Abstract
Background
Adverse events resulting from medical care continue to be a significant cause of morbidity and mortality globally. Many individuals experience harm due to medical errors, particularly in developing nations. The primary objective of this study was to evaluate the patient safety culture among pharmacy professionals employed in public hospitals within Bahir Dar City, Ethiopia.
Methods
A descriptive institutional-based cross-sectional study was conducted between March 2024 and April 2024. The Pharmacy Survey on Patient Safety Culture (PSOPSC) assessment tool was administered to all pharmacy professionals working at the three public hospitals. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 26, followed by univariable and multivariable logistic regression analyses to identify predictors. Variables with a P value < 0.05 at a 95% Cl in the multivariable analysis were declared statistically significant.
Results
Of the 118 participants, 110 responded, resulting in a response rate of 93.2%. The positive response rates for the 11 patient safety culture dimensions varied from 40.91–70.61%. According to the Agency for Health Research and Quality (AHRQ) guidelines, the average positive response rate was moderate at 59.09%. The lowest positive response rate was for ‘communication about mistakes’ at 40.91%, while ‘teamwork within a unit area’ had the highest positive response rate of 70.61%. The seven dimensions that fell within the AHRQ standard had a moderate positive response rate, ranging from 50.3 to 69.69%, whereas ‘teamwork within a unit area’ (70.61%) and ‘response to mistakes’ (70.45%) had a high positive response rate within the high positive response rate of the AHRQ standard (≥ 70.0%). However, two other dimensions, ‘communication about mistakes’ (40.91%) and ‘communication openness’ (48.47%) had a low positive response rate within the low positive response rate of the AHRQ standards (< 50.0%). Of the participants, 30.9% reported at least one event over the past year, while 37.3% rated the level of patient safety as 'very good or excellent'. Several factors were found to have a significant association with the level of positive response rate on patient safety culture, including educational level, years of working experience in the hospital and unit area, direct interaction with patients, patient safety training, and five dimensions of patient safety culture: staff training and skills, communication openness, communication about prescriptions across shifts, communication about mistakes, and physical space and environment.
Conclusions
A moderate level of patient safety culture indicated that targeted interventions are required to address key areas contributing to this moderate positive response rate. To create effective hospital pharmacy settings, teamwork, leadership skills, effective communication, employee counseling, adequate staffing, prompt response procedures, and accurate reporting protocols are essential.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12913-025-13396-z.
Keywords: Patient safety, Patient safety culture, Healthcare quality, Adverse events reported, Patient safety grade, Hospital pharmacy, Ethiopia
Introduction
Medication errors are a major cause of patient harm within healthcare systems. These errors can occur at any stage of medication use, including prescription, dispensing, administration, and monitoring. According to the World Health Organisation (WHO) report, 5% of patients worldwide suffer from preventable medication-related harm. In Low and Middle Income Countries (LMICs), the incidence of preventable medication-related harm was 7%, whereas in High-Income Countries (HICs), it was 4%. Southeast Asia and Africa had the highest rates of preventable medication-related harm, occurring at 9% [1, 2].
Worldwide, approximately 53% of preventable medication-related related adverse effects occur at the prescribing/ordering stage, whereas an additional 36% occur during the monitoring/reporting stage. In LMICs, nearly 80% of preventable medication-related harm occurs during the ordering/prescribing stage [2].
Annual hospital incidents in LMICs are estimated to reach 134 million, leading to approximately 2.6 deaths. In nine African countries, approximately 8.4% of patients in hospitals experienced adverse drug reactions, with approximately 43.5% of these reactions being preventable. The analysis revealed significant challenges, including the fact that 57.4% of the prescriptions contained prescribing errors and 15.5% had dose-related issues [2, 3].
Medication-related harm is responsible for half of all preventable harm in the healthcare system. Antibiotics, antipsychotics, cardiovascular drugs, gastrointestinal drugs, and non-steroidal anti-inflammatory drugs are responsible for at least 10% of the medication-related harm [2]. Settings for elderly patient care experience the highest rate of preventable medication harm (11%). The level of preventable harm ranged from severe to mild, with 26% being classified as clinically severe or life-threatening, 40% as moderate, and 39% as mild. The stages of medication usage that lead to the highest rates of preventable harm are primarily the prescription stage, accountable for 58% of cases, and the monitoring stage, which accounts for 47% of cases [1, 4].
