Patient Safety in Blood Transfusion Laboratories;

Beyond Punitive Environment

Tg. Mohamad Iskandar Tg. Mohamad Rosman1, Fairuz Nadiah Nordin1*, Noraziani Khamis1, Muhammad Nur Amir Abdul Rassip1, Sunita S. Shanmugam1,
Nor Hanizah Abdul Gapal1, Idaleswati Nor Mohamed2, Nang Pah Nik Ibrahim2, Noryati Abu Amin2
1Institutefor Health Management, National Institutes of Health (NIH), Ministry of Health Malaysia
2 National Blood Centre, Ministry of Health Malaysia

*Corresponding author: Fairuz Nadiah Nordin [nadiah.ndn@moh.gov.my] Institute for Health Management, National Institutes of Health, Block B1 Jalan Setia Murni, U13/52, Setia Alam, 40170, Shah Alam, Selangor

Introduction Materials and Methods

Patient safety culture (PSC) is the beliefs, values and norms shared by Study design; Instrument;
healthcare practitioners in an organization influencing their actions and ü Cross-sectional ü Self administered, online
behaviors towards patient safety1. Practicing patient safety culture is Data collection; ü Hospital Survey on Patients Safety
fundamental for Medical Laboratory Technologist (MLTs) even they do not ü October until November 2020 Culture questionnaire1 with
interact directly with patients. Ensuring safe transfusion of blood and blood Sampling; comment box
products is the 6th Goal of the Malaysian Patient Safety Goals. In 2018, 47 ü Average positive response were
ü Universal sampling
cases of actual transfusion error and 407 near miss were reported in average of the item-level percent
Malaysia2. There is a lack of study on MLTs when evaluating the culture of Criteria; positive response within a patient
patient safety. Poor safety culture put patients at risk of adverse transfusion ü Inclusion: MLTs involved in safety composite, represented as
reactions and infection transmitted infections. transfusion medicine in their daily positive reaction towards PSC
works and on-call ü Areas of strength = composites
Objectives ü Exclusion: MLTs working in Pusat with 75% or more respondents
Darah Negara (PDN) and involving answered positively
ü To assess patient safety culture among MLTs working in transfusion in blood mobile team only ü Areas needing improvement =
medicine services in Ministry of Health (MOH) hospitals composites with 50% or fewer
ü To determine the relationship between patient safety composites and the respondents did not answer
overall perception of patient safety positively, or respondents
ü To determine the predictors of the overall perception of patient safety answered negatively

Results
How did they rate their workplace How did they score on patient safety culture? What are their concerns?
safety culture? Organizational learning 83.7% Actions towards error reporting 4.7%
Supervisor expectations 80.7% Teamwork issues 4.7%
Acceptable
23% Teamwork within units 77.9% Blame culture 6.3%

Poor Feedback and communication 76.2% Need improvements to work procedures 9.4%
1%
Management support 71.0% Increased workload 12.5%
Teamwork across hospital units 66.0% Wrong work procedure, not following SOP 12.5%
Frequency of events reported 63.7% Infrastructure issues 20.3%
Very good
59% Excellent Overall perceptions of patient
59.6%
17% safety Staffing issues and inadequate staff 29.7%
Communication openness 56.4%
Figure 1: Respondents’ values on overall Figure 3: Themes arise from open-ended comments
patient safety grade of workplace or unit Staffing 29.2% (subthemes=64)
(n=445)
Nonpunitive response to error 24.0%

Legend: Areas of strength Areas needing improvement

Table 1: Correlation among patient safety
composites and overall perception of patient Table 2: Regression analysis between overall perception of patient
safety Figure 2: Respondents’ average positive response on patient safety
safety and composites
composites (n=454)
Overall Overall perceptions of patient safety
perception Variables
Patient safety composites B CI (95%) P-value
of patient
• There were 454 respondents Organizational learning 0.231 0.118, 0.359 <0.001*
safety
**
Organizational learning 0.341 • 76% from 445 respondents rate their workplace as Supervisor/manager expectation 0.283 0.118, 0.262 <0.001*

0.428
** excellent and very good on value of overall patient Teamwork within units -0.159 -0.169, -0.029 0.006*
Supervisor/manager expectation
** safety culture (Figure1)
Teamwork within units 0.145 Feedback and communication 0.129 0.007, 0.206 0.036*
**
• “Non-punitive response” and “Staffing” were the
Feedback and communication 0.303 areas needing improvement (Figure 2) Management support 0.114 -0.001, 0.188 0.053
**
Management support 0.279 • “Staffing” were highlighted as a main concern from Teamwork across hospital units -0.009 -0.083, 0.072 0.882
0.237
** open ended comments (Figure 3) Frequency of events reported -0.026 -0.065, 0.037 0.578
Teamwork across hospital units
* • Overall perception of patient safety were significantly Communication openness
Frequency of events reported 0.102 -0.079 -0.140, 0.024 0.165
correlated with all other composites except for
**
Communication openness 0.220 “Staffing” (Table 1) Staffing 0.081 -0.007, 0.188 0.079

Staffing 0.070 • Regression highlighted significant associations Nonpunitive response to error 0.095 0.006, 0.147 0.035*
0.160
** between overall perception of patient safety and Multiple linear regression, R2 = 0.239 𝛽0 = 6.534
Non-punitive response to error
composites from areas of strength and areas needing Model = “Enter” method in SPSS Statistics, B – standardized regression coefficient,
Pearson’s correlation
improvement except for “Staffing” (Table 2) *p<0.05
Note: **– significant at p<0.01 (2-tailed);
* – significant at p<0.05 (2-tailed)

Discussion Conclusion
ü “Staffing” and staff inadequacies were revealed as major issues based ü Patient safety culture must be integrated and
on our findings. Staffing in the healthcare sector is in short-supply, strengthened within patient care, including MLTs in
especially in many developing countries3. However, additional workforce
does not necessarily improve MLTs overall perception of patient safety laboratories
ü “Non-punitive response to error” was another major concern among ü Organizations need to embrace non-punitive actions
MLTs in this study, as reported in other local studies4-5. This may affect towards errors in order to improve staff’s perception to
voluntary error reporting, which may increase the risk of error incidence
patient safety. This will positively influence the safety of
ü Adopting a non-punitive culture within an organization may potentially
improve perception of patient safety among MLTs where error is being
patients
used as opportunity to learn and improve

Acknowledgement References
1
We wish to thank the Director General of Health for given us permission to present this poster. We would Sorra et al. AHRQ Hospital Survey on Patient Safety Culture: User’s Guide, 2018
2
also like to express appreciation for all the support from all parties that have contributed directly or Patient Safety Unit, MOH. Malaysian Patient Safety Goals, Annual Report 2018. Technical Report, MOH, 2019.
3
indirectly in this study. Hamaideh SH. Mental health nurses/ perceptions of patient safety culture in psychiatric settings. Int Nurs Rev 2017
4
Nabilah H, et al. Do we communicate openly in healthcare delivery? International Journal of Current Research and Academic Review 2014.
5
RESEARCH POSTER PRESENTATION DESIGN © 2019
Mohd Idris, et al. A Study on Patient Safety Culture in Ministry of Health Hospitals. IHM, 2014.
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