Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

Abstract

The main aim of this work is to investigate the impact of effective communication on patient safety on the Primary Healthcare Centers (PHC) in Jeddah province. To achieve this objective study adopted the descriptive analytical approach. The data needed to achieve this objective is obtained by distribution a survey questionnaire to the sample of the study represented by healthcare providers working in these centers. After survey questionnaire returned, the researcher was able to collect a round (150) valid questionnaire form. The data collected is entered and treated by using (SPSS). The results of analysis of data concluded with number of findings, the most important ones are: The study established there was a statistically significant positive relationship between the core elements of effective communication and patient safety. In particularly the study revealed that patient safety had a significant high positive correlation with the two-core element of effective communication (cultural difference, and sharing decision making) at the significant level (0.01), whereas, the other result proved that there is a significant association between patient safety and empathy and establish relationship at the significant level (0.05). Based on the findings of this study, the recommendation made from those results are the following: In order to the required patient safety in Primary Healthcare centers in Jeddah province, effective communication practicing should be given valued importance, to make more improvement in patient safety in Primary Healthcare Centers in Jeddah province, the PHC management should sustain and give more importance to cultural difference and sharing decision making, It was very important for PHC, management to improve the practicing empathy and establish relations as ones of the most important elements of effective communication. That can be reached through planning for comprehensive training programs in work for all staff, and finally it was very important of PHC, management to study the status of information gathering as one of the core elements of effective communication as the analysis of multiple regression confirmed that gathering of information has no significant effect on patient safety. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

تأثير التواصل الفعال على سلامة المرضى في مراكز الرعاية الصحية

بمحافظة جدة في المملكة العربية السعودية دراسة تحليلية

امال الصومالي

المستخلص

الهدف الرئيسي من هذه الدراسة هو دراسة تأثير التواصل الفعال على سلامة المرضى في مراكز الرعاية الصحية الأولية في محافظة جدة. ولتحقيق هذه الدراسة الموضوعية اعتمدنا المنهج الوصفي التحليلي. ويتم الحصول على البيانات اللازمة لتحقيق هذا الهدف من خلال توزيع استبيان وعينة الدراسة ممثلة من قبل مقدمي الرعاية الصحية العاملين في هذه المراكز. وبعد الانتهاء من الاستبيان، تمكن الباحث من جمع (150) استبانة صالحة. وتم إدخال البيانات ومعالجتها باستخدام (SPSS). وعند تحليل نتائج البيانات توصلت الدراسة إلى: وجود ارتباط إحصائي هام وإيجابي بين العناصر الأساسية للاتصال الفعال وسلامة المرضى. وقد أظهرت الدراسة بشكل خاص وجود علاقة ارتباط معنوي وإيجابي للغاية بين سلامة المرضى والعنصرين الأساسيين في التواصل الفعال (الاختلاف الثقافي وتقاسم اتخاذ القرار) عند مستوى معنوي (0.01)، في حين أثبتت النتيجة الأخرى أن هناك ارتباط كبير بين سلامة المرضى والتعاطف وإقامة علاقة عند مستوى معنوي (0.05). وبناء على النتائج التي توصلت إليها هذه الدراسة، نجد أن التوصيات على النحو التالي: من أجل ضمان سلامة المرضى المطلوبة في مراكز الرعاية الصحية الأولية في محافظة جدة، ينبغي إعطاء أهمية فعالة لممارسة التواصل، من أجل زيادة تحسين سلامة المرضى في مراكز الرعاية الصحية الأولية في محافظة جدة، يجب على إدارة الرعاية الصحية الأولية الحفاظ على الاختلاف الثقافي ومشاركة القرار وتمكين أهمية كبيرة لهما، ومن المهم ايضاَ على إدارة الرعاية الصحية الأولية تحسين الممارسة في التعاطف مع المرضى والعلاقات بين المرضى والكادر الصحي باعتبارهما من أهم عناصر الاتصال الفعال. ويمكن الوصول إلى ذلك من خلال التخطيط لبرامج التدريب الشاملة في العمل لجميع الموظفين، وأخيرا كان على إدارة الرعاية الصحية الأولية، دراسة حالة جمع المعلومات باعتبارها واحدة من العناصر الأساسية للاتصال الفعال كما أكد تحليل الانحدار المتعدد أن جمع المعلومات ليس له تأثير كبير على سلامة المرضى.

Table of Contents

Dedication………………………………………………………………………………………………………………………. II

Acknowledgement………………………………………………………………………………………………………….. III

Abstract………………………………………………………………………………………………………………………… IV

Chapter one: Introduction………………………………………………………………………………………………….. 2

1.1 Background of the study…………………………………………………………………………………….. 2

1.2 Research Problem……………………………………………………………………………………………… 4

1.3 Research Gap…………………………………………………………………………………………………… 4

1.4 Rationale of the Research………………………………………………………………………………….. 4

1.5 Research Objectives………………………………………………………………………………………….. 5

1.6 Research Model and Dimensions…………………………………………………………………………. 5

1.7 Research Hypothesis…………………………………………………………………………………………. 5

1.8 Research Methodology………………………………………………………………………………………. 6

1.9 Research Scope…………………………………………………………………………………………………. 6

1.10 Research Structure………………………………………………………………………………………….. 6

Chapter Two: Literature Review and Previous Studies…………………………………………………………… 8

2.1 Introduction……………………………………………………………………………………………………… 8

2.2 Literature Review……………………………………………………………………………………………… 8

2.2.1 Communication and patient safety…………………………………………………………… 8

2.2.2 Establish relationship……………………………………………………………………………. 11

2.2.3 Empathy……………………………………………………………………………………………… 12

2.2.4 Gathering information………………………………………………………………………….. 12

2.2.5 Shared decision making…………………………………………………………………………. 13

2.2.6 Cultural differences………………………………………………………………………………. 14

2.2.7 Patient safety management……………………………………………………………………. 15

2.2.8 Management of patient safety in Saudi Arabia………………………………………… 16

2.2.9 Essential safety standards requirements…………………………………………………. 16

2.3 Previous studies………………………………………………………………………………………. 17

3.1 Introduction……………………………………………………………………………………………………. 28

3.2 The Research Methodology:…………………………………………………………………………….. 28

3.3 The Research Approach and Design………………………………………………………………….. 28

3.4 Population and Sampling Techniques:………………………………………………………………… 28

3.5 Data Collection Tool………………………………………………………………………………………… 30

3.6 Survey Questionnaire Reliability………………………………………………………………………. 30

3.7 Survey Questionnaire Validity………………………………………………………………………….. 31

3.8 Statistical Techniques for Data Analysis…………………………………………………………….. 32

Chapter Four: Data Analysis and Interpretations………………………………………………………………….. 35

4.1 Introduction……………………………………………………………………………………………………. 35

4.2 Section One…………………………………………………………………………………………………….. 35

4.3 Section Two: The Descriptive Analysis of the Sample Response.…………………………… 37

4.4 Section Three: Examining Significant Differences Related to Demographic Characteristics. 52

4.5 Summary of Results…………………………………………………………………………………………. 55

Chapter Five: Summary, Conclusion and Recommendation………………………………………………….. 59

5.1 Summary of Results…………………………………………………………………………………………. 59

References…………………………………………………………………………………………………………………….. 63

Appendix………………………………………………………………………………………………………………………. 69

Chapter One:

Introduction

Chapter one: Introduction

1.1 Background of the study

Patients safety is at the core of health services provision and is considered as one of crucial issues in health research, having ranked as one of the significant global public health concern (Vincent, 2011; p2). The World Health Organization (WHO) has identified patient safety as one of the challenges in healthcare provision and has went ahead to set up guidelines to improve patient safety. Patient safety issues affect all countries irrespective of their economic development. The WHO (2007) has set six international safety goals to achieve patient safety. The safety goals to attain patient safety include reducing the risk of reducing nosocomial infections, improving patients identification, effective communication, improving the safety of high-alert medications, safe surgery and reducing patients falls.

Patient safety encompasses avoiding and preventing harm to the patients or injuries or any adverse resulting from the health care delivery process (Patient Safety Group, 2012). According to WHO, patient safety is described as an event or circumstance that could have resulted, or did result, in unnecessary harm to a patient. It includes harmful incidents (formerly adverse or sentinel), no harm incidents (that reach the patient but did not cause harm), and near miss (also known as close calls).

Nadzam (2009) underlines the significance of effective communication in the countless interactions that between healthcare workers in the workplace. This suggests that staff must communicate effective and enhance collaboration in healthcare teams to ensure accurate and timely delivery of information. A dearth of effective communication in health care teams may compromise patients safety and negate the health outcomes.

Public health care requires establishing and/or building community relationship in public health as a significant aspect in healthcare practice. Community relationships are important in ensuring public participation in healthcare provision. Partnering with community in the provision of healthcare enables the identification of health problems accurately as well as developing more holistic and effective solutions (Minnesota Department of health office of performance improvement, 2014).

Empathy, a constituent of cognitive, emotional and executive syndrome is an emotional reaction in social communication that perceives meaningful cues from the surrounding by which it aligns the abilities of correctly interpreting the meaning of stimuli to human emotions. It is the ability to accept another individual’s perspective. Getting insight on empathy as a dimension of social communication will assist in understanding emotions; improve social abilities and communication with significant greater sensitivity to patient’s feelings and the consequences of an individual behavior (Jemczura, 2004).

According to WHO (2012), individual health information must accompany the patient when receiving care from healthcare providers. This calls for data interoperability as a prerequisite to effective utilisation of health information. Information and communication technology (ICT) has enormous potential in delivering improvement in healthcare systems in both the developed and the developing countries through enhancement of access to patients’ health information, in essence making healthcare delivery not only effective, but efficient. ICT also improves the quality of health services while ensuring it is relatively cost-effective. For instance, tracking specific health problems and their management over time, may assist in developing optimal diagnosis and therapy that can lead to improved health outcomes.

According to Margot (2006), data gathering is a crucial nursing role that is fundamental in provision of optimum patient care. Data collected from patients can be used in the evaluation of the patient condition and planning the optimal treatment. Data collection is a first step in clinical care that enables the nurse to accurately identify symptoms and diagnosis for appropriate interventions.

Effective physician-patient communication helps in the decision-making process and is the single most significant enabler of delivery of quality care in the physician-patient dyad. It is therefore to have clear, empathetic and respectful communication that supports information exchange in the shared decision-making as well in patients’ self-management (Huy & Kristiana, 2014, p.7). According to Tereza and Fleury (1999, p.110), cultural difference is an aspect that arises from the mixture of people of different group identities within the social system. On the other hand, Mannix and Neals (2005) and Jackson, Joshi, and Erhardt (2003) have argued that cultural difference is just one of the aspect that a person uses to uncover personal differences. Cultural differences include variations in the population such as gender, age, race, culture, and physical adequacies. Other definitions of cultural differences include ethnic and nationality, social class as well as religion and ways of communication and learning.

1.2 Research Problem

The research problem revolves around investigating the impact of effective communication in healthcare clinical centers on patient safety. The current research is significant since it seeks the positive impact of effective communication on patient safety which has a direct role on collect the needed information to attend the patient professionally.

1.3 Research Gap

The need for reducing patients harm resulting from lack of patient safety in the clinical settings motivates the need for this study. There is a dearth of research on the impact of effective communication in improving patient safety in the context of Saudi Arabia. The study is relevant for various stakeholders in the healthcare sectors including health practitioners and patients. The outcome of the study seeks to contribute to the current body of knowledge on the impact of effective communication in the healthcare settings in the context of Saudi Arabia. From the recommendations of this study, suggestions will be availed on a suitable framework for improving the quality of care through effective communication.

1.4 Rationale of the Research

This research has a valuable significance to the patients, the healthcare providers and the community at large. For the community it raises the community awareness about the issue of patient safety, and the importance of effective communication between patients and healthcare providers. For healthcare providers, this research will seek to increase awareness on the importance of healthcare information as an ethical attribute of protecting patients from preventable harm in the healthcare setting. For the patient safety, this research will contribute in proposing workable recommendations that can contribute to the achievement of patient safety through provision of high-quality care.

1.5 Research Objectives

This research attempts to achieve the following objectives:

To assess the role of effective communication on patients’ safety.
To examine how the healthcare staff give high rate for the effectiveness of communication on patient safety.

1.6 Research Model and Dimensions

The research model is illustrated in the following diagram:

Independent Variable Dependent Variables

Independent Variable: effective communication includes the following:

Establish relationship
Empathy
Gathering information
Share decision making
Cultural differences

Dependent Variables: patient safety

1.7 Research Hypothesis

H1: A significant relationship exists between establish relationship and patient safety.

H2: There is a positive and significant relationship between empathy and patient safety.

H3: There is a significant relationship between gathering information and patient safety.

H4: There is a significant relationship between share decision making and patient safety.

H5: There is a significant relationship between cultural differences and patient safety.

1.8 Research Methodology

Research methodology embodies a systematical organization and completion of research to unravel a research problem. The method applied in this study is a descriptive analytical approach. The researcher defines the type of method applied, the methods of data collection, target population and an appropriate sample for the study. In addition, the methods for data collection and the research strategy as well as data analysis approach are determined. This study will include all professionals’ health care (physicians-nurses and other healthcare providers) and managerial employees working in the healthcare field. Therefore, the total population in the four healthcare centers will be 150 subjects. The research will take all number of healthcare providers in the selected four healthcare centers due to their small population.

1.9 Research Scope

Place: This study will be applied in primary health care centers in Alhamra, Bryman, Almahjar and Khalid alnamodagi healthcare centers, Jeddah province – MOH.

Time: January –February –March 2018

Subject: The Impact of Effective communication on Patient safety

1.10 Research Structure

Chapter One: Introduction

Chapter Two: Literature Review and Previous Studies

Chapter Three: Research Methodology

Chapter Four: Data Analysis and Interpretation

Chapter Five: Summary, Conclusion and Recommendation

Chapter Two:

Literature Review and Previous Studies

Chapter Two: Literature Review and Previous Studies

2.1 Introduction

Responsibility of ensuring patient safety in healthcare institutions in any given society is connected with the roles and responsibilities of various parties including nurses, physicians, and the management of the healthcare institutions, in addition to the patient family. In this regard, the accessibility and provision of flexible communication tools, is considered to have much importance, and an essential element which can effectively contribute to achievement of high-quality care for the patient.

