Avaliação da cultura de segurança do paciente em hospitais brasileiros: um estudo transversal e nacional

Abstract

Introduction: The National Patient Safety Program (PNSP), considered a milestone for the development of actions aimed at patient safety, was created to perform the relevant role of regulating issues related to the quality and safety of health services in Brazil, implementing simple and effective strategies, preventing and reducing adverse events related to assistance in health services. Among the strategies linked to the PNSP, the Integrated Plan emerged to improve the quality of health services, apply good patient safety practices and evaluate care risk management, promoting a safety culture. Recently, the Integrated Plan has encouraged the use of a new tool to assess patient safety culture in Brazilian hospitals: the Hospital Safety Culture E-Questionnaire. Objective: To analyze the results of the patient safety culture in Brazilian hospitals based on the evaluations carried out with the E-questionnaire software in 2021s’. Method: This is a descriptive study, based on the analysis of secondary data available in the database of E-questionnaire data. Hospitals with Intensive Care Unit beds that had a response rate >70% were included, with assessments starting between January 1st and December 31st, 2021. The questionnaire used as a data collection instrument by the participating hospitals is a Brazilian version, translated and validated from the Hospital Survey on Patient Safety Culture, which also has a section with good practice indicators. As variables, 42 questions were used that make up the 12 dimensions/indicators composed of safety culture present in the questionnaire. In addition, two outcome indicators were included: “reported adverse events” and “classification of patient safety in the service”. Results: Altogether, assessments from 156 hospitals were included and considered in this study. Regarding sent questionnaires, the response rate was 89.0% (n=22,539). The groups of professionals that stood out with participation were the nursing technicians/assistants (36.0%) and nurses (21.1%). The dimensions that stood out positively were: Organizational learning/continuous improvement (86.8%), Supervisor/manager expectations and actions promoting patient safety (80.9%) and Teamwork in the unit/service (75.3%). One dimension was highlighted with a low percentage of positive responses: non-punitive response to errors (34.2%). Overall, 82.9% of respondents rate the level of patient safety as “excellent” or “good”. Conclusions: This is the largest study to assess the level of patient safety culture in Brazilian hospitals. From it, it was possible to identify strengths and weaknesses that can and should serve as material to guide new actions in the following years aiming at continuous improvement. It is important to implement improvement cycles to effectively increase the level of safety culture in the service. It is recommended that services disseminate the results of both the national assessment and the hospital assessment with their collaborators. By linking this and other actions, employees can feel more motivated to strive to improve the indicators that were identified as having the greatest weaknesses.