Research Article
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KLİNİK YÖNETİŞİM İKLİMİNİN HASTA GÜVENLİĞİ KÜLTÜRÜ İLE İLİŞKİSİNİN YAPISAL EŞİTLİK MODELLEMESİYLE İNCELENMESİ

Year 2022, Volume: 7 Issue: 3, 444 - 460, 20.10.2022
https://doi.org/10.35232/estudamhsd.1074600

Abstract

Bu araştırmanın amacı, farklı statülerdeki hastanelerde klinik yönetişim ikliminin hasta güvenliği kültürü ile ilişkisinin incelenmesidir. Kesitsel nitelikteki bu araştırma; Haziran 2020-Nisan 2021 tarihleri arasında İstanbul’da farklı statüdeki 9 hastanede görev yapan, çok aşamalı örnekleme yöntemiyle seçilen ve araştırmaya katılmaya gönüllü olan, 2.055 hekim ve hemşire ile gerçekleştirilmiştir. Araştırma verileri, kişisel bilgi formu, klinik yönetişim iklim ölçeği ve hasta güvenliği kültürü ölçeği kullanılarak toplanmıştır. Toplanan veriler, Yapısal Eşitlik Modeli (YEM) ile değerlendirilmiş, verilerin analizinde SPSS 24,0 ve AMOS 24,0 programları kullanılmıştır. Ölçüm modelinin doğrulayıcı faktör analizi sonucu, standart faktör yüklerinin 0,516-0,90 aralığında olduğu, 6 alt boyuttan oluşan klinik yönetişim iklimi ve 12 alt boyuttan oluşan hasta güvenliği kültürü ölçeklerinin boyut yapısının korunduğu tespit edilmiştir. YEM analizi sonuçlarına göre; klinik yönetişim ikliminin hasta güvenliği kültürüne etkisinin (β=0,690; p<0,05) pozitif yönde ve istatistiksel olarak anlamlı olduğu ayrıca, klinik yönetişim iklimi (KYİ) değişkeninin, hasta güvenliği kültürü (HGK) değişkenini %39,8 oranında açıkladığı (R2=0,398) belirlenmiştir. Hastanelerde klinik yönetişim iklimi değişkenleri ile hasta güvenliği kültürü değişkenleri arasında pozitif yönde önemli ilişki olduğu, hasta güvenliği kültürünün gelişmesi için klinik yönetişimin güçlendirilmesinin önemli olduğu anlaşılmaktadır. Bu çalışmada elde edilen bulguların, sağlık politikacılarına strateji oluşturmada yol gösterebileceği ayrıca sağlık hizmetlerinin daha kaliteli ve güvenli sunulmasına katkı sağlayacağı düşünülmektedir.

Thanks

Çalışmanın gerçekleştirildiği hastane yönetici ve çalışanlarına katkılarından dolayı teşekkür ederim. Ayrıca, İstanbul İl Sağlık Müdürlüğü yöneticilerine teşekkür ederim.

