Pepito, J. A.

39

Patient satisfaction with nursing care quality

and patient safety culture in the
medical-surgical unit
Joseph Andrew T. Pepito

Date Received: 20th of October, 2016 Date Accepted: 12th of December, 2016

ABSTRACT
The objective of the study was to determine a significant relationship between patient safety culture as
perceived by the nurses. The study was done in the medical-surgical units of a private hospital in Cebu
City. The respondents were 131 regular nurses assigned in the medical surgical units and patients
admitted in the medical-surgical units. Quota/purposive sampling technique was used. Research tools
used were the Modified Hospital Survey on Patient Safety Culture developed by the Agency of
Healthcare Research and Quality and the Modified Patient Satisfaction with Nursing Care Questionnaire
developed by Laschinger, Hall, Pedersen & Almost. Results showed that majority (52.475%) of the
regular nurses assigned in the medical-surgical units of a private hospital in Cebu City have positive
assessments with regards to the perceptions, values, attitudes and patterns of behavior that determine
the dedication to, manner and mastery of an institutions management of health and safety indicating a
positive patient safety culture. 55% of the patient respondents rated the nursing care quality in medical-
surgical units as “Excellent” or “Very Good” indicating a positive patient satisfaction rating. Spearman’s
Rho revealed that there is no significant relationship between patient safety culture as perceived by
nurses and patient satisfaction to nursing care quality. Mann-Whitney Test and Kruskall-Wallis Test for
Difference revealed no significant difference in perception in patient safety culture based on the
demographic profiles of nurses and no significant difference in patient satisfaction to nursing care
quality based on the demographic profiles of the patients. Some dimensions of patient safety culture
had less than 50% of the nurse respondents giving a positive assessment which indicated that these
were areas needing of improvement. Continuous evaluation of patient safety in the hospital is needed
to assess strengths and areas needing improvement. Continuous re-evaluation of policies is needed to
ensure its effectiveness in the attainment of the patient safety culture of the organization.

Keywords: culture, patient, safety, satisfaction

I. INTRODUCTION value to a healthcare institution. With a deeper

Fitzpatrick, ray once stated that patient satisfaction is understanding of patient satisfaction and the
an indicator of system performance and the quality of determination of its existing level, healthcare services
healthcare provision (Fitzpatrick, 1991). Patient can be made relevant to the needs of the people and
satisfaction is a major indicator of the quality of care patients. Research has also identified the link between
provided by a healthcare institution. It is an emerging the outcomes of the patients and the scores of patient
health policy all over the world. A review of literature satisfaction (Institute of Medicine, 2001). The
relevant to patient satisfaction reveals that the assessment from the perspective of the patients gives
assessment of the patient satisfaction level is a tool that them a voice, which would aid in making health services
determines the quality of healthcare delivery, an analysis more responsive to the patient’s needs and their
of the existing situation and a workout strategy that can expectations (World Health Organization, 2000).
improve it. It is very useful to understand the needs of One of the major health care services is nursing care.
the patient therefore patient satisfaction is of very high Nursing care contributes a huge part to the patient
healing process. Even if a hospital has enough

ORCID Number: 0000-0003-1403-1572, J. A. Pepito. Author is with Beta Nu Delta Nursing Society. (e-mail: eo@betanudelta.com).