An estimated 2 to 4 million non-lethal preventable harms occur each year, and up to 400,000 hospitalised patient deaths per year may result from preventable harm worldwide [1, 5–7]. This issue has a far-reaching impact, causing reputational damage to healthcare systems. Consequently, trust in healthcare services is eroded, and the morale and well-being of healthcare workers are adversely affected. Additionally, public opinion about the value of investing precious societal resources in healthcare systems is also negatively impacted [7, 8].
Patient safety culture (PSC) is a multifaceted framework that encompasses various dimensions, which in turn influence a range of discretionary actions linked to patient safety [9]. Establishing a robust PSC is crucial, and it begins with a profound understanding of the values, beliefs, and norms that dominate an Organisation. This involves acknowledging what is considered significant and which attitudes and behaviors related to patient safety are endorsed, recognized, and expected [10].
The overall level of positive PSC among healthcare providers in different public hospitals in Ethiopia ranged from 44.0 to 50.1% [11–22]. Limited research has been conducted to investigate patient safety culture within a hospital environment among healthcare professionals. However, none of these studies have focused on hospital pharmacy environments in Ethiopia. This study is the first of its kind in Ethiopia to investigate patient safety culture in hospital pharmacy environments. The primary objective of this study was to assess the PSC among pharmacy professionals at public hospitals in Bahir Dar city using a PSOPSC assessment tool in the specified area of study. The results of this study are expected to provide insight into the healthcare system within the organisations and a better understanding of PSC in the selected public hospitals, ultimately enhancing the quality of pharmaceutical care services.
Methods
Study area
The study was conducted at public hospitals found in Bahir Dar city, on Tibebe Ghion Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and Addis Alem General Hospital. At the time of the study, a total of 60, 40, and 18 pharmacy professionals were available in Tibebe Ghion Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and Addis Alem General Hospital, respectively.
Study design and period
A descriptive institutional-based cross-sectional study was conducted from March 1, 2024 to April 30, 2024.
Inclusion and exclusion criteria
Pharmacy professionals (pharmacist and pharmacy technician) who had been employed in those hospitals for at least six months were included in the study, whereas those with less than six months of work experience, allied healthcare professionals (nurses, physicians, and laboratory technicians), and personnel who did not have direct contact with patients (accountants and drivers) were excluded.
Independent variables
Sociodemographic characteristics of the pharmacy professionals (gender, educational level, working unit area, working year in hospital and unit area, working hours per week, training, and direct interaction with patients).
Dependent variables
The patient safety culture in hospital pharmacy settings encompasses various dimensions, including teamwork, physical space, training, leadership, communication, counseling, staffing, responding, and reporting.
Sample size determination and sampling procedures
All pharmacy professionals working in the pharmacy setting of these selected hospitals in Bahir Dar city were involved in the study.
Data collection tool and procedures
The PSOPSC tool, which is a standard instrument developed by the AHRQ, was used to collect data [23–25]. It contains two sections: (1) the pharmacy professionals’ sociodemographic characteristics and (2) the PSC dimensions, which includes 36 items that evaluate 11 dimensions of organizational patient safety culture in hospital pharmacy settings. The questionnaire also included three questions that asked hospital pharmacy professionals to rate how frequently errors were reported/documented, and one question asked them to rate the overall patient safety grade [23, 24].
Both frequency scales (never to always) and five-point Likert scales (strongly agree to strongly disagree) were used to measure the portions’ questions. The questionnaire was independently administered to 118 pharmacists and pharmacy technicians in their respective units after obtaining verbal informed consent.
Data quality assurance
A pretest was performed on 5% of randomly selected pharmacy professionals to ensure the feasibility of the study and the appropriateness and consistence of data collection tool. Following the computation, the Cronbach’s alpha values for the composites ranged from 0.765 to 0.901, with an average of 0.828. The obtained Cronbach’s alpha values are considered acceptable, as they exceed the threshold of 0.60 specified in the PSOPSC user’s guide [24]. It was found that each dimension met the required standard of reliability and the composites showed consistent results. Three data collectors attended a one-day training session that covered the basic principles of the questionnaire and its correct application. A supervisor who provided prompt feedback during the process and ensured that the data were complete and logically consistent at the end of each day oversaw the data collection process.
Data processing, analysis, and presentation
Data were collected, checked for completeness and consistency, coded, and analysed using Microsoft Excel and SPSS version 26. The positive response rate was calculated according to the formula outlined in the user’s guide of the PSOPSC [25]. Reverse coding was applied to items with negative wording. Descriptive analysis was performed, and the results were presented in terms of frequency using tables and graphs. The Hosmer-Lemeshow model fitness and multi-collinearity tests were performed to check the model fitness and the existence of multi-collinearity, respectively. The Hosmer-Lemeshow model fitness statistic (P < 0.05) and the collinearity statistics (Variance inflation factor (VIF) > 10 and tolerance (T) < 0.1) were considered suggestive of the model does not fit well and the existence of multi-collinearity, respectively. In the multivariable analysis, predictors with a P value ≤ 0.25 that were associated with the outcome variable in the univariable analysis were selected. Variable in the multivariable analysis with a P value less than 0.05 was considered statistically significant.
