Improving Patient Safety Culture in Conflict-Affected Zones: A Cross-Sectional Survey of North Kivu Surgical Personnel in the Democratic Republic of the Congo.
| Title: | Improving Patient Safety Culture in Conflict-Affected Zones: A Cross-Sectional Survey of North Kivu Surgical Personnel in the Democratic Republic of the Congo. |
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| Authors: | Bake JF; General Surgery Department, University of Goma, Goma, Democratic Republic of the Congo.; Masumbuko CK; General Surgery Department, Catholic University of Graben, Butembo, Democratic Republic of the Congo.; Kibendelwa ZT; Internal Medicine Department, University of Kisangani, Kisangani, Democratic Republic of the Congo.; Lubuto GB; General Surgery Department, General Referral Hospital of Walikale, Walikale, Democratic Republic of the Congo.; Kyembwa JM; Pediatrics Department, Provincial Hospital of North-Kivu, Goma, Democratic Republic of the Congo.; Nzala EK; General Surgery Department, General Referral Hospital of OICHA, Beni, Democratic Republic of the Congo.; Kakule PW; General Surgery Department, General Referral Hospital of Musienene, Lubero, Democratic Republic of the Congo.; Akumbi CB; Anesthesiology Department, General Referral Hospital Charité Maternelle, Goma, Democratic Republic of the Congo.; Kitutu JZ; Anesthesiology Department, General Referral Hospital Charité Maternelle, Goma, Democratic Republic of the Congo.; Wakilongo TB; General Surgery Department, General Referral Hospital of Nyiragongo, Nyiragongo, Democratic Republic of the Congo.; Hangi TK; General Surgery Department, General Referral Hospital of Masisi, Masisi, Democratic Republic of the Congo.; Kwiraviwe WK; General Surgery Department, General Referral Hospital of Bethesda, Goma, Democratic Republic of the Congo.; Musemakweli B; General Surgery Department, General Referral Hospital of Rutshuru, Rutshuru, Democratic Republic of the Congo.; Bahati BT; Obstetrics and Gynecology Department, General Referral Hospital of Virunga, Goma, Democratic Republic of the Congo.; Bakabona SK; Obstetrics and Gynecology Department, General Referral Hospital of Virunga, Goma, Democratic Republic of the Congo.; Poenaru D; Pediatric Surgery Department, McGill University, Montreal, Canada. |
| Source: | World journal of surgery [World J Surg] 2025 May; Vol. 49 (5), pp. 1269-1279. Date of Electronic Publication: 2025 Feb 07. |
| Publication Type: | Journal Article; Multicenter Study |
| Language: | English |
| Journal Info: | Publisher: Wiley Country of Publication: United States NLM ID: 7704052 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2323 (Electronic) Linking ISSN: 03642313 NLM ISO Abbreviation: World J Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2024- : [Hoboken, NJ] : Wiley; Original Publication: New York, Springer International. |
| MeSH Terms: | Patient Safety*/standards ; Operating Rooms*/organization & administration ; Organizational Culture* ; Safety Management*; Humans ; Cross-Sectional Studies ; Democratic Republic of the Congo ; Male ; Female ; Adult ; Surveys and Questionnaires ; Middle Aged |
| Abstract: | Background: Patient safety culture significantly impacts outcomes in surgery, where preventable errors can occur. This study assessed patient safety culture and its determinants in operating rooms across North Kivu, a conflict-affected province in the eastern Democratic Republic of the Congo (DRC).; Methods: A descriptive multicenter cross-sectional study was conducted from July to September 2024 in five urban and six rural hospitals. The French version of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was administered to 328 operating room healthcare professionals.; Results: The response rate was 78% (256 completed surveys). Urban hospitals accounted for 55.5% of respondents, who were 73.4% male and 62.5% under the age of 40. The overall composite score for patient safety culture was 63.2%. Teamwork (81.1%) and management support for patient