University of the Visayas Journal of Research

40 Pepito, J. A.

competent physicians, it would not be enough if there is correlation between patient safety culture as perceived
no appropriate and sufficient nursing care. Nurses have by the regular nurses and patient satisfaction with
a 24 hour contact with patients. They are in the nursing care quality in the medical-surgical units of a
frontlines. Patient expectations from nurses should be private hospital in cebu city. There has been very little
satisfied with a compassionate and competent evaluation of the patient safety culture in the hospitals
approach. Denying the patient of appropriate care of cebu city. Only one other study evaluated patient
means the healing process is compromised. The safety culture in their hospital and it was by Arcenal
assessment of the satisfaction of patients with nursing (2015) entitled “south general hospital employees’ level
care is important in order to determine areas of of safety culture and work attiude: proposed program
dissatisfaction and improve services. design for organizational setting enhancement towards
Patient safety is the central theme and ultimate patient safety”.
objective of health care quality. One of the most
important challenges that is faced by healthcare today is II. THEORETICAL FRAMEWORK
ensuring the safety of everyone that comes into contact Comfort theory by Katharine Kolcaba states the duty
with healthcare services. Patient safety in developing to meet the patient’s comfort needs (Kolcaba, 2011).
countries faces harsher threats and challenges because Nurses address those needs by doing an assessment the
of an environment with scarcer resources and patient’s need for comfort, the development and
inadequate infrastructure. There is little information on implementation of the right nursing interventions and
the rate of preventable patient harm in developing the evaluation of the comfort of the patient following
countries in southeast asia or about the healthcare the interventions. Hupcey (2000) found out that patients
quality (WHO, 2015). depicted emotions of discomfort when they perceive
Patient safety is a fundamental of nursing care. that they were not safe. Patient discomfort would lead
Nurses’ code of ethics state that it is the nurses’ to lower patient satisfaction. Meeting the patient’s
responsibility to provide safe, competent and ethical needs would result in the improvement of patient
care. Nurses play a critical role in ensuring the safety of satisfaction.
the patient. They are in charge of monitoring of patients
for clinical deterioration, they also have to be able to III. METHODOLOGY
detect errors and near misses, they also have roles in Correlational Research Design was used in this study.
the understanding of care processes and weaknesses in The study was conducted in the medical-surgical units of
systems and the performance of countless other tasks a private hospital in Cebu City. One hundred thirty one
that ensure patients receive high-quality care. (131) medical-surgical nurses and 131 patients were
Improvement of patient safety regarding risks and used in the study. Patients who were not included were
outcomes in a healthcare system depends on the those who were unconscious and those who are
building of patient safety culture. undergoing a treatment regimen that affects
Hupcey (2000) found out that patients depicted participation in the study such as mechanical ventilation,
emotions of discomfort when they perceive that they sedation and restraint. The sampling technique used was
were not safe. Patient discomfort would lead to lower quota/purposive sampling. Because of the confidentiality
patient satisfaction. It has been hypothesized that procedures of the hospital, purposive sampling was
patient safety and patient satisfaction are correlated due used. Patients whose attending physicians agreed to
to the fact that both are embodiments of a fundamental their participation in the study were included as
culture of the hospital, one that is committed to the respondents. Not all physicians agreed to the
welfare of patients and undergoes steps that would be participation of their patients in the study which made
able satisfactorily to meet or surpass the expectations of the use of a sampling frame listing inapplicable.
patients while at the same time, promoting a care that is Modified Hospital Survey on Patient Safety Culture.
without error (Wolosin, 2008). The Hospital Survey on Patient Safety Culture was
A positive patient safety culture may receive designed to measure the patient safety culture of
complimentary appraisals from patients. A positive hospitals. The Hospital Survey on Patient Safety Culture
patient safety culture may not only result in positive has 42 items that are categorized into 12 dimensions of
assessments from patients, but it would also lead to a Patient Safety Culture. Organizational views and customs
decrease in episodes of unfavorable events occurring in related to the four factors of culture can be evaluated by
a hospital as cited by Mardon, Khanna, Sorra, Dyer, and the Hospital Survey on Patient Safety Culture (Jones,
Famolaro (2010). Skinner, Sun, Mueller & Xu, 2008 ).
This study was undertaken to determine the There are 12 dimensions that are measured by the

UVJOR2016 Volume 10 Issue 1

 Pepito, J. A. 41

survey and these are: Teamwork within units, this that can handle the workload. This dimension has 4
dimension determines if staff provide each other with items (Famolaro et al., 2014).
support, is respectful to one another and if they work Hospital handoffs and transitions, this dimension
together as a team. This dimension has 4 items. refers to the transfer of patient care and patient
Supervisor/manager expectations and promoting safety information across units in the hospital and during the
actions, this dimension determines whether the changing of shifts. This dimension has 4 items. And, Non-
leadership takes into account suggestions by the staff, punitive response to errors, this dimension refers to the
gives praise to the staff for the application of patient freedom staff has with regards to the reporting of
safety procedures that improve patient safety and does adverse events and their mistakes not being held
not encourage hastier work through the use of short contrary to them. This dimension has 3 items (Famolaro
cuts. This dimension is 4 items. et al., 2014).
Organizational learning, this dimension refers to the A five-point Likert scale is being utilized in the
existence of a continuing improvement in patient safety questionnaire and required the participants to signify
done by staff which involves learning from errors and the extent to which agreed or disagreed with the
the evaluation of the effectiveness of new interventions statements composing the questionnaire. By counting
that are implemented. This dimension has 3 items the number of positive responses to items that compose
(Famolaro et al., 2014). a dimension, a composite frequency can be made.
Hospital management support for patient safety, this A positive patient safety culture is defined as the
dimension refers to the hospital management’s majority of the healthcare workers (>50%) having a
commitment to the provision of a work climate that positive assessment with regards to the perceptions,
results in the promotion of patient safety and displays if values, attitudes and patterns of behavior that
patient safety is the first priority or is only considered if determine the dedication to, manner and mastery of an
an adverse even occurs. This dimension has 3 items. institution’s management of health and safety. A neutral
(Famolaro et al., 2014) patient safety culture is defined as 50% of the healthcare
Overall perceptions of patient safety, this dimension workers giving positive assessments with regards to the
refers to the staffs’ opinions about procedures and perceptions, values, attitudes and patterns of behavior
systems designed to prevent errors from happening in that determine the dedication to, and manner and
hospital units and also about the staffs’ methods of mastery of an institution’s management of health and
coping with work pressure related to preventing medical safety. A negative patient safety culture is defined as
errors. This dimension has 4 items. Feedback and having <50% of the healthcare workers giving positive
communication about errors, this dimension refers to assessments with regards to the perceptions, values,
whether staffs are updated about errors that occur, attitudes and patterns of behavior that determine the
informed about changes put in place based on report on dedication to, and manner and mastery of an
events and a discussion of ways to prevent mistakes institution’s management of health and safety.
from occurring again. This dimension has 3 items The instrument was pretested at another private
(Famolaro et al., 2014). hospital and produced a Cronbach alpha of 0.80. Face
Communication Openness, this dimension refers to validity was addressed through a consultation with a
the freedom of staff to speak up whenever they witness psychometrician and the research mentor. Content
something that may affect patient care negatively, their validity was addressed through a consultation with 3
freedom to question people with more authority and the senior nursing service administrators specifically the
staff’s courage to speak up when something isn’t right. chief nurse, the staff development officer and a senior
This dimension has 3 items. Frequency of Events supervisor using the Validators’ Questionnaire
Reported, this dimension refers to how frequently staff Assessment. The scale level content validity index
report every type of error such as latent errors, ranged from 4.4 to 4.8 which indicated that the
accidents, and near misses. This dimension has 3 items questionnaire has high validity.
(Famolaro et al., 2014). Modified Patient Satisfaction with Nursing Care
Teamwork across hospital units, this dimension Quality Questionnaire. Developed by Laschinger et al.
determines if the units within the hospital coordinate (2005) the questionnaire aims to represent the patient’s
and cooperate with each other and the encouragement point of view regarding the quality of nursing care they
among staff from other units for the provision of the are receiving. It consists of 17 questions which can be
best quality of care for the patients. This dimension has classified into 2 major categories namely information
4 items. Staffing, this dimension refers to the adequacy given by nurses and quality of nursing care. The
of staff and the appropriate number of working hours questionnaire required participants to indicate on a five-