In this chapter, patient safety, and effective communication are the major issues of the subject of the study which will be discussed in detail. The literature reviewed will cover the two concepts, patient safety, and effective communication within the frame of this chapter. Patient safety would be defined by the principles of management of patient safety, and how to assess patient safety as well as the role of nurses in patient safety. Formal aspect of communication, strategies for effective communication, in addition to barriers to effective communication.

2.2 Literature Review

The following sections present Communication and patient safety, Establish relationship, Empathy, Gathering information, Share decision making, Cultural differences, Patient safety management, Management of patient safety in Saudi Arabia and Essential safety standards requirements.

2.2.1 Communication and patient safety

Effective communication is an essential life skill that requires continuous development and improvement. Individuals with good communication skills develop empathy and trust from other easily. Good communicators are able to align their communication to align with the audience situation. Communication is a complex two-way process that is characterized by much iteration that focuses on developing mutual understanding between parties to the communication. Communication encompasses different aspects including words, facial expression, voice, pictures, tones, body languages as well as clothing and graphics (Team FME, 2013, p.4).

Communication is defined by two approaches namely the social construction approach and the information engineering approach. Social construction approach underlies the creation of a dynamic context in team communication while information engineering approach entails the linear transmission of messages via a conduit which guarantee effective communication through an accurate and unbroken transmission. In essence, information engineering results in the receiver understanding the message by decoding the messages. The information engineering framework is hindered by psychological and physical noise in the system. On the other hand, social construction framework of communication does not have a neutral conduit; rather it considers communication as a social process where meaningful common environment is constructed. The social construction approach is limited in the sense that it does not address how communication patterns generate and sustain team communication. In team communication, there is both social construction of reality and transmission that include implicit and explicit frameworks that a team develops in order to fit certain roles, goals and behavior (MPH, 2011; p2).

According to the WHO report (2009; p18) regarding the human factors in patient safety, efficiency and high-quality output in the workplace relies on effective communication. It is through good communication in the workplace that knowledge is transferred, predictable behavior patterns and relationships established as well as establishment of effective team coordination and leadership. According to the report, the standard model of communication entails the sender encoding an idea into a message, which is then transformed to one or more receivers who then decode it back to the original idea.

The report categorized communication problems as system failures, message and reception failures. Common communication failures include:

Organizational system failures where channels of communication are non-existent, rarely used or in some cases are malfunctioning.
Transmission failures, where communication channels exist, but information is not transmitted.
Reception failures occurs when communication channels exists and the information is sent, but it is misinterpreted by the recipient or there are delays such that communication is not effective. Reception failures are mostly caused by equipment failures or physiological problems.
Lastly, there is failure occasioned by interference between rational and emotional context such as communication failures due to an argument.

According to the National Health Service (NHS, 2010; p8) in the UK, national benchmarks for communication require communication needs to be assessed and appropriate methods applied to enable effective communication between the patients and carers. These national benchmarks patient to the accessibility of information, acceptable and accurate information which should be actively and consistently shared to meet the needs of the patients. Effective communication among the staff in the healthcare settings ensures that staff are able to maintain safety and quality of patient and continuity in their service for all.

Several studies have demonstrated that ineffective communication among healthcare practitioners as a leading factor in medical errors occurrence and patients harm (Woolf, 2004; Lingard, 2004, P.330; Leonard, 2004, P.68). A review of reports from the joint commission also corroborates the findings from these studies where it reveals that failures in communication being implicated in over 60 percent of sentinel events. In another study by Zwarenstein and Reeves (2002; p243), ineffective communication in medical teams is linked to adverse patients outcome associated with low safety standards and compromised error prevention mechanism. Moreover, in the acute healthcare settings failures in communication result in lengthy hospital stays and patients harm as well as increased cost of healthcare , caregiver low satisfaction that leads to high turnover in healthcare facilities.

Patient safety research developed as intellectual history of patient safety accumulated (Linda, 2008, p6). Initially there were debates on whether patients safety can be considered as a risk in healthcare delivery, a philosophy that encompasses explanatory frameworks, ethical principles as well as methods or as a discipline or an attribute with its own goals.

There are several definition of patient safety including the Institute of Medicine in the USA which defines patient safety as freedom from accidental injury, while the National Patient Safety Foundation defined patient safety as a key aspect emerging from the appropriate interaction of components of the healthcare system with a for patient safety.

According to Linda (2008; p1), patient safety is a health care discipline that utilises safety science approaches towards achieving a trustworthy system of health care delivery. Patient safety seeks to reduce the incidence of adverse events or their impacts and maximise recovery from such events. It has also been defined as the prevention, avoidance and improvement from recovery adverse events in occurring in healthcare settings (Vincent, 2011, p1). Patient safety calls for rapid intervention in case patient safety is infringed and supporting staff in erecting measures to guarantee patient safety in the healthcare settings.

2.2.2 Establish relationship

The quality of care for the patient depends on effective communication that seeks a patient-centered care based on a sound therapeutic relationship between the physician and the patient. Effective communication is a vehicle towards which healthcare is optimized through the facilitation of a therapeutic relationship. For instance, the cornerstone of the nursing practice rests on the registered nurses’ ability to build therapeutic relationships with the patients. A successful doctor-patient relationship develops under an environment of shared perceptions and knowledge regarding the disease as well as the nature of the treatment and the underlying treatment goals (Razzaghi & Afshar, 2016). Through shared knowledge settings, the patient can effectively participate in the decision-making process regarding his or her health. The importance of establishing a relationship between the patient and the physician is underpinned by the need to understand patients’ experiences and interpret the negative impact on patients’ health outcomes (Razzaghi & Afshar, 2016). In most cases, patients are not in a position to make informed decisions without having relevant information regarding the disease and therapeutic management. Effective communication enables the physician to develop a sound and effective relationship with the patient such that the patients can receive quality care and understand the goal of the care.

Effective communication in the physician-patient interaction is a core element of patient-centered care since it facilitates the provision of quality care and influences patient outcome. It leads to the development of the shared perception of the patient condition and helps in effective participation of the patients in the decision-making process regarding their health. Insight into the patient’s experiences ensures the patient can make relevant and informed decisions towards the improvement of the therapeutic care (Begum, 2015).

2.2.3 Empathy

Effective communication is shaped by basic techniques such as assertiveness, listening, and empathy (Begum, 2015). In the context of health care, one of the most important social factors a physician should possess is professional empathy. Physician’s empathy is a critical component of effective communication in doctor-patient communication (Jani, Blane, & Mercer, 2012). The physician should possess professional empathy involving three attributes that include (1) understanding the experiences and concerns of the patients, and (2) emotional awareness. These help in contextualizing patient’s own feelings and (3) being able to communicate the understanding of the patient with the intention of assisting (Cánovas et al., 2017). The level of physician professional empathy has a far-reaching impact on the therapeutic outcome. Jani, Blane, and Mercer (2012) have recognized the role of physician’s professional empathy in determining the patient’s clinical outcome. Empathy is important in the healthcare in promoting meaning and reducing stress and compassion fatigue. Fostering physician professional empathy has the effect of reducing patients’ stigmatization. Empathy, for instance, can reduce stigmatization since it prevents the adoption of common culturally negative stereotypes towards the patient’s conditions. Empathy also helps in earning patients’ trust and satisfaction, helping to eliminate ambiguity and uncertainties about the nature of the symptoms the patients are presenting (Cánovas et al., 2017). Empathy leads to the generation of dispositional optimism which can improve the patient outcome though it is not a coping strategy. Dispositional optimism precedes motivational aspects and the adoption of an active and adaptive approach towards one health. This optimism contributes to the psychosocial factors that are important in determining the positive outcome of the patients in improving the quality of life for the patients (Cánovas et al., 2017). Empathy promotes meaning to the therapy and mitigates against compassion fatigue and stress.

2.2.4 Gathering information

A core skill enshrined in medical practice is the physician’s ability to effectively communicate with the patients by developing good interpersonal skills in gathering information from the patients. The ability to obtain information from the patient through effective communications promotes precise diagnosis of the patients and also allows the physician to give therapeutic instructions to the patients. Ultimately, information gathering is a critical component of medical practice that helps in achieving therapeutic goals (Giroldi et al., 2015). Gathering information as an aspect of effective communication in the physician-patient relationship leads to reduction of iatrogenic harm in health care delivery (Kelley et al., 2014). The fundamental principle in gathering information from patients helps in the mitigation of systemic errors and when objectively utilized they assist in incident reporting. In gathering information from patients, physicians’ communication strategies are key, such as the empathic interruption so as to furnish the physician with the necessary information while meeting the patient’s need for social closeness (Giroldi et al., 2015). Gathering information helps in proper diagnosis of the patients and improves the efficiency of a patient-centered approach to healthcare, which ultimately improves patient satisfaction. Gathering information as a strategy for effective communication is linked to the traditional paternalistic model that acknowledges the significance of the patient’s story in the course of the provision of healthcare (Kelley et al., 2014). Gathering information can be viewed as part of cognitive and emotional care offered to the patient which enhances physician-patient relationship. In gathering information from patients, physicians are argued to ask open-ended questions and resist the urge to interrupt patients such that they are able to identify and respond to patients’ concerns and expectations, and appropriately diagnose the patient and offer appropriate therapy (Giroldi et al., 2015). These techniques serve as factors that improve the quality of information exchange and produce a richer interpersonal interaction in the healthcare settings.

2.2.5 Shared decision making

The pinnacle of patient-centered care rests in a shared decision-making process that involves physicians and patients jointly participating in making health care decisions (Barry & Edgman-Levitan, 2012). Effective communication between physicians and patients as well as the shared decision-making process takes into consideration the patient’s circumstances, informed preferences, and the associated uncertainties related to the intervention. Shared decision making goes beyond identifying the risk and benefits of the intervention strategy to provide informed consent. In the framework of effective physician-patient communication shared decision making takes into consideration the patient circumstances, informed preferences and the associated uncertainties related to the intervention (Elwyn, 2014). Traditional, the decision-making process rested on the clinicians making decisions for the patients. However, in a patient-centered care, shared decision making recognizes the difference between the patient and the physicians and puts the consideration of the expertise such that the decision made resonates along a continuum of two extremes, a patient-driven and a physician-driven decision-making process (Guyatt et al., 2014).

Shared decision making is only attainable in an environment of effective physician-patient communication. The quality of communication within the physician-patient dyad is the most significant determining factor of the quality of care delivered to the patients. Shared decision making as an aspect of effective communication between the physician and the patient supports and enhances patient empowerment, better management of emotions, and improves the social support offered to the patient. Moreover, shared decision making contributes to higher quality decision making and greater knowledge of the patient concerning the disease such that there is improved adherence to treatment and better self-management (Legare et al., 2012). It is important to mention that the lapse in communication between the patient and the physician compromises the shared decision-making process, creating room for medical errors and undesirable patient health outcomes (Legare et al., 2012).

2.2.6 Cultural differences

Cultural differences have been attributed as barriers or enablers of an effective and satisfying physician-patient relationship (Schouten et al., 2007). In contemporary multicultural society, health care practitioners are increasingly confronted with patients from different cultural backgrounds. These affect the effectiveness of interpersonal relationship and communication between the patients and the doctor. Linguistic barriers exist between different cultures and affect the delivery of good quality care in a wider diversity of patients. In the context of cultural differences between the physician and the patients, patients find it emotionally demanding and may compromise the quality of healthcare (Almutairi, 2015). These differences affect the inter-cultural medical communication between the physician and patients’ interactions. Cultural differences add one more dimension to an already complex communication between the doctor and the patient. Healthcare providers’ knowledge and patients’ acculturation and good exchange between the physician and the patients impacts effective communication in the physician-patient relationship. The actual participative behaviors of the patients and the disentanglement of the concept of the patient participation are influenced by cultural differences (Schouten et al., 2007).

Cultural differences act as barriers or enablers of an effective and satisfying physician-patient relationship (O’Malley et al., 2016). In a multicultural society, health care practitioners are increasingly confronted with patients from different cultural backgrounds who compromise interpersonal relationships and effective communication in the doctor-patient interactions. Cultural differences include linguistic barriers which make the interactions between the patients and their physicians emotionally demanding. It complicates an already complex relationship between the physicians (Schouten & Meeuwesen, 2006).

2.2.7 Patient safety management

According to Emanuel (2008; p17) patient safety is one of the main concerns overwhelming healthcare administrators and system planners, since harm to patient often comes from a failing system (not and individual) that lacks the human and /or non-human resources necessary to provide patients with the proper level of care. As reported by Alkorashy (2013; p1376) managing patient safety needs to start with evaluation the degree of harm and concludes with the plan of action for maintaining patient safety. In this context, WHO, (2012; p2) has published a comprehensive guide on patient safety. It is evident that patient safety is a leading cause of negative outcomes on patient’s health including in the Eastern Mediterranean region where an unacceptable number of patients have been reported to experience harm in the course of health care delivery. Since patient safety is a global public health concern, there is a need to get more insight on the problem with the aim of improving patient safety.

For effective management of patient safety, The Joint Commission International, has published International patient safety goals (IPSG) in the year 2013, to be applied and followed by all member countries, and to be effective from 1, April 2014, and each goal is compound with its standard, intent, and measurable elements. (JCI, 2013; p.22-28). These six goals are as follows:

Correctly identification of patients.
Improving effective communication
Ensuring the safety of higher-alert medications.
Ensuring safe surgery.
Minimizing hospital-associated infections.
Reducing patients harm due to falls.