Operational definitions
Adverse events
These are unintended and harmful outcomes that occur during or after the use of medical treatment or intervation [1, 2].
The positive response rate was calculated by combining the “strongly agree” and “agree” response categories, as well as the “always” and “most of the time” response categories [11–14].
The negative response rate was calculated by combining the “strongly disagree” and “disagree” response categories, as well as the “never” and “rarely” categories [11–14].
Accordance to the AHRQ recommended standards, a mean score of 70% or higher indicates a high positive response rate for patient safety culture. Scores ranging from 69 to 51% were classified as a moderately positive response rate for the HSOPSC questions. A mean score of below 50% on the HSOPSC questions suggests a low or inadequate level of positive responses regarding patient safety culture [11–14, 16, 17, 25–27].
Results
Sociodemographic characteristics
Of the 118 questionnaires administered to pharmacists and pharmacy technicians, 110 were completed and returned, resulting in a response rate of 93.2%. More than half, (54.5%) of the pharmacy professionals were male, while 63 (57.3%) were pharmacists. More than two-thirds, 61 (73.5%) of them had worked in hospitals for one to five years. Every pharmacy professional had worked in a single working unit area for less than a year. Furthermore, 63 (75.9%) of those professionals did not receive any training on patient safety, and around two-thirds, 56 (67.5%), had direct patient interaction experience (Table 1).
Table 1.
Sociodemographic characteristics of pharmacy professionals at public hospitals, Bahir dar, ethiopia, 2024 (n = 110)
| Variables | Categories | Frequency | Percentage |
|---|---|---|---|
| Gender | Male | 60 | 54.5 |
| Female | 50 | 45.5 | |
| Educational level | Pharmacist | 63 | 57.3 |
| Pharmacy Technician | 57 | 42.7 | |
| Working Unit Area | Surgical | 15 | 13.6 |
| Gynecology | 16 | 14.5 | |
| OPD | 30 | 27.3 | |
| Medical | 21 | 19.0 | |
| Emergency | 20 | 18.2 | |
| Others | 8 | 7.3 | |
| Working year in the Hospital | Less than 1 | 7 | 6.4 |
| 1–5 | 67 | 60.9 | |
| 6–10 | 30 | 27.3 | |
| Greater than 11 | 6 | 5.5 | |
| Working year in the Unit Area | Less than 1 | 109 | 99.1 |
| 1–5 | 1 | 0.9 | |
| 6–10 | 0 | 0 | |
| Greater than 11 | 0 | 0 | |
| Working hours per week | Less than 30 | 12 | 10.9 |
| 30–40 | 67 | 60.9 | |
| Greater than 40 | 31 | 28.2 | |
| Direct interaction with patients | Yes | 70 | 63.6 |
| No | 40 | 36.4 | |
| Patient safety training | Yes | 33 | 30.0 |
| No | 77 | 70.0 | |
| Total | 110 | 100 | |
Patient safety culture dimensions
The overall average positive response rate was 59.09%, with a range of 40.91–70.61%. The lowest positive response rate was observed in communication about mistakes (40.91%), whereas the highest positive response rates were seen in teamwork in the unit area (70.61%), followed by response to mistakes (70.45%) (Table 2; Fig. 1).
Table 2.