University of the Visayas Journal of Research

42 Pepito, J. A.

point Likert scale their ratings of the nursing care quality respondents’ length of service in years were from 1 year
as perceived by the participant. to 3 years.
Having majority (>50%) of the respondents giving an
assessment of “Excellent” or “Very Good” to the items Table 1
Demographic Profile of the Respondents
indicated a positive patient satisfaction on the quality of Distribution of Nurse Respondents by Age
care given by nurses as perceived by the patients. Age Group f %
Less than 25 55 41.9
Having majority (50%) of the respondents giving an 25-29 72 54.9
assessment of “Good” to the items indicated a neutral 30 and above 4 3.2
Distribution of Nurse Respondents by Gender
patient satisfaction on the quality of care given by nurses Gender f %
as perceived by the patients. Having majority (50%) of Male 36 27.5
the respondents giving an assessment of “Poor” or “Fair” Female 95 72.5
Distribution of Nurse Respondents by Patient Load
to the items indicated a negative patient satisfaction on Number of Patients f %
the quality of care given by nurses as perceived by the 1-4 0 0
5-6 9 6.9
patients. 7-8 99 75.6
The instrument was pretested at another private 9-12 23 17.5
Distribution of Nurse Respondents by Experience
hospital and produced a Cronbach alpha of 0.76. Face Experience in Years f %
validity was addressed through a consultation with a Novice 9 6.9
Advanced Beginner 94 71.8
psychometrician and the research mentor. Content Competent 18 13.7
validity was addressed through a consultation with 3 Proficient 10 7.6
Distribution of Patient Respondents by Age (years)
senior nursing service administrators specifically the Age f %
chief nurse, the staff development officer and a senior Young Adulthood 59 45.0
Middle Adulthood 58 44.3
supervisor using the Validators’ Questionnaire Old Adulthood 14 10.7
Assessment. The scale level content validity index Distribution of Patient Respondents by Gender
Gender f %
ranged from 4.1 to 4.7 which indicated that the Male 76 58.0
questionnaire has high validity Female 55 42.0
Distribution of Patient Respondents by Highest Educational Attainment
Frequency and percentage was used to profile the Gender f %
respondents. In the determination of the patient safety High School Graduate 25 19.1
College graduate 94 71.8
culture of nurses and patient satisfaction, frequency and Post-graduate 12 9.2
percentage was used. The magnitude and direction of ∑ 131 100.0

the relationship between the perceived patient safety Out of the 131 patient respondents, mostly or 45%
culture of nurses and the perceived satisfaction of were young adults and then followed by 44.3% middle
patients was determined using Spearman’s rho adult and 10.7% old adult. More than half or 58% of the
correlation and Nonparametric tests (Mann-Whitney patient respondents were male while 42% were female.
and Kruskal-Wallis) was used for the determination of a Majority or 71.8% of the patient respondents were
significant difference of the perceived patient safety college graduate, followed 19.1% who were high school
culture among the demographic profiles of nurses as graduate and the remaining 9.2% had post-graduate
well as patient satisfaction among the demographic degree.
profiles of the patient respondents.
Table 2
IV. RESULTS AND DISCUSSION Positive Assessment of the 12 Dimensions of Patient Safety Culture
Dimension % of + Assessments
The average age was 24.89 years old with a standard Teamwork Within Units 96.2
deviation of 1.98 years. The age of the oldest nurse Supervisor/Manager expectations and actions 53.4
promoting patient safety
respondent was 32 years old while the youngest nurse Organizational Learning 90.8
respondent was 22 years old. All the nurse respondents Management Support for Patient Safety 38.9
Overall Perceptions of Patient Safety 45.8
were in the young adulthood age group. The majority of Feedback and Communication about error 75.6
the nurse respondents were female comprising 72.5% of Communication Openness 47.3
Frequency of Events Reported 55.0
the total number of respondents while the remaining Teamwork Across Units 55.7
27.5% were male. The average number of patient in a Staffing Level 8.4
Handoffs and Transitions 58.8
day of the nurse respondent was 8 with a standard Nonpunitive response to errors 3.8
deviation of 1. The minimum number of patient in a day Composite Average Score 52.475

