Tommaso Bellandi

Background: Vaccine hesitancy is a problematic phenomenon for vaccination campaigns. It played a significant role during the recent COVID-19 pandemic, where the role of HealthCare Workers (HCW) was particularly relevant. Understanding the motivation of HCW regarding vaccines is, therefore, paramount. Design and methods: We presented an online questionnaire to 5283 Italian HCW to investigate the role played by personal reasons and the potential perception of risk, the social environment, and the vaccine efficacy and safety perception in affecting HCW willingness to adhere to the vaccination campaign. Results: First, we discovered that those who took the vaccine to minimize health risk tended to vaccinate earlier, whereas those who did it due to social pressure received it later. Second, that those who indicated acquaintances as more important than the workplace in their vaccination choice showed more altruistic-related reasons to vaccinate, and the reverse held true. Third, that regarding two salient features of the vaccine, namely safety and efficacy, only the former was playing a role in the willingness to vaccinate, whereas the latter did not show an impact. Conclusions: The lessons that can be taken from these results are that future communication campaigns that push toward a timely vaccination should focus less on the social pressure, especially the one related to work environments, and more on the internal motivations of workers. Moreover, we can conclude that emphasizing the safety features of vaccines tend to play a more significant role in shaping vaccine behaviors than emphasizing efficacy.

Aim(s): To adapt and validate the HSOPS 2 instrument for the Italian context and to describe the current patient safety culture amongst healthcare personnel working in Italian hospitals. Design: Cross‐sectional study. Methods: We adapted and validated the HSOPS 2 instrument following the COSMIN guidelines: we performed a forward‐backward translation , calculated the content validity index, evaluated face validity, acceptability (percentage of participants responding to all items on the questionnaire and to every specific item), construct validity (confirmatory factor analysis), and internal consistency (Cronbach's alpha for each dimension). We then performed a cross‐sectional study following the guidelines of the original instrument: we categorised the responses into “positive,” “negative,” and “midpoints.” For each dimension we calculated the average percentage of positive responses. We repeated this process, dividing the responses by various sample characteristics (e.g., profession), and compared them using the chi‐square test. Data were collected between April and November 2023. Results: A total of 633 hospital personnel participated in the survey, and 473 completed the questionnaire in its entirety. The dimensions of “teamwork”, “supervisor”, “manager”, or “clinical leader support”, and “communication about error” emerged as dimensions with higher percentages of positive responses, while those that received lower percentages were “hospital management support for patient safety”, “staffing and work pace”, and “response to error”. We identified statistically significant differences in many dimensions between gender, profession, and clinical inpatient units. Conclusions: These findings provide a comprehensive overview of challenges and opportunities within the healthcare sector as regards patient safety culture and can inform the development of targeted interventions aimed at improving patient safety across healthcare organisations. Implications for the Profession and/or Patient Care: Proper assessment of safety culture, one of the main indicators of patient safety, can inform the development of effective strategies and interventions to enhance patient safety. Impact: What problem did the study address? To effectively assess patient safety culture, it is essential to use valid and reliable tools. It is crucial to proactively assess patient safety culture in hospital personnel, whether employed in clinical units, in management, or in support services, to develop initiatives aimed at improving patient safety. What were the main findings? The use of the adapted and validated version of the HSOPS 2 will produce valid and reliable evidence on patient safety culture. Perception of patient safety culture differs amongst respondents according to gender, profession, clinical setting. The dimensions of “hospital management support for patient safety”, “staffing and work pace”, and “response to error” were identified as those with the greatest need for improvement. Where and on whom will the research have an impact? Patient safety heavily impacts care at every level; therefore, this study could have an impact on healthcare organisations as well as healthcare workers, patients, and their families. By making available an instrument that can contribute to a proper assessment of patient safety culture, this study might contribute to the development of appropriate strategies and targeted interventions to improve patient safety, quality of care and satisfaction while decreasing adverse events and related costs. Reporting Method: The COSMIN guidelines were used for the validation of the instrument; the STROBE reporting guidelines were used for the cross‐sectional study. Patient or Public Contribution: No patient or public contribution.

Second victim syndrome (SVS) refers to the psychological trauma experienced by healthcare workers (HCