Enhancing patient safety practices in Addis Ababa public hospitals: an explanatory sequential mixed methods study

The study aimed to identify strategies to improve patient safety practices in public hospitals in Addis Ababa.

A sequential, explanatory, mixed-methods study design guided by a pragmatic paradigm was employed. Heterogeneous stratified random selection and purposive sampling techniques were applied. A structured, self-administered questionnaire, a document review checklist and a Focus Group (FG) interview guide were used. Descriptive logistic regression and thematic analysis were conducted.

365 clinicians and 289 nonclinical respondents participated. The response rate was 98.7%. The 150 FG participants were engaged in 15 FG interviews, and 54 documents were reviewed. The overall composite score for patient safety practices is 61.4%. 123 (33.6%) clinician respondents were unaware of patient safety guidelines, despite 269 (73.7%) indicating that they were available at their department. The non-clinician respondents working 40-54 h per week had 5.491 times higher odds of perceiving a good patient safety practice than those working 39 h (AOR = 5.491, 95% CI = 1.971-13.61, p < 0.05). Only 92 (25.2%) of the clinician respondents reported proper adverse event reporting and scoring practices in their working units. Inadequate teamwork, staff shortage, inadequate staff training and lack of essential medical supplies were identified as patient safety gaps.

The study may have the following limitations. Participants may have responded in socially acceptable ways to avoid judgment or repercussions, leading to overreporting of positive practices and distorting the study's findings. Additionally, reliance on participants' memory could introduce inaccuracies, especially for older or emotionally charged events, thereby affecting the reliability of self-reported data. Furthermore, the results may apply only to public hospitals in Addis Ababa and those operating under similar conditions.

The findings presented in this study aim to provide practical solutions to the patient safety challenges faced by the national health system. This research will serve as a valuable resource for the health system by presenting meaningful data that can be used as a framework for evidence-based practices in public hospitals. Additionally, universally applicable strategic interventions were developed to enhance patient safety across various healthcare settings, raise the standard of care and improve safety in hospitals.

The proposed patient safety strategies can serve as a valuable resource for evidence-based practices, helping to create a national patient safety plan and guide national health policy. The study's recommendations focus on enhancing the quality of patient care and promoting safer practices across similar healthcare institutions. The validated patient safety strategies will inform national health policy and contribute to the development of a comprehensive national patient safety strategy.

The developed strategies were based on the empirical study findings and presented to a panel of experts for validation and refinement.