was 6 while the maximum was 10 patients. More than

half or 56.5% of the nurse respondents had 8 – 10 A positive patient safety culture is defined as the
patients per day. Majority or 71.8% of the nurse majority of the healthcare workers (>50%) having a

UVJOR2016 Volume 10 Issue 1

 Pepito, J. A. 43

positive assessment with regards to the perceptions, were Positive patient safety culture were
values, attitudes and patterns of behaviour that Supervisor/Manager Expectations and actions promoting
determine the dedication to, manner and mastery of an patient safety, Frequency of Events Reported, Teamwork
institution’s management of health and safety. Patient Across Units and Handoffs and Transitions.
safety culture has 12 dimensions. These dimensions Supervisor/manager expectations & actions
measure the opinions of hospital staff regarding issues in promoting patient safety which had 53.4% (70) of the
patient safety, medical errors and reporting of events. nurse respondents having a positive perception which
The dimensions having >75% of the respondents having meant that only a little more than half of the nurse
a positive assessment which indicated that it was a respondents believe that the leadership takes into
patient safety strength were Teamwork Within Units, account suggestions by the staff, gives praise to the staff
Organizational Learning and Feedback and for the application of patient safety procedures that
Communication about Error. improve patient safety and does not encourage hastier
Teamwork Within Units had 96.2% (126) of the nurse work through the use of short cuts.
respondents having a positive perception which meant The quality of leadership has been shown in studies to
that staff provide each other with a lot of support. It also have a potential impact in the climate of the
shows that when a lot of work needs to be done, the organization (Wu, Chen, & Li, 2008). For example, the
staffs in the unit work together as a team to get things relationship between safety culture and leadership has
done. There is also a generous show of respect for one been linked to the supervisor’s concern for the well-
another in the unit. For a team to work effectively, each being of his group members (Hofmann, Morgeson, &
member needs to possess special knowledge, attitude, Gerras, 2003). As a result, a shared perception on safety
skills and the positive inclination towards working in a climate is made because of interactions between
team Cannon-Bowers, Tannenbaum, Salas, and Volpe, member and leader (Kozlowski & Doherty, 1989).
(1995 as cited in Baker, Day & Salas, 2006). Research has shown that a psychologically safe culture
Organizational Learning had 90.8% (119) of the nurse that advances interpersonal risk taking which results in
respondents having a positive perception which meant learning are created by leaders (Edmondson, 1999).
that there is a continuing improvement in patient safety Frequency of events reported had 55.0% (72) of the
done by staff which involves learning from errors and nurse respondents having a positive perception which
the evaluation of the effectiveness of new interventions meant that only a little more than half of the nurse
that are implemented. The nurse respondents believe respondents report every type of error such as latent
that mistakes have led to positive changes in the hospital errors, accidents and near misses which may be due to a
and that there is continued evaluation of the punitive response from the hospital and would result in
effectiveness of change. Hospitals with positive lesser reports of errors that happen.
organizational learning assessments are sensitive to Incident reporting systems are used by hospitals to
errors, have processes for problem identification, they monitor patient safety issues and adverse events
learn from errors, suggestions for improving care are (Farley, 2008).
valued, have systems in place that decrease or eliminate Because of the importance of incident reporting
threats that are identifiable, has commitment to learning systems it should promoted for use in healthcare
for secure care, is aware of the hazards of insufficient institutions. Incident reporting systems should be simple
knowledge, and constantly informs the patient regarding so that staff may be able to utilize them with minimal or
his/her care (Heidari, Nayeri, Ravari, & Sabzevari, 2016) without training (Karsh, Escoto, Beasley, & Holden,
And, Feedback & communication about error which 2006).
had 75.6% (99) of the nurse respondents having a Teamwork Across Units had 55.7% (73) of the nurse
positive perception which meant that staffs are updated respondents having a positive perception which meant
about errors that occur, informed about changes put in that only a little more than half of the nurse respondents
place based on report on events and a discussion of believe that the units within the hospital coordinate and
ways to prevent mistakes from occurring again. The cooperate with each other and there is encouragement
provision of timely feedback about actions and among staff from other units for the provision of the
improvements to avoid future errors to the reporter best quality of care for the patients. Staffs feel that it is
significantly improves error reporting and the level of often uncomfortable working with people from other
patient safety in the hospital (Force, Deering, & Hubbe, units. This may be due to the utilization of ineffective
2006). communication techniques that do not effectively and
The dimensions having >50% of the respondents efficiently relay vital information needed for patient care
having a positive assessment which indicated that they across units.