References

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  • Haxby E, Hunter D, Jaggar S. Clinical governance and patient safety. In:Hammond S. An Introduction to Clinical Governance and Patient Safety. 1st edition. Oxford University Press; New York 2010, pp 1-9.
  • Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Health Care. [Internet]. 2003 [cited 2020 Aug 16];12(2):17-23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765782/
  • Gunawan D, Hariyati TS. The implementation of patient safety culture in nursing practice. Enfermería Clínica. 2019; 29(S2):139-145. doi:10.1016/j.enfcli.2019.05.007.
  • Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000.
  • Sağlık Hizmetleri Genel Müdürlüğü Sağlıkta Verimlilik, Kalite ve Akreditasyon Dairesi Başkanlığı, Güvenlik Raporlama Sistemi 2017 Türkiye İstatistikleri Raporu. Sağlık Bakanlığı, Ankara, 2018. ISBN: 978-975-590-695-9.
  • Gürdoğan EP. Bir Üniversite Hastanesinde Hemşirelerin Klinik Yönetişim İklim Düzeyinin İş Doyumuna Etkisi, [Doktora Tezi], İstanbul: Marmara Üniversitesi, Sağlık Bilimleri Enstitüsü; 2012.
  • Sarchielli G. et al. Is medical perspective on clinical governance practices associated with clinical units performance and mortality?. A cross-sectional study through a record-linkage procedure. SAGE Open Medicine. 2016;4:1–12. doi:10.1177/2050312116660115.
  • Marin GA, Ruiz FR. Clinical governance and patient safety culture in clinical laboratoriesin the Spanish National Health System. Revista de Calidad Asistencial. 2017;32(6):303-315. doi:10.1016/j.cali.2017.07.003.
  • Halton K, Hall L, Gardner A, MacBeth D, Mitchell BG. Exploring the context for effective clinical governance in infection control. American Journal of Infection Control. 2017;45(3): 278-283. doi:10.1016/j.ajic.2016.10.022.
  • Karassavidou E, Glaveli N, Zafiropoulos K. Assessing hospital's readiness for clinical governance quality initiatives through organizational climate. Journal of Health Organization and Management. 2011;25(2):214-40. doi:10.1108/14777261111134437.
  • Dreliozi A, Siskou O, Maniadakis N, Prezerakos P. Clinical Governance and Effective Quality&Risk Management in Greek Hospitals. International Journal of Health Research and Innovation [Internet]. 2013 [cited 2021 Sep 6];1(3):7-17. Available from: http://www.scienpress.com/Upload/IJHRI/Vol%201_3_2.pdf
  • Kline RB. Principles and Practice of Structural Equation Modeling. 2nd ed. New York: Guilford Press; 2005.
  • Jackson DL. Revisiting sample size and number of parameter estimates: Some support for the N:q hypothesis. Structural Equation Modeling. A Multidisciplinary Journal. 2003;10(1):128–141. https://doi.org/10.1207/S15328007SEM1001_6.
  • Freeman T. Measuring progress in clinical governance: assessing the reliability and validity of the Clinical Governance Climate Questionnaire.  Health Services Management Research, Health Services Management Centre. [Internet]. 2003 [cited 2021 Feb 02];16(4):234-250. Available from: https://pubmed.ncbi.nlm.nih.gov/14613621/
  • Sorra JS, Nieva VF. Hospital survey on patient safety culture. Rockville. [Internet]. 2004 [cited 2021 Jun 30];MD:AHRQ Publ. No.04-0041. Available from: https://proqualis.net/sites/proqualis.net/files/User%20guide%20HSOPSC.pdf
  • Filiz E. Hastanede hasta güvenliği kültürü algılamasının ve sağlık çalışanları ile toplumun hasta güvenliği hakkındaki tutumunun belirlenmesi [Yüksek Lisans Tezi ], Konya: Selçuk Üniversitesi, Sağlık Bilimleri Enstitüsü;2009.
  • Chandraharan E. Arulkumaran S. Clinical Governance. Obstetrics Gynaecology& Reproductive Medicine. [Internet]. 2007 [cited 2022 Jan 16];17(7):222–224. Available from: https://www.researchgate.net/publication/257692469_Clinical_governance
  • AHRQ, Hospital Survey on Patient Safety Culture:2018 User Database Report. Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 [Internet]. 2018 [cited 2021 Jun 23]:1-146. Available from:https://www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/2018hospitalsopsappendixes.pdf
  • Davvetas V, Diamantopoulos A, Zaefariana G, Sichtmann C. Ten basic questions about structural equations modeling you should know the answers to–But perhaps you don't. Industrial Marketing Management, 2020;90:252-263. doi:10.1016/j.indmarman.2020.07.016.
  • Novikova SI, Richman DM, Supekar K, Barnard Brak L, Hall D. NDAR: A Model Federal System for Secondary Analysis in Developmental Disabilities Research. 2013;45:123-153. https://doi.org/10.1016/B978-0-12-407760-7.00003-7.
  • Alkış N. BAYES Yapısal Eşitlik Modellemesi: Kavramlar ve Genel Bakış. Gazi İktisat ve İşletme Dergisi [Internet]. 2016 [cited 2022 Jan 30];2(3):105‐116. Available from: https://dergipark.org.tr/tr/download/article-file/222932
  • Byrne BM. Structural Equation Modelling with AMOS; Basic Concepts, Applications and Programming. 2nd. ed., New York-London: Routledge Taylor&Francis Group; 2010.
  • Phakiti A, De Costa P, Plonsky L, Starfield S. The Palgrave handbook of applied linguistics research methodology. 1st ed. Sydney: Palgrave; 2018.
  • Schumacker RE, Lomax RG. A Beginner's Guide to Structural Equation Modelling. 3rd. ed., New York-London:Taylor & Francis Group; 2010.
  • Bayram N. Yapısal Eşitlik Modellemesine Giriş Amos Uygulamaları. İstanbul, Ezgi Yayınevi; 2013.
  • Raykov T. Estimation of composite reliability for congeneric measures. SAGE Publications, Applied Psychological Measurement. 1997;21(2):173–184. doi:10.1177/01466216970212006.
  • Fornell C, Larcker DF. Evaluating Structural Equation Models with Unobservable Variables and Measurement Error [Internet].1981[cited 2021 Oct 1];18(1):39-50. Available from:https://www.jstor.org/stable/3151312
  • Hayran O. Sağlık için Yönetişim ve Klinik Yönetişim. SD Dergi. [Internet]. 2012 [cited 2022 Jan 30] Available from: http://www.sdplatform.com/Yazilar/Kose-Yazilari/485/Saglik-icin-yonetisim-ve-klinik-yonetisim.aspx
  • Lale BM. Hemşirelerin Çalışma Ortamına İlişkin Algıları ve Klinik yönetişim İklimi Düzeyleri [Yüksek Lisans Tezi], İstanbul: Marmara Üniversitesi Sağlık Bilimleri Enstitüsü;2019.
  • Neal A, Griffin MA, Hart PM. The impact of organizational climate on safety climate and individual behavior. Safety Science [Internet]. 2000 [cited 2021 Jun 12];4(1-3):99-109. Available from:https://www.sciencedirect.com/science/article/abs/pii/S0925753500000084
  • Taş Y, Akpınar AT, İşçi E. Kalite Yönetim Sistemi ile Hasta Güvenliği Kültürü İlişkisinin Belirlenmesine Yönelik Bir Araştırma: Üniversite Hastanesi. [Internet]. 2013[cited 2021 Aug 08]; Available from:https://www.researchgate.net/publication/270271279
  • Levine KJ, Carmody M, Silk KJ. The influnece of organizational culture, climate and commintment on speaking up about medical errors. Journal Nursing Managing. 2020;28(1):130-138. doi:10.1111/jonm.12906.
  • Brown A. Communication and leadership in healthcare quality governance finding from comparative case studies of eight public hospitals in Australia. Journal Health Organizational Managing. 2020;34(2):144-161. doi:10.1108/JHOM-07-2019-0194.