Response rate of individual items and dimensions among pharmacy professionals at public hospitals, Bahir dar, ethiopia, 2024 (n = 110)
| Individual Items and dimensions | Negative, n (%) | Neutral, n (%) | Positive, n (%) |
|---|---|---|---|
| ● Physical space and environment (Cronbach’s α = 0.813, VIR = 1.181, and PRR = 58.5)* | |||
| A1. This pharmacy is well organized | 25 (22.7) | 20 (18.2) | 65 59.1) |
| A5. This pharmacy is free of clutter | 28 (25.5) | 31 (28.2) | 51 (46.4) |
| A7. The physical layout of this pharmacy supports good workflow | 23 (20.9) | 10 (9.1) | 77 (70.0) |
| ● Teamwork in the unit area (Cronbach’s α = 0.806, VIR = 1.109, and PRR = 70.61)* | |||
| A2. Staff work together as an effective team | 14 (12.7) | 8 (7.3) | 88 (80.0) |
| A4. The staff in this pharmacy clearly understand their roles and responsibilities. | 19 (17.3) | 15 (13.6) | 76 (69.1) |
| A9. Staff treat each other with respect | 26 (23.6) | 15 (13.6) | 69 (62.7) |
| ● Staff training and skills (Cronbach’s α = 0.869, VIR = 1.532, and PRR = 59.09)* | |||
| A3. Technicians in this pharmacy receive the training they need to perform their jobs | 39 (35.4) | 19 (17.3) | 52 (47.3) |
| A6. Staff in this pharmacy have the skills they need to do their jobs well | 10 (9.1) | 20 (18.2) | 80 (72.7) |
| A8. Staff who are new to this pharmacy receive adequate orientation | 25 (22.7) | 19 (17.3) | 65 (60.0) |
| A10. The staff received enough training from this pharmacy | 30 (27.3) | 18 (16.4) | 62 (56.4) |
| ● Communication openness (Cronbach’s α = 0.765, VIR = 1.445, and PRR = 48.47)* | |||
| B1. Staff ideas and suggestions are valued in this pharmacy | 20 (18.2) | 14 (12.7) | 76 (69.1) |
| B5. Staff feel comfortable asking questions when they are unsure about something | 45 (40.9) | 30 (27.3) | 35 (31.8) |
| B10. It is easy for the staff to speak up to their supervisor/manager about patient safety concerns in this pharmacy. | 38 (34.6) | 23 (20.9) | 44 (44.5) |
| ● Patient counseling (Cronbach’s α = 0.832, VIR = 1.354, and PRR = 66.67)* | |||
| B2. They encourage patients to talk to pharmacists about their medications | 16 (14.6) | 12 (10.9) | 82 (74.6) |
| B7. Their pharmacists spend enough time talking to patients about how to use their medications | 30 (27.3) | 15 (13.6) | 65 (59.1) |
| B11. Their pharmacists tell patients important information about their new prescriptions | 16 (14.6) | 21 (19.1) | 73 (66.4) |
| ● Staffing, work pressure, and pace (Cronbach’s α = 0.851, VIR = 1.231, and PRR = 57.73)* | |||
| B3. Staff take adequate breaks during their shifts | 31 (28.2) | 15 (13.6) | 64 (58.2) |
| B9. They do not feel rushed when processing prescriptions | 19 (17.3) | 35 (31.8) | 56 (50.9) |
| B12. They have enough staff to handle the workload | 29 (26.4) | 15 (13.6) | 66 (60.0) |
| B16. Interruptions/distractions in this pharmacy (from phone calls, faxes, customers, etc.) doesn’t make it difficult for staff to work | 22 (20.0) | 20 (18.2) | 68 (61.8) |
| ● Communication about prescription across shifts (Cronbach’s α = 0.791, VIR = 2.24, and PRR = 50.30)* | |||
| B4. They have clear expectations about the exchange of important prescription information across shifts | 22 (20.0) | 19 (17.3) | 69 (62.7) |
| B6. They have standard procedures for communicating prescription information across shifts | 50 (45.5) | 35 (31.8) | 25 (22.7) |
| B14. The status of problematic prescriptions is well communicated across shifts | 18 (16.4) | 20 (18.2) | 72 (65.5) |
| ● Communication about mistakes (Cronbach’s α = 0.801, VIR = 1.987, and PRR = 40.91)* | |||
| B8. Staff in this pharmacy discuss mistakes | 41 (37.3) | 30 (27.3) | 39 (35.5) |
| B13. When patient safety issues occur, the staff will discuss them | 35 (31.8) | 22 (22.7) | 49 (45.5) |
| B15. They talk about ways to prevent mistakes from happening again in this pharmacy | 44 (40.0) | 20 (18.2) | 46 (41.8) |
| ● Responses to mistakes (Cronbach’s α = 0.804, VIR = 1.012 and PRR = 70.45)* | |||
| C1. Staff are treated fairly when they make mistakes | 20 (18.2) | 13 (11.8) | 77 (70.0) |