University of the Visayas Journal of Research

44 Pepito, J. A.

Insufficient teamwork and communication in monitored for effectiveness and is dynamic according to
providing health-care services have been determined as the needs that has to be addressed in the hospital. The
crucial factors in adverse events that occur in patients. administration’s role in continuous quality improvement
Many adverse events have some relation to the is the provision of working support to channel
communication failures and errors in patient handoffs productive change and the improvement of
from one department to another which can be avoided inconsistencies.
through the use of effective teamwork practices. Organizational structures and control systems interact
(Petersen, Brennan, O’Neil, Cook, & Lee, 1994). to produce shared values, beliefs and behavioral norms
And, Handoffs and Transitions which had 58.8% (77) that are necessary to support a safety culture that is
of the nurse respondents having a positive perception patient-centric (Hellings, Schrooten, Klazinga, &
which meant that only a little more than half of the Vleugels, 2007 ).
nurse respondents believe that the transfer of patient Communication openness which had 47.3% (62)
care and patient information across units in the hospital which meant that less than half of the staff believe that
and during the changing of shifts is effective. Handoffs they have the freedom to speak up whenever they
that are ineffective can result in breaches in patient witness something that may affect patient care
safety and gaps in patient care including wrong site negatively, that they are free to question people with
surgery, errors in medication and death of patients. more authority and that they have the courage to speak
Communication breakdown has been cited as a major up when something isn’t right.
reason in ineffective handoffs (Gandhi, 2005). Ineffective communication between health care
The dimensions having <50% of the respondents professionals has been indicated by current research as
having a positive assessment which indicated that they the leading cause of medical errors and patient harm
were Areas needing improvement were Management (Leonard, Graham, & Bonacum, 2004).
support for patient safety, Overall perceptions of patient The areas of great concern were those having <10% of
safety and Communication openness. the respondents having a positive assessment which
Areas needing improvement were Management indicated that these areas need immediate attention.
support for patient safety which had 38.9% (51) which These areas are Staffing and Nonpunitive response to
meant that less than half of the staffs believe that the errors.
hospital management has a commitment to the These patient safety dimensions need serious
provision of a work climate that results in the promotion attention because of the very low percentage of staff
of patient safety. Less than half believe that the work having a positive perception. Staffing level only had 8.4%
climate isn’t conducive to patient safety and staffs (11) of the staff having a positive perception which
believe that the management does not put patient meant that a huge majority of the staff believe there is
safety as top priority and would only get interested in an inadequacy of staff that can handle the workload and
patient safety when an adverse event happens. staff experience an inappropriate number of working
In the review of Parand, Dopson, Renz and Vincent hours.
(2014) found out that healthcare managers have an Hart Research Associates conducted a study and they
important role in the maintenance and the promotion of found out that nurses believe that understaffing has a
safe and quality care. Time spent, engagement and significant influence in the quality of care patients
activities of hospital managers and boards influence received. Understaffing resulted to inadequate time to
safety and quality performance. The management’s comfort, assist or educate the patient and their families.
commitment towards patient safety through the Patients wait for longer periods of time for their
provision of resources, education and role accountability medications and procedures and medication errors had
would shape employees perceptions on patient safety. a greater frequency (Hart, 2003).
Overall perceptions of patient safety had 45.8% Research done by New England Journal of Medicine
(60) which meant that less than half of the staff believe (NEJM), Journal of American Medical Association (JAMA)
that procedures and systems designed to prevent errors and Joint Commission (JCO) have come to the conclusion
from happening in hospital units and staffs’ methods of that the number of patients a nurse has to take care for
coping with work pressure related to preventing medical has a very influential impact on the health outcomes of
errors is effective. Less than half believe that patient the patient (Stefanini, 2003). Poor outcomes and higher
safety is never sacrificed to get more work done, serious actual costs have been related to short staffing as cited
mistakes do not happen in the hospital just by chance by Blegen (2006).
and there are patient safety problems in units. Findings from the AHRQ study revealed that hospitals
Systems of the hospital should be continually whose registered nurse staffing was high had lower rates