2.2.8 Management of patient safety in Saudi Arabia

The Central Board for Accreditation of Healthcare Institutions (CBAHI) role is to grant healthcare accreditation to all governmental and private healthcare facilities within the Kingdom of Saudi Arabia to manage patient safety. CBAHI was originally a non-profit organization referred as Saudi Health Council. The board is responsible for setting standards for quality and safety to ensure guarantee improved and safe healthcare outcomes. CBAHI was set through a ministerial decree, number 144187/11 on October, 2005 as the Central Board for Accreditation of Healthcare institutions. Initially it was tasked with initiation of a national voluntary healthcare accreditation program. Later in 1434/2013, the Council of Ministers mandated accreditation by CBAHI and gave it its current name (CBAHI, 2016).

The mission of the Saudi Central Board is to advance healthcare quality and patient safety by encouraging healthcare facilities to continually abide by accreditation standards. The vision of the Saudi Central Board is to be the regional leader in improving healthcare quality and patient safety. Therefore, within the third edition of CBAHI updated standards have been renewed and revised for hospitals to advance quality care and patient safety. The standards were updated with four goals in mind: (CBAHI, 2016; p19)

Develop new standards related to patient safety.
Refine existing standards.
Improve the clarity and applicability of standards, and
Update the terminology to reflect current contexts.

2.2.9 Essential safety standards requirements

To manage effective patient safety program, CBAHI, confirms that the compliance with the standards did not guarantee a safe environment. Different strategies and tools have been introduced to enhance patient safety and reduce the risk of adverse effects. Having a patient safety program and a system for incidents reporting are just few examples, but also the concept of Essential Safety Requirements (ESRs). There are (16) essential safety requirements distributed in this updated copy of (CBAHI, 2016; p20). These ESRs include the following:

The hospital has a process for proper credentialing of staff members licensed to provide patient care.
Medical staff members have current delineated clinical privileges.
Policies and procedures guidelines on the handling, use and administration of blood products.
Patients at risk for developing venous thromboembolism are identified and managed.
The hospital has a process to ensure correct identification of patients.
The hospital has a process to prevent wrong patient, wrong site, and wrong surgery/ procedure.
Anesthesia staff members have the appropriate qualifications.
Qualified staff perform moderate and deep sedation/ analgesia.
There is a designated multidisciplinary committee that provides oversight of the infection prevention and control program.
Facility design and available supplies support isolation practices.
The hospital has a system for the safety of high alert medication.
The hospital has a system for the safety of look-alike and sound-alike (LASA) medications.
The hospital has a process for monitoring, identifying, and reporting significant medication errors, including near misses, hazardous conditions, and at-risk behaviors that have the potential to cause patient harm.
The blood bank develops a process to prevent disease transmission by blood/ patient transfusion.
The hospital ensures that all its occupants are safe from radiation hazards.
The hospital ensures proper maintenance of the medical gas system.

2.3 Previous studies

Dingley (2008) conducted a study on the role of provider communication strategy enhancement in the improvement of patient safety. The fundamental aim of the study was to create, apply, and appraise comprehensive provider/team communication strategy, leading to a toolkit generalizable to other care settings. The specific objectives of the study included implementing a structured communication tool, a standardized escalation procedure as well as conducting multidisciplinary patient-centered rounds using a daily goals sheet and having team handles. The study was carried at Denver Health and Hospital Authority in its 477-bed capacity medical center which was integrated in an urban safety net system. The study was based on a pre-test/post-test study design, with baseline and post-intervention data which was gathered on pilot units in Medical Intensive Care Unit (MICU), Acute Care Unit (ACU) as well as Inpatient Behavioral Health Unit (IBHU). Upon analysis of the 495 communication events after implementation of the toolkit, the study reported a reduced treatment period, increased satisfaction of nurses and increased resolution of post-intervention patient issues. From the results, the toolkit is applicable in healthcare facility since it avails a framework for implementing communication strategies and teamwork tailored to the facility settings. Most of communication events on MICU, 74.6 percent, were face-to-face verbal communication while 61.6 percent communication events on ACU entailed numeric pagers complemented by follow-up or return phone calls.

Caprice (2007) studied patterns of communication failure leading to injury in surgical patients. This study aimed to propose possible intervention methods that could control or impede communication breakdown in surgical patients. The data collected by reviewing 444 surgical malpractices from 4 liability insurers. 60 cases were identified as resulting from communication breakdown leading to patient harm. Upon analysis for common characteristics, the two surgeon-reviewers identified patterns and potential intervention strategies for mitigating communication breakdown and evaluation of their potential effect. Over 81 communications breakdown were reported in 60 cases, broken down in cases occurring at 38 percent, 30 percent and 32 percent in preoperative, intraoperative and postoperative periods, respectively. Only 72 percent of the cases reported a single communication breakdown. Most of the communication breakdown were in verbal communication constituting 92 percent and entailed one transmitter and one receiver at 64 percent. Most of the communication breakdown in the teams implicated surgeons. The nature of communication breakdown was in the areas of responsibilities ambiguity at 73 percent and status symmetry at 74 percent. Other communication breakdowns were in hand-offs, 43% and transfers in patient’s location at 39 percent. From the study, most of the communication breakdowns were characterized by failures to notify the surgeon in attendance regarding critical events and also failure to attend hand-off. The proposed intervention could prevent communication breakdown by 45-73 percent in the study cases series. In conclusion, the study observed that throughout the continuum of care, serious communication breakdowns are prevalent and are characterized by verbal communication failures between the attending surgeon and other caregivers. The communication breakdowns are typified by lack of clarity in the team responsibilities. Proposed interventions measure should involve defining the triggers for verbal communication failures between attending surgeons and other caregivers in the aspects of structured hand-offs, transfer procedures as well as standardized use of read-backs.

Donna (2008) studied the improvement of clinical communication and patient safety resulting from clinician-recommended solutions. This study explored the perspectives of clinicians on clinician-clinician communication to ensure pediatric safety based on 90 minutes focus group interviews. The focus groups included physicians, pharmacists and nurses selected from the Pediatric Patient Safety Consortium in 5 Chicago area hospitals. The study participants were required to address issues related to effective communication and the associated safety risks to the patients and recommendations to avert the risks. In particular, the study focused on patients safety solutions recommended by clinicians. Overall, the study had 65 focus groups with the study identifying solutions that were categorized in seven key themes. The themes included electronic medical records, use of technology in managing health information, round care plans for coordinating care and effective communication, management of communication during the transition period, identification of knowledge and gaps in experience, organization role in communication, team-based solutions, as well as orders and consultations.

In a study by Ruane (2016) on building a culture of patient safety focused on defining patient safety culture. The study also seeks to provide the best practices of cultivating a culture of patient safety in healthcare facilities. The study used a documentary approach that reviewed literature sources on teamwork and employees engagement, patient safety culture, role of the leadership, best practices in enhancing patient safety, enshrining a culture of patient safety and enhancing best practices in patient safety Ruane (2016) established that a majority of patients experience harm in healthcare institutions across the United States. Patients safety is a prominent concern for health practitioners where healthcare leaders pride themselves in delivering safe and highly effective patient care in order to build a culture of patient safety. Several recommendation are made in the study includes the need to shift focus from blame to a culture of accountability and empowerment that facilitates healthcare staff to have the necessary resources to deliver safe and effective care to patients.

The study of Smith (2016) under the title “Reducing Medical Errors and Increasing Patient Safety in Healthcare”. The aim of this study was to explore effective patient safety practices to reduce and prevent medical errors in health care. The researcher depended on the documentary approach which based on reviewing a number of literatures that address Patient Safety Culture, Medical Errors and Strategies to Reduce Medical Errors, Reporting, Increased Education, Communication, Disclosure of Medical Errors, Communication Solutions and Electronic Health Records. The study found many findings, including: The patient safety movement has been a major focus for nearly 20 years. The unnecessary harm to patients in health care and the failure to apply patient safety practices resulted in increased medical errors and harm to patients. Practices such as disclosure of medical errors, open communication, and transparency from leaders provided healthcare professionals with the essential skills required to apply patient safety practices that reduced medical errors. Some patient safety practices included disclosing medical errors, increased education, safety checklists, hand-off bundles, and electronic medical records. Implementation of patient safety practices resulted in a reduction of medical errors and an improvement of the quality of care for the patient. The study recommended several recommendations, including: It is essential to provide healthcare professionals with the skills required to influence change in patient safety practices.

The study of Weller et al. (2014) under the title “Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare”. The aim of this study was to explore challenges exist in the healthcare environment in a framework of educational, psychological and organizational challenges to the development of effective healthcare teams. The researcher depended on the documentary approach which was based on a literature review on information sharing, team effectiveness, the challenge of information sharing in teams, and measures to improve information sharing. The study also focused on strategies for overcoming educational, psychological and organizational barriers, with the aim creating a culture that supports healthcare team communication. Among the findings from the study, the study noted that there was increased complexity and the need for specialized skills to meet the current needs in the healthcare sector, including effective communication in teamwork as well as best practices in patient care. In order to overcome these barriers, the study established the need to redefine healthcare teams from just a collection of individuals coming from different disciplines to ensuring cohesiveness in teams. In addition, the effectiveness of sharing information may require support from the organization, for example in setting up communication protocols. The study also identified structured operating room briefings timetabled into the activities of the day as being important in sharing the mental model as well as enhancing the safety of the patient. For instance, structure operating room briefings timetabled to the day’s activities can ensure timely antibiotic administration, thereby averting patient harm. Other recommendations made by the study include the need for more studies to assess intervention measures that can enhance effective communications and aid sharing of information. Interventions may be the next significant step in improving patients health outcomes.

The study of Doyle et al. (2013) under the title “A systematic review of evidence on the links between patient experience and clinical safety and effectiveness”. This study aimed to explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. The researcher based the systematic review approach which based on reviewing 55 literature sources that address a broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Findings from the study included the establishment of harmonious positive relationship between patient safety, patient experience and clinical effectiveness for different settings, diseases areas and outcome measures. There was a affirmative relationship between patient experience and self-rated, objectively measured health outcomes. In addition, adhering to the recommended clinical practice and medication as well as preventative care was linked to patient experience. Aspects of preventative care include the use of screening services, adopting health-promoting behavior as well as immunization. Other patient experience related aspects in patient safety include resources that determine length of hospital stays, patients hospitalization as well as primary care visits. From the study, it is evident that there are positive relationships between patient’s experience and the measures of technical quality of patient care as well as adverse effects. Positive associations between patient experience and safety of the patient as well as clinical effectiveness were prevalent. The study recommended the need for clinicians not to ignore patient experience and terms as mood-oriented or subjective since patient experience cannot be separated the safety and effectiveness of clinical practice.

The study of Brock et al. (2013) under the title “Inter-professional education in team communication: working together to improve patient safety”. This study aimed to report the effectiveness of a simulation-based inter-professional Team STEPPS training in impacting student attitudes, knowledge and skills around inter-professional communication. The study includes 3 acute cases in adults to establish that communication in a healthcare team should be developed collaboratively. The healthcare team comprised 9 inter-professional faculty members, 19 volunteers and 6 staff members. The Inter-Professional Team Capstone experience was structured to train students pooled from 4 healthcare professional programmes to practice as a team. The volunteers could opt to participate in any of the three focal area of training namely, obstetric, pediatric and adult acute are cases. The study applied 2 instruments for both pre- and post-training sessions. Th aim was to evaluate attitudes in team communications using the Team STEPPS Teamwork Attitudes Questionnaire (TAQ). TAQ is a validated instrument made up 30 Likert-type items that evaluates attitudes based on five dimensions namely, communication, leadership, mutual support, situational awareness and team. A 21-item instrument AMUSE (Attitudes, Motivation, Utility and Self-Efficacy) was used to evaluate attitudes. Among the study findings were the significant of team structure, mutual support, situation monitoring, attitudinal shift in team performance. Other significant aspects identified by the Team STEPPS tool included patients advocacy, and inter-professional team communication in ensuring patient safety. The study demonstrated that positive attitudinal and knowledge effects and positive attitudinal shifts are relevant in a large-scale inter-professional Team STEPPS-based training. The study recommended several recommendations, including: inter-professional teams simulation-based training as a first step towards ameliorating communication skills in clinical teams practice.

The study of Künzle et al. (2010) under the title “Ensuring patient safety through effective leadership behavior: A literature review”. This study aimed to provide a systematic review on the findings of effective leadership strategies in critical care teams. The researcher depended on the documentary approach which based on reviewing a number of literatures that address defining leadership in critical care teams, Findings on input factors, Findings on leadership processes and Findings on leadership outcomes. The study found many findings, including: Leadership behavior in critical care teams could be defined as a fluid process among team members dependent upon the interplay between discrete individual behaviors and group behavior. Most of the literature reviewed agrees on two critical functions of leadership: (1) to help the team to complete a task and (2) to keep team members maintained and functioning. For medical organizations as well as critical care teams, it is important to know how they perform and how team performance can be assessed and influenced. Within the studies reviewed above, leadership behavior was measured either by external ratings of leadership behavior (e.g. LBDQ, OTAS), self-assessment (e.g. ORMAQ, interviews), or clinical outcomes (e.g. classification of morbidities, length of hospital stay). The findings of this review imply that leadership training may be one of the crucial factors enhancing team performance. Experiences from aviation settings demonstrate the importance of teamwork training (also known as crew resource management training) for team performance and safety improvements. The study recommended several recommendations, including: One important area for future research is to examine the link between leadership behavior and team effectiveness.

The study of Nadzam (2009) titled “Nurses’ role in communication and patient safety”. This study aimed to find out Nurses’ role in communication and patient safety. The researcher depended on the documentary approach which based on reviewing a number of literatures that address communication and teamwork, Disruptive and intimidating behaviors, strategies to improve communication, System wide communication strategies, Structured communication techniques, Nurse-physician communication strategies and General communication strategies. The study found many findings, including: As the frontline deliverers of patient care, nurses have the opportunity to make effective and lasting improvements in communication. Strategies for promoting effective communication among all healthcare providers include Look for systems problems, not people problems. Do not allow staff to play the blame game. Also, explore the way staff members think. There are many types of tests to explore the ways people communicate. Other strategies for promoting effective communication among all healthcare providers include Promote listening skills, consider education on effective listening, and allow that listening without agreeing is acceptable. As well as encouraging staff participation in education of their peers. For example, case presentations given by nurses to their peers are a good way to get nurses on separate shifts to work on a common problem. The study recommended several recommendations, including: To successfully implement a communication initiative – whether it is a cultural shift, a process change, or a new system that promotes communication as a fundamental component of patient safety— organizations should take an organized approach that involves stakeholders in every step.

