Safety Culture of Healthcare Settings: Exploring Impact of Cognitive, Behavioral, and Contextual Determinants

Abstract

Research and practice in occupational safety have traditionally been dominated by technical, engineering, and human factor approaches. It is not possible to measure safety culture directly as it emerges from deep-seated organizational and individual beliefs. Safety culture characteristics can be reviewed indirectly by combining both quantitative assessment and qualitative assessment of an organizational safety culture. In current research the influence on occupational safety culture has been examined from a psychological perspective, considering the factors at individual and organizational levels that have a significant impact on employee safety performance in a healthcare setting. The healthcare industry has been categorized as a high hazard industry because of both potential risk of morbidity and mortality. The safety culture of healthcare has significant influence of contextual and cognitive determinants, which help in carrying out safe work practices. Three independent studies were conducted to achieve the research objectives. Study I aimed at the preparation of instruments. This study was further carried out into three phases. Phase 1 was the adaptation of Safety Culture Related Cognitive Factor Questionnaire. The questionnaire was initially used in an oil refinery therefore, it was adapted to measure the health belief constructs that are perceived susceptibility, perceived severity, perceived barriers, perceived benefits, and queues to actions in the healthcare settings. Phase 2 was the development of Hospital Hazards Identification Checklist. The checklist was developed by identifying the domain through deductive approach. The relevant literature review suggested scarcity of tools on workplace hazards. The items of the checklist were generated through an inductive approach; focus group discussions were carried out with healthcare workers. Focused group discussions xxiv provided insight from the perspective of Pakistani healthcare workers. The barriers and challenges that were faced by healthcare workers during safety performance were identified. Thematic analysis was carried out to create a framework of occupational hazards faced by healthcare workers in Pakistani context generating broader categories such as physical hazards, biological hazards, chemical hazards, and psychosocial hazards. The emerged themes were then utilized to develop item pool for Hospital Hazards Identification Checklist (HHIC). The content validity of the items was established through content validity index and content validity ratio. Phase 2 also dealt with Exploratory Factor Analysis (EFA) (N=213) of the developed checklist which resulted in a uni-factor model of (HHIC). The construct validity of HHIC was also established through Confirmatory Factor Analysis (CFA) on an independent sample (N=556). Phase 3 dealt with pilot testing of instruments (N=213) in which the descriptive properties and preliminary relationship trends of the study variables were explored. It was concluded from the findings that all the study instruments are reliable and valid. Study II comprised of the main study, and it was aiming at testing numerous theory-based hypotheses and to explore the interactive relationships between cognitive determinants of behavior (perceived susceptibility, perceived severity, perceived barriers, perceived benefits and cues to actions) contextual factors (teamwork climate, safety climate, job satisfaction, stress recognition, perception of management, and working conditions) and safety performance among healthcare professionals. It was found that perceived susceptibility was a significant mediator in relationship between contextual determinants (teamwork climate, safety climate, job satisfaction, perception of management and working conditions) and safety performance. Perceived severity also mediated the relationship xxv between contextual determinants (teamwork climate, safety climate, job satisfaction, stress recognition, and perception of management) and safety performance. Perceived benefits were also significantly mediating the relationship between contextual factors (teamwork climate, safety climate, job satisfaction, stress recognition, perception of management, and working conditions) and safety performance. Further, hospital hazards are significantly positively moderating the relationship between perceived severity and safety performance. Hospital hazards exacerbated the strength of relationship between perceived benefits and safety performance. Hospital hazards also positively moderated perceived barriers and safety performance whereas hospital hazards diminished the strength of relationship between perceived susceptibility and safety performance. Hospital hazards are significantly negatively moderating the relationship between contextual determinants (teamwork climate, safety climate, job satisfaction, stress recognition, perception of management, and working conditions) and safety performance. Path analysis was carried out in AMOS v.21 to see the significant direct and indirect effects on various paths. Study III was carried out when WHO declared the outbreak of a COVID-19 to be a Public Health Emergency of International Concern. The study had explored the changing pattern across Time 1 (T1) and Time 2 (T2) in safety performance that was use of personal protective equipment and safety compliance pre and post COVID-19. The findings showed that health beliefs got firm in T2 as in comparison to T1. Safety performance and compliance with universal safety precautions increased in T2 as in comparison to T1. It can be summed from the findings of the research that developing countries, in particular, have numerous challenges to improve health and safety, which could be mitigated by knowing how health and safety systems function.