UVJOR2016 Volume 10 Issue 1

 Pepito, J. A. 45

of five adverse events for patients having pneumonia, meant they had a neutral rating to the nursing care
shock, upper gastrointestinal bleeding, urinary tract quality in the medical surgical unit while Seventy two or
infections and longer stays in the hospital, patients who 55% of the patients gave an “Excellent” or “Very Good”
have had major surgery had lower rates of two adverse rating to most of the items in the questionnaire which
events which are urinary tract infections and failure to meant they had a positive rating to the nursing care
rescue (Hickam, Severance, Feldstien, Ray, & Gorman, quality in the medical surgical unit of the private hospital
2003). in Cebu.
And, Nonpunitive Response which only had 3.8% (5) Spearman’s Rho correlation revealed that out of the
of the staff having a positive perception which meant 12 dimensions of patient safety culture, only
that a huge majority of staff believe they have no Supervisor/manager expectations & actions promoting
freedom with regards to the reporting of adverse events patient safety showed a significant relationship with
and their mistakes are being held against them. patient satisfaction
Marx (2001) stated a nonpunitive environment has to
be created to promote reporting of one’s own or others’ Table 5
Mann-Whitney Test for Difference in the Patient Safety Culture as perceived by
mistakes and ways to address them. Without the Nurses according to Nurse Respondents’ Gender
creation of a nonpunitive environment, it will be nearly Dimension of patient safety culture z p Interpretation
Team work within units -0.496 0.620 Not Significant
impossible to improve the safety of the organizational Supervisor/manager expectations &
-0.060 0.953 Not Significant
system. actions promoting patient safety
Organizational learning -1.224 0.221 Not Significant
A composite average score of 52.475% meant that Management support for patient safety -0.461 0.645 Not Significant
more than half of the nurses working in the Medical- Overall perceptions of patient safety -0.561 0.575 Not Significant
Feedback & communication about
Surgical units of a private hospital in Cebu have a -2.817 0.005 Significant
error
Communication openness -0.780 0.436 Not Significant
positive assessment with regards to the perceptions, Frequency of events reported -0.540 0.589 Not Significant
values, attitudes and patterns of behavior that Teamwork across units -1.921 0.055 Significant
Staffing level -0.438 0.661 Not Significant
determine the dedication to, manner and mastery of an Handoffs & transitions -1.232 0.218 Not Significant
institutions management of health and safety. Nonpunitive response -0.085 0.932 Not Significant

Table 3 Mann-Whitney U test revealed that perceived patient

Patient Satisfaction to Nursing Care Quality in the Medical Surgical Unit
Rating f % safety culture dimensions were the same among male
Excellent or Very Good 72 55.0 and female nurses.
Good 41 31.3
Poor or Fair 18 13.7
Among the patient safety culture dimensions, there
Total 131 100.0 was a significant difference in the patient safety culture
dimension feedback and communication about error
Table 4
Spearman’s Rho Correlation for the relationship between Patient Safety Culture between male and female nurse respondents, z=-2.817
as perceived by the nurses and Patient Satisfaction to Nursing Care Quality and p<0.05. Female nurse respondents had positive
Dimension of patient safety Patient perception toward feedback and communication about
culture Satisfaction p Interpretation
Team work within units rs=0.076 0.388 Not Significant error compared with males who had negative
Supervisor/manager Expectations &
rs=0.285 0.001 Significant perception.
actions promoting patient safety
Organizational learning rs=0.111 0.205 Not Significant
Management support for patient Table 6
rs=0.134 0.127 Not Significant Mann-Whitney Test for Difference in the Patient Safety Culture as perceived by
safety
Overall perceptions of patient safety rs=0.042 0.635 Not Significant the Nurses according to Nurse Respondents’ Patient Load
Feedback & communication about Dimensions z p Interpretation
rs=0.102 0.248 Not Significant
error Team work within units -1.356 0.175 Not Significant
Communication openness rs=0.057 0.515 Not Significant Supervisor/manager
Frequency of events reported rs=0.157 0.074 Not Significant expectations & actions -0.658 0.511 Not Significant
Teamwork across units rs=0.134 0.126 Not Significant promoting patient safety
Staffing level rs=-0.058 0.510 Not Significant Organizational learning -0.324 0.746 Not Significant
Handoffs & transitions rs=0.008 0.931 Not Significant Management support for patient
-0.887 0.375 Not Significant
Nonpunitive response rs=0.058 0.509 Not Significant safety
Overall perceptions of patient
-0.079 0.937 Not Siginificant
safety
Eighteen (18) or 13.7% of the patients gave a “Poor” Feedback & communication
-0.044 0.965 Not Significant
about error
or “Fair” rating to most of the items in the questionnaire Communication openness -0.877 0.380 Not Significant
Frequency of events reported -0.948 0.343 Not Significant
which meant that they had a negative rating to the Teamwork across units -0.656 0.512 Not Significant
nursing care quality in the medical-surgical unit. Staffing level -1.184 0.237 Not Significant
Handoffs & transitions -0.441 0.659 Not Significant
Forty-one (41) or 31.3% of the patients gave a “Good” Nonpunitive response -0.024 0.981 Not Significant
rating to most of the items in the questionnaire which