Examining the relationship of clinical governance climate and patient safety culture with structural equation modelling

Year 2022, Volume: 7 Issue: 3, 444 - 460, 20.10.2022
https://doi.org/10.35232/estudamhsd.1074600

Abstract

The purpose of this study is to evaluate the relationship between clinical governance climate and patient safety culture in hospitals with different statuses. This cross-sectional study is conducted with 2055 volunteer physicians and nurses, working in 9 different hospitals in Istanbul between June 2020 and April 2021. Subjects are chosen on a volunteer basis and multi-stage sampling method is used. Research data is collected via a questionnaire consisting of a clinical governance climate scale,  patient safety culture scale and demographics. Data is evaluated with the Structural Equation Model (SEM) and data is analyzed by using SPSS 24.0 and AMOS 24.0 programs. As a result of the confirmatory factor analysis of the measurement model, it is determined that the standard factor loads are in the range of 0.516-0.90 the dimensional structure of the clinical governance climate scales consisting of 6 sub-dimensions and the patient safety culture scales consisting of 12 sub-dimensions are preserved. According to the results of SEM analysis; the effect of clinical governance climate on patient safety culture (β=0.690; p<0.05) is positive and statistically significant. In addition, the clinical governance climate (CGC) variable is able to explain the patient safety culture (PSC) variable at a rate of 39.8% (R2=0.398).  There is a significant positive relationship between clinical governance climate variables and patient safety culture variables in hospitals and strengthening, clinical governance is important for the development of patient safety culture. Findings of this study may guide health politicians in strategy development  and contribute to better quality and safe delivery of health services.

References

  • Scally L, Donaldson J. Clinical governance and the drive for quality improvement in the new NHS in England. British Medical Journal. 1998;317(7150):61–65. doi:10.1136/bmj.317.7150.61.
  • Haxby E, Hunter D, Jaggar S. Clinical governance and patient safety. In:Hammond S. An Introduction to Clinical Governance and Patient Safety. 1st edition. Oxford University Press; New York 2010, pp 1-9.
  • Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Health Care. [Internet]. 2003 [cited 2020 Aug 16];12(2):17-23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765782/
  • Gunawan D, Hariyati TS. The implementation of patient safety culture in nursing practice. Enfermería Clínica. 2019; 29(S2):139-145. doi:10.1016/j.enfcli.2019.05.007.
  • Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000.
  • Sağlık Hizmetleri Genel Müdürlüğü Sağlıkta Verimlilik, Kalite ve Akreditasyon Dairesi Başkanlığı, Güvenlik Raporlama Sistemi 2017 Türkiye İstatistikleri Raporu. Sağlık Bakanlığı, Ankara, 2018. ISBN: 978-975-590-695-9.
  • Gürdoğan EP. Bir Üniversite Hastanesinde Hemşirelerin Klinik Yönetişim İklim Düzeyinin İş Doyumuna Etkisi, [Doktora Tezi], İstanbul: Marmara Üniversitesi, Sağlık Bilimleri Enstitüsü; 2012.
  • Sarchielli G. et al. Is medical perspective on clinical governance practices associated with clinical units performance and mortality?. A cross-sectional study through a record-linkage procedure. SAGE Open Medicine. 2016;4:1–12. doi:10.1177/2050312116660115.
  • Marin GA, Ruiz FR. Clinical governance and patient safety culture in clinical laboratoriesin the Spanish National Health System. Revista de Calidad Asistencial. 2017;32(6):303-315. doi:10.1016/j.cali.2017.07.003.
  • Halton K, Hall L, Gardner A, MacBeth D, Mitchell BG. Exploring the context for effective clinical governance in infection control. American Journal of Infection Control. 2017;45(3): 278-283. doi:10.1016/j.ajic.2016.10.022.
  • Karassavidou E, Glaveli N, Zafiropoulos K. Assessing hospital's readiness for clinical governance quality initiatives through organizational climate. Journal of Health Organization and Management. 2011;25(2):214-40. doi:10.1108/14777261111134437.
  • Dreliozi A, Siskou O, Maniadakis N, Prezerakos P. Clinical Governance and Effective Quality&Risk Management in Greek Hospitals. International Journal of Health Research and Innovation [Internet]. 2013 [cited 2021 Sep 6];1(3):7-17. Available from: http://www.scienpress.com/Upload/IJHRI/Vol%201_3_2.pdf
  • Kline RB. Principles and Practice of Structural Equation Modeling. 2nd ed. New York: Guilford Press; 2005.
  • Jackson DL. Revisiting sample size and number of parameter estimates: Some support for the N:q hypothesis. Structural Equation Modeling. A Multidisciplinary Journal. 2003;10(1):128–141. https://doi.org/10.1207/S15328007SEM1001_6.
  • Freeman T. Measuring progress in clinical governance: assessing the reliability and validity of the Clinical Governance Climate Questionnaire.  Health Services Management Research, Health Services Management Centre. [Internet]. 2003 [cited 2021 Feb 02];16(4):234-250. Available from: https://pubmed.ncbi.nlm.nih.gov/14613621/
  • Sorra JS, Nieva VF. Hospital survey on patient safety culture. Rockville. [Internet]. 2004 [cited 2021 Jun 30];MD:AHRQ Publ. No.04-0041. Available from: https://proqualis.net/sites/proqualis.net/files/User%20guide%20HSOPSC.pdf
  • Filiz E. Hastanede hasta güvenliği kültürü algılamasının ve sağlık çalışanları ile toplumun hasta güvenliği hakkındaki tutumunun belirlenmesi [Yüksek Lisans Tezi ], Konya: Selçuk Üniversitesi, Sağlık Bilimleri Enstitüsü;2009.
  • Chandraharan E. Arulkumaran S. Clinical Governance. Obstetrics Gynaecology& Reproductive Medicine. [Internet]. 2007 [cited 2022 Jan 16];17(7):222–224. Available from: https://www.researchgate.net/publication/257692469_Clinical_governance
