The purpose of this study was to assess the knowledge, influence, and attitudes of medical caregivers toward patient safety and how they are related to each other, in order to have an advanced basis on which to improve their knowledge and attitudes toward that topic. Only a few studies were found from previous literature connected to medical caregivers’ knowledge regarding patient safety. More research has been conducted regarding medical caregivers’ safety attitudes but none on their specific influence. Most of the other studies assessed composites of prevailing patient safety culture [2, 5] or the frequency and nature of adverse events in hospitals . Thus, there exists a gap in the available information as to how knowledge and attitudes regarding patient safety are connected.
“Patient safety” is a relatively new field in Egypt. In a study assessing the perceptions of patient safety culture among health-care workers in Beni-Suef University hospital, it was found that healthcare workers had low perceptions about patient safety culture. Only two dimensions showed positivity above 50%. The highest dimension was “Teamwork within units” (57.4%) while the lowest positive mean score dimension was “Frequency of events reporting” (23.2%). That study recommended that patient safety needs to be incorporated into the education of health professionals . The questionnaire used was adopted from the one designed for evaluation of the implementation of the WHO Patient safety curriculum for medical schools .
In this study, the mean age of the participants was about 28 years. They were particularly a young group of medical caregivers with about 40% of them graduated within the last 5 years, while in a study conducted in Alexandria university participants were in their mid-thirties . The median years since fellowship completion was 13 years in a study by Berman et al. , which was an online survey, conducted on 353 surgeons addressing knowledge, attitudes, and perceptions surrounding the culture of patient safety. In a systematic review conducted by Brasaite et al., most of the health care professionals had many years of work experience (mean = 23.9 years) and their mean age was 46.7 years .
The current study included a multidisciplinary, relatively junior group of physicians, not like that by Berman et al. , but to some extent like that conducted in Alexandria University . Only 20.3% of current study participants took courses in patient safety much less than those in Brasaite et al. where (54.4%) had received information during their continuing education about patient safety .
On a 5-point Likert scale, knowledge of these study participants which mainly centralized around error reporting was high in less than 40% of participants. In Berman et al. , Likert scale was dichotomized, and 60% of the participants stated that adverse event reporting improves patient safety, focusing on systems rather than individual accountability. In a study done on graduated medical students in Saudi Arabia, 42% of the participants rated their knowledge as good regarding the factors influencing patient safety, 37.3% regarding the different types of medical errors, and 28% regarding what should happen if an error is made . That study stated that a study in UK concluded that medical students had little knowledge of how to report errors and also another multi-institutional survey demonstrated that knowledge levels are limited across different medical degrees and specialties. Also, findings of the study conducted by Brasaite et al. in three multi-disciplinary hospitals in Western Lithuania showed that health care professionals had low levels of safety knowledge  were in accordance with Oliveira et al.’s study conducted in a public university of Paraná, Brazil who stated that knowledge of patient safety among multi-professional residents was borderline satisfactory . In a study conducted in Iran, 73% of students had negative opinions about “medical error reporting” . On the other hand, in another study conducted in Italy, an unexpected high percentage of physicians (78.5%) believe that hospitals reporting medical errors voluntarily to a state agency reduces the number of medical errors .
Current study participants reported that their higher influence to improve patient safety was through talking about their own errors and filling in report forms. The majority in Almaramhy et al. study agreed to support those who make unintentional errors (76.0%) and 80.7% agreed not to blame their peers for their mistakes. In that study, participants did not recognize their active role in solving patient safety problems; however, they were willing to change practice to improve patient safety . On the other hand, the surgeons in Berman et al.’s study declared that “The doctor bears ultimate responsibility for his/her patient's safety” .
Attaining high attitude toward patient safety among three quarters of current study participants is a positive finding—a higher percent than that reported by Almaramhy et al., around 50% . This also goes in accordance with Brasaite et al.’s study which found that in general health care professionals had positive attitudes to patient safety . Similarly, higher positive attitudes were reported in Flotta et al. in Italy ranging from 87 to 98% on different items among the participants . As a related topic, Nabilou et al. stated that the respondents’ attitudes toward patient safety education were positive . In the other studies, despite positive safety attitudes being reported, there are variations in how medical caregivers evaluated their attitudes in different dimensions regarding patient safety.
Higher positive attitude than gained knowledge toward patient safety pinpointed in this study is a common finding throughout related studies [12, 15, 17, 19]. Strikingly, there was not any correlation between knowledge and attitudes of participants in the current study. While in Brasaite et al., safety knowledge had significant positive low and medium correlations with attitudes .
In this study, the only association was between taking previous training courses in patient safety and caregivers’ perceived influence on patient safety. This goes in accordance with Berman et al. who did not find association between years since completion of fellowship and likelihood of feeling engaged in safety initiatives . In the study conducted in Alexandria University , there was no statistically significant difference between perceptions of the participants in different work settings but their perceptions about patient safety decreased as their years of experience increased which is consistent with Brasaite et al. where participants who did not receive information about patient safety during their vocational and continuing education had a worse safety knowledge, and a positive correlation was found with the length of their work experience . Flotta et al. concluded that the number of years elapsed since graduation was the only variable associated with the knowledge of evidence-based patient safety practices . Moreover, a positive attitude was significantly predicted by a lower number of years elapsed since graduation. The relationships between students’ attitudes to patient safety and years of study, sex, and course were significant in Nabilou et al.’s study . One last point is that, although responses were self-reported in an anonymous and confidential setting, yet we must take into consideration that using self-administered questionnaires may predispose participants to over- or under-report their attitudes. So, we may consider an even worst scenario than that depicted by the medical caregivers.
The WHO (2009) stated that one of the examples where further research is needed to reduce patient harm is poor knowledge . Although the current study did not find a direct positive association between studied participants’ knowledge attitudes toward patient safety, other research suggests that medical care providers’ ability to deal with adverse events depends on their opportunities for learning. Attitudes related to patient safety issues were seen as positive among medical caregivers. It thus opens the door for open discussion of how to further develop their knowledge, discussing medical errors with colleagues, and reporting errors to supervisor followed by constructive feedback are ultimately important.
Limitations of study
This study had some limitations including being a cross-sectional study that relied on self-reported knowledge, attitude, and influence; this is subject to reporting bias. Moreover, purposive sampling technique might hinder generalizability of results.