University of the Visayas Journal of Research

46 Pepito, J. A.

There was also a significant difference in the patient V. CONCLUSION

safety culture dimension teamwork across units. Female Based on the findings, the following conclusions are
nurse respondents had positive perception toward made:
teamwork across unit compared with the male nurse There was no significant relationship between patient
respondents. safety culture as perceived by nurses and patient
Mann-Whitney U test revealed that perceived patient satisfaction to nursing care quality. Although patient
safety culture dimensions were the same among those safety culture is an important factor for patient safety,
handling 5 to 6 patients, 7 to 8 patients and 9-12 patient satisfaction is not heavily reliant on the level of
patients per day. patient safety culture an institution has.
Patient safety culture as perceived by nurses was the
Table 7
Kruskal-Wallis Test for Difference in the Patient Safety Culture as perceived by same in both male and female nurse respondents.
Nurses according to Nurse Respondents’ Experience (Years) Patient safety culture as perceived by nurses were the
Dimension of patient safety culture H df p Interpretation
Team work within units 1.630 3 0.653 Not Significant. same among those handling 5 to 6, 7 to 8 and 9-12
Supervisor/manager expectations & 0.368 3 0.947 Not Significant patients per day. Patient safety culture as perceived by
actions promoting patient safety
Organizational learning 1.563 3 0.668 Not Significant nurses were the same among the length of experience
Management support for patient safety 2.672 3 0.445 Not Significant (years) group of the nurse respondents.
Overall perceptions of patient safety 3.421 3 0.331 Not Significant
Feedback & communication about error 6.566 3 0.087 Not Significant Perceived patient satisfaction with nursing care
Communication openness 6.269 3 0.099 Not Significant quality was the same across age group of the patient
Frequency of events reported 5.899 3 0.117 Not Significant
Teamwork across units 4.247 3 0.236 Not Significant respondents. Perceived patient satisfaction with nursing
Staffing level 3.018 3 0.389 Not Significant
Handoffs & transitions 5.477 3 0.140 Not Significant
care quality was the same in both male and female
Nonpunitive response 1.200 3 0.753 Not Significant patient respondents. Perceived patient satisfaction with
nursing care quality was the same across educational
Kruskal-Wallis test revealed that perceived patient level of the patient respondents.
safety culture of nurses were the same among the
length of experience (years) group of the nurse Originality Index: 92 %
respondents. Similarity Index: 8%
Paper ID: 901748534
Table 8 Grammar: Checked
Test for the Difference in the Patient Satisfaction to Nursing Care Quality
according to the Patient Respondents’ Profile.
Patient Profile p Interpretation
REFERENCES
Age 0.178 Not Significant
Gender 0.708 Not Significant Arcenal, L. (2015). South general hospital employees’ level of safety
Educational Attainment 0.566 Not Significant
culture and work attitude: proposed program design for
Frequency of Admission 0.572 Not Significant
organizational setting enhancement towards patient safety.
Graduate School Journal: Cebu Doctors' University, 33.
A p value of 0.178 indicated there was no significant Blegen, M. (2006). Patient safety in hospital acute care units. Annual
difference in patient satisfaction across age groups. Review of Nursing Research, 24, 103-125
Cannon-Bowers, J., Tannenbaum, S., Salas, E., & Volpe, C. (1995).
Results showed that older patients had more or less the Defining competencies and establishing team training
same satisfaction rating to nursing care quality with the requirements. In R. Guzzo, & E. Salas (Eds.). Team effectiveness
young and middle aged patients. and decision making in organizations (pp. 333–80). San
Francisco: Jossey-Bass.
A p value of 0.708 indicated that there was no Edmondson, A. (1999). Psychological safety and learning behavior in
significant difference in patient satisfaction between work teams. Administrative Science Quarterly, 44(2), 350-383.
Famolaro, T., Yount, N., Willow, B., Elizabeth, F., Liu, H., &Sorra, J.
male and female patients.
(2016). Hospital survey on patient safety culture: 2016 user
A p value of 0.566 indicated that there was no comparative database report. Retrieved October 16, 2015, from
significant difference in patient satisfaction across https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/qu
ality-patient
educational attainment. Kruskal-Wallis test revealed that
safety/patientsafetyculture/hospital/2016/2016_hospitalsops_repo
perceived patient satisfaction was the same across rt_pt1.pdf
educational level of the patient respondents. Farley, D., Haviland, A., Champagne, S., Jain, A., Battles, J., Munier,
W., & Loeb, J. (2008). Adverse-event-reporting practices by US
A p value of 0.572 indicated that there was no Hospitals: Results of a national survey. Quality and Safety in
significant difference in patient satisfaction across Health Care, 17(6),416-423. doi: 10/1136/qshc.2007.024638
frequencies of admission. Kruskal-Wallis test revealed Fitzpatrick, R. (1991). Surveys of patient satisfaction: Important
general consideration.British Medical General, 302(6781).
that perceived patient satisfaction was the same across Retrieved July 20, 2016, from
frequencies of admission of the patient respondents. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1669267/

