Libyan Journal of Medical Sciences

: 2020  |  Volume : 4  |  Issue : 4  |  Page : 179--183

Assessment of patient safety culture in benghazi children's hospital from the viewpoint of nursing staff

Ainas Salem Eltarhuni1, Hajir Omar Tawfeeq2, Jebril S El-Abidi3,  
1 Department of Health Services Administration, Faculty of Public Health, University of Benghazi, Benghazi, Libya
2 Dietician, Faculty of Public Health, University of Benghazi, Benghazi Children Hospital, Benghazi, Libya
3 Department of Paediatric, Faculty of Medicine, University of Benghazi, Benghazi, Libya

Correspondence Address:
Dr. Ainas Salem Eltarhuni
Eltarhuni, Department of Health Services Administration, Faculty of Public Health, University of Benghazi, Benghazi


Background: patient safety is a critical component of health-care quality, and it is considered as an important issue worldwide. This study aimed to assess patient safety culture (PSC) among nurses and to investigate the areas of deficiencies for improvement. Methods: A descriptive cross-sectional study was conducted on nurses working at Benghazi Children's Hospital. A self-administered questionnaire containing 12 dimensions was used to assess the Hospital Survey on PSC including patient safety grade and number of events reported. Results: Only 87 of the total 118 distributed questionnaires were returned, giving a response rate of 73.7%. The overall positive response rate of PSC was 47%. The dimension with the highest positive score and considered areas of strength were teamwork within units (72%). The dimension with the lowest percentage of positive response rate was nonpunitive response to error (30%). Conclusion: Improving PSC should be a priority among hospital administrators. Staff should be encouraged to report errors spontaneously and without any fear.

How to cite this article:
Eltarhuni AS, Tawfeeq HO, El-Abidi JS. Assessment of patient safety culture in benghazi children's hospital from the viewpoint of nursing staff.Libyan J Med Sci 2020;4:179-183

How to cite this URL:
Eltarhuni AS, Tawfeeq HO, El-Abidi JS. Assessment of patient safety culture in benghazi children's hospital from the viewpoint of nursing staff. Libyan J Med Sci [serial online] 2020 [cited 2023 Mar 27 ];4:179-183
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Full Text


Patient safety remains one of the biggest challenges for health-care organizations. Millions of patients suffer injuries or death annually due to unsafe medical care worldwide.[1],[2] This injury is caused by a range of medical errors or adverse events.[2]

According to the WHO (2011), a study in the Eastern Mediterranean and Africa showed that approximately one-third of patients who suffered a harmful incident died. However, 4 out of 5 incidents are preventable through improving all aspects of patient safety.[3]

Most health organizations pay more attention toward safety to treat patients with less unintentional harm.[4] The Institute of Medicine defines patient safety as “the prevention of harm to patients.”[5]

The WHO defined patient safety as “the reduction of risk unnecessary harm associated with healthcare to an acceptable minimum.”[6] Improvement in patient safety is one of the major international priorities as there are occurred several errors and unnecessary losses in health-care practices.[7]

The core element in improving patient safety is safety culture. Safety culture was defined in a report of Agency for Healthcare Research and Quality (AHRQ, 2016) as “the common values, beliefs, behaviours, perceptions and attitudes of health-care personnel that determine the commitment and proficiency of an organization health and safety management.”[8]

This study aimed to assess patient safety culture (PSC) from the view of point of nursing staff affiliated to Benghazi Children's Hospital and to investigate the areas of deficiencies for improvement.


Study design, setting, and duration

This was a descriptive cross-sectional study conducted over a period (from October 2019 to February 2020). The target population encompassed nurses working in Benghazi Children's Hospital.

Sampling and tool

A questionnaire of the AHRQ titled Hospital Survey on Patient Safety Culture[8] was distributed to the entire target group estimated as 118 out of a total of 170 hospital nurses. Incomplete and invalid questionnaires were excluded and 87 questionnaires were returned and included in the analysis, yielding an overall response rate of 73.7%.

The data collection instrument was composed of the sociodemographic variables and 12 dimensions of PSC with 42 items: 7 dimensions measuring PSC at unit level, 3 dimensions at hospital level and 2 outcome dimensions. The questionnaire also includes two questions that ask respondents to provide an overall patient safety grade for their work area, and number of events reported in the last 12 months. Most of the survey's items were developed on a Likert scale using five-point response categories in terms of agreement or frequency.

The scores of 75% and above are considered as good PSC/area of strength, between 50% and 75% considered as neutral, while <50% considered as poor/low PSC/need improvement.[9]

The questionnaire was translated into Arabic, and a pilot test was conducted on a small number of health workers (10% of sample size) to modify any ambiguities in words. Cronbach's alpha for all subscales was 0.781, which had acceptable levels of reliability.

A formal letter from the hospital director was sent to the chief nursing officer at the hospital to encourage nurses to participate in the study. Verbal consent was obtained from all the participants after explaining the purpose of the study. The nurses have the right to refuse participation in the study. In addition, the confidentiality of information and anonymity of the participant was maintained.

Data collection and analysis

Data were entered and analyzed using the Statistical Package for the Social Sciences, version 22 (IBM Corp. in Armonk, NY). Descriptive statistics were used to display and compare the proportions and frequencies of participants' background information and PSC dimensions.

