Work Organization and Management as the Strongest Predictors of

Patient Safety Implementation at a Type D Hospital

Ade Ayu Siskantari

, I Gede Putu Darma Suyasa

1 b

, Ni Luh Adi Satriani

1 c

and Ni Putu Ayu J. Sastamidhyani

2 d

Master of Nursing Program, Faculty of Health, Institute of Technology and Health Bali, Indonesia

Bachelor of Nursing Program, Faculty of Health, Institute of Technology and Health Bali, Indonesia

Keywords: Hospital Management, Nursing Care, Patient Safety.

Abstract: Patient safety is a system that prioritize safe patient care. Implementing patient safety can generate solutions

to minimize risks and prevent injuries caused by patient care errors. This study aimed to analyze determinant

factors of patient safety at a type D hospital in Lombok, Indonesia by looking at nurse behavior. A cross-

sectional study was conducted in June 2022. A sample of 106 nurses from inpatient wards were selected to

be respondents. Ethical clearance was granted by ITEKES Bali Research Ethics Committee. Data were

collected using a valid and reliable questionnaire based on six patient safety criteria. Using SPSS 20.0, chi-

square analyses were conducted for bivariate analyses and continued with multiple logistic regression for

variables with a p-value of < 0.25. Bivariate analyses showed that the characteristics of nurses (age, gender,

education level, years of service, and training) and work environment did not affect nurse behavior towards

patient safety implementation. Logistic regression indicated that organization and management were the

strongest predictors of patient safety at the hospital (OR = 3.438, 95% CI = 1.53-7.75). Type D hospitals need

to develop organizational and managerial capacities to maintain and promote patient safety.

1 INTRODUCTION

Patient safety is fundamental to establish high quality

health care. A well-qualified hospital should meet six

standards, i.e., patient safety, effective, efficient, fair,

and timely services (Whitehead et al., 2010). It is

globally estimated that 64 million disabilities happen

annually due to unsafe hospital care. Unsafe care in

developing countries lead to 134 million adverse

events each year and 2.6 million deaths. In high-

income countries, it is estimated that about 1 in 10

patients is mistreated while receiving treatment at a

hospital (WHO, 2018).

A hospital, a place for modern health services, is

an organization with complexity of capital,

technology, work, profession, system, quality, and

risk. Patient safety incidents are relatively frequent in

hospital care (Whitehead et al., 2010).

Patient safety incidents in Indonesia from 2006 to

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2011 reached 877 incidents. Based on the Report of

the Indonesian Patient Safety Committee of Hospitals

from January 2010 to April 2011, the adverse events

were recorded. About 8.76% of them resulted in

death; 2.19% caused permanent injuries; 21.17% led

to severe injuries, and 19.71% caused minor injuries

(Harsul et al., 2020). The same report also mentions

that 11,558 patient accidents were found at hospitals

from 2015 to 2019. Patient safety has become a

community demand; hence, patient safety programs

needs to be done by healthcare providers (Lambogia

et al., 2016).

Based on a preliminary study, two to three adverse

events were found at the investigated hospital each

year from 2019 to 2020. The data from Nursing

Management Department show that nurses tend to

make mistakes in patient identification.

Improvement strategies for patient safety are

regulated by the Indonesian Ministry of Health

Siskantari, A., Suyasa, I., Satriani, N. and Sastamidhyani, N.

Work Organization and Management as the Strongest Predictors of Patient Safety Implementation at a Type D Hospital.

DOI: 10.5220/0011938500003576

In Proceedings of the 2nd Bali Biennial International Conference on Health Sciences (Bali BICHS 2022), pages 39-44

ISBN: 978-989-758-625-5

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

(Kemenkes RI, 2017) by giving six goals and seven

steps toward patient safety. These strategies help the

hospital plan and measure work performance. The

goals are focused on problematic areas in health care

by collecting suggestions from experts before

reaching agreed solutions. The six goals of hospital

patient safety are carried out by (1) identifying

patients correctly; (2) improving effective

communication; (3) improving the drug's safety; (4)

ensuring the correct surgical site, correct procedure,

correct patient surgery; (5) reducing the risk of

infection; and (6) reducing the risk of injury to

patients from falls.

