Preparation to the 1st International Conference on Health

Administration and Policy (ICOHAP)

Safety Culture at PKU Muhammadiyah Hospital: A Case Study
Ajeng Titi Probo Rahayanti1, Arlina Dewi2
1
Postgraduate Program of Hospital Management, Universitas Muhammadiyah Yogyakarta, Indonesia
2
Postgraduate Program of Hospital Management, Universitas Muhammadiyah Yogyakarta, Indonesia
E-mail: dewikoen@yahoo.com

Keywords : Patient Safety Culture, MAPSaF

Abstract : Patient safety culture is a system that can give patients safe feeling to avoid incidents such as adverse
events, near misses, and medical errors. The objective of this study is to know and to explore the
implementation dimension of patient safety culture at PKU Muhammadiyah Bantul Hospital. The cross-
sectional study was conducted and collected using questionnaires with MAPSaF (Manchester Patient
Safety Framework), consisted of 10 question elements and 24 aspects. The respondents were 67 nurses of
PKU Muhammadiyah Bantul Hospital. There were 5 maturity levels which can describe patient safety
culture, namely pathologic, reactive, calculative, proactive, and generative. The result of the study shows
that there were 7 questions in the proactive level, specifically extending the commitment to repair
sustainability, priority given to patient safety, evaluation of incidents and best practices, learning and
effective change, management civil and safety issues, as well as staff and cooperation team education and
training. There is 1 question in the calculative level, namely the communication of patient safety issues.
The last level is generative that consists of 2 questions, system error and individual responsibility and the
recording of incidents and best practices.
1. INTRODUCTION
Patient safety can be interpreted as an
attempt to prevent an imminent danger to the
patient. The concept of patient safety must be
implemented completely and
comprehensively. According to The American
Hospital Association (AHA) in 1999, patient
safety is the strategic primacy. Patient safety
is a system which is capable of providing
safety to patients. Systems on patient safety
caused by human errors in taking action can
mitigate injury, which is possible to happen.
Patient safety according to Sunaryo (2009) is
the existence or inexistence of any errors or
free from injuries due to an accident.
Patient safety was launched firstly in
Australia in 2000 by the Ministry of Health
(MOH) of Australia. In Indonesia itself, it was
launched by the Committee for Hospital
Patient Safety (KKPR) in 2005 under the
Indonesian Hospital Association (PERSI). In
Indonesia, PERSI was the first organization to
set and initiate hospital patient safety
movement, which was inaugurated/launched
by the Minister of Health at the opening of
the National PERSI Seminar on August 21st,
2005. The legal basis is also reinforced by the
presence of the Health Minister Regulation
No. 11/2017 on Hospital Patient Safety
governing patient safety standards and 7 steps
towards hospital patient safety, and therein
also sets the goal of hospital patient safety.
Hospital is a miniature of a society
because a hospital is an organization engaged
in the service sector, which is characterized
by labor-intensive, capital-intensive, and
technology-intensive characteristics
(Poerwani and Sopacua, 2006). Therefore,
hospital services become more complex with
very distinct characteristics. Various
unexpected incidents (KTD) and near misses
(KNC) will often occur and will result in the
death of a patient. The sense of security error
is most frequently caused by human error
associated with the risk in terms of safety, and
this is caused by the failure of a system
operated by an individual (Reason, 2009).
The main cause is human error, but in
resolving the problems of the unexpected
incidents (KTD), only intervening an
individual who makes a mistake will not
solve the problem. The incident of a particular
accident in a hospital would be detrimental to
the parties involved in a particular
organization such as the hospital staff and
patients. The effect of an accident is the
decrease in the level of public confidence in
the health service according to Flynn (2002)
in Cahyono (2008).
Based on the result of research
conducted by Danu Puguh (2017), Pupuk
Kaltim Hospital has made a decision on
accidents caused by falling. This is proven by
the letter of the director's decision in 2014
about policies of patient fall risk reduction.
There were several obstacles to the
implementation of patient fall risk prevention
in Pupuk Kaltim Hospital. Firstly, there has
not been an implementation of the initial
assessment of hospitalized patients from the
ER. Secondly, it has not carried out a daily
inpatient evaluation routine. There should be
an SOP. There were still 26 unsafe beds with
insecure gurneys—there were only three of
them, the third class care patients did not get
anti-slippery footwear, and hospital
wristbands of fall risk patients are often
empty.
PKU Muhammadiyah Bantul General
Hospital is a hospital which has the obligation
to implement safety in providing services.
New accreditation standards in Bantul
Muhammadiyah Hospital began to be
implemented in 2012.
 The accreditation is in accordance with N Characteristics
the Act No. 44 of 2009 on Hospital, which o. of Respondents Nu Percen
asserts that each hospital should be able to mbe tage
obtain accreditation. Accreditation aims to r
1 Age
improve patient safety. Therefore,
- 20-25 11 17%
accreditation is able to improve the culture
- 26-30 27 40%
and quality of PKU Muhammadiyah Bantul
- ≥31 29 43%
Hospital. 4 groups of new hospital
Total 67 100%
accreditation standards deal with patient 2 Gender
safety. - Woman 62 93%
- Man 5 7%
PKU Muhammadiyah Bantul Hospital
Total 67 100%
UNIT I from 2006 to 2016 has already been
3 Period Years of
implementing patient safety and has already service
provided the results of patient safety - ≤5 years 17 25%
implementation in Bantul Muhammadiyah - ≥6-10 39 58%
Hospital. UNIT I was classified as less years
satisfying, in which there were some cases of - ≥11 years 11 17%
unwanted pregnancy. Total 67 100%
4 Level of
Based on the above background, the education
researchers formulated the problem of the - Associate 34 51%
research: How is the overview of the patient (D3)
safety culture at PKU Bantul Hospital Unit I? - Bachelor 9 36%
(D4)
2. RESEARCH METHODS - Bachelor 24 13%
(S1)
This study used a cross-sectional Total 67 100%
quantitative approach because the researchers 5. Socialization
wanted to measure all variables at the same of patient
time. The population comprised of all nurses safety
at the clinic of PKU Muhammadiyah Bantul - Already 21 31%
Hospital Unit I. There were 67 respondents as - Not yet 19 29%
the sample, taken by purposive sampling. The - Unaware 27 40%
data was collected using questionnaires. The Total 67 100%
data analysis technique used in this research
was frequency distribution.