Analysis of responses to different questions for positive answers calculated the percentage for each item, whereas negatively worded items were calculated by making reverse coding.


General results

[Table 1] shows distribution of nurses according to work area or unit in the target hospital.{Table 1}

As regards the length of experience, the majority of them (72.4%) had worked for more than 10 years in the profession, and more than one-third of the participants (37.9%) had an experience of more than 15 years at the target hospital. Most of the study participants with an average working hour between 20 and 39 h/week constituted (46%). More details in [Table 1].

The majority of the respondents (92%) have direct contact with patients.

Patient safety culture

[Table 2] illustrates that the positive response rate for the 12 PSC dimensions ranged from 30% to 72%, and the average positive response rate for all dimensions was 47%.{Table 2}

Patient safety culture at hospital units described

The highest percentage of positive responses at the unit level (72%) was obtained by the “teamwork within units” dimension, while “nonpunitive response to error” dimension received the lowest percentage of positive responses (30%). Details in [Table 2] and [Table 3].{Table 3}

[Table 4] shows that all the three dimensions of PSC at hospital level were the most potential areas needs improvement (<50%) include teamwork across units (42%), management support for patient safety (35%), and handoffs and transition (31%).{Table 4}

The positive response rate for the two outcome dimensions including overall perceptions of patient safety and frequency of event reported was <50%, more details in [Table 5].{Table 5}

Patient safety grade

The percentage of the participants who gave medium or acceptable grade of patient safety to their hospital was (35.6%), and 32.2% reported that an excellent grade followed by 27.6% reported a very good safety grade. The majority of the nurses (83.9%) had not reported any event reporting during the past 12 months.


The findings of this study showed that the majority of the nurses have direct interaction with the patients. Although about two-third of the nurses rated the overall patient safety grade in their hospital as excellent or very good, the average of positive response rate for the 12 dimensions of PSC was 47%, which was not at a desirable level. (no change for this statement, it is clear and we intended the meaning of this sentence). This result was analogous to a study performed in Ethiopia,[9] while it was lower than several previous studies conducted in Oman (58%), Saudi (58%), Iran (62.9%), and China (65%).[10],[11],[12],[13] On the other hand, the study of El-Shabrawy et al. affiliated in Beni-Suef University Hospital (2016) revealed that the mean response rate for all PSC dimensions was lower compared to the present study.[14] This discrepancy might be due to the difference in organizational behavior among countries. The potential explanation might be due to high economic development, and patient safety issues were introduced in those countries early.[10] In general, none of the PSC dimensions in the current study reached the set value of 75% of positive response. In spite of having some areas for improvement, it was found many areas of strength, particularly with unit-level dimensions (teamwork within units, organizational learning, and supervisor/manager expectation).

Teamwork within units has emerged as the first highlight area of strength which obtained a score of 72%; in addition to that, it was the prevailing dimension in almost PSC studies including this study.[10],[11],[15],[16],[17],[18],[19] This indicated that nurses in the present study feel supportive and respected in their units and have cooperated with their close partners in the same department as a team.

The second highest dimension was organizational learning for continuous improvement, and this was concordant with many previous studies in Palestine, Jordan, Portugal, and Southwest Ethiopia.[20],[15],[17],[9] This indicated respondents doing things to improve patient safety.

The results of the present study demonstrated that several safety culture dimensions considered as high priority areas need potential improvement. Seven dimensions received < 50% of positive responses.

Nonpunitive response to errors received the lowest dimension of PSC in this study, which was consistent with the findings of majority of the studies in the Arabic countries and across the world.[4],[11],[12],[16],[17],[18],[19],[20] This reflected to health-care providers feel their mistakes may hold against them and saved in their personal file. Contrary to these results, Mohamed et al. (2015) in Egypt revealed that nonpunitive response to errors scored 66.7%.[21]

The frequency of event reported scored 31%, which is closely related to nonpunitive response to error because the fear of punishment has been consistently found to reduce the frequency of error reporting.[10] This result was matched with the result of Al-Nawafleh et al. (2016).[15]

Health-care providers might be afraid to be punished if they disclose errors as punitive response system can lead to underreporting adverse events in hospital. Many errors in health care were unreported for various reasons including fear of blame and shame culture, humiliation, the presence of a punitive response to errors, and the fact that reporting would not usually result in an actual change.[22] These reasons could explain why the majority of the nurses did not write any incident reports in the past 12 months.

Handoffs and transitions also scored 31%, which was similar to the findings of the studies conducted in Jordan.[15] On the contrary, in a study performed in Romania, “Handoffs and transitions” scored 84%.[23]

The result means that there may be problems in data exchange within and between different hospital units. Lack of continuity in the process of information exchange at the time of transferring the patient raises the risk of errors and may threaten the safety of patients.[24]


The present study had highlighted the assessment of PSC among nurses in public hospitals. According to the findings of this study, a score of PSC was at a low level and most nurses did not report any error in the past 12 months. Organizational learning and teamwork within units had the highest positive response rate among all safety culture dimensions, and nonpunitive response to error was the lowest area need improvement.

Improving PSC should be a priority among hospital administrators. Building safety culture needs to encourage staff to report adverse events without fear of punishment and negative reactions. Also, eliminating blame culture and 20 providing a good work environment will encourage patient safety.


The authors would like to thank all nurses who participated in this study for their time and cooperation.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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