safety (77.7%) received the highest positive responses, whereas error reporting (39.9%) and patient safety event reporting (50%) scored lower. Half (49.6%) of the respondents rated patient safety as excellent or very good. There were no significant differences in overall mean composite scores between urban and rural hospitals (p = 0.677) and between medical and paramedical staff (p = 0.694).; Conclusions: The patient safety culture rating in North Kivu falls below international standards, highlighting an urgent need for improvement, particularly in error response and event reporting. Developing a tailored patient safety bundle for the region is essential to enhance overall health outcomes.; (© 2025 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).) |
| Comments: | Comment in: World J Surg. 2025 May;49(5):1280-1281. doi: 10.1002/wjs.12561.. (PMID: 40193206) |
| References: | V. F. Nieva and J. Sorra, “Safety Culture Assessment: A Tool for Improving Patient Safety in Healthcare Organizations,” Quality and Safety in Health Care 12, no. Suppl. 2 (2003): 17–24.; R. K. Shah and S. A. Godambe, “Patient Safety and Quality Improvement in Healthcare: A Case‐Based Approach,” Patient Safety and Quality Improvement in Healthcare: A Case‐Based Approach (2020): 1–383.; A. Azyabi, W. Karwowski, and M. R. Davahli, “Assessing Patient Safety Culture in Hospital Settings,” International Journal of Environmental Research and Public Health 18, no. 5 (2021): 1–36, https://doi.org/10.3390/ijerph18052466.; L. T. Kohn, J. M. Corrigan, and S. Molla, “To Err Is Human Building a Safer Health System,” Regulatory Toxicology and Pharmacology 52 (2008).; A. Lee, A. Finstad, B. Tipney, et al., “Exploring Human Factors in the Operating Room: Scoping Review of Training Offerings for Healthcare Professionals,” BJS Open 6, no. 2 (2022), https://doi.org/10.1093/bjsopen/zrac011.; T. L. Rodziewicz and J. E. Hipskind, Medical Error Reduction and Prevention ‐ StatPearls. [Internet] (Treasure Island, FL: StatPearls Publishing, 2024), 1–25. https://www.ncbi.nlm.nih.gov/books/NBK499956/.; G. Mathys, “Bringing History Back In: Past, Present, and Conflict in Rwanda and the Eastern Democratic Republic of Congo,” Journal of African History 58, no. 3 (2017): 465–487, https://doi.org/10.1017/s0021853717000391.; World Health Organization. Global Patient Safety Report 2024. [Internet] (Geneva: World Health Organization, 2024). https://www.who.int/publications/i/item/9789240095458.; Agency for Healthcare Research and Quality. Hospital Survey on Patient Safety Culture Version 2.0 User’s Guide (Rockville, MD: AHRQ Publication, 2019), 41. https://www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hospitalsurvey2‐users‐guide.pdf.; J. Sorra, L. Gray, S. Streagle, T. Famolaro, N. Yount, and J. Behm, “Hospital Survey on Patient Safety Culture: User’s Guide,” Agency of Healthcare Research in Quality, [Internet] (2018): 1–50, www.ahrq.gov.; H. H. Alrahbi, S. K. Al‐Toqi, S. Sony, and N. Al‐Abri, “Assessment of Patient Safety Culture Among Healthcare Providers,” Global Journal of Health Science 13, no. 2 (2020): 59, https://doi.org/10.5539/gjhs.v13n2p59.; M. Smits, C. Wagner, P. Spreeuwenberg, G. Van Der Wal, and P. P. Groenewegen, “Measuring Patient Safety Culture: An Assessment of the Clustering of Responses at Unit Level and Hospital Level,” Quality and Safety in Health Care 18, no. 4 (2009): 292–296, https://doi.org/10.1136/qshc.2007.025965.; J. Hiromi, H. Okuyama, T. F. Galvao, and M. T. Silva, “Healthcare Professional’s Perception of Patient Safety Measured by the Hospital Survey on Patient Safety Culture: A Systematic Review and Meta‐Analysis,” Scientific World Journal (2018): 2018.; Mv Rao, D. Thota, and P. Srinivas, “A Study to Assess Patient Safety Culture Amongst a Category of Hospital Staff of a Teaching Hospital,” IOSR Journal of Dental and Medical Science 13, no. 3 (2014): 16–22, https://doi.org/10.9790/0853‐13341622.; A. D. G. Nwosu, E. Ossai, F. Ahaotu, O. Onwuasoigwe, A. Amucheazi, and