Patient safety culture in Italian out-of-hours primary care service: a national cross-sectional survey study

Jacopo Demurtas; Pierpaolo Marchetti; Alberto Vaona; Nicola Veronese; Stefano Celotto; Ellen Catharina Deilkås; Dag Hofoss; Gunnar Tschudi Bondevik

doi:10.3399/bjgpopen20X101098

Patient safety culture in Italian out-of-hours primary care service: a national cross-sectional survey study

BJGP Open. 2020 Dec 15;4(5):bjgpopen20X101098. doi: 10.3399/bjgpopen20X101098. Print 2020 Dec.

Authors

Jacopo Demurtas^{1

2}, Pierpaolo Marchetti³, Alberto Vaona⁴, Nicola Veronese⁵, Stefano Celotto⁶, Ellen Catharina Deilkås⁷, Dag Hofoss⁸, Gunnar Tschudi Bondevik^{9

10}

Affiliations

¹ OOH Primary Care Service, Azienda USL Sud Est Toscana, Grosseto, Italy eritrox7@gmail.com.
² Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
³ Department of Diagnostics and Public Health, Verona University, Verona, Italy.
⁴ OOH Primary Care Service, Azienda ULSS 9 Scaligera, Verona, Italy.
⁵ Primary Care Department, Azienda ULSS 3 Serenissima, Venice, Italy.
⁶ Primary Care Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
⁷ Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
⁸ Department of Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway.
⁹ National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway.
¹⁰ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

Abstract

Background: Out-of-hours (OOH) services in Italy provide >10 million consultations every year. To the authors' knowledge, no data on patient safety culture (PSC) have been reported.

Aim: To assess PSC in the Italian OOH setting.

Design & setting: National cross-sectional survey using the Safety Attitudes Questionnaire - Ambulatory Version (SAQ-AV).

Method: The SAQ-AV was translated into Italian and distributed in a convenience sample of OOH doctors in 2015. Answers were collected anonymously by Qualtrics. Stata (version 14) was used to estimate Cronbach's alpha, perform exploratory and confirmatory factor analysis, correlate items to doctors' characteristics, and to do item descriptive analysis.

Results: Overall, 692 OOH doctors were contacted, with a 71% response rate. In the exploratory factor analysis (EFA), four factors were identified: Communication and Safety Climate (14 items); Perceptions of Management (eight items); Workload and Clinical Risk (six items); and Burnout Risk (four items).These four factors accounted for 68% of the total variance (Kaiser-Meyer-Olkin [KMO] statistic = 0.843). Cronbach's alpha ranged from 0.710-0.917. OOH doctors were often dissatisfied with their job; there is insufficient staff to provide optimal care and there is no training or supervision for new personnel and family medicine trainees. Service managers are perceived as distant, with particular issues concerning the communication between managers and OOH doctors. A large proportion of OOH doctors (56.8%) state that they do not receive adequate support.

Conclusion: These findings could be useful for informing policies on how to improve PSC in Italian OOH service.

Keywords: Healthcare quality improvement; Italy; patient safety; safety management; statistical factor analysis; surveys and questionnaires.