The Association Between Cognitive Medical Errors and Their Contributing Organizational and Individual Factors

Figures & data

Table 1 Results of the Pilot Study (N=50)

Scale	Cronbach’s Alpha	Cronbach’s Alpha Based on Standardized Items	No. of Items
MEs	0.570	0.544	6
Causes (MEs)	0.695	0.691	3
Organizational safety culture	0.602	0.608	5
Organizational blame culture	0.780	0.787	13
Policies and procedures	0.674	0.681	5
Workload and complexity of tasks	0.876	0.877	5
Stress	0.633	0.683	6
Sleep and fatigue	0.577	0.553	4

Abbreviation: MEs, medical errors.

Table 2 Demographic Profile of the Respondents

Categories	Frequency	Percentage
Type of hospital
University hospital	171	42.8
Governmental public hospital	150	37.5
Private hospital	79	19.8
Age
20–30 years	169	42.2
31–40 years	196	49.0
41–50 years	30	7.5
51–60 years	4	0.01
Over 60 years	1	0.002
Gender
Male	190	47.5
Female	210	52.5
Profession/job title
Nurse	284	71.0
Head of department	37	9.3
Head of medical unit	3	0.8
Resident doctor	69	17.3
Specialist doctor	7	1.8
Educational level
Diploma	31	7.8
Graduate degree	283	70.8
Postgraduate degree	53	13.3
High specialty in medicine	33	8.3
Years of experience at the current hospital
Less than 1 year	47	11.8
1–5 years	131	32.8
6–10 years	105	26.3
11–20 years	103	25.8
More than 20 years	14	3.5
Years of experience in the health sector
Less than 1 year	39	9.8
1–5 years	110	27.5
6–10 years	122	30.5
11–15 years	77	19.3
16–20 years	35	8.8
More than 20 years	17	4.3
Number of training courses completed in the preceding 12 months
0–5	351	87.7
6–10	36	0.9
11–15	4	0.01
More than 15	9	0.02

Table 3 Exploratory Factor Analysis and Cronbach’s Alpha

Items	Factor Loadings	Cronbach’s Alpha	KMO	Sig.
Medical Error 1	Removed <0.5	0.89	0.54	< 0.001
Medical Error 2	Removed <0.5
Medical Error 3	0.929
Medical Error 4	0.931
Mistake	0.753		0.66	< 0.001
Slip	0.807		0.66	< 0.001
Lapses	0.818		0.66	< 0.001
Blame Culture 1	0.556	0.66	0.76	< 0.001
Blame Culture 2	0.580
Blame Culture 3	0.662
Blame Culture 4	0.677
Blame Culture 5	0.641
Blame Culture 6	0.567
Safety Culture 1	Removed <0.5	0.77	0.80	< 0.001
Safety Culture 2	0.670
Safety Culture 3	0.599
Safety Culture 4	0.529
Safety Culture 5	Removed <0.5
Safety Culture 6	0.651
Safety Culture 7	0.702
Safety Culture 8	Removed <0.5
Safety Culture 9	0.643
Safety Culture 10	0.629
Policies & Procedures 1	0.754	0.75	0.77	< 0.001
Policies & Procedures 2	0.684
Policies & Procedures 3	Removed <0.5
Policies & Procedures 4	0.808
Policies & Procedures 5	0.748
Complexity of task 1	0.637	0.76	0.81	< 0.001
Complexity of task 2	0.848
Complexity of task 3	0.871
Complexity of task 4	0.617
Complexity of task 5	0.769
Stress 1	0.542	0.66	0.72	< 0.001
Stress 2	0.603
Stress 3	Removed <0.5
Stress 4	0.692
Stress 5	0.757
Stress 6	0.744
Sleep & Fatigue 1	Removed <0.5	0.72	0.51	< 0.001
Sleep & Fatigue 2	Removed <0.5
Sleep & Fatigue 3	0.849
Sleep & Fatigue 4	0.836

Abbreviation: KMO, The Kaiser–Meyer–Olkin.