3. RESULTS AND DISCUSSION

3.1 Description
Respondents’ Profile
Table 4.1 Profile of Respondents
3.2 Description of 10 Dimensions of
of
Patient Safety Culture Research
Result
Table 4.2. 10 Dimensions of Patient Safety Culture
No. Dimension Percent 1 Staff is 18 26.9
aware of any
1 Thorough commitment to 11.98% possibilities
sustainable improvement or risks
which will
2 Priority given to patient safety 12.08% probably
happen so
3 System error and individual 8:40% that it
responsibility reduces the
number of
4 Recording of incidents and 8:26% SOPs
best practices because
patient
5 Evaluation of incidents and 12:54% safety has
best practices been
understood
6 Learning and effective 8.62%
by everyone.
changes
Patients and
7 Communication on patient 12.60% families are
safety issues involved in
giving
8 Personnel management and 4:27% advice.
safety issue
2 SOPs, 49 73.1
9 Education and training of staff 8.36% protocols,
and policies
10 Teamwork 12.86% are
discussed
Primary data source, 2018 and
implemented
The results of this study indicate that as the basic
patient safety culture dimension with the service.
highest percentage is teamwork (12.86%). Patients and
Meanwhile, the dimension with the lowest families are
percentage is nursing management and safety involved in
issue (4:27%) decision-
making
Table 4.3 SOP & Policies services.

No. SOP and Frequency Percentage Primary data source, 2018

Policy (%)
Aspects

as basic services (73.1.%). According to the

The results show that more than half
of the respondents have a commitment to
the improvement aspect, and the selection
of standard operating procedures, protocols,
and policies are discussed and implemented
researchers, the respondents preferred the
commitment aspect for improvement.
Patients and families are involved in
decision-making services.
Table 4.4 Risk Management System
No Aspects of Frequency Percentage safety
. risk (%)
management 1 Hospital has 9 13.4
system a culture that
is open and
1 The entire 18 26.9 fair. Staff
staff is feel a good
consistent in cultural
implementing atmosphere.
a risk
management 2 Staff feel 56 82.1
system and safe to report
sustainable incidents.
quality
improvement. 3 The culture 3 4.5
is open and
2 Risk 71.6 fair, but staff
management have not felt
system has it.
been more
widely Primary data source, 2018
socialized in
hospitals and
community The results show that more than half
organizations. of the respondents feel safe to report any
incidents (82.1%). According to the study,
3 Risk 1 1.5 the staff feel safe to report any incidents,
management especially at the level of incident reporting
system has not
been widely Table 4.6 The reporting system and its
socialized. usefulness

Primary data source, 2018 No Aspects of Frequency Percentage

. the reporting (%)
system and
The results show that more than half its usefulness
of the respondents agree that risk
management system has been socialized 1 KP incidents 9 13.4
more widely in hospitals and community are always
organizations (71.6%). According to the reported to
researchers, the risk management system is the correct
already socialized more widely in hospitals system.
and community organizations.
2 The reporting 56 82.1
process is
easy to do
Table 4.5 Safety culture of patients and friendly.

No. Cultural Frequency Percentage 3 Hospitals do 2 3.0

aspects of (%) not routinely
patients’ use staff's
 report, but focuses on
reports are the individual
obtained from and the
other sources environment
such as audits in the vicinity
and patient of the
complaint incident
forms. itself.