I. Akhideno, “Patient Safety Culture in the Operating Room: A Cross‐Sectional Study Using the Hospital Survey on Patient Safety Culture (HSOPSC) Instrument,” BMC Health Services Research 22, no. 1 (2022): 1–13, https://doi.org/10.1186/s12913‐022‐08756‐y.; T. Yayehrad, Y. Getachew, and W. Muluken, “Patient Safety Culture and Associated Factors of Regional Public Hospitals in Addis Ababa,” BMC Health Services Research 24, no. 1 (2024): 1–9, https://doi.org/10.1186/s12913‐024‐11262‐y.; P. Occelli, J. L. Quenon, M. Kret, et al., “Validation of the French Version of the Hospital Survey on Patient Safety Culture Questionnaire,” International Journal for Quality in Health Care 25, no. 4 (2013): 459–468, https://doi.org/10.1093/intqhc/mzt047.; B. Boussat, P. François, G. Gandon, et al., “Inconsistencies Between Two Cross‐Cultural Adaptations of the Hospital Survey on Patient Safety Culture Into French,” Journal of Patient Safety 17, no. 8 (2021): E1186–E1193, https://doi.org/10.1097/pts.0000000000000443.; J. Giai, B. Boussat, P. Occelli, et al., “Hospital Survey on Patient Safety Culture (HSOPS): Variability of Scoring Strategies,” International Journal for Quality in Health Care 29, no. 5 (2017): 685–692, https://doi.org/10.1093/intqhc/mzx086.; Y. SMF Jugessur, “Reliability and Internal Consistency of Data: Significance of Calculating Cronbach’s Alpha Coefficient in Educational Research,” International Journal of Humanities and Social Science Invention, [Internet] 11, no. 4 (2022): 9–14, www.ijhssi.org.; F. Emel, “Safety Culture Among Operating Room Healthcare Workers: Still a Long Way to Go. An Analytical Cross‐Sectional Study From Turkey,” (2023): 1–14, https://revistas.udes.edu.co/cuidarte/article/view/2872.; J. V. Dis, “Where We Live: Health Care in Rural vs Urban America the Effects of Socioeconomic Status on Health in Rural and Urban America,” 287, no. 1 (2016).; S. L. Makali, J. C. Lembebu, R. Boroto, et al., “Violence Against Health Care Workers in a Crisis Context: A Mixed Cross‐Sectional Study in Eastern Democratic Republic of Congo,” Conflict and Health 17, no. 1 (2023): 1–11, https://doi.org/10.1186/s13031‐023‐00541‐w.; C. R. Mushagalusa, D. G. Mayeri, B. Kasongo, et al., “Human Resources for Health Profile of Health Care Workers in a Context of Instability: A Cross ‐ Sectional Study of Four Rural Health Zones in Eastern DR Congo (Lessons Learned),” Human Resources for Health (2023): 1–15: [Internet], https://doi.org/10.1186/s12960‐023‐00816‐6.; The Safeguarding Health in Conflict Coalition. Critical Condition: Violence against Health Care in Conflict (Baltimore, MD: Safeguarding Health in Conflict Coalition, 2023). https://insecurityinsight.org/wp‐content/uploads/2024/05/2023‐SHCC‐DRC.pdf.; C. Altare, E. B. Malembaka, M. Tosha, et al., “Health Services for Women, Children and Adolescents in Conflict Affected Settings: Experience From North and South Kivu, Democratic Republic of Congo,” Conflict and Health 14 (2020): 1–19, https://doi.org/10.1186/s13031‐020‐00265‐1.; C. Altare, V. Castelgrande, M. Tosha, E. B. Malembaka, and P. Spiegel, “From Insecurity to Health Service Delivery: Pathways and System Response Strategies in the Eastern Democratic Republic of the Congo,” Global Health Science and Practice 9, no. 4 (2021): 915–927, https://doi.org/10.9745/ghsp‐d‐21‐00107.; U. Haque, M. H. Bukhari, N. Fiedler, et al., “A Comparison of Ukrainian Hospital Services and Functions Before and During the Russia‐Ukraine War,” JAMA Health Forum 5, no. 5 (2024): 1–12, https://doi.org/10.1001/jamahealthforum.2024.0901.; K. D. Konlan and J. Shin, “The Status and the Factors That Influence Patient Safety in Health Care Institutions in Africa: A Systematic Review,” PLOS Global Public Health, [Internet] 2, no. 12 (2022): e0001085, https://doi.org/10.1371/journal.pgph.0001085.; F. Labat and A. Sharma, “Qualitative Study Exploring Surgical Team Members’ Perception of Patient Safety in Conflict‐Ridden Eastern Democratic Republic of Congo,” BMJ Open 