| C4. This pharmacy helps staff learn from their mistakes rather than punishing them | 12 (10.9) | 28 (25.5) | 70 (63.6) |
| C7. They look at staff actions and the way they do things to understand why mistakes happen in this pharmacy | 7 (6.4) | 10 (9.1) | 93 (84.5) |
| C8. Staff feel like their mistakes are not held against them | 15 (13.6) | (22.7%) | 70 (63.6) |
| ● Organizational learning–continuous improvement (Cronbach’s α = 0.871, VIR = 1.221, and PRR = 58.18)* | |||
| C2. When a mistake happens, they try to figure out what problems in the work process led to the mistake | 29 (26.4) | 10 (9.1) | 71 (64.5) |
| C5. When the same mistake keeps happening, they change the way they do things | 34 (30.9) | 23 (20.9) | 53 (48.2) |
| C10. Mistakes have led to positive changes in this pharmacy | 22 (20.0) | 20 (18.2) | 68 (61.8) |
| ● Overall perceptions of patient safety (Cronbach’s α = 0.901, VIR = 1.009 and, PRR= 69.69)* | |||
| C3. This pharmacy places more emphasis on patient safety than on sales | 8 (7.3) | 11 (10.0) | 91 (82.7) |
| C6. This pharmacy is good at preventing mistakes | 27 (24.5) | 23 (20.9) | 60 (54.6) |
| C9. The way they do things in this pharmacy reflects a strong focus on patient safety | 18 (16.4) | 13 (11.8) | 79 (71.8) |
| Overall mean level of PSC (Cronbach’s α = 0.828 and VIR = 1.393)* | 25 (22.73) | 20 (18.18) | 65 (59.09) |
*The Hosmer-Lemeshow model fitness statistic (P > 0.05) and the VIF of all variables is below 10 and tolerance (T) values are above 0.1, which indicates that the model is effective and the absence of multi-collinearity in the model
PRR Mean positive response rate, PSC Patient safety culture, A1-A10, B1-B16 and C1-C8 Correspond to AHRQ survey items, VIF Variance Inflation Factor
Fig. 1.
Percent-positive response rate on PSC among pharmacy professionals by dimensions at public hospitals, Bahir Dar, Ethiopia, 2024 (n = 110)
Number of events reported and patient safety grade
Among the pharmacy professionals, 21 (19.09%) reported patient safety events most of the time or always within the unit area. In contrast, more than half of those professionals, 63 (57.27%), never reported any patient safety events (supplementary Table 1). Furthermore, 34 (30.9%) pharmacy professionals reported one or more patient safety events in the past 12 months, whereas 76 (69.1%) never reported any event (Fig. 2).
Fig. 2.
Number of Events Reported in the past 12 Months by pharmacy professionals at public hospitals, Bahir Dar, Ethiopia, 2024 (n = 110)
Half of the pharmacy professionals, 55 (50.0%), rated the level of patient safety grade as fair or good, whereas 41 (37.3%) of them rated Very good or Excellent. However, 14 (12.7%) of the pharmacy professionals rated the patient safety grade as Poor (Fig. 3).
Fig. 3.
Overall patient safety culture grading among pharmacy professionals at public hospitals, Bahir Dar, Ethiopia, 2024 (n = 110)
Factors that are associated with patient safety culture
Logistic regression analysis was conducted involving both univariable and multivariable. This analysis aimed to assess the impact of participant sociodemographic factors and patient safety dimensions on the overall positive response rate regarding the PSC. In the multivariable analysis, it was found that five sociodemographic characteristics were significantly associated with the level of positive response rate on PSC. These characteristics included educational level, working year in the hospital, working year in the unit area, direct interaction with patients, and patient safety training. The association was statistically significant at P < 0.05. Furthermore, 45.45% of the patient safety dimensions were significantly associated with the level of positive response rate of PSC. These dimensions included staff training and skills, communication openness, communication about prescription across shifts, communication about mistakes, and physical space and environment. The association was also statistically significant at P < 0.05 (Table 3).
Table 3.
