Patient Safety Culture in Tunisia: Defining Challenges and Opportunities

Abstract

Background: Although adverse events in health care have been a center of attention recently, patient safety culture in primary care is relatively neglected. This study aimed to provide a baseline assessment of patient safety culture in the primary healthcare centers and explore its associated factors. Methods: This is a multicenter cross-sectional descriptive study. It was conducted in the center of Tunisia over a period of 4 months. It surveyed 30 primary healthcare centers, thus 251 staff members. It used the French-validated version of the Hospital Survey on Patient Safety Culture questionnaire. Results: The total number of respondents was 214 participants with a response rate of 85%. The dimension of "teamwork within units" had the highest score (71.47%). Though, three safety dimensions had very low scores, which are "frequency of event reporting," "on-punitive response to errors," and "staffing" with the following percentages 31.43, 35.36, and 38.43%, respectively. As for associated factors, the dimension of "Frequency of reported events" was significantly higher among professionals involved in risk management committees (p = 0.01). Conclusion: This study demonstrated that the level of the patient safety culture needs to be improved in primary healthcare centers in Tunisia. As well, the results obtained highlight the necessity of the implementation of quality management system in primary healthcare centers.

The Perception of Patient Safety Culture among Physicians at an Academic Tunisian Hospital

“…However, our results were comparable to those reported in the Belgian and French studies where the score for this dimension was less developed with 70% and 72.9% respectively [25,30]. For Tunisian studies, our score was better than that found in the study of Bouafia et al (63.3%) [12] and Ben Rejab et al [13] and similar to that found in the study of Mallouli et al [14], but this does not mean that this dimension is well developed, it still requires a major challenge to overcome.…”

“…In total with 9 dimensions out of 10 to be improved according to our results and according to other recent studies carried out in our country [13,14], patient safety seems to be an axis of work to be developed in the Tunisian health system in general.…”

“…It was considered a dimension to be improved since it had a score between 50% and 75%. Although this score is higher than other national and international studies [12][13][14]24,[26][27][28], this dimension requires more interest. Communication within and across hospital units is essential in an environment of care, especially as the patient is usually treated by several health professionals from different specialties [31].…”

“…The public hospitals are relatively well distributed geographically in terms of physical facilities but remains facing challenges in terms of quality, access and performance [11]. Some studies were conducted to assess safety culture in Tunisian hospitals [12][13][14]. However, more studies are needed in this field and collaborative efforts must be combined to promote safety culture.…”

“…This dimension had the lowest scores in several developing countries such as Saudi Arabia [28], Lebanon [27], Pure [33], Egypt [34] and turkey [29] with 22%, 24.3%, 30%, 32% and 32% respectively. It was also undeveloped at the national level [13,14]. Indeed, the declaration of the error, which is essential to achieve a culture of learning, can only occur in a non-punitive environment where adverse events may be reported without people being blamed.…”