Nurse behavior towards patient safety is

influenced by internal and external factors. Internal

factors are factors that come from within a person and

are innate characteristics. External factors are often

the dominant factors that influence one’s behavior

(Notoatmodjo, 2014). Nurses’ characteristics are

inherent aspects that can affect one’s learning process

and behavior. These characteristics include age,

gender, tenure, education level, and training (Robbins

& Judge, 2015). Other factors related to patient safety

are the nature of work, the physical environment, the

organizational, social, and management environment,

and the external environment (Hughes, 2014).

The work environment, i.e the hospital

environment, can determine the quality and safety of

services provided by nurses to patients. A previous

study found that a good working environment such as

adequate lighting and low noise in the work area

affects the implementation of patient safety (Agus,

2017). Attitude and behavior are the main reinforcing

factors in patient safety culture. In addition to these

factors, organizational behavior factors include

leadership, alertness, communication, teamwork,

stress, fatigue, satisfaction, team leadership, and

decision-making. According to Griffin (2016),

organization and management units are a group of

people aimed at providing quality and safe services

through various assets including professional

management, commitment and leadership,

organizational culture, and existing information

systems.

A hospital in Central Lombok, West Nusa

Tenggara, Indonesia became the focus of this study.

It has an important role for the community, especially

the people in Central Lombok, which live quite far

from the city. The hospital continues to strive to

improve the quality of hospital services by improving

patient safety and preventing healthcare incidents.

Having the recommended patient safety goals and

steps, this study seeks to examine determinant factors

associated with nurse behavior towards patient safety

at a type D hospital of Central Lombok, West Nusa

Tenggara, Indonesia.

2 METHODS

A quantitative study with a cross-sectional design was

carried out at a type D hospital in Central Lombok,

West Nusa Tenggara, Indonesia, from March to May

2022. The dependent variable was nurse behavior

towards patient safety at the hospital. The

independent variables were nurse characteristics (i.e

age, gender, education, tenure, and training), work

environment (i.e lighting and noise in the workplace),

and work organization and management (supervision,

organizational culture, and effective communication).

A sample of 106 nurses at a type D hospital were

selected through non-probability sampling. The

inclusion criteria for sample selection were that

nurses worked in an inpatient ward and had worked

for at least 3 months. The study instrument was a set

of valid and reliable questionnaires. The data were

collected using a self-completed questionnaire that

the respondents filled out. The data were then

examined using the chi-square test and logistic

regression.

3 RESULTS

Table 1: In-ward nurse behavior towards the implementation

of patient safety at a type D hospital based on six goals of

patient safety (n = 106).

Categor

Poo

47 44.3

Goo

59 55.7

Table 1 shows that most nurses (59 people, 55.7%)

have good behavior towards the implementation of

six patient safety goals.

Table 2: Nurse characteristics (n = 106).

Characteristics n %

≤ 27.24 years 58 54.7

> 27.24

ears 48 45.3

Gende

Male 39 36.8

Female 67 63.2

Education level

Diploma-3 50 47.2

loma-4 6 5.7

Nursing graduate school 50 47.2

Tenure

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≤ 1.77 years 66 62.3

> 1.77

ears 40 37.7

Training

Never ha

98 92.5

Ever ha

8 7.5

This study found that 58 (54.7%) nurses were

≤27.24 years old, and two-thirds of the participants

were female (67, 63.2%). The number of respondents

who had a Diploma-3 (47.2%) and nursing education

(47.2%) was equal. As many as 62.3% of nurses had

worked for ≤ 1.77 years. The majority or 98 (92.5%)

nurses never took any training on patient safety at the

hospital (Table 2).