Association of sociodemographic characteristics and patient safety dimensions with the level of PSC among pharmacy professionals at public hospitals, Bahir dar, ethiopia, 2024 (n = 110)
| Variables | Categories | AOR (95%Cl) | P-value |
|---|---|---|---|
| Educational level | Pharmacy Technician | 1 | |
| Pharmacist | 1.2 (0.98–1.5) | 0.001** | |
| Working Year in the Hospital | Less than 1 | 1 | |
| 1–5 | 1.0 (0.8–1.4) | 0.06 | |
| 6–10 | 1.1 (0.88–1.48) | 0.01* | |
| Greater than 11 | 2.0 (1.4-3.0) | < 0.001** | |
| Working Year in the Unit Area | Less than 1 | 1 | |
| 1–5 | 1.2 (0.95–1.6) | 0.06 | |
| 6–10 | 2.5 (1.6–3.8) | 0.02* | |
| Greater than 11 | 2.8 (1.8–4.2) | 0.001** | |
| Direct Interaction with Patients | No | 1 | |
| Yes | 3.02 (2.6-5) | < 0.001** | |
| Patient safety training | No | 1 | |
| Yes | 1.8 (1.2–2.8) | < 0.001** | |
| Teamwork in the unit area | Positive response | 1.3 (0.87–1.76) | 0.09 |
| Negative response | 1 | ||
| Staff training and skills | Positive response | 1.5 (1.2-2.0) | < 0.001** |
| Negative response | 1 | ||
| Communication openness | Positive response | 2.5 (1.5–3.8) | 0.001** |
| Negative response | 1 | ||
| Communication about prescription across shifts | Positive response | 1.3 (0.95–1.85) | 0.02* |
| Negative response | 1 | ||
| Communication about mistakes | Positive response | 3.0 (2.2-4.0) | 0.001* |
| Negative response | 1 | ||
| Responses to the mistakes | Positive response | 1.4 (0.93–2.2) | 0.08 |
| Negative response | 1 | ||
| Physical space and environment | Positive response | 3.8 (2.53–5.4) | 0.001** |
| Negative response | 1 |
* statistically significant at p < 0.05
** Statistically significant at p 0.001
Discussion
This study is the first to use the PSOPSC to investigate patient safety culture within hospital pharmacy settings in Ethiopia. The comprehensive PSOPSC survey is specifically designed for hospital pharmacy settings, providing a suitable framework for assessing the patient safety climate from a hospital pharmacy perspective. The survey will allow pharmacies to evaluate their patient safety culture’s strengths and identify areas for improvement within their quality improvement initiatives, ultimately reducing the risk of medication-related harm to patients.
The overall average Patient Reported Result (PRR) for the 11 Patient Safety Culture (PSC) dimensions in this study was 59.09%, with a range of 40.91% to 70.61. This falls within the Agency for Healthcare Research and Quality (AHRQ) moderate positive response rate standard value of 69%−51% and is lower than other similar studies conducted in China and the USA (Table 4) [28, 29]. The overall average PRR for hospital pharmacy professionals in China across the 11 dimensions was 71.0%, with a range of 50.0–89% [28]. In the United States, the figure was 78.0%, ranging from 41 to 90% [29]. In the United States, patient counseling had the highest PRR (90.0%), followed by communication openness (87.0%). In contrast, in China, communication about prescription across shifts had the highest PRR (89.0%), followed by staff training and skills (88.0%). Conversely, in Bahir Dar city public hospitals, the dimension of teamwork in the unit area had the highest PRR (70.61%), followed by responses to mistakes (70.45%). Significant differences were observed between the remaining nine dimensions across each study area. This variation might be due to the differences in organizational behavior across countries, including administrative values, organizational commitments, and leadership styles [28, 29].
Table 4.
Comparison of the positive response rate of patient safety culture among pharmacy professionals in Bahir Dar City public hospitals with other similar studies, 2024 (n = 110)
| PSOPSC dimensions | USA | China | Bahir Dar City |
|---|---|---|---|
| Teamwork in the unit area | 79 | 86 | 70.61 |
| Physical space and environment | 72 | 69 | 58.5 |
| Staff training and skills | 79 | 88 | 59.09 |
| Communication openness | 87 | 64 | 48.47 |
| Patient counseling | 90 | 57 | 66.67 |
| Staffing, work pressure, and pace | 41 | 50 | 57.73 |
| Communication about prescription across shifts | 81 | 89 | 50.3 |
| Communication about mistakes | 79 | 62 | 40.91 |
| Responses to the mistakes | 79 | 65 | 70.45 |
| Organizational learning – continuous improvement | 83 | 84 | 58.18 |
| Overall perceptions of patient safety | 84 | 80 | 69.69 |
| Overall level of patient safety culture | 78 | 71 | 59.09 |
PSOPSC Pharmacy Survey on Patient Safety Culture, AHRQ Agency of Healthcare Research and Quality
In comparison to other studies conducted on community pharmacies or healthcare providers in different parts of Ethiopia, such as those in the South Wollo zone, Bahir Dar City, Addis Ababa city, Bale Zone, Dessie town, Jimma Zone, Amhara region, and Gondar city, this study’s overall average PRR is higher than the rates found in the South Wollo zone (50.1%) [17], Bahir Dar City (50.9%) [30], Addis Ababa city (48.8%) [15], Bale Zone (44.0%) [14], Dessie town (44.8%) [12], Jimma Zone (46.7%) [11], Amhara region (46.0%) [13], and Gondar city (45.3%) [16]. This variation may be due to the differences in the study setting, the number of hospitals included in the study method, and the duration of the study.