UVJOR2016 Volume 10 Issue 1

 Pepito, J. A. 47

Force, M., Deering, L., & Hubbe, J. (2006). Effective strategies to Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor:
increase reporting of medication errors in hospitals. Journal of The critical importance of effective teamwork and communication
Nursing Academy, 36(1), 34–41 in providing safe care. Quality Safety Health Care, 13(Suppl 1),
Gandhi, T. (2005). Fumbled handoffs: One dropped ball after another. 85-90.doi: 10.1136/qshc.2004.010033
Annals of Internal Medicine, 142(5), 352–358 Mardon, R., Khanna, K., Sorra, J., Dyer, N., & Famolaro, T. (2010).
Hart, P. (2003). Patient to nurse staffing ratios: Perspectives from Exploring relationships between hospital patient safety culture
hospital nurses. Retrieved July 3, 2016, from and adverse events. Journal of Patient Safety,6(4), 226-32. doi:
http://www.protectmasspatients.org/docs/HartStaffingReport2003 10.1097/PTS.0b013e3181fd1a00
.pdf. Marx, D. (2001). Patient safety and the “just culture”: A primer for
Heidari, S., Nayeri, N. D., Ravari, A., & Sabzevari, S. (2016). How health care executives. Retrieved July 15, 2016, from
organizational learning is associated with patient rights: A https://nursing2015.files.wordpress.com/2010/02/mers.pdf
qualitative content analysis. Global Health Action, 9. doi: Parand, A., Dopson, S., Renz, A., & Vincent, C. (2014). The role of
10.3402/gha.v9.30939. hospital managers in quality and patient safety: A systematic
Hellings, J., Schrooten, W., Klazinga, N., & Vleugels, A. (2007 ). review. BMJ Open, (4). doi:10.1136/bmjopen-2014-005-055.
Challenging patient safety culture: Survey results. International Petersen, L. A., Brennan, T. A., O’Neil, A. C., Cook, E. F., & Lee, T.
Journal of Health Care Quality Assurance,20(7), 620-632. doi: H. (1994). Does housestaff discontinuity of care increase the risk
10.1108/09526860710822752 for preventable adverse events? Annals of Internal Medicine,
Hickam, D., Severance, S., Feldstien, A., Ray, L., & Gorman, P. 121(11), 866–872
(2003). The effect of healthcare working conditions on patient Salas, E. & Cannon-Bowers, J. (2001). The science of training: A
safety. Retrieved July 29, 2016, from decade of progress. Annual Review of Psychology, 52(1), 471-99
https://www.ncbi.nlm.nih.gov/pubmed/12723164. Stefanini, C. (2003). H. 1282 safe staffing levels and quality care: A
Hofmann, D., Morgeson, F., & Gerras, S. (2003). Climate as a critical combination whose time has come. Massachusetts Nurse,
moderator of the relationship between LMX and content-specific 74(2), 4.
citizenship behavior: Safety climate as an exemplar. Journal of Wolosin, R. J. (2008, June). Safety and satisfaction: Where are the
Applied Psychology, 88(1), 170–178. doi: 10.1037/0021- connections?.Patient Safety and Quality Healthcare. Retrieved
9010.88.1.170 February 3, 2016, from
Hupcey, J. (2000). Feeling safe: Psychosocial needs of ICU patients. http://www.psqh.com/mayjun08/satisfaction.html
Journal of Nursing Scholarship, 32(4), 36-367 World Health Organization. (2000). The World Health report 2000:
Institute of Medicine. (2001). Crossing the quality chasm: A new Health systems: improving performance. Retrieved August 28,
health system for the 21st century. Retrieved August 1, 2016, 2016, from http://www.who.int/whr/2000/en/whr00_en.pdf
from https://www.ncbi.nlm.nih.gov/pubmed/25057539 World Health Organization. (2015). Regional Strategy for patient
Jones, K., Skinner, A., Xu, L., Sun, J. & Mueller, K. (2008). The safety in the WHO Southeast Asia region (2016-2025). Retrieved
AHRQ hospital survey on patient safety culture: A tool to plan August 4, 2016, from
and evaluate patient safety programs. Retrieved October 15, http://www.searo.who.int/entity/patientsafety/en/
2015, from http://www.ncbi.nlm.nih.gov/books/NBK43699/ Wu, T. C., Chen, C. H., & Li, C. C. (2008). A correlation among
Karsh, B., Escoto, K., Beasley, J., & Holden, R. (2006). Toward a safety leadership, safety climate and safety performance. Journal
theoretical approach to medical error reporting system research of Loss Prevention in the Process Industries, 21(3), 307-318.
and design. Applied Ergon, 37(3), 283-95 Retrieved September 20, 2016, from
Kozlowski, S., & Doherty, M. (1989). Integration of climate and http://www.sciencedirect.com/science/article/pii/S095042300700
leadership: Examination of a neglected issue. Journal of Applied 1362
Psychology,74(4), 546–553.
Laschinger, H., Hall, L., Pedersen, C., & Almost, J. (2005). A
psychometric analysis of the patient satisfaction with nursing care
quality questionnaire: An actionable approach to measuring
patient satisfaction. Journal of Nursing Care Quality, 20(3),220-
230

University of the Visayas Journal of Research

48 Pepito, J. A.

AUTHOR
Joseph Andrew T. Pepito, RN, MAN was born in Cebu City on June 21, 1991. Obtained his Bachelor of
Science in Nursing degree in 2012 and his Masters of Arts in Nursing: major in Medical-Surgical Nursing in
2017 from Cebu Doctors’ University in #1 P.V. Larrazabal Avenue Mandaue City, Cebu, Philippines.
He is currently the Training and Data Management Manager of the Center for Research and Development of the
University of the Visayas located in Dionisio Jakosalem St., Cebu City, Cebu. His research interest is in nursing
specifically in the field of gerontology.
Mr. Joseph Andrew T. Pepito is the senior executive officer of Beta Nu Delta Nursing Society and the Nursing
PRO of the Cebu Doctors’ University Alumni Association.

UVJOR2016 Volume 10 Issue 1