6, no. 4 (2016): 1–10, https://doi.org/10.1136/bmjopen‐2015‐009379.; W. Aouicha, M. A. Tlili, J. Sahli, et al., “Patient Safety Culture as Perceived by Operating Room Professionals: A Mixed‐Methods Study,” BMC Health Services Research, [Internet] 22, no. 1 (2022): 1–12, https://doi.org/10.1186/s12913‐022‐08175‐z.; A. S. Haugen, E. Søfteland, G. E. Eide, M. W. Nortvedt, K. Aase, and S. Harthug, “Patient Safety in Surgical Environments: Cross‐ Countries Comparison of Psychometric Properties and Results of the Norwegian Version of the Hospital Survey on Patient Safety,” BMC Health Services Research 10 (2010): 1–10, https://doi.org/10.1186/1472‐6963‐10‐279.; M. Mallouli, M. A. Tlili, W. Aouicha, et al., “Assessing Patient Safety Culture in Tunisian Operating Rooms: A Multicenter Study,” International Journal for Quality in Health Care (2017): 1–7.; World Health Organization. Patient Safety Incident Reporting and Learning Systems: Technical Report and Guidance (Geneva: World Health Organization, 2020). https://iris.who.int/bitstream/handle/10665/334323/9789240010338‐eng.pdf.; S. A. Pasinringi, N. B. Noor, A. F. A, A. Silviyah, and N. A. A, “Patient Safety Culture Across Hospital in South Sulawesi Province, Indonesia: Comparing Between Urban,” Sub Urban and Rural Areas 5, no. 5 (2015): 1–4.; M. P. T. Pimentel, S. Choi, K. Fiumara, A. Kachalia, and R. D. Urman, “Safety Culture in the Operating Room: Variability Among Perioperative Healthcare Workers,” Journal of Patient Safety 17, no. 6 (2021): 412–416, https://doi.org/10.1097/pts.0000000000000385.; R. Hare, A. Tapia, E. R. Tyler, et al., Surveys on Patient Safety CultureTM (SOPS®) Hospital Survey 2.0: 2022 User Database Report: (Prepared by Westat, Rockville, MD, Under Contract No. HHSP233201500026I/HHSP23337004T [Internet], Rockville, MD: Agency for Healthcare Research and Quality, 2022). AHRQ Publication No. 22(23)‐0066. https://www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/2022‐hsops2‐database‐report‐appendixes.pdf.; S. Radhakrishna, “Culture of Blame in the National Health Service; Consequences and Solutions,” British Journal of Anaesthesia, [Internet] 115, no. 5 (2015): 653–655, https://doi.org/10.1093/bja/aev152.; P. S. Network 2019. “Measuring and Achieving a Culture of Safety,” https://psnet.ahrq.gov/primer/culture‐safety#.; World Health Organization. Implementation Manual WHO Surgical Safety Checklist 2009 (Geneva: World Health Organization, 2009). https://www.who.int/publications/i/item/9789241598590.; A. B. Haynes, T. G. Weiser, W. R. Berry, et al., “A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population,” New England Journal of Medicine 360, no. 5 (2009): 491–499, https://doi.org/10.1056/nejmsa0810119.; A. S. Haugen, E. Søfteland, S. K. Almeland, et al., “Effect of the World Health Organization Checklist on Patient Outcomes,” Annals of Surgery 261, no. 5 (2015): 821–828, https://doi.org/10.1097/sla.0000000000000716.; T. G. Weiser and A. B. Haynes, “Ten Years of the Surgical Safety Checklist,” British Journal of Surgery 105, no. 8 (2018): 927–929, https://doi.org/10.1002/bjs.10907.; M. C. White, K. Randall, V. A. Ravelojaona, et al., “Sustainability of Using the WHO Surgical Safety Checklist: A Mixed‐ Methods Longitudinal Evaluation Following a Nationwide Blended Educational Implementation Strategy in Madagascar,” BMJ Global Health 3, no. 6 (2018): 1–10, https://doi.org/10.1136/bmjgh‐2018‐001104.; King’s Global Health Partnership. “Safe Surgery Saves Lives in the Democratic Republic of the Congo,” (2021): 1–5, https://www.thet.org/safe‐surgery‐saves‐lives‐in‐the‐democratic‐republic‐of‐the‐congo/. |
| Contributed Indexing: | Keywords: Democratic Republic of the Congo; conflict‐affected region; operating rooms; patient safety culture |
| Entry Date(s): | Date Created: 20250208 Date Completed: 20250508 Latest Revision: 20250520 |
| Update Code: | 20260130 |
| DOI: | 10.1002/wjs.12497 |
| PMID: | 39921361 |
| Database: | MEDLINE |
Journal Article; Multicenter Study