The study of Tjia (2009) under the title “Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety”. This study aimed to describe nurses_ perceptions of nurse-physician communication in the long-term care (LTC) setting. It was a mixed method study including a self-administered questionnaire and qualitative semi structured telephone interviews of licensed nurses from 26 LTC facilities in Connecticut. The questionnaire measured perceived openness to communication, mutual understanding, language comprehension, frustration, professional respect, nurse preparedness, time burden, and logistical barriers. Qualitative interviews focused on identifying barriers to effective nurse-physician communication that may not have previously been considered and eliciting nurses_ recommendations for overcoming those barriers. The study found many findings, including: Nurses identified several barriers to effective nurse-physician communication: lack of physician openness to communication, logistic challenges. Other barriers identified by nurses were the lack of professionalism, and language barriers. Feeling hurried by the physician was the most frequent barrier (28%), followed by finding a quiet place to call (25%), and difficulty reaching the physician (21%). The study recommended several recommendations, including: there was consensus that nurses needed to be brief and prepared with relevant clinical information when communicating with physicians and those physicians needed to be more open to listening.

The study of Manser (2009) under the title “Teamwork and patient safety in dynamic domains of healthcare: a review of the literature”. This study aimed to examine current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. The researcher depended on the documentary approach which based on reviewing a number of literatures that address teamwork and patient safety in dynamic domains of healthcare. The study found many findings, including: Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. Research focusing on healthcare providers‟ perceptions of teamwork demonstrated that (a) staff ‟s perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff wellbeing, which may impact clinician‟ ability to provide safe patient care. Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. The study recommended several recommendations, including: future research needs to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review.

The study of Rosenstein & O’Daniel (2008) under the title: “A survey of the impact of disruptive behaviors and communication defects on patient safety”. This study aimed to review the results of a recent survey that was conducted to assess the significance of disruptive behaviors and their effect on communication and collaboration and impact on patient care. VHA West Coast administered a 22-question survey instrument—Nurse Physician: Impact of Disruptive Behavior on Patient Care—to a convenience sample. Of the 388 members hospitals (in four VHA regions) invited, 102 hospitals participated in the survey (26% response rate). Results from surveys received from January 2004 through March 2007 are represented. Of the 4,530 participants, 2,846 listed their titles as nurses, 944 as physicians, 40 as administrative executives, and 700 as “other.” The study found many findings, including: 77% of the respondents reported that they had witnessed disruptive behavior in physicians— 88% of the nurses and 51% of the physicians. Sixty-five percent of the respondents reported witnessing disruptive behavior in nurses at their hospitals—73% of the nurses and 48% of the physicians. Also, Sixty-seven percent of the respondents agreed that disruptive behaviors were linked with adverse events; the result for medical errors was 71%, and patient mortality, 27%. Disruptive behaviors lead to potentially preventable adverse events, errors, compromises in safety and quality, and patient mortality. The study recommended several recommendations, including: There should be strategies to address disruptive behaviors that should (1) prevent disruptive events from occurring, (2) deal with events in real time to prevent staff or patient harm, and (3) initiate post-event review, actions, and follow-up.

Chapter Three:

Research Methodology

Chapter Three: Research Methodology

3.1 Introduction

This chapter is devoted to discuss the research methodology adopted in the current study. That is in this chapter the focus is on explaining the research methods, and methodology, beside that the tools and techniques used for data collection and analysis. In addition to that population and sample of the study are to be determined on a scientific basis. The reliability and validity statistics for the data collection tools should be assessed.

3.2 The Research Methodology:

The research methodology is about how the research would conduct his/ her research taking the main objectives of the study into consideration. The research methodology is defined by Kothari (2004) as a way of to systematically solve the research problem; in addition to that it may be understood as a science of studying how research is done scientifically, and the logic behind using the different methods. Maylor & Blackmon (2005) argued that the research methodology was implemented through several different designs, the plan for conducting the study, through translating the research methodology into specific research methods, and techniques used to collect and analyze the data.

3.3 The Research Approach and Design

There are two main approach designs, the quantitative and qualitative research design. However, Kothari (2004), stated that the research design should include a research problem, protocols as well as techniques for data collection. In addition, the target population should be identified and methods for data processing and analysis. Based on the research objective of the current study, which investigates the impact of effective communication on patient safety, a quantitative research design will be applied.

3.4 Population and Sampling Techniques:

The population of the current study includes all professional healthcare providers in healthcare centers. They are physicians, nurses, administrators, pharmacists, dental technician, laboratory technician and x-ray technician because of a limited number of populations. There are 214 healthcare centers in Jeddah province. The researcher selected four healthcare government centers in Jeddah province which were obtained national accreditation CBAHI with different locations. The first healthcare center selected is in the north Jeddah (Khaled alnamodage), the second seleted center is in the south Jeddah (Almihjar), the third selected center is in the east Jeddah (Alhamra) and the fourth selected center is in the west Jeddah (Bryman). After the survey questionnaire distributed to the target participants in these four healthcare centers in Jeddah province, the researcher was able to collect around (150) questionnaire forms which valid for data analysis. The details of the questionnaires collected were presented in the table below:

Table No. (3-1) showed the distribution of healthcare provider’s participants of the study in the four centers

Healthcare centers	Categories	Number of participants	Total	Percent %
Alhamra healthcare center	Physician	10	40	26.7
	Dental technician	3
	Pharmacist	3
	Nurse	13
	Administrative	6
	x-ray technician	3
	Lab technician	2
Bryman healthcare center	Physician	8	35	23.7
	Dental technician	2
	Pharmacist	3
	Nurse	12
	Administrative	5
	x-ray technician	3
	Lab technician	2
Almihjar healthcare center	Physician	3	41	27.3
	Dental technician	2
	Pharmacist	1
	Nurse	20
	Administrative	11
	x-ray technician	2
	Lab technician	2
Khaled healthcare center	Physician	6	34	22.7
	Dental technician	3
	Pharmacist	2
	Nurse	13
	Administrative	10
	x-ray technician	Service not available
	Lab technician	Service not available
Total			150	100.0

3.5 Data Collection Tool

To collect the primary data in this study, the survey questionnaire method was prepared. The survey questionnaire method was designed to include the three sections as follows:

Section one: the demographic characteristics of the participants of the study, they include five variables: gender, age, position, education level, and years of experiences.

Section two: include the independent variable which effective communication, the effective communication dimension is divided into five sub-dimensions, and each one contains a set of statement. The sub-dimensions include: establish relationship, empathy with patients, gathering information, share decision making and cultural differences.

Section Three: This section includes the dependent variable which is patient safety, and it was include a set of items.

3.6 Survey Questionnaire Reliability

To measure the internal consistency of the survey questionnaire method, and to make sure that it was efficient to collect the needed data, a pilot study was conducted by distributed a limited number of questionnaire forms to the target population of the study. Around (34) questionnaires obtained. To measure the reliability statistics. Cronbach’s Alpha coefficient was used, and the results are presented in table No. (3-2) below:

Table No. (3-2) shows the reliability statistics of the questionnaire method.

Dimensions	No. of items	Cronbach’s Alpha Coefficient first round	Cronbach’s Alpha Coefficient second round
Dimension one: effective communication
Establish relationship	6	0.789	0.746
Empathy with patient	6	0.891	0.901
Gathering information	6	0.929	0.935
Share decision making	4	0.828	0.809
Cultural differences	5	0.897	0.898
Dimension two : patient safety
patient safety	8	0.958	0.940
Overall reliability	35	0.969	0.967

It was noticed from the statistics in the above table, that the overall Cronbach’s Alpha coefficient for the survey questionnaire method was reaching (0.969), which is considered as a very high value indicating that the survey method has achieved a very high level of reliability. This means that the survey questionnaire method was efficient to be used for data collection. In addition to that all dimensions have achieved also very high reliability statistics.

The results in the above table, showed that in post-test to examine the reliability of the survey questionnaire, it was noticed that the overall reliability of the survey questionnaire has achieved a very high reliability as Cronbach’s Alpha coefficient is reaching (0.967). This guarantee that the method is efficient to collect the data needed. In addition to that, it was noticed all dimension have scored high values, confirming the suitable of the survey questionnaire method reliability.

Furthermore, the survey questionnaire reliability was examined by using the Split-half techniques by using Person’s correlation coefficient, and corrected by Spearman’s correlation coefficient and the results are demonstrated in the table below:

Table No. (3-3) shows the survey questionnaire reliability by Split-half method.

	Correlation	P-value
Person’s Correlation	0.832**	0.00
Spearman correlation coefficient	0.908**	0.00

* indicated that correlation is significant at the (0.01) significant level

The results in the above table, revealed that Person’s Correlation and Spearman’s Brown correlation coefficients, are very high indicating that the survey questionnaire method has achieved a very high reliability what guaranteed that the method is well prepared and constructed, therefore, it will contribute in gathering the suitable data to achieve the research objectives.

3.7 Survey Questionnaire Validity

The survey questionnaire validity was measured through using Person’s correlation coefficient to find the relationship between each dimension and sub-dimension to which it belongs, and the results have been demonstrated as in the table below:

Table No. (3-4) survey questionnaire method validity by Person’s Correlation coefficient

Sub-dimension 2 : Establishing relationship		Sub-dimension 2: empathy with patients		Sub-dimension3: gathering information
Item No.	Correlation coefficient	Item No.	Correlation coefficient	Item No.	Correlation coefficient
1	0.576**	7	0.735**	13	0.860**
2	0.765**	8	0.765**	14	0.918**
3	0.609**	9	0.860**	15	0.842**
4	0.638**	10	0.836**	16	0.897**
5	0.554**	11	0.846**	17	0.893**
6	0.633**	12	0.824**	18	0.731**

Sub-dimension4: share decision making		Sub-dimension5: cultural differences		Dimension two: patient safety
19	0.874**	23	0.761**	28	0.705**
20	0.527**	24	0.822**	29	0.856**
21	0.883**	25	0.794**	30	0.893**
22	0.801**	26	0.919**	31	0.837**
		27	0.937	32	0.773**
				33	0.876**
				34	0.873**
				35	0.859**

*indicated that the correlation coefficient is statistically significant at the (0.01) significant level

The results in the above table, confirmed that all correlation coefficients values were statistically significant at the (0.01), which indicated that each item is positively correlated with the dimension to which it belongs. This means that all items will achieve the objective of measurement in the dimension to which it related. Therefore, this evidence support that the survey questionnaire method has a very good validity indicator.

3.8 Statistical Techniques for Data Analysis

To analyze and interpret the data collected in a well scientific form, the researcher uses various statistical methods including the descriptive and inferential statistical methods. the descriptive statistical methods include: frequencies, percentages, and that is to describe the participants of the study according to the demographic characteristics, while the means and standard deviation were used to assess the participants responses with regard to the survey questionnaire items in order to evaluate the impact of effective communication on patient safety. In addition, the research hypotheses and validity of the questionnaire was tested using the Person’s Correlation coefficient. The reliability of the survey questionnaire was tested using the Cronbach’s Alpha .

Chapter Four:

Data Analysis and Interpretations

Chapter Four: Data Analysis and Interpretations

4.1 Introduction

The main objectives of this study are to assess the role of effective communication on patient’s safety in governmental healthcare centers in Jeddah city, and addition to that the study will examine how healthcare staff give high rate for the effectiveness of communication safety in these public health institutions. Therefore, the data analysis in this chapter will concentrate to answer the research questions, and testing the research hypotheses through the employment of suitable statistical techniques, which would include descriptive analytical methods, and correlation. Based on the previous introduction, the data analysis will proceed as follow: Section one: The participants of the study demographic characteristics analysis, Section two: the descriptive analysis of the sample responses and Section three: testing the research hypotheses.

4.2 Section One

The participants of the study demographic characteristics analysis. The participants of the study profile will include five demographic characteristics, (gender, age, job position, education level, and years of experience), and the results are displayed in the following table:

Table No. (4-1) Frequency and percentage for demographic information

		Frequency	Percent %
Gender	Male	50	33.3
	Female	100	66.7
	Total	150	100.0%
Age	Less than 30 years	16	10.7
	30- to less than 40	104	69.3
	40- to less than 50	23	15.3
	50 years and over	7	4.7
	Total	150	100.0%
Position	Administrative	33	22.0
	Nursing	57	38.0
	Physician	27	18.0
	X-ray	8	5.3
	Laboratory	6	4.0
	Dental	10	6.7
	Pharmacy	9	6.0
	Total	150	100.0%
Education level	High school/Diploma	52	34.7
	College Diploma/Community	43	28.7
	University Degree	44	29.3
	Postgraduate	11	7.3
	Total	150	100.0%
Years of experience	1-to less than 5 years	17	11.3
	5-To less than 10	50	33.3
	10-to less than15	41	27.3
	15 years and over	42	28.0
	Total	150	100.0%

The outcomes in the above table No. (4-1) shows that

Indicated that the female participants of this research comprised the majority with (66.7%) that two thirds of the total healthcare providers, whereas the male represent just one third (33.3%). Therefore, this result might be a direct result of the easiness to the researcher to contact more female, and this trend actually is possible as most of the nursing jobs in KSA, were occupied by females.
The distribution of healthcare providers in Jeddah health centers sample of the study according to age, it was noticed that the majority of the participants’ ages with 69.3% between (30- to less than 40) years, while 10.7% their ages are less than 30 years, whereas 15.3% their ages between (40- to less than 50) years, where only 4.7% their ages at 50 years and over. Thus, it could be concluded that all healthcare providers working in the government healthcare centers are at the age of youth, which indicated that most participants are in the productive age.
The distribution of healthcare providers by job position, according the nursing position comprised the majority with 38.0%, followed by administrative and physician by 22.0% and 18% successively, whereas other positions have less percent the highest is dental by 6.7%, laboratory by 4.0%. Thus, it could be concluded that, there are three job position including (nursing, administrative, and physician) comprised the majority of participants by 68.0% of the total sample. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies
Which demonstrates the participants of the study depending on their standard of education. The participants as healthcare providers who hold High School/Diploma represents the majority with 34.7%, while those who hold university degree constitute 29.3%, while the participants who hold college diploma/community represent about 28.7%, whereas postgraduate constitute just 7.3%.
Demonstrated the Participants of the study according to years of experience. It was noticed that there are about 33.3% of the participants have experience between (5-to less than 10) years, while 28.0% of the healthcare providers have experience 15 years and over, whereas 27.3% of the participants have between (10-to less than 15) years, whereas only 11.3% who have experience between (1- to less than 5) years.