Primary data source, 2018 Primary data source, 2018

The results show that more than half The results point out that more than
of the respondents believe that the reporting half of the respondents (73.1%) reckon that
process is easy to do and friendly (82.1%). KP incident and near miss investigation
Based on the research, the reporting process focus on improvement, but it also involves
is easy to do, and it is preferable to be the patient. Although the incidence of KP
friendly. and near miss focus on improvement, it was
preferred to involve the patient.
Table 4.7 Focus of investigation
Table 4.8 Individual acting to decide post-
incident changes
No. Aspects of Frequency Percent
Data Analysis age (%) No. Individual Frequency Percentage
with the role (%)
1 The 9 13.4 of deciding
investigation change after
of KP incident
incident
involves 1 KP incident 10 14.9
internal and is discussed
external openly along
investigators with the staff
to the to elicit a
organization. particular
change.
2 KP incidents 49 73.1
and near 2 Staff actively 52 77.6
misses focus participate in
on deciding
improvement, changes after
but it also KP incident
involves the and are
patient. committed to
implementing
3 The 9 13.4 it.
investigation
of KP 3 Patient 5 7.5
incidents and Safety
near misses Committee
 and the The results show that more than half
manager of the respondents have the information
decide a about KP distributed at the briefing session,
certain which has been scheduled by the staff
change, but it (68.7%). The information about KP is
lacks staff distributed at the briefing sessions, which is
involvement. preferred to be scheduled by the staff.

Primary data source, 2018 Table 4.10 Staff feeling supported

No Staff feeling Frequency Percentage

The results show that more than half supported (%)
of the respondents consider that staff
participate actively in deciding changes 1 Personnel 11 16.4
after KP incident and are committed to management
implementing it (77.6%). Staff actively reflects and
participate in deciding changes after KP discusses
incident and it is preferred that they commit the
to implementing them. competence
of the staff.
Table 4.9 Sharing information Supervision
and
No Aspects of Frequ Percentage mentoring
.
sharing ency (%) of the health
information staff are
prioritized.

1 Innovative ideas 13 19.4 2 The 48 71.6

regarding KP management
are designs the
communicated support
and the lines of needs. The
communication health of the
are provided. staff is
prioritized.
2 Information 46 68.7
about KP 3 Personnel 8 11.9
distributed at management
briefing sessions procedure is
has been a way to
scheduled by the control the
staff. staff .

3 There is a lot of 8 11.9 Primary data source, 2018

information
about KP, but
few are The results indicate that more than
understood by half of the respondents (71.6%) think that
the staff. the management designs the support of the
workers’ needs. Their health needs to be
Primary data source, 2018 prioritized. According to the researchers,
 the management designs support for the and vision.
health workers’ needs. It is preferable to
consider the health of workers. 2 Collaboration 49 73.1
between
Table 4.11 The need for training members of
the team is
good.
No. Training needs Frequency Percentage 3 Team 6 9.0
(%) members
include multi-
1 Staff are given the 13 19.4 event in
opportunity to take elements, but
part in training in do not have a
accordance with commitment
their needs. to the team.
2 There is an effort 51 76.1 Primary data source, 2018
to identify training
needs and align it
with the needs of The results indicate that more than
the hospital staff. half of the respondents believe that
collaboration between members of the team
3 Training is held to 3 4.5 goes well. (73.1%). According to the
meet the needs of researchers, that collaboration among team
the hospital. members is preferably good.
Primary data source, 2018
4. CONCLUSION Commented [DH2]: Please make it a paragraph as the
publisher does not require it to be explained point by point
Based on the results of the study, it
The results point out that more than
can be concluded that:
half of the respondents agree that there is an
attempt to identify training needs and align A. There are seven dimensions of patient
it with the needs of the hospital staff.
safety culture based on the MaPSaF
(76.1%). According to the researchers, there
is an attempt to identify training needs. It is questionnaire. On the proactive level,
preferred to align it with the needs of the there is a thorough commitment to
hospital. sustainable improvement and priority is Commented [DH1]: This and every other sentence
given to patient safety; incident following the result from the table are basically a repetition
Table 4.12 Sense of belonging as a member evaluation and best practices; learning of the previous sentence. I don’t know if the authors meant
of a team otherwise, but I think these sentences should be erased.
and effective changes; staff management
No. Sense of Frequency Percentage and safety issues; education and training
belonging as a (%) of staff; as well as teamwork
member of a B. There are two dimensions of patient
team safety culture based on the MaPSaF
1 The team 12 17.9 questionnaire on the generative level.
appears to These include system error and
have a similar individual responsibility as well as
understanding
 recording of incidents and best
practices.
C. There is one dimension of patient safety
culture based on the MaPSaF
questionnaire on the calculative level,
namely the communication on patient
safety issues.
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