Table 3: Workplace variable category (n = 106).

Cate

n %

h ris

57 53.8

Low risk 49 46.2

Table 3 shows that 57 (53.8%) nurses perceive their

workplace has a high-risk work environment with

poor lighting and high noise.

Table 4: Work organization and management category (n =

106).

Cate

n %

Poo

57 53.8

Goo

49 46.2

Table 4 shows that 57 nurses (53.8%) have poor

perceptions of work organization and management.

Table 5: Relationship between nurse characteristics and

nurse behavior towards the implementation of patient safety

at a type D hospital.

Independent

Variables

Nurse behavio

p OR

Poo

Goo

n % n %

≤27.24 years 28 59.6 30 50.8

0.484

1.42

5>27.24

ears 19 40.4 29 49.2

Gende

Male 19 40.4 20 33.9

0.624

1.32

3Female 28 59.6 39 66.1

Education

Diploma 3 21 44.7 29 49.2

0.516 -

loma 4 4 8.52 3.4

Nursing

graduate

school

22 46.8 28 47.5

Tenure status

Recent 33 70.2 33 55.9

0.192

1.85

7Lon

14 29.8 26 44.1

Trainin

Never ha

44 93.6 54 91.5

1.000

1.35

8Ever ha

3 6.4 5 8.5

Table 5 informs that the relationship between

nurse characteristics and nurse behavior towards the

implementation of six patient safety goals at the

hospital. This study found that there was no

significant relationship between age (OR= 0.48; p=

1.425) and gender (OR= 0.62; p= 1.323) with nurse

behavior.

In Diploma-3 education category, the number of

nurses who have good behavior (49.2%) is higher

than that of nurses who have poor behavior (44.7%).

This study found no significant relationship between

education level and nurse behavior towards the

implementation of patient safety.

Nurses with the average of tenure period of ≤1.77

years have poor behavior (70.2%); this number is

higher than nurses with poor behavior in the same

category (55.9%). This study indicated that there was

no significant relationship between tenure status and

nurse behavior (p = 1.857).

Untrained nurses mostly posed poor behavior

towards patient safety (93.6%). This study indicated

that there was no significant relationship between the

training experience and nurse behavior (p= 1.358).

Table 6: Relationship between workplace environment and

nurse behavior towards the implementation of patient safety

at a type D hospital.

Category

Nurse behavio

p OR

Poo

Goo

n%n %

Poo

33 70.2 24 40.7

0.005 3.438

Good 14 29.8 35 59.3

Table 7 showed relationships between organization

and management and nurse behavior in implementing

six targets of patient safety in type D hospitals. The

results of the study analysis indicated that

organization and management had a strong

relationship with nurse behavior in implementing six

Work Organization and Management as the Strongest Predictors of Patient Safety Implementation at a Type D Hospital

targets of patient safety in a type D hospital (OR=

3.438; p= 0.005).

4 DISCUSSIONS

The results of this study found that female nurses had

better behavior towards patient safety than male ones.

This study is in line with research conducted by

Pambudi et al. (2018) who found no significant

relationship between gender and nurse behavior

towards patient safety at the inpatient room of Panti

Waluya Hospital, Malang. A study by Nurhanifah et

al. (2021) also shows a similar result in the inpatient

ward of the Aceh Government Hospital, Indonesia. In

general, gender is used to distinguish an individual's

sexual identity. Some differences between men and

women are problem-solving skills, analytical skills,

competitive drive, motivation, social skills, and

learning abilities. Women are more likely to conform

to authority, while men are more aggressive and more

likely to have expectations of success. However, the

differences are slight between men and women

(Robbins & Judge, 2015). With no guarantee, men

will perform better than women, considering

obidence which is mostly posed by women (Prima et

al., 2020). Although nursing positions are occupied

by women, there is no significant difference in

productivity between men and women (Robbins &

Judge, 2015).