In this study, there was substantial variability in the percentage of positive response rates across the 11 dimensions. While all dimensions had more than 50% of positive response rates, two dimensions stood out as having lower rates: communication about mistakes (40.91%) and communication openness (48.47%). Among the 11 dimensions, communication about mistakes had the lowest PRR, whereas teamwork within a unit area had the highest PRR (70.61%). This finding is consistent with similar studies conducted in Bale Zone Hospitals (73.4%) [14] and the Amhara region (72.0%) [13], suggesting that pharmacy professionals are generally positive about supporting one another and working together as a team to improve patient safety. However, the rate in this study was lower than that reported in other similar studies, such as those conducted in China (86.0%) [28], the USA (79.0%) [29], and various parts of Ethiopia, including the Jimma Zone (82.0%) [11], Dessie town (74.14%) [12], Addis Ababa city (77.7%) [15], and Gondar city (75.0%) [16]. Despite this, there is a need to strengthen teamwork among pharmacy staff, as it is crucial for promoting a collaborative and supportive work environment [31, 32].
The dimensions with the most potential for improvement in this study area were communication about mistakes and communication openness, with positive response rates of 40.91% and 48.47%, respectively. This is consistent with findings from other similar studies conducted in the Jimma zone and the Amhara region [11, 13].
Pharmacy professionals rated patient safety grades as fair (22.5%), good (27.5%), very good (21.8%), and excellent (15.5%), while 12.7% rated them as poor. The proportion of very good or excellent ratings in this study (37.3%) was slightly higher than that in the study conducted in Jimma zone (34.0%) [11] and Addis Ababa (35.7%) [15]. However, it is slightly lower than in other similar studies conducted in the Bale Zone (38.3%) [14].
Promoting adverse event reporting among pharmacists is essential for identifying and addressing potential risks in patient care. Notably, less than half of the participants (30.9%) reported at least one event, whereas more than two-thirds of the participants (69.1%) did not report a single event over the past year. The distribution of reported events among participants was as follows: 12.1% reported 1 to 2 events, 10.8% reported 3 to 5 events, 3.6% reported 6 to 10 events, and 4.4% reported 11 or more events. This finding is consistent with a similar study conducted in the Jimma Zone, which reported a comparable rate of 31.0% [11]. However, it is higher than the rate reported in the Bale Zone, which was 12.6% [14]. This may be attributed to insufficient training in safety-related matters, disparities in capacity, and a lack of encouragement for reporting errors. Establishing a secure reporting environment, providing feedback on reported events, and maintaining confidentiality can contribute to higher reporting rates and facilitate the process of learning from mistakes to prevent similar occurrences in the future [11, 14].
The results of the multivariable logistic regression analysis indicate that educational level, working year in the hospital, working year in the unit area, and direct interaction with patients were factors associated with a positive level of patient safety culture. Pharmacy professionals with a bachelor’s degree (AOR = 1.2, 95%CI: 0.98–1.5, P < 0.001) showed a significant difference in the positive level of patient safety culture compared to those with a diploma. In terms of years of service in the hospital, pharmacy professionals with more than 11 years of service (AOR = 2.0, 95% CI: 1.4-3.0, P < 0.001) and those with 6–10 years of service (AOR = 1.1, 95%CI: 0.88–1.48, P = 0.01) had a significant difference in the positive level of patient safety culture compared to those with less than one year of service. Similarly, pharmacy professionals with more than 11 years of service in the unit area (AOR = 2.8, 95% CI: 1.8–4.2, P < 0.001) and those with 6–10 years of service (AOR = 2.5, 95% CI: 1.6–3.8, P = 0.02) had a significantly positive level of patient safety culture compared to those with less than one year of service in the unit area.
Those pharmacy professionals who had direct interaction with patients had a significantly higher level of patient safety culture (AOR = 3.02, 95% CI: 2.6-5.0, P < 0.001) compared with those who did not. Similarly, pharmacy professionals who received patient safety training also demonstrated a significantly higher level of patient safety culture (AOR = 1.8, 95% CI: 1.2–2.8, P < 0.001) compared with those who did not receive training. This indicates that factors such as educational level, working year in the hospital, working year in the unit area, direct interaction with patients, and patient safety training all have an impact on the level of positive patient safety culture among pharmacy professionals.