Thus, it can be said the years of experienced for most participants would enable the healthcare providers to assess fairly the effectiveness of communication on patient safety.

4.3 Section Two: The Descriptive Analysis of the Sample Response.

The main aim of this section is to provide answer to the research main questions, which have been set as follows:

How can effective communication contribute positively on the achievement of patient safety?
What are the core elements of effective communication that enhance patient safety in public healthcare institutions in the Kingdom of Saudi Arabia?
What are the main barriers of effective communication and its effect on patient safety?

To answer the previous research questions, descriptive statistics through employment of the means and standard deviation was run and the results would be presented in the following tables. In the first part, the analysis would cover the participant’s responses with regard to variables of effective communication including (establishing relationship, empathy with patient, gathering information, share decision making, and cultural differences). These variables are expected to significant effect on patient safety in healthcare centers in Jeddah. Therefore, the results of descriptive statistics are conducted as will be shown in the following tables:

Table No. (4-2) the participant’s responses with regard to the impact of establish relationship on patient safety.

Item No.	Establish relationship	Mean	Standard deviation	Chi. Square	P. Value	Ranking
1	PHC staff speak with patients in an acceptable speed to enable them to understand the conversation	4.29	0.95	154.2**	0.00	6
2	PHC staff speak to patients with interest and activity	4.65	0.50	96.16**	0.00	2
3	PHC staff focus on patients when speaking without distraction and interruption	4.69	0.53	198.11**	0.0	1
4	PHC staff talk with patients patiently and endure their questions	4.63	0.55	88.84**	0.0	4
5	PHC staff respond to patients’ needs quickly and calm down their anxiety.	4.64	0.51	92.16**	0.00	3
6	Workers seek to build good relationships with patients to improve their impressions.	4.58	0.58	75.72**	0.00	5
	Overall mean	4.58	0.44

**indicated that Chi-Square test is statistically significant at the (0.01) significant level

The statistics in table No. (4-2) demonstrated the participants of the current study perceptions with regard to the impact of establish relationship on patient safety, it was obvious that all participants have strongly agreed that, establish relationship has a very strongly impact on patient safety in the government healthcare centers in Jeddah province. In addition to that it was noticed that all values of Chi-Square test are statistically significant at the (0.01) significant level. This means the establish relationship has a significant impact on patient safety.

To assess how establish relationship have a significant effect on patient safety, the detailed healthcare providers perceptions about that, have to conduct as in the following paragraphs: Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

When participants of the study were being asked to show their perceptions with regard to the statement No.3, stated that 🙁 PHC staff focus on patients when speaking without distraction and interruption), it was noticed that the majority of participants of the study strongly agreed that Public health centers staff focus on patients when speaking without distraction and interruption. This very high response was supported by the mean value equal to (4.69) with standard deviation (0.53). Hence it could be concluded that the most obvious impact of establish relationship is within staff focusing on patient when speaking without distraction and interruption.

While when healthcare providers participants of the study were being required to provide their through with regard to the statement No.2, stated that (PHC staff speak to patients with interest and activity), the results in table No. (4-2) revealed that the majority of participants strongly agreed that PHC staff speak to patient with interest and activity, which has a very considerable effect on patient safety. This very high response was supported by the mean value equal to (4.65) with standard deviation (0.50). This result confirmed that the majority of healthcare providers working in healthcare centers always are keen to speak with patients with interest and actively.

Whereas, when participants of the study were being asked to present their perceptions with regard to the statement No.6, stated that: (Workers seek to build good relationships with patients to improve their impressions), the results in table No. (4-2) showed that the majority of participants strongly agreed that workers in PHC, always seek to build good relationship with patients to improve their impressions. This very high response was supported by the mean value to participants responses equal to (4.58) with standard deviation (0.58). So this result proved that one of the most important advantages of establish relationship with patient is to improve patient’s impressions about the staff, and the healthcare center. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

In last, when participants of the study were being required to show their perceptions with regard to the statement No.1, stated that: (PHC staff speak with patients in an acceptable speed to enable them to understand the conversation), the results in table No. (4-2) showed that the majority of participants strongly agreed that workers in PHC, always speak with patients in an acceptable speed to enable them understand the conservation. The high rating to this response was supported by the mean value equal to (4.29) with standard deviation (0.95).

In conclusion to participants perceptions with regard to establish relationship impact on patient safety, it could be concluded that, establishment of relationship has a very considerable impact on patient safety, in particularly, the most important ways to do that include: focusing of PHC staff on patient when speak without distraction and interruption, speaking with patients with interest and activity, responding to patients needs quickly and calm down their anxiety, in addition to that staff talking with patients patiently and endure their questions.

Table No. (4-3) the participant’s responses with regard to the impact of empathy with patient on patient safety.

Item No.	Empathy with patients	Mean	Standard deviation	Chi. Square	P. Value	Ranking
7	PHC staff select the right time to talk to patients	4.46	0.63	120.67**	0.00	6
8	PHC staff answer the patients’ questions with a warm welcome	4.57	0.52	75.88**	0.00	2
9	PHC staff consider the psychological state of the patients during the conversation	4.62	0.50	87.24**	0.00	1
10	PHC staff respond to patients and listen to them without interruption	4.53	0.55	68.32**	0.00	3
11	PHC staff direct his/her eyes to the patients’ faces while talking to them	4.53	0.63	135.07**	0.00	5
12	PHC staff are smiling while directing attention to patients	4.53	0.59	63.88**	0.00	4
	Overall mean	4.54	0.46

**indicated that Chi-Square test is statistically significant at the (0.01) significant level

The results in table No. (4-3) showed the participants of the current study perceptions with regard to the impact of empathy with patients on patient safety, it was noticed from the statistics in table above that the majority of participants have strongly agreed that, empathy with patients is one of the core components of effective communication that has a strong impacted on patients’ safety in the public healthcare centers in Jeddah city. Furthermore, it could be noticed that all values of Chi-Square test indicated that, there is a significant impact of empathy with patient on patient safety.

To examine how empathy with patients has significant impact on patient safety, the detailed healthcare provider’s perceptions about that, was conducted as in the following:

When participants of the study were being asked to show their perceptions with regard to the statement No.9, stated that 🙁 PHC staff consider the psychological state of the patients during the conversation), it was noticed that the majority of participants strongly agreed that PHC staff have the knowledge to consider the psychological state of the patient during the conservation with him This very high response was supported by the mean value equal to (4.62) with standard deviation (0.50). Therefore, this indicated that the majority of staff working in PHC, have been well trained to take the psychological state of the patient when trying to get the needed information from him.

While when healthcare providers participants of the current study were being required to provide their perceptions with regard to the statement No.8, stated that (PHC staff answer the patients’ questions with a warm welcome), the results in table No. (4-3) confirmed that the majority of participants strongly agreed that PHC staff answer the patients’ questions with a warm welcome. The existence of a warm welcome by PHC staff was supported by the mean value equal to (4.57) with standard deviation (0.52). This result confirmed that the majority of healthcare providers working in healthcare centers always keep in mind the importance of being welcome with their patients, because this will have a great effect on the psychological state of the patients.

It has noticed that, when participants of the current study were being required to present their perceptions with regard to the statement No.11, stated that (PHC staff direct his/her eyes to the patients’ faces while talking to them), the results in table No. (4-3) confirmed that the majority of participants strongly agreed that PHC staff usually direct his/her eyes to the patients’ facers while talking to them. This positive state of dealing with patients by healthcare providers in PHC was supported by the mean value equal to (4.53) with standard deviation (0.63).

Whereas, when participants of the current study were being asked to show their perceptions with regard to the statement No.7, stated that (PHC staff select the right time to talk to patients), the results in table No. (4-3) confirmed that the majority of participants strongly agreed that PHC staff always select the right time to talk to patients. This positive state of dealing with patients by healthcare providers in PHC was supported by the mean value equal to (4.46) with standard deviation (0.63).

In conclusion, with regard to the effect of empathy with patient practiced by healthcare providers in PHC, it could be observed that, the majority of participants strongly agreed that this empathy has a very strong impact on patient safety, which means that all staff have a great knowledge about how to deal with patients with empathy, which would affect positively on patients’ treatment and medication. It was noticed that, the most importance practices of empathy with patients that have positively impact on patients’ safety are: considering the psychological state of the patients during conservation, answering the patients’ questions with a warm welcome, responding to patients and listen to patients without interruption, smiling while directing attention to patient.

Table No. (4-4) the participant’s perceptions with regard to the impact of gathering information on patient safety.

Item No.	Gathering information	Mean	Standard deviation	Chi. Square	P. Value	Ranking
13	PHC staff use clear and appropriate words to express what the patient wants	4.62	0.54	86.52**	0.00	3
14	PHC staff must direct the patient to their correct destinations in a fast and fast manner to carry out the necessary tests	4.62	0.53	86.52**	0.00	4
15	PHC staff use a clear and understandable voice when collecting information from the patient	4.63	0.52	90.28**	0.00	2
16	PHC staff use facial expressions are used during conversation and good listening when the patient is asked for information about him.	4.55	0.59	143.60**	0.00	5
17	PHC staff should keep the patient information updated in a special place.	4.49	0.69	130.69**	0.00	6
18	PHC staff are confirmed patient information for medicines and medical devices.	4.65	0.50	96.16**	0.00	1
	Overall mean	4.59	0.49

**indicated that Chi-Square test is statistically significant at the (0.01) significant level

The results in table No. (4-4) showed the participants’ perceptions with regard to the impact of gathering information as one of the core elements of effective communication on patient safety, it was observed that as indicated by the statistics in table above that the majority of participants strongly agreed that, gathering information is one of the core components of effective communication has strong impact on patients’ safety in PHC in Jeddah city.

The results in the above table, also showed that all values of Chi-Square test are statistically significant at the (0.01) significant level, which proved that gathering information has a significant impact on patient safety.

To examine how gathering information has a significant impact on patient safety, the detailed perceptions of participants are conducted as in the following:

When participants of the current study were being asked to provide their perceptions with regard to the statement No.18, stated that 🙁 PHC staff are confirmed patient information for medicines and medical devices), it could be observed that, the majority of participants strongly agreed that PHC staff are confirmed patient information for medicines and medical devices. This positive practice was supported by the mean value equal to (4.65) with standard deviation (0.50). Therefore, these results proved that one of the most elements of gathering information by healthcare providers is that, at the first step PHC staff have to confirm patient information for medicines and medical devices as well.

Whereas, when participants of the current study were being required to provide their perceptions with regard to the statement No.15, stated that (PHC staff use a clear and understandable voice when collecting information from the patient), the results in table No. (4-4) revealed that the majority of participants strongly agreed that PHC staff use a clear and understandable voice when collecting information from the patient. The positive a warm welcome provided by PHC staff was supported by the mean value equal to (4.63) with standard deviation (0.52). This result confirmed that using a clear and understandable voice when collecting information from patients, has a very positive impact on patient safety.

On the other hand, when participants of the current study were being asked to provide their perceptions with regard to the statement No.16, stated that (PHC staff use facial expressions are used during conversation and good listening when the patient is asked for information about him), the results in table No. (4-4) showed that the majority of participants strongly agreed that PHC staff use facial expressions during conservation and good listening when the patient is asked for information about him. The positive state of expression of healthcare providers was supported by the mean value equal to (4.55) with standard deviation (0.59). Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

Whereas, when healthcare providers as participants in this study when they were being asked to show their perceptions with regard to the statement No.17, which stated that: (PHC staff should keep the patient information updated in a special place), the results in table No. (4-4) revealed that, the majority of participants strongly agreed that PHC staff should keep the patient information updated in a special place. This very positive perceptions was supported by the mean value (4.49) with standard deviation equal to (0.69). Hence, it could be concluded that staff usually are accustomed to keep the patient information updated in a special place, as a feed back to follow his medication situation on a professional way.

In conclusion to participant’s responses with regard to the importance, and impact of gathering information as one of the tools of effective communication for patient safety, the results confirmed that the majority of participants strongly agreed that gathering information about the patient has a very positive impact on patients’ safety. In addition to that the results confirmed that the most important indication behind that include: PHC staff are usually confirmed patient information for medicines and medical devices, and they use a clear and understandable voice when collecting information about the patient, and use clear and appropriate words to express what the patient wants, in addition to that they must direct the patient to their correct destinations in a fast manner to carry out the necessary tests.

Table No. (4-5) the participant’s perceptions with regard to the impact of share decision making on patient safety.

Item No.	Share decision making	Mean	Standard deviation	Chi. Square	P. Value	Ranking
19	PHC staff explains medical terminology to patients and share their information	4.52	0.61	61.32**	0.00	1
20	PHC staff take the benefit from the proposed ideas offered by the patient	4.38	0.69	101.89	0.00	2
21	Patients are given details of their illness if you are authorized	4.31	0.75	84.13**	0.00	4
22	All the details of patient given to his family if you are authorized	4.31	0.74	83.23**	0.00	3
	Overall mean	4.38	0.57

**indicated that Chi-Square test is statistically significant at the (0.01) significant level

The results in table No. (4-5) showed the participants’ perceptions with regard to the impact of share decision making as one of the core elements of the impact of effective communication on patient safety, it was noticed that the statistics in table No. (4-5) showed that the majority of participants strongly agreed that, share decision making is one of the most important elements of effective communication to impact on patient safety. In addition to that, the results showed that, all values of Chi-Square test are statistically significant at the (0.01) significant level. This indicated that, share decision making has a significant impact on patient safety.