The results of this study showed that nurses with

a Diploma-3 education level had good behavior

towards patient safety. However, no significant

relationship was found between education level and

nurse behavior. Agus (2017) stated that education

levels are not associated with the implementation of

patient safety at hospitals. Contrastly, Nurhanifah et

al. (2021) and (Prima et al., 2020) concluded that

nurses’ education levels are associated with the

implementation of patient safety. This indicates that

education levels cannot always be associated with

nurse competence and job. Nurses, therefore, have to

develop intellectual, interpersonal, technical, and

moral abilities (Nursalam, 2014).

This study found that nurses who had shorter work

experience had poor behavior towards patient safety

goals. It further showed that there was no significant

relationship between work period and nurse behavior.

Longer tenure and work experience do not guarantee

that someone will take safe actions to avoid accidents.

Safety at work might be established once one is

familiar with their workplace. They have adapted to

their environment because they are very familiar with

the environment, and they become less careful.

Mulyatiningsih (2013) similarly stated that length of

work does not have a significant relationship with

nurse behavior towards patient safety. Different

results obtained by Agus (2017) show that tenure

affects the implementation of patient safety. A longer

working period might be a influencing factor of

patient safety, but it does not ensure one’s

productivity (Robbins & Judge, 2015).

Moreover, the results of this study showed that

there was no significant relationship between training

and nurse behavior towards patient safety.

Mulyatiningsih (2013) reports that training is

significantly not associated with the implementation

of patient safety. However, Agus (2017) mentioned

that training likely increases patient safety at dr.

Slamet General Hospital, Garut West Java. Training

is a short-term educational process that uses

systematic and organized procedures. It provides non-

managerial workers with technical knowledge and

skills for a specific purpose (Lee et al., 2018).

This study found that in risky work environment

category, nurses had poor behavior towards patient

safety. It demonstrated that there was no significant

relationship between the work environment and nurse

behavior. However, Mulyatiningsih (2013) argued

that work environment is positively associated with

nurse behavior towards patient safety. For example,

good lighting in the workplace is essential to improve

performance, convenience, and safety. Various

environmental factors in the operating room might

affect surgical performance including lighting. Thus,

improving the physical facilities likely has a

significant impact on employee and patient outcomes

(Dianat et al., 2013). A previous study by Nugrahanto

(2015) found that the physical workplace

environment affects patient safety incidents.

Increased work accidents occur due to inadequacy of

quick situational detection, eye staining, headaches,

and fatigue caused by a poor lighting system (Ghana

Health Service, 2010).

A good and low-risk working environment can

provide safe care, thus reducing errors and improving

patient safety (Flynn et al., 2012) in healthcare

services such as preparation and administration of

prescption to patients. Distractions and interruptions

must be minimized to establish a conducive working

environment which affect nurses’ concentration,

especially on safe drug administration (Hyde et al.,

2016).

Besides, nurses who thought that work

organization and management variables were poorly

performed posed poor behavior towards patient safety

goals. The results showed that there was a significant

relationship between work organization and

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

management and nurse behavior towards patient

safety. With that said, Agus (2017) confirmed that

training is associated with organization and

management of patient safety. Since patient safety is

a variable to measure and evaluate the quality of

nursing services, it is important to pay attention to

these two vairbales (Nursalam, 2014). According to

Potter & Perry (2017), several actions related to work

organization and management that may prevent

patient safety incidents are supervision and guidance

(i.e., socialization, training, and monitoring). Having

well-trained leadership capacities, nurses can

optimize their role in hospital management.

5 CONCLUSIONS

Based on the results of this study, it can be concluded

that nurse behavior towards patient safety at the

investigated hospital was in a good category (55.7%).

Nurse characteristics (i.e age, gender, education,

tenure, and training) and workplace environment

were not associated with nurse behavior towards

patient safety. Work organization and management

were instead associated with nurse behavior towards

the implementation of patient safety. The findings

suggest the importance of monitoring and evaluating

on how nurses and patients work together to achieve

safety goals.

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