The recent increase in knowledge and interest in health care has brought patient safety and the quality of healthcare services to light. In particular, there has been growing attention to improving patient safety culture after the publication of the Institute of Medicine(IOM) report ‘To Err is Human: Building a Safer Health System’ in 1999, and related issues have been reflected in important health policies (Lee & Lee, 2009). Despite the effort, adverse events occur daily in health care contexts. Large-scale international reviews of patient charts estimated that 4-17% of hospital admissions are associated with adverse events (Rafter et al., 2015). In the European Union member states, estimated 8–
12% adverse event rates among hospitalizations were reported (WHO, 2016). Recent data from the U.S. have also shown that 210,000 to 440,000 preventable deaths related to adverse events occur annually (James, 2013).
Experiencing a patient death or harm due to an unexpected patient safety event or medical error causes psychological trauma and various personal, emotional, and professional problems in health care providers (Scott et al., 2009). 14-30% of health care providers are directly or indirectly involved in patient safety incidents, and about 50%
experience at least one patient safety incident during their career. All health care providers have the potential for falling victim to adverse events or medical errors (Edrees,
Paine, Feroli, & Wu, 2011). Symptoms experienced by healthcare providers after a patient safety incident include sleep disorder, burnout, reduced job satisfaction, feelings of guilt and anger, and fear of punishment (Rassin, Kanti, & Silner, 2005; Scott et al., 2009; Waterman et al., 2007; Wu, 2000).
Therefore, if not abated or treated, the symptoms and reactions caused by patient safety incidents, can harm the emotional and physical health of health care providers and subsequently compromise patient safety, and further increases the likelihood of committing errors and providing suboptimal care (Quillivan, Burlison, Browne, Scott, &
Hoffman, 2016). These conditions lower the quality of health care services, continue to pose threats to patient safety (Abbasi et al., 2017), and eventually undermine the quality of healthcare services and can inflict financial damage on the hospital (Chard, 2010;
Shanafelt et al., 2010).
Quality of work life is determined by the emotions and feelings that employees have toward their work and is improved through a synergetic relationship among co-worker and supervisor support, teamwork and communication, and organizational characteristics (Abbasi et al., 2017). Quality of work life affects not only job satisfaction but also organizational productivity and self-actualization of individual employees (Mosadeghrad, Ferlie, & Rosenberg, 2011).
Abbasi et al.(2017) identified the supervisor’s leadership and management style, decision-making latitude, shift working, salary and benefits, relationship with colleagues, workload and work strain, and demographic characteristics as factors affecting the quality
of work life. Other factors that have been studied include organizational culture, clinical competence, burnout, and social support (Abbasi et al., 2017; Ghouligaleh, Farahani, Karahroudy, Pourhoseingholi, & Mojen, 2018; Gifford, Zammuto, & Goodman, 2002;
Hsu, 2016; Thakre, Thakre, & Thakre, 2017).
Since 2010, korea studies have been conducted to relate organizational culture to quality of work life and organizational effectiveness (An, Yom, & Ruggiero, 2011).
Additionally, (Abbasi et al., 2017) presented organizational culture, social support, employee health, and organizational health as influence factors of the quality of work life of clinical nurses.
The quality of work life of nurses is closely related to health care services and patient safety (Kowitlawkul et al., 2018). Patient safety incidents lower the quality of work life of nurses by causing physical and psychological distress, which leads to turnover intention or absenteeism (Burlison, Quillivan, Scott, Johnson, & Hoffman, 2016).
It is crucial to manage the quality of work life of nurses who have experienced patient safety incidents in order to maintain the quality of health care services. (Abbasi et al., 2017) stated that organizational support—a strong patient safety culture, colleagues support, supervisor support, institutional support—can alleviate distress from patient safety incidents. Another study shows that supportive interactions with colleagues and supervisors can help nurses cope with the stress after experiencing patient safety incidents (Burlison et al., 2016).
Additionally, the stress symptoms following patient safety incidents were
alleviated by a non-punitive work environment, openly discussing about incidents, exchanging incident-related information with co-workers, and constructive feedbacks from the supervisor or organization (Seys et al., 2013). Another study found that creating a just culture encompassing the above-mentioned elements is a primary factor of reducing the distress following patient safety incidents (Joesten, Cipparrone, Okuno-Jones, &
DuBose, 2015). Additionally, In the Just culture, providing support at leadership and management levels helps them cope with the feelings of guilt and shame associated with medical errors (Denham, 2007; Joesten et al., 2015; Scott et al., 2010).
Many studies have emphasized the support needed for health care providers who suffer from distress caused by patient safety incidents, but few examine the effect of patient safety incidents on the work life of nurses (Schelbred & Nord, 2007).
Hence by using a mixed methods approach, this study aimed to: 1) investigate in a quantitative study the correlation between each of the variables within the framework of the Culture-Work-Health Model developed by Peterson & Wilson (2002) and the quality of work life of nurses who experienced patient safety incidents; 2) closely examine in a qualitative study the personal experience of nurses following patient safety incidents and its effect on their quality of work life. By combining the findings of the above two studies, this study developed a comprehensive understanding of the quality of work life of nurses who experienced patient safety incidents.
The results of this study will serve as evidence in developing stress management programs and intervention strategies aimed at helping nurses manage their physical and
psychological symptoms and improve quality of work life after experiencing patient safety incidents.