To assess how sharing decision making has a significant impact on patient safety, the detailed perceptions of participants are carried out as follows:

When participants of the study were being asked to provide their perceptions with regard to the statement No.19, stated that 🙁 PHC staff explains medical terminology to patients and share their information), it could be noticed that, the majority of participants strongly agreed that PHC staff explains medical terminology to patients and share their information. This positive practice was supported by the mean value equal to (4.52) with standard deviation (0.61). Therefore, these results confirmed that, most staff usually explains medical terminology to patients in a positive way, which contributed in the improvement of the effective communication on patient safety.

Whereas, when participants of the current study were being required to provide their perceptions with regard to the statement No.20, stated that (PHC staff take the benefit from the proposed ideas offered by the patient), the results in table No. (4-5) revealed that the majority of participants strongly agreed that PHC staff take the benefit from the proposed ideas offered by the patient. This positive indication was supported by the mean value equal to (4.38) with standard deviation (0.69). This result confirmed that usually PHC staff take the benefit from the proposed ideas offered by the patient in order to make good decision for his medication on a professional manner.

While, when participants of the current study were being asked to show their perceptions with regard to the statement No.22, stated that (All the details of patient given to his family if you are authorized), the results in table No. (4-5) confirmed that the majority of participants strongly agreed that all details of patient given to his family if the healthcare provider is authorized by the patient to do that. This positive perception was supported by the mean value equal to (4.31) with standard deviation (0.74). This means that if healthcare providers as employees don’t have the light from the patient to give any details about his disease or medication, he can’t do that, which indicated that healthcare providers they deal with the patient in a trustful manner, and keeping everything about him secret, unless the patient authorized him.

In conclusion, when participants of the current study were being required to show their perceptions with regard to the statement No.21, stated that (Patients are given details of their illness if you are authorized), the results in table No. (4-5) confirmed that the majority of participants strongly agreed patients are given details of their illness if the healthcare provider is being authorized. This positive perception was supported by the mean value equal to (4.31) with standard deviation (0.75), which indicated that all healthcare providers understand that they will not spread the details of the patients’ illness unless they were being authorized officially either by patient himself or the medication physician who is only responsible to speak with the patient directly and not with any other one if not authorized by the patient.

Therefore, based on the previous analysis of the participants perceptions with regard to the impact of share decision making as one of the main elements of effective communication to impact on patient safety, it could be noticed that sharing of decision making has a strong impact on patient safety. The results have shown that the most important effect of sharing decision making have come through staff explaining medical terminology to patient and share their information, and staff taking of the benefit from the proposed ideas offered by the patient, and keep secret of the details of patient illness if not authorized.

Table No. (4-6) the participants perceptions with regard to the impact of cultural difference on patient safety.

Item No.	Cultural difference	Mean	Standard deviation	Chi. Square	P. Value	Ranking
23	PHC staff accept constructive criticism offered by patients without anger	4.36	0.59	52.68**	0.00	5
24	PHC staff demonstrate Policies and procedures for the patient in an acceptable manner	4.54	0.57	67.1**	0.00	3
25	PHC staff shake hands with patients to calm their mental state	4.40	0.75	164.53**	0.00	4
26	PHC staff take care that your sitting position is appropriate when dealing with the patient	4.56	0.54	73.56**	0.00	2
27	PHC staff use a quiet and comfortable tone of voice during dealing with patient	4.58	0.52	78.12**	0.00	1
	Overall mean	4.49	0.51

**indicated that Chi-Square test is statistically significant at the (0.01) significant level

The results in table No. (4-6) showed the participants’ perceptions with regard to the impact of cultural differences as one of the main elements of the impact of effective communication on patient safety, it was noticed that the statistics in table above showed that the majority of participants strongly agreed that, cultural differences is considered as of the elements of effective communication to impact on patient safety. Furthermore, the results in the above table, showed that all values of Chi-Square test are statistically significant, indicating that, cultural differences have a significant impact on patient safety. To assess how cultural differences has a significant impact on patient safety, the detailed perceptions of participants are carried out as follows:

When participants of the study were being asked to provide their perceptions with regard to the statement No.27, stated that 🙁 PHC staff use a quiet and comfortable tone of voice during dealing with patient), it could be noticed that, the majority of participants strongly agreed that PHC staff use a quiet and comfortable tone of voice during dealing with patient. This positive practice was supported by the mean value equal to (4.58) with standard deviation (0.52). Therefore, this result support that most staff usually use quiet and comfortable tone of voice during dealing with patients in order to let them to have a complete rest, which will contribute in the achievement of patient safety.

Based on the statistics in table No. (4-6), when participants of the current study were being required to provide their perceptions with regard to the statement No.26, stated that (PHC staff take care that your sitting position is appropriate when dealing with the patient), the results in table No. (4-10) showed that the majority of participants strongly agreed that PHC staff take care that their sitting position is appropriate when dealing with the patient. This positive practice of sitting was supported by the mean value equal to (4.56) with standard deviation (0.54). This result confirmed that usually PHC staff take care of their sitting position when dealing with the patient to let him to be in a comfortable situation. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

On the other hand, when participants were being asked to present their thoughts and opinion with regard to the statement No.25, which stated that: (PHC staff shake hands with patients to calm their mental state), it could be confirmed that the majority of healthcare providers working in PHC, who participate in this study strongly agreed that, PHC staff shake hands with patients to calm their mental state. The positive effect of this practice was supported by the mean value equal to (4.40) with standard deviation (0.75).

In last, when participants were being asked to present their thoughts and opinion with regard to the statement No.23, which stated that: (PHC staff accept constructive criticism offered by patients without anger), it could be observed that the majority of healthcare providers working in PHC, who participate in this study strongly agreed that, PHC staff accept constructive criticism offered by patients without anger. The positive effect of this practice was supported by the mean value equal to (4.36) with standard deviation (0.59). Therefore, the acceptance of PHC staff for constructive criticism from patients without anger, indicate that all staff are well trained to deal with patients as customers.

In conclusion to the analysis of the participants perceptions with regard to the impact of take care of cultural differences by healthcare providers in PHC in Jeddah, the results found that most participants strongly agreed that cultural difference has to impact on patient safety effectively. The results found that the most important indications supporting that include: staff use a quiet and comfortable tone of voice during dealing with patient, staff taking care of their sitting position is appropriate when dealing with the patient, in addition to that staff acceptance of constructive criticism offered by patient without anger.

Table No. (4-7) the participants perceptions with regard to patient safety in PHC in Jeddah.

Item No.	Patient safety	Mean	Standard deviation	Chi. Square	P. Value	Ranking
28	PHC staff trained on different aspects of international patient safety goals (IPSGs).	4.60	0.53	81.48**	0.00	3
29	PHC staff are aware about there is monitoring of IPSGs evidenced in reports, meeting minutes, and action plans for improvements.	4.55	0.62	141.52**	0.00	7
30	PHC staff are aware of applying the policy of patient identifiers and when to be used.	4.58	0.56	154.59**	0.00	6
31	PHC staffs are aware about there is the policy for effective identification of patients who are at risk for falling.	4.58	0.56	75.96**	0.00	4
32	PHC staff are aware about the hand hygiene policy is properly implemented.	4.69	0.46	22.43**	0.00	1
33	PHC staff are aware about there is a process for preventing medications errors.	4.65	0.53	94.84**	0.00	2
34	PHC staff are aware of a list of cases involving sentinel events	4.58	0.58	153.20**	0.00	5
35	PHC staff are aware of applying the process of handling sentinel events includes reporting within 24 hours, formation of a team for studying the causes of the event (root cause analysis) within 10 working days.	4.54	0.61	139.97**	0.00	8
	Overall mean	4.60	0.49

The results in table No. (4-7) showed the participants’ perceptions with regard to the actual situation of patients’ safety in PHC in Jeddah city, it was noticed that the statistics in table above confirmed that the majority of participants strongly agreed that, there are much care was taken towards the patient safety.

To assess the most important indications which present the patient safety situation in PHC in Jeddah city, the detailed analysis of participants’ perceptions are carried out as follows: When participants of the study were being asked to provide their thoughts with regard to the statement No.32, which stated that 🙁 PHC staff are aware about the hand hygiene policy is properly implemented), the results in the above table showed that, the majority of participants strongly agreed that PHC staff usually aware that the hand hygiene policy is properly implemented. The highly positive perceptions of the participants were supported by the mean value equal to (4.69) with standard deviation (0.49). Hence, this result support that the majority of staff usually aware that the hand hygiene policy is properly implemented.

Whereas, when participants of the study were being asked to present their opinions with regard to the statement No.33, which stated that 🙁 PHC staff are aware about there is a process for preventing medications errors), the results in table No. (4-7) showed that, the majority of participants strongly agreed that PHC staff usually are aware about the process for preventing medications errors). The highly positive perceptions of the participants were supported by the mean value equal to (4.65) with standard deviation (0.53). Therefore, this result support that the majority of staff always put high value to the awareness about the process for preventing mediations errors.

While, when participants of the study were being required to show their perceptions with regard to the statement No.29, which stated that: (PHC staff are aware about there is monitoring of IPSGs evidenced in reports, meeting minutes, and action plans for improvements), the results in table No. (4-7) revealed that, the majority of participants strongly agreed that PHC staff are aware about monitoring of IPSGs in reports, meeting minutes, and action plans for improvement. So, these positive perceptions of the participants were supported by the mean value equal to (4.55) with standard deviation (0.62).

At last, when participants of the study were being asked to show their perceptions with regard to the statement No.35, which stated that 🙁 PHC staff are aware of applying the process of handling sentinel events includes reporting within 24 hours, formation of a team for studying the causes of the event (root cause analysis) within 10 working days), the results in table No. (4-7) revealed that, the majority of participants strongly agreed that PHC staff are aware of applying the process of handling sentinel events includes reporting within 24 hours, formations of a team for studying the causes of the event (root cause analysis).

Therefore, based on data analysis of the participants as healthcare providers in PHC in Jeddah, with regard to patients’ safety, it could be concluded that most participants strongly agreed that, all staff are well aware about patients’ safety, in particularly they are aware about hand hygiene policy is properly implemented, and they are aware about the process for preventing medications errors, and in addition to that in order to achieve patients’ safety staff trained on different aspects of international patient safety goals, and also they are aware about the policy for effective identification of patients who are at risk for falling.

Table No. (4-8) shows overall participants responses with regard to impact of effective communication dimensions of patient safety.

	Overall
Independent variables	Mean	Standard deviation	Chi. Square	P. Value	Ranking
Establish relationship	4.58	0.44	149.73**	0.00	2
Empathy with patients	4.54	0.46	150.00**	0.00	3
Gathering information	4.59	0.49	336.64**	0.00	1
Share decision making	4.38	0.57	152.40**	0.00	5
Cultural difference	4.49	0.51	141.72**	0.00	4

**indicated that Chi-Square test is statistically significant at the (0.01) significant level

The statistics in table No. (4-8) revealed that the most important effect on patient safety has resulted from gathering information as one of the core elements of effective communication, followed by establish relationship at the second level, while empathy with patient safety has come at the third level among the factors that impact patient safety, where cultural difference has come at the fourth level in terms of impacting the patient safety, where share decision making has the a significant impact also, as the last elements of effective communication.

4.4 Section Three: Examining Significant Differences Related to Demographic Characteristics.

To examine whether there are significant differences in healthcare providers perceptions with regard to the impact of effective communication on patient safety, related to the demographic characteristics including (gender, age, position, education level, and experiences) analysis of variances techniques have been performed. To examine if there are statistically significant difference related to gender, T-test statistics was run, whereas to examine if there are significant differences related to (age, position, education level, and years of experience) One-Way Analysis of variance (ANOVA) was performed. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

The results of the previous tests are presented as in the following tables:

Table No. (4-9) results of testing the significant differences in the impact of effective communication on patient safety related to gender.

Main variables	Gender	Sample size	Mean	Standard deviation	T-test	df	P-value
Establish relationship	Female	50	4.59	0.44	0.198	148	0.84
	Male	100	4.58	0.43
Empathy with patient	Female	50	4.57	0.46	0.521	148	0.60
	Male	100	4.53	0.46
Gathering information	Female	50	4.63	0.53	0.632	148	0.53
	Male	100	4.58	0.46
Share decision making	Female	50	4.42	0.62	0.607	148	0.55
	Male	100	4.36	0.54
Cultural difference	Female	50	4.52	0.56	0.478	148	0.63
	Male	100	4.47	0.48
Patient safety	Female	50	4.66	0.51	1.042	148	0.30
	Male	100	4.57	0.48

The results in table No. (4-9) found that, there are no statistically significant differences between healthcare providers’ perceptions in PHC in Jeddah, towards the effective communication impact on patient safety related to gender. This means that gender was not regarded as an independent variable that have no effect on the participant’s perceptions with regard to the impact of effective communication on patient safety in Jeddah healthcare institutions.

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

Table No. (4-10) showed the results of analyzing the impact of effective communication on patient safety related to age.

	Mean values by age group				F	P-value
	Less than 30	30-to 40	40-to 50	50+
Establish relationship	4.44	4.60	4.62	4.45	.927	.429
Empathy with patients	4.40	4.58	4.55	4.26	1.618	.188
gathering information	4.46	4.60	4.62	4.79	.793	.500
share decision making	4.27	4.40	4.41	4.18	.589	.623
cultural differences	4.33	4.51	4.57	4.29	1.146	.333
patient safety	4.47	4.63	4.61	4.41	.811	.490

The results of analysis of variances in table No. (4-10) showed that, there are no statistically significant differences between participants perceptions with regard to the impact of effective communication on patient safety, as all P-values of the F-statistics are greater than the (0.05) significant level. This means age variations of the respondents as an independent demographic variable would not be considered as a factor that effect on participant’s attitudes towards the impact of effective communication through all its core elements on patient safety. This indicated that all participants strongly agreed that effective communication has a significant impact on patient safety.

