Improving patient safety in Palestinian hospitals: a cross-sectional and retrospective chart review study

Patient safety is the central component of health-care quality. There is a lack of patient safety data in the occupied Palestinian territory. The aim of this study was to assess patient safety and explore relationships between patient safety culture and the prevalence of adverse events at the department level.

Between May 25, 2009, and June 1, 2010, the Arabic validated Hospital Survey on Patient Safety Culture was used to measure the norms and perceptions of health professionals regarding safety. The survey was used in eight medical departments in two hospitals (Al Makassed hospital and Al Ahli hospital in the West Bank; four departments per hospital). During the same period, a retrospective review of medical records was done to identify adverse events using the validated Palestinian version of the Global Trigger Tool. Descriptive statistics and Spearman's rho coefficient were used. Ethical approval was obtained from the participating hospital boards and the Palestinian health authorities, and written consent was obtained from participants.

640 randomly selected records (320 records per hospital) were reviewed, and 428 health-care workers participated in the safety culture assessment (response rate 74%). 213 (50%) participants were nurses, 163 (38%) were doctors, and 52 (12%) were other health-care professionals. Patients had a mean age of 44·2 years (SD 19·6; range 18-95) and a mean length of stay of 4·8 days (SD 5·6; range 1-70). 91 (14%) records included an adverse event. Adverse events were negatively associated with the aggregate safety culture (r=-0·905; p=0·0009), hospital management support (r=-0·881; p=0·0017), non-punitive response to errors (r=-0·731; p=0·019), communication and feedback on errors (r=-0·905; p=0·0009), teamwork (r=-0·886; p=0·0021), organisational learning (r=-0·778; p=0·011), and supervisor actions promoting patient safety (r=-0·857; p=0·0029), indicating that departments with a more positive patient safety culture had lower rates of adverse events.

Safety must be improved for Palestinian patients. To promote patient safety, managers and policy makers should acknowledge and allocate resources for enhancing overall safety culture, hospital management support, non-punitive response, communication on errors, teamwork, organisational learning, and supervisor actions.

Research and development, KU Leuven, Leuven, Belgium.