Of the 11 patient safety dimensions, five were significantly associated with a positive level of patient safety culture. These dimensions included staff training and skills, communication openness, communication about prescriptions across shifts, communication about mistakes, and physical space and environment. Pharmacy professionals who responded positively to these dimensions were more likely to have a positive patient safety culture compared with those who responded negatively. The adjusted odds ratios (AOR) for these dimensions were as follows: staff training and skills (AOR = 1.5, 95% CI: 1.2-2.0, P < 0.001), communication openness (AOR = 2.5, 95% CI: 1.5–3.8, P < 0.001), communication about prescriptions across shifts (AOR = 1.3, 95% CI: 0.95–1.85, P = 0.02), communication about mistakes (AOR = 3.0, 95% CI: 2.2-4.0, P < 0.001), and physical space and environment (AOR = 3.8, 95% CI: 2.53–5.4, P < 0.001). Improving these patient safety dimensions within the pharmacy department could enhance collaboration, information sharing, and ultimately improve patient safety culture [33, 34].
Strengths and limitations of the study
Strengths
This study’s findings may not be generalizable to private healthcare settings, health centers, and clinics due to its limited scope to public hospitals. Additionally, the study’s reliance on the PSOPSC to measure PSC in a hospital pharmacy setting is a novel approach, making it difficult to establish a baseline for comparison. Furthermore, the study’s focus on pharmacy professionals may not provide a comprehensive understanding of the safety culture, as the perspectives of other administrative bodies were not considered.
Limitations
This study’s findings may not be generalizable to private healthcare settings, health centers, and clinics due to its limited scope to public hospitals. Additionally, the study’s reliance on the PSOPSC to measure PSC in a hospital pharmacy setting is a novel approach, making it difficult to establish a baseline for comparison. Furthermore, the study’s focus on pharmacy professionals may not provide a comprehensive understanding of the safety culture, as the perspectives of other administrative bodies were not considered.
Conclusion
The results showed that the overall level of positive response rate for patient safety culture was moderate, according to the Agency for Health Research and Quality (AHRQ) recommended standards. The two dimensions, teamwork within a unit area and response to mistakes, had a high positive response rate. However, the other nine dimensions had a moderate positive response rate, with communication about mistakes and communication openness being the exceptions, as they had a low positive response rate according to standard values. Additionally, the trend of reporting adverse events and rating patient safety grade in the pharmacy settings of the hospital was also low. It was found that educational level, working year in the hospital, working year in the unit area, direct interaction with patients, and patient safety training, and the five patient safety dimensions, including staff training and skills, communication openness, communication about prescriptions across shifts, communication about mistakes, and physical space and environment had a significant association with the level of positive response rate on patient safety culture.
Recommendation
Encouraging open communication is crucial in hospital settings, particularly when it comes to the sharing of prescription information across shifts and discussing mistakes that occur. Regular feedback on performance is also essential for fostering a culture of transparency. By addressing these communication challenges, hospitals can promote a positive response rate for patient safety culture.
Patient safety is significantly enhanced when pharmacy professionals are encouraged to report adverse events. This allows for the identification and addressing of potential risks, ultimately leading to improved patient safety. A safe reporting environment, coupled with feedback on reported events and confidentiality, can increase reporting rates and facilitate learning from errors.
The selection of leaders or managers who prioritize patient safety sets the tone for a culture of safety within the pharmacy. By promoting a culture of continuous improvement, the attitudes and behaviors of pharmacy professionals toward patient safety culture can be positively influenced.
Supplementary Information
Supplementary Table 1: Reporting Patient Safety Events in unit/work area to patients’ safety culture.
Acknowledgements
The authors extend their deepest gratitude to the data collector and the study participants.
Abbreviations
- AHRQ
Agency for Health Research and Quality
- LMICs
Low and Middle Income Countries
- PRR
Positive Response Rate
- PSC
Patient Safety Culture
- PSOPSC
Pharmacy Survey on Patient Safety Culture
Authors’ contributions
All authors made a significant contribution to the work reported. BAM: conceptualisation, data curation, formal analysis, preparation of the original draft and revision and approval of its submission. SG, and ST, DD: conceptualisation, data collection, data curation, formal analysis and validation. BAM and DD: review and editing. All authors have agreed on the journal to which the article will be submitted and have given their final approval for publication.
Funding
This study did not receive any specific project funding.
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
Ethical approval was obtained from the Ethical Review Board of Bahir Dar University, College of Medicine and Health Science, School of Pharmacy (Ref.No. cmhs2879/20/15). Oral informed consent was obtained from the study participants before data collection, and to ensure the privacy of the participants, the study was strictly anonymous. This research was conducted in accordance with the national regulations and institutional policies on ethics and with the tenets of the Helsinki Declaration.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Authors’
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplementary Table 1: Reporting Patient Safety Events in unit/work area to patients’ safety culture.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.