Table No. (4-11) showed the results of analyzing the impact of effective communication on patient safety related to job position.

	Mean values by job							F	P-value
	Admin.	nursing	physician	X-ray	Lab.	dental	Pharm.
Establish relationship	4.39	4.66	4.73	4.35	4.47	4.37	4.85	3.548**	.003
Empathy with patients	4.33	4.63	4.67	4.42	4.28	4.40	4.80	3.044**	.008
gathering information	4.50	4.66	4.64	4.38	4.33	4.48	4.91	1.716	.121
share decision making	4.26	4.43	4.62	4.06	3.96	4.30	4.47	2.260*	.041
cultural differences	4.41	4.57	4.57	4.35	4.20	4.26	4.58	1.309	.257
patient safety	4.39	4.68	4.75	4.34	4.46	4.54	4.75	2.466*	.027

The results of analysis of variance in table No. (4-11) found that there are statistically significant differences between participants’ perceptions regarding the impact of establish relation, empathy with patient, share decision making, and patient safety, related to Job position of participants of the study. This mean participants have different opinions towards the impact of establish relationship, empathy with patient, and share decision making on patient safety. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

Table No. (4-12) showed the results of analyzing the impact of effective communication on patient safety related to education level.

	Mean values by educational level				F	P-value
	High school/diploma	College/ diploma community	University degree	postgraduate	F	P-value
Establish relationship	4.54	4.60	4.56	4.71	.511	.675
Empathy with patients	4.53	4.56	4.50	4.64	.289	.833
gathering information	4.60	4.62	4.53	4.70	.472	.703
share decision making	4.35	4.31	4.43	4.64	1.131	.338
cultural differences	4.53	4.42	4.46	4.64	.742	.529
patient safety	4.53	4.59	4.62	4.82	1.063	.367

The results of analysis of variances in table No. (4-12) showed that there are no statistically significant differences between participants perceptions towards the impact of the core elements of effective communication on patient safety related to educational level. This indicated the variation of education level was not considered as an independent variable that has an effect on participant’s attitudes towards the impact of effective communication on patient safety.

Table No. (4-13) showed the results of analyzing the impact of effective communication on patient safety related to years of experience.

	Mean values by years of experience				F	P-value
	1-to less than 5	5- to less than 10	10- to less than 15	15 years and over	F	P-value
Establish relationship	4.52	4.57	4.61	4.59	.172	.915
Empathy with patients	4.33	4.60	4.60	4.49	1.877	.136
gathering information	4.32	4.60	4.65	4.65	2.129	.099
share decision making	4.07	4.47	4.43	4.35	2.284	.081
cultural differences	4.26	4.50	4.56	4.49	1.479	.223
patient safety	4.35	4.61	4.74	4.54	2.945*	.035

*indicated that the difference is significant at the (0.05) significant level.

The results in the above table No. (4-13), showed that there are no statistically significant differences between participants attitudes regarding the impact of effective communication on patient safety related to years of experience. This means that all participants strongly agreed that all core elements of effective communication have an impact on patient safety. While the result found that there is a significant difference between participant’s attitudes towards the patient safety.

4.5 Summary of Results

Based on data analysis and testing the research hypotheses, the study concluded with the following outcomes:

With regard to establish relationship impact on patient safety, the concluded that establish relationship has a very considerable impact on patient safety, in particularly, the most important ways to do that include: focusing of PHC staff on patient when speak without distraction and interruption, speaking with patients with interest and activity, responding to patients needs quickly and calm down their anxiety.
Concerning the effect of empathy with patient practiced by healthcare providers in PHC, the study revealed that, the majority of participants strongly agreed that empathy has a very strong impact on patient safety, which means that all staff have a great knowledge about how to deal with patients with empathy, which would affect positively on patients’ treatment and medication.
The study found that, the most importance practices of empathy with patients that have positively impact on patients’ safety are: considering the psychological state of the patients during conservation, answering the patients’ questions with a warm welcome, responding to patients and listen to patients without interruption, smiling while directing attention to patient.
The study showed that, with regard to the importance, and impact of gathering information as one of the tools of effective communication for patient safety, the results confirmed that the majority of participants strongly agreed that gathering information about the patient has a very positive impact on patients’ safety. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies
With regard to the impact of share decision making as one of the main elements of effective communication to impact on patient safety, it could be noticed that sharing of decision making has a strong impact on patient safety. The results have shown that the most important effect of sharing decision making have come through staff explaining medical terminology to patient and share their information, and staff taking of the benefit from the proposed ideas offered by the patient, and keep secret of the details of patient illness if not authorized.
The study found that most participants strongly agreed that cultural difference has to impact on patient safety effectively. The results found that the most important indications supporting that include: staff use a quiet and comfortable tone of voice during dealing with patient, staff taking care of their sitting position is appropriate when dealing with the patient, in addition to that staff acceptance of constructive criticism offered by patient without anger.
The study explored that, all staff are well aware about patients’ safety, in particularly they are aware about hand hygiene policy is properly implemented, and they are aware about the process for preventing medications errors, and in addition to that in order to achieve patients’ safety staff trained on different aspects of international patient safety goals, and also, they are aware about the policy for effective identification of patients who are at risk for falling.
The results of T-test to examine whether there are significant differences between healthcare providers in PHC in Jeddah with regard to the impact effective communication on patient, the results don’t find any significant differences related to gender of participants.
The study showed that there are no statistically significant differences between healthcare providers perceptions towards the impact of effective communication on patient safety in PHC, in Jeddah city related to age, educational level, and years of experiences of the participants.
The study detected that, there are statistically significant difference between healthcare providers perceptions with regard to the impact of effective communication within establish relationship, empathy with patient and gathering information related to job position.
The study found that, there is a significant difference between participants attitudes towards the patient safety related to years of experience, and it was concluded that the significant difference are positive to the health care providers who have years of experience between (10- to less than 15) years. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

Chapter Five:

Summary, Conclusion and Recommendation

Chapter Five: Summary, Conclusion and Recommendation

5.1 Summary of Results

This chapter presents the summary of findings, conclusions and recommendation of the study. The study variables are categorized into dependent and independent variables. The dependent variable in this study is patient safety, whereas the independent variable is effective communication, which is represented by five variables including (establish or building relationship, empathy with patient, gathering information, share decision making, and cultural difference).

2 Research Summary

In Chapter one, the impact of effective communication in the healthcare setting in on patient safety is examined. The study is justified in that it seeks to identify how effective communication can have a positive impact on patient safety by providing the needed information to the practitioners. The study seeks to raise awareness of the need for patient safety and the precise contribution of effective communication.

In the second chapter, the researcher assesses the role of effective communication on patient’s safety and investigates the perception of healthcare staff on the contribution of effective communication to the overall patient safety. Five independent variables were identified as playing a critical role in effective communication and ensuring the safety of the patients. These included effective contribution assisted in establishing a relationship in the healthcare settings and empathy as well as helping in gathering information, contributed to the shared decision-making process, and also played significant roles in bridging cultural differences. The five independent factors were investigated for their impact on patient safety. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

The third chapter describes the methodology utilized in the research process. The study relied on a descriptive analytical approach in the research design. A population of 150 research subjects was selected from the target population that included staff from four healthcare centers in Jeddah province, Saudi Arabia. The study employs a survey questionnaire in the data collection. The chapter also presents the reliability as well as the validity of the survey questionnaire used in the study as well as the statistical techniques that data is analyzed for descriptive statistics to present the demographics of the research participants. Pearson correlation coefficient is used to test the five hypotheses proposed in chapter one. The reliability of the questionnaire items is tested using the Cronbach’s alpha. This chapter number four of the study is specified for data analysis and interpretations, and mainly it concentrated to find answer to the research questions.

Chapter four describes the data analysis and interpretation process and mainly it concentrated to find answer to the research questions. The chapter has provided a summary of the key findings from the data collected in the methodology section including the demographic data grouping the research subjects based on gender, age and position in the healthcare center. Six issues emerge from the data collection process. The six issues affect the relationship between PHC staff and the patients. The six issues are; establish relationship, empathy, gathering information, share decision making, cultural differences, and demographic characteristics. The independent variables are analyzed in the chapter and their mean, standard deviation, and chi-square as well as the p-value for their confidence level provided in this chapter. In addition, questionnaire’s items related to patient safety have also been analyzed with all items demonstrating high significance based on their p-value which is below 0.05. Overall, all the independent variables, establish a relationship with patients, and empathy with patients helped in gathering information and assisted the shared decision-making process as well as bridged the cultural differences were significant in influencing patient safety since they all reported a p-value of zero from the analysis based on 95% confidence level. Based on ANOVA the demographics of gender did not have any significant influence on the five independent factors that affect patient safety in effective communication. This was also similar to the age of the research participants; however, the position of the research subjects influenced their perception of the independent factors on patient safety in view of effective communication.

3 Research Conclusion

PHC has applied a set of establish relationship technique which positively affected on patient safety services, in particularly, that a set of techniques like the focusing on a patient when speaking without distraction and interruption. Also responding to patients needs quickly and calm down their anxiety.
PHC took into consideration publish of communication culture process that strongly appropriate of empathy with the patient which has a very strong impact on patient safety through the applied a good dealing art with the patient. It means that all staff has a great knowledge about how to deal with patients, their treatment, and their medication.
PHC has provided policies of gathering health information which positively affected patient safety. It is usually confirmed patient information for medicines and medical devices, PHC staff use a clear, understandable voice when collecting information about the patient. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies
PHC has applied sharing decision mechanism which positive effect on patient safety through explaining medical terminology to the patient that help them to choose the right health path, share their information and keep the details of the patient illness secret.
PHC is keeping indicators of culture difference supporting patient safety services positively like staff use a quiet and comfortable tone of voice during dealing with patients, staff acceptance of constructive criticism offered by patient without anger.
In the analysis of demographic characteristic for the five independent variables, none of the variables demonstrated any significant differences between groups since p-value was not significant (p>0.05) for the average scores for “establish relationship”, “empathy with patients”, “gathering information”, “share decision making”, “cultural differences”, and the averages scores for patient safety. It means all healthcare provider given a high rate for the effectiveness of communication on patient safety.

4 Research Recommendation

Improve the PHC services and continuously for the process of the special procedures of establishing relationships with patients by updating the policies and procedures of PHC continuously and commensurate with the current situation.
Setting regular meetings among staff to develop the process of empathy with patients for attained great treatments and services with appropriate methods.
Trying to increase staff knowledge of gathering information mechanism by apply training courses to reduce medical errors. Also, ensure that there are patients’ rights and responsibilities approved.
Determining regular revision of PHC sharing decision rules through insert patients for sharing decision as PHC priority service.
Develop PHC indicators plans annually by documenting performance indicators for different cultures.
Provide training sessions to improve effective communication skills with patients. Also, motivate staff who work at PHC to do their work by following PHC rules and regulations. Moreover, motivate staff morally and through promotions and bonuses.

References

Alan H. Rosenstein, & Michelle O.Daniel, (2008), A Survey of the Impact of Disruptive Behaviors and Communication Defects on Patient Safety, The Joint Commission Journal on quality and patient Safety, Vo.34, No.8. Retrieved from: http://www.mc.vanderbilt.edu/root/pdfs/nursing/ppb_article_on_disruptive.pdf

Alkorashy, H. A. E. (2013). Factors shaping patient safety management in the Middle East hospitals from nursing perspective: a focus group study. Middle-East Journal of Scientific Research, 15(10), 1375-1384.

Almutairi, K. M. (2015). Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia. Saudi Medical Journal, 36(4), 425–431. https://doi.org/10.15537/smj.2015.4.10133

A.M. Aboul-Fotooh, N.A. Ismail, H.S. EzElarab, & G.O. Wassif (2012), Assessment of Patient Safety Culture among Health-Care Providers at a teaching hospital in Cairo, Egypt, Estern Mediterranean Health Journal Vol.18, No.4.

Barry, M. J., & Edgman-Levitan, S. (2012). Shared Decision Making — The Pinnacle of Patient-Centered Care. New England Journal of Medicine, 366(9), 780–781. https://doi.org/10.1056/NEJMp1109283

Begum, T. (2015). Doctor Patient Communication: A Review. Journal Of Bangladesh College of Physicians And Surgeons, 32(2), 84. http://dx.doi.org/10.3329/jbcps.v32i2.26036

Brock, D., Abu-Rish, E., Chiu, C. R., Hammer, D., Wilson, S., Vorvick, L. & Zierler, B. (2013). Interprofessional education in team communication: working together to improve patient safety. BMJ Quality & Safety, 22(5), 414-423.

Cánovas, L., Carrascosa, A., García, M., Fernández, M., Calvo, A., Monsalve, V., & Soriano, J. (2017). Impact of Empathy in the Patient-Doctor Relationship on Chronic Pain Relief and Quality of Life: A Prospective Study in Spanish Pain Clinics. Pain Medicine. http://dx.doi.org/10.1093/pm/pnx160

Casey A. Wallis A. (2011), Effective Communication: Principle of Nursing Practice E. Journal of Art & Science, 25 (32) 35-37.

Creswell (2003). research design, qualitative, quantitative, and mixed methods approach, Sage Publication Inc., California.

Dingley, C., Daugherty, K., Derieg, M. K., & Persing, R. (2008). Improving patient safety through provider communication strategy enhancements.

Donna M.W. (2008), Improving Clinical Communication and Patient Safety: Clinician- Recommended Solutions, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago.

Doyle, C., Lennox, L. & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ open, 3(1), e001570.

