years	80.3 (13.2)	70.5 (19.2)	84.3 (16.2)	55.7 (27.4)	74.3 (18.2)	65.8 (18.4)	71.8 (11.3)
More than 40 years	73.6 (19.5)	69.6 (18.1)	74.7 (20.4)	40.8 (27.8)	61.7 (22.5)	59.2 (19.9)	63.3 (13.9)
F	5.418	3.636	8.568	7.152	10.957	3.764	14.058
p-value	0.005	0.028	0.000	0.001	0.000	0.024	0.000
Job category
Nurse	79.7 (11.6)	68.4 (18.4)	80.6 (16.7)	57.9 (27.2)	67.3 (22)	64.5 (20.2)	69.7 (11.8)
Technologist/technician	76.8 (12.9)	68.1 (19.9)	80.9 (18.4)	47.8 (27.8)	74.5 (18.8)	63.4 (20.3)	68.6 (12.4)
Physician	79.3 (14.8)	74.9 (16.8)	80 (19.8)	42.5 (28.2)	63.4 (20.9)	65 (21.7)	67.5 (13.1)
Pharmacist/pharmacy tech.	79.4 (13.2)	64.3 (19.6)	83.6 (15.8)	54.1 (29.5)	74.7 (22.7)	58.5 (18.8)	69.1 (11.4)
Other	68.5 (24.1)	63.5 (22.7)	73.9 (19.8)	40.7 (25.6)	63.7 (21.3)	56.1 (15)	61.1 (16.9)
F	4.268	2.523	1.390	4.337	3.333	1.765	3.122
p-value	0.002	0.041	0.238	0.002	0.011	0.136	0.015
Job title
Nurse in charge	83.6 (7.72)	79.7 (12.6)	87.7 (18.2)	59.7 (22.3)	78.8 (32.1)	81.9 (17.5)	78.6 (12.7)
Manager	88.8 (10.8)	82.6 (12.3)	94.3(6.91)	47.9 (21.6)	82.1 (14.9)	84.8 (17.9)	80.1 (10.1)
Nonsupervisory	77.1 (15.2)	67.8 (19.5)	79.5 (18.0)	50.4 (28.6)	67.9 (21.9)	61.4 (19.4)	67.3 (12.8)
F	2.860	3.650	3.194	0.538	2.558	9.627	6.659
p-value	0.059	0.027	0.042	0.584	0.079	0.000	0.001
Education level
Diploma	76.3 (15.3)	65.7 (19.8)	78.9 (17.6)	51.1 (27.8)	67.8 (21.7)	61.5 (19.7)	66.9 (13.0)
Bachelor	81.2 (13.8)	74.2 (17.7)	83.2 (18.3)	48.1 (28.9)	70.9 (20.9)	65.5 (20.7)	70.5 (13.2)
Board	77.6 (15.0)	78.8 (5.4)	76.4 (24.4)	51.8 (36.9)	61.9 (21.5)	60.7 (13.8)	66.8 (7.9)
F	3.895	6.920	1.754	0.357	0.965	1.239	2.312
p-value	0.021	0.001	0.175	0.700	0.382	0.291	0.101

Sexton JB, Helmreich RL, Neilands TB, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res. 2006;6(1):44. doi:10.1186/1472-6963-6-44

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