  • AHRQ, Hospital Survey on Patient Safety Culture:2018 User Database Report. Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 [Internet]. 2018 [cited 2021 Jun 23]:1-146. Available from:https://www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/2018hospitalsopsappendixes.pdf
  • Davvetas V, Diamantopoulos A, Zaefariana G, Sichtmann C. Ten basic questions about structural equations modeling you should know the answers to–But perhaps you don't. Industrial Marketing Management, 2020;90:252-263. doi:10.1016/j.indmarman.2020.07.016.
  • Novikova SI, Richman DM, Supekar K, Barnard Brak L, Hall D. NDAR: A Model Federal System for Secondary Analysis in Developmental Disabilities Research. 2013;45:123-153. https://doi.org/10.1016/B978-0-12-407760-7.00003-7.
  • Alkış N. BAYES Yapısal Eşitlik Modellemesi: Kavramlar ve Genel Bakış. Gazi İktisat ve İşletme Dergisi [Internet]. 2016 [cited 2022 Jan 30];2(3):105‐116. Available from: https://dergipark.org.tr/tr/download/article-file/222932
  • Byrne BM. Structural Equation Modelling with AMOS; Basic Concepts, Applications and Programming. 2nd. ed., New York-London: Routledge Taylor&Francis Group; 2010.
  • Phakiti A, De Costa P, Plonsky L, Starfield S. The Palgrave handbook of applied linguistics research methodology. 1st ed. Sydney: Palgrave; 2018.
  • Schumacker RE, Lomax RG. A Beginner's Guide to Structural Equation Modelling. 3rd. ed., New York-London:Taylor & Francis Group; 2010.
  • Bayram N. Yapısal Eşitlik Modellemesine Giriş Amos Uygulamaları. İstanbul, Ezgi Yayınevi; 2013.
  • Raykov T. Estimation of composite reliability for congeneric measures. SAGE Publications, Applied Psychological Measurement. 1997;21(2):173–184. doi:10.1177/01466216970212006.
  • Fornell C, Larcker DF. Evaluating Structural Equation Models with Unobservable Variables and Measurement Error [Internet].1981[cited 2021 Oct 1];18(1):39-50. Available from:https://www.jstor.org/stable/3151312
  • Hayran O. Sağlık için Yönetişim ve Klinik Yönetişim. SD Dergi. [Internet]. 2012 [cited 2022 Jan 30] Available from: http://www.sdplatform.com/Yazilar/Kose-Yazilari/485/Saglik-icin-yonetisim-ve-klinik-yonetisim.aspx
  • Lale BM. Hemşirelerin Çalışma Ortamına İlişkin Algıları ve Klinik yönetişim İklimi Düzeyleri [Yüksek Lisans Tezi], İstanbul: Marmara Üniversitesi Sağlık Bilimleri Enstitüsü;2019.
  • Neal A, Griffin MA, Hart PM. The impact of organizational climate on safety climate and individual behavior. Safety Science [Internet]. 2000 [cited 2021 Jun 12];4(1-3):99-109. Available from:https://www.sciencedirect.com/science/article/abs/pii/S0925753500000084
  • Taş Y, Akpınar AT, İşçi E. Kalite Yönetim Sistemi ile Hasta Güvenliği Kültürü İlişkisinin Belirlenmesine Yönelik Bir Araştırma: Üniversite Hastanesi. [Internet]. 2013[cited 2021 Aug 08]; Available from:https://www.researchgate.net/publication/270271279
  • Levine KJ, Carmody M, Silk KJ. The influnece of organizational culture, climate and commintment on speaking up about medical errors. Journal Nursing Managing. 2020;28(1):130-138. doi:10.1111/jonm.12906.
  • Brown A. Communication and leadership in healthcare quality governance finding from comparative case studies of eight public hospitals in Australia. Journal Health Organizational Managing. 2020;34(2):144-161. doi:10.1108/JHOM-07-2019-0194.
There are 34 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Nuran Eraslan 0000-0003-4683-4302

Osman Hayran 0000-0002-9994-5033

Serhat Yüksel 0000-0002-9858-1266

Publication Date October 20, 2022
Submission Date February 16, 2022
Published in Issue Year 2022 Volume: 7 Issue: 3

Cite

Vancouver Eraslan N, Hayran O, Yüksel S. KLİNİK YÖNETİŞİM İKLİMİNİN HASTA GÜVENLİĞİ KÜLTÜRÜ İLE İLİŞKİSİNİN YAPISAL EŞİTLİK MODELLEMESİYLE İNCELENMESİ. ESTUDAM Public Health Journal. 2022;7(3):444-60.

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