Abordagem multidimensional da segurança do doente nas instituiçoes de saúde do sector público da Região do Algarve – Portugal

Laburpena

BACKGROUND: The Region of Health of Algarve, Portugal, is a territory with specific singularities, marked by structural difficulties in the development of health services, namely due to its distance from the large urban centres where specialized hospitals are concentrated. It is assumed that by mobilizing local strategies and collective action in clinical governance, risk minimization and patient safety can be ensured, thus ensuring improved quality of care. The 2014 European Commission report concerning the Patient Safety, demonstrates the need to improve the education and training of health professionals in the recording of incidents and use of reporting systems, involvement of the patient and improvements in policies and programs relating to patient safety. OBJECTIVE: The purpose of this study is to get to know and analyse the determinants of the environment favourable to the practice of patient safety in public health organizations in the Algarve - Portugal region through a developed questionnaire ("Multidimensional Approach to Patient Safety in Health Institutions of the Public Sector of the Algarve- Portugal Region ") with a version adapted for professionals and another for users / patients. METHODS: Sample of 376 health professionals and 241 patients from the health region of the Algarve. To evaluate the psychometric properties of the developed questionnaire, a confirmatory factorial analysis (AFC) was performed. The validity of construct and internal consistency was verified. To estimate and demonstrate the proposed model, Amos software was used to model structural equations (SEM). The open questions and the documents were the object of content analysis in thematic and categorical form, followed by lexical treatment using the Iramuteq software. RESULTS: The analysis of the psychometric properties of the questionnaire resulted in reasonably good levels of property values. The internal reliability of each factor identified for the patients, by determining the Cronbach's alpha coefficient was 0.806 (the management of the Health Unit organization, 9 items), 0.896 (experience during their stay in the health unit, 11 items), 0.904 (to the experience regarding the incident (clinical error) that suffered, 6 items); (healthcare experience, 12 items), 0.805 (regarding the adverse event notification, 7 items), 0.819 (perception of healthcare experience, 12 items), 0.703 (management and organization of the Health Unit, 9 items) ). Considered as "Good" and "Very Good", regarding internal consistency. Although the set of dimensions within the questionnaires requires a greater refinement of scale, the questionnaires cover a wide range of subdimensions and provide important information about the safety culture in both versions (Professionals and Patients) allowing to estimate and demonstrate the model through SEM. CONCLUSIONS: The AMSDISSPRA-PT, professionals and patients' versions, are therefore eligible to measure the safety culture from the multidimensional point of view. The level of safety culture found in health facilities in the Algarve region is not desirable (ideal), the lack of human resources and the consequent overload of work negatively affects the provision of care, and often the bosses adopt authoritarian positions and centralizing, which compromise teamwork. There is evidence that the region has lower levels of safety culture than nationals. Patients have poor knowledge regarding patient safety, clearly evidenced in their safety objectives in providing healthcare.