Perspectives of healthcare professionals in Qatar on causes of medication errors: A mixed methods study of safety culture

Derek Stewart (Corresponding Author), Binny Thomas, Katie MacLure, Abdulrouf Pallivalapila, Wessam El Kassem, Ahmed Awaisu, James S McLay, Kerry Wilbur, Kyle Wilby, Cristin Ryan, Andrea Dijkstra, Rajvir Singh, Moza Al Hail

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BACKGROUND: There is a lack of robust, rigorous mixed methods studies of patient safety culture generally and notably those which incorporate behavioural theories of change. The study aimed to quantify and explain key aspects of patient safety culture which were of most concern to healthcare professionals in Qatar.

METHODS: A sequential explanatory mixed methods design of a cross-sectional survey followed by focus groups in Hamad Medical Corporation, Qatar. All doctors, nurses and pharmacists were invited to complete the Hospital Survey on Patient Safety Culture (HSOPS). Respondents expressing interest in focus group participation were sampled purposively, and discussions based on survey findings using the Theoretical Domains Framework (TDF) to explain behavioural determinants.

RESULTS: One thousand, six hundred and four questionnaires were received (67.9% nurses, 13.3% doctors, 12.9% pharmacists). HSOPS composites with the lowest levels of positive responses were non-punitive response to errors (24.0% positive) and staffing (36.2%). Specific TDF determinants potentially associated with these composites were social/professional role and identity, emotions, and environmental context and resources. Thematic analysis identified issues of doctors relying on pharmacists to correct their errors and being reluctant to alter the prescribing of fellow doctors. There was a lack of recognition of nurses' roles and frequent policy non-adherence. Stress, workload and lack of staff at key times were perceived to be major contributors to errors.

CONCLUSIONS: This study has quantified areas of concern relating to patient safety culture in Qatar and suggested important behavioural determinants. Rather than focusing on changing behaviour at the individual practitioner level, action may be required at the organisational strategic level to review policies, structures (including resource allocation and distribution) and processes which aim to promote patient safety culture.

Original languageEnglish
Article numbere0204801
JournalPloS ONE
Issue number9
Publication statusPublished - 28 Sept 2018

Bibliographical note

This publication was made possible by NPRP grant NPRP 7-388-3-095 from Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the authors.


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