Table 4 Categories of Model Fit and Their Cutoff Values

Name of Category	Name of Index	Level of Acceptance
Absolute fit index	RMSEA	RMSEA < 0.08
	GFI	GFI > 0.90
Incremental fit index	AGFI	AGFI > 0.90
	CFI	CFI > 0.90
	TLI	TLI > 0.90
	NFI	NFI > 0.90
Parsimonious fit index	Chisq/df	Chi-Square/df < 3.0

Note: Source: Awang (2015).⁶⁶

Abbreviations: RMSEA, root mean square error of approximation; GFI, goodness of fit index; AGFI, adjusted goodness of fit index; CFI, comparative fit index; TLI, Tucker-Lewis index; NFI, normed fit index; NFI, modification indices.

Table 5 AVE and CR Values for the Hospital Organizational Factors Construct

Construct	Item	Factor Loading	CR (>0.6)	AVE (>0.5)
Organizational factors	Organizational culture	0.87	0.81	0.69
	Policies and procedures	0.79
Organizational culture	Safety Culture 2	0.59	0.72	0.34
	Safety Culture 4	Deleted
	Safety Culture 6	0.64
	Safety Culture 7	0.65
	Safety Culture 9	0.53
	Safety Culture 10	0.51
Policies and procedures	Policies & Procedures 1	0.61	0.76	0.45
	Policies & Procedures 2	0.57
	Policies & Procedures 4	0.84
	Policies & Procedures 5	0.63

Abbreviations: CR, composite reliability; AVE, average variance extracted; SC, safety culture.

Table 6 AVE and CR Values for the Psychological and Functional Construct

Construct	Item	Factor Loading	CR (>0.6)	AVE (>0.5)
Psychological and Functional	Workload and Complexity of task	0.75	0.73	0.50
	Stress	0.88
	Sleep and fatigue	0.41
Workload and Complexity of task	Workload and Complexity of task 1	0.52	0.81	0.48
	Workload and Complexity of task 2	0.81
	Workload and Complexity of task 3	0.86
	Workload and Complexity of task 4	0.50
	Workload and Complexity of task 5	0.71	0.70	0.44
Stress	Stress 1	Deleted
	Stress 2	Deleted
	Stress 4	0.63
	Stress 5	0.64
	Stress 6	0.71
Sleep and fatigue	Sleep & Fatigue 3	0.71	0.72	0.57
	Sleep & Fatigue 4	0.80

Abbreviations: CR, composite reliability; AVE, average variance extracted.

Table 7 AVE and CR Values for the MEs Construct

Construct	Item	Factor Loading	CR (>0.6)	AVE (>0.5)
MEs	Mistake	0.57	0.73	0.49
	Slip	0.82
	Lapses	0.69

Abbreviations: MEs, medical errors; CR, composite reliability; AVE, average variance extracted.

Table 8 The Standardized Regression Weights and Its Significance for Each Path

Endogenous Construct	Exogenous Construct	Standardized Regression Coefficient	Estimate	t-value	p-value
MEs	Hospitals’ organizational factors	−0.058	−0.117	−0.982	0.326
	Psychological and functional factors	0.369	0.838	6.421	<0.001

Abbreviation: MEs, medical errors.

Figure 1 Suggested conceptual model of ME factors.

Table 9 Independent Variables Influencing MEs

The University Hospital
MEs	Independent Variables	Standardized Regression	Estimate	t-value	p-value
	Hospital organizational factors	−0.026	−0.047	−0.293	0.770
	Psychological and functional factors	0.108	0.131	1.380	0.167
The Governmental Public Hospital
MEs	Hospital organizational factors	−0.090	−0.131	−0.841	0.400
	Psychological and functional factors	0.179	0.250	2.128	0.033
The Private Hospital
MEs	Hospital organizational factors	−0.194	−0.279	−1.560	0.119
	Psychological and functional factors	0.682	0.853	7.652	<0.001

Abbreviation: MEs, medical errors.

Awang Z. Validating the Measurement Model: CFA. A Handbook on SEM. 2nd ed. Kuala Lumpur: Universiti Sultan Zainal Abidin; 2015:54–73.

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