Elwyn, G. (2014). Shared decision-making: merging evidence into patient- centered care. European Journal for Person Centered Healthcare, 2(1), 30. http://dx.doi.org/10.5750/ejpch.v2i1.693

Emanuel, L., Berwick, D., Conway, J., Combes, J., Hatlie, M., Leape, L., & Walton, M. (2008). Advances in patient safety What exactly is patient safety? In K. Henriksen, J. B. Battles, M. A. Keyes, & M. L. Grady (Eds.), Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment). Agency for Healthcare Research and Quality.1-17.

Gay, L.R, & Airasian, P. (2000), Educational Research: Competencies for Analysis and application (6^th edition), Upper Saddle River, NJ: Prentice Hall Hohn W.

Giroldi, E., Veldhuijzen, W., Dijkman, A., Rozestraten, M., Muris, J., van der Vleuten, C., & van der Weijden, T. (2015). How to gather information from talkative patients in a respectful and efficient manner: a qualitative study of GPs’ communication strategies. Family Practice, 33(1), 100-106. http://dx.doi.org/10.1093/fampra/cmv094

Greenberg, C., Regenbogen, S., Studdert, D., Lipsitz, S., Rogers, S., Zinner, M., & Gawande, A. (2007). Patterns of Communication Breakdowns Resulting in Injury to Surgical Patients. Journal of the American College of Surgeons, 204(4), 533-540. doi: 10.1016/j.jamcollsurg.2007.01.010.

Guyatt, G.H., Mulla, S.M., Scott, I.A., Jackevicius, C.A., & You, J.J. (2014). Patient engagement and shared decision-making. Journal of General Internal Medicine. Springer New York LLC. https://doi.org/10.1007/s11606-013-2727-3.

Jackson, S. E., Joshi, A. & Erhardt, N. L. (2003), Recent research on team and organizational diversity: SWOT analysis and implications. Journal of Management, 29(6), 801-830.

Jani, B., Blane, D. & Mercer, S. (2012). The Role of Empathy in Therapy and the Physician-Patient Relationship. Forschende Komplementärmedizin / Research in Complementary Medicine, 19(5), 252-257. http://dx.doi.org/10.1159/000342998.

Jemczura Teresa, (2004), Empathy as a form of interpersonal communication. Retrieved from: http://www.biblioteka.vpu.lt/pedagogika/PDF/2005/75/jemczura.pdf

Joint commission (2013), International Patient Safety Goals. Retrieved from: http://www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf

Künzle, B., Kolbe, M., & Grote, G. (2010). Ensuring patient safety through effective leadership behaviour: a literature review. Safety Science, 48(1), 1-17. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

Kothari, C.R. (2004). Research methodology: Methods and techniques. New Age International.

Legare, F., Turcotte, S., Stacey, D., Ratte, S., Kryworuchko, J., & Graham, I.D. (2012). Patients’ perceptions of sharing in decisions: a systematic review of interventions to enhance shared decision making in routine clinical practice. The Patient: Patient-Centered Outcomes Research, 5, 1–19. https://doi.org/http://dx.doi.org/10.2165/11592180-000000000-00000

Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: the critical importance of effective teamwork and communication in providing safe care. BMJ Quality & Safety, 13(suppl 1), i85-i90.

Linda E., Don, B., Conway, J., Combes, J., Hatlie, M., Leape, L., Reason, J., Schyvce, P., Vincent, C., & Walton, M. (2005), What Exactly is Patient Safety. Retrieved from: http://www.ahrq.gov/downloads/pub/advances2/vol1/advances-emanuel-berwick_110.pdf

Lingard, L., Espin, S., Whyte, S., Regehr, G., Baker, G. R., Reznick, R. & Grober, E. (2004). Communication failures in the operating room: an observational classification of recurrent types and effects. BMJ Quality & Safety, 13(5), 330-334.

Mannix, E. & Neale, M.A. (2005), What differences make a difference: The promise and reality of diverse teams in organizations. Psychological Science in the Public Interest, 6(2), 31-55.

Manser, T. (2009). Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiologica Scandinavica, 53(2), 143-151.

Margot Phaneuf R.N, (2006). Data Collection: The basis for all nursing interventions. Retrieved from:http://www.infiressources.ca/fer/depotdocument_anglais/data_collection-the_basis_for_all_nursing_interventions.pdf

Maylor, H., & Blackmon, K. (2005). Chapter 5: Scientist or Ethnographer: Two models for designing and doing research. Researching Business and Management, 134-164.

Minesota Department of health office of performance improvement, (2014), Building Community Relationship, public health and the community, CHS Administration Handbook. Retrieved from: http://www.health.state.mn.us/divs/opi/gov/chsadmin/docs/community_relationships.pdf

Ming Lim, H. & Siste Kurniasanti, K. (2017). Shared Decision Making and Effective Physician-Patient Communication: The Quintessence of Patient-Centered Care. International Journal of Medical Students, 3(1), 7-9. Retrieved from https://www.ijms.info/index.php/IJMS/article/view/106

MPH, L. L. (2011), Canadian Framework for Teamwork and Communication List Review.pdf, Teamwork and communication in health care. Retrieved from: http://www.patientsafetyinstitute.ca/en/toolsResources/teamworkCommunication/Documents/Canadian%20Framework%20for%20Teamwork%20and%20Communications%20Lit%20Review.pdf

Nadzam, D.M. (2009). Nurses’ role in communication and patient safety. Journal of Nursing Care Quality, 24(3), 184-188.

National Health Service, NHS. (2010). Essence of Care, Benchmarks for Communication Retrieved from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216695/dh_119973.pdf

Noordeen S. (2012), The Role of Jordanian Hospital Nurses in Promoting Patients’ Health. Queen Margaret University, PhD in Nursing, International Journal of Nursing 1(1). Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.300.8945&rep=rep1&type=pdf

O’Malley, A.S., Collins, A., Contreary, K., & Rich, E.C. (2016). Barriers to and Facilitators of Evidence-Based Decision Making at the Point of Care. MDM Policy & Practice, 1(1), 238146831666037. https://doi.org/10.1177/2381468316660375

Rachel E.D., Rosamond, J., Sevdalis, N. & Vincent C., (2007), Patient Involvement in Patient Safety: what Factors influence patient participation and engagement, Journal Compilation, Blackwell Publishing Ltd Health Expectations, 10, 259-267.

Ros, W. (2012), Effective Communication Skills for the Caring Nurse, the Great Teachers, Tertiary Place. Retrieved from: http://www.pearsonlongman.com/tertiaryplace/pdf/ros_wright_effective_comm_skills_for_the_caring_nurse_aug2012.pdf

Rosenstein, A. H. & O’Daniel, M. (2008). A survey of the impact of disruptive behaviors and communication defects on patient safety. The Joint Commission Journal on Quality and Patient Safety, 34(8), 464-471.

Ruane, S. (2016). Building a culture of patient safety. Master‟s of Science in Healthcare Administration. Utica College. USA.

Saudi Central Board for Accreditation of Healthcare Institutions, CBAHI. (2016). Essential national requirement for patient safety. Retrieved from: https://portal.cbahi.gov.sa/english/patient-safety/essential-safety-requirements

Saudi Central Board for Accreditation of Healthcare Institutions, CBAHI. (20016). Management of patient safety in Saudi Arabia. Retrieved from: https://portal.cbahi.gov.sa/english/home

Schouten, B.C., & Meeuwesen, L. (2006). Cultural differences in medical communication: A review of the literature. Patient Education and Counseling. https://doi.org/10.1016/j.pec.2005.11.014

Schouten, B.C., Meeuwesen, L., Tromp, F., & Harmsen, H.A.M. (2007). Cultural diversity in patient participation: The influence of patients’ characteristics and doctors’ communicative behaviour. Patient Education and Counseling, 67(1–2), 214–223. https://doi.org/10.1016/j.pec.2007.03.018

Shannon, D.W. & Myers, L.A. (2012). Nurse to Physician Communication: Connecting for Safe. Patient Safety & Quality Healthcare, 9 (5). Retrieved from:www.PSQH.com.

Smith, S. (2016). Reducing medical errors and increasing patient safety in health care. Master‟s of Science in Healthcare Administration. Utica College. USA.

Tereza, M. & Fleury, L. (1999), The Management of Cultural Diversity: Lessons From Brazilian, Industrial Management, 3, 109.

Team, F.M.E. (2013). Effective Communications. Retrieved from: http://www.free-management-ebooks.com/dldebk-pdf/fme-effective-communication.pdf

Tjia, J., Mazor, K.M., Field, T., Meterko, V., Spenard, A., & Gurwitz, J.H. (2009). Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety. Journal of patient safety, 5(3), 145.

Vincent, C. (2011). The essentials of patient safety. Download disponibile all’indirizzo www1. imperial. ac. uk/medicine/about/institutes/patientsafetyservicequality. Retrieved from: http://www.wiley.com/legacy/wileychi/vincent/supp/Essentials_final_complete.pdf

Weller, J., Boyd, M., & Cumin, D. (2014). Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate medical journal, 90(1061), 149-154.

Woolf, S.H., Kuzel, A.J., Dovey, S.M., & Phillips, R.L. (2004). A string of mistakes: the importance of cascade analysis in describing, counting, and preventing medical errors. The Annals of Family Medicine, 2(4), 317-326.

World Health organization (2009), Human Factors in Patient Safety review of topics and tools, report for methods and measure working group of WHO Patient Safety. Retrieved from: https://blogs.cmdn.dundee.ac.uk/humanfactors/files/2013/09/WHO-Human-Factors-in-Patient-Safety-Review-of-Topics-and-Tools.pdf

World Health organization, The Joint Commission, & Joint Commission International. (2007). Patient identification.Patient Safety Solutions, 1(2), 1-4.

World Health Organization (2012), management patient information, trends and challenges in member states. Based on the findings of the second Global Survey on e-health, Global Observatory for e-health series –Volume 6. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

Zwarenstein, M., & Reeves, S. (2002). Working together but apart: Barriers and routes to nurse–physician collaboration. The Joint Commission Journal on Quality Improvement, 28(5), 242-7,209. https://doi.org/10.1016/S1070-3241(02)28024-4

Appendix

King Abdulaziz University

College of Economics and Administration

Dears, Health Care Provider

I am in a process to complete my Executive Master degree in Health management from Health Service and Hospital Administration Department in College of Economics and Administration at the University of King Abdulaziz, Jeddah, by conducting this current research with the title:

The Impact of Effective communication on Patient safety in primary health care center in KSA

I have the pleasure, to introduce this Questionnaire for your consideration, I hope that you will give it part of your precious time to read all items, and provide the answer by checking (√) at the levels that match your opinion in the accurate and serious way that contributed in the achievement of research objectives.

I assured to you that, all information will be in highly confidential, and only will be used for scientific research.

Researcher

Amal Alsomali

PART 1

Personal Information

Please tick (×) in the appropriate box that applies to you

Gender: Male Female
Age: Less than 30 30- Less than 40

40- Less than 50 50 and over

Position: Administrative Nursing

Physician X-ray

Laboratory Dental

Pharmacy

Education: High school/diploma College diploma/Community Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

University degree Postgraduate

Years of Experience: Less than a year 1- Less than 5

5- Less than 10 10- Less than 15

15 and over

PART 2

This section contains a set of questions that measure the level of effective communication skills with patients in your primary health care center. Please tick (√ ) in the appropriate box that applies to you

No.	Item	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Establish relationship
1.	PHC staff speak with patients in an acceptable speed to enable them understand the conversation
2.	PHC staff speak to patients with interest and activity
3.	PHC staff focus on patients when speaking without distraction and interruption
4.	PHC staff talk with patients patiently and endure their questions
5.	PHC staff respond to patients’ needs quickly and calm down their anxiety.
6.	Workers seek to build good relationships with patients to improve their impressions.
Empathy with patients
1.	PHC staff select the right time to talk to patients
2.	PHC staff answer the patients’ questions with a warm welcome
3.	PHC staff consider the psychological state of the patients during the conversation
4.	PHC staff respond to patients and listen to them without interruption
5.	PHC staff direct his/her eyes to the patients’ faces while talking to them
6.	PHC staff are smiling while directing attention to patients
Gathering information
1.	PHC staff use clear and appropriate words to express what the patient wants
2.	PHC staff must direct the patient to their correct destinations in a fast and fast manner to carry out the necessary tests
3.	PHC staff use a clear and understandable voice is used when collecting information from the patient
4.	PHC staff use facial expressions are used during conversation and good listening when the patient is asked for information about him.
5.	PHC staff should keep the patient information updated in a special place.
6.	PHC staff are confirmed patient information for medicines and medical devices.
Share decision making
1.	PHC staff explains medical terminology to patients and share their information
2.	PHC staff take the benefit from the proposed ideas offered by the patient
3.	Patients are given details of their illness if you are authorized
4.	All the details of patient given to his family if you are authorized
Cultural differences
1.	PHC staff accept constructive criticism offered by patients without anger
2.	PHC staff demonstrate Policies and procedures for the patient in an acceptable manner
3.	PHC staff shake hands with patients to calm their mental state
4.	PHC staff take care that your sitting position is appropriate when dealing with the patient
5.	PHC staff use a quiet and comfortable tone of voice during dealing with patient

PART 3

This section contains a set of questions that measure the patient safety Aspects in primary health care centers. Please tick (√ ) in the appropriate box that applies to you. Effective Communication on Patient safety at Healthcare Centers Essay assignments and case studies

No.	Item	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Patient safety
1.	PHC staff trained on different aspects of international patient safety goals (IPSGs).
2.	PHC staff are aware about there is monitoring of IPSGs evidenced in reports, meeting minutes, and action plans for improvements.
3.	PHC staff are aware of applying the policy of patient identifiers and when to be used.
4.	PHC staffs are aware about there is the policy for effective identification of patients who are at risk for falling.
5.	PHC staff are aware about the hand hygiene policy is properly implemented.
6.	PHC staff are aware about there is a process for preventing medications errors.
7.	PHC staff are aware of a list of cases involving sentinel events
8.	PHC staff are aware of applying the process of handling sentinel events includes reporting within 24 hours, formation of a team for studying the causes of the event (root cause analysis) within 10 working days.

Thank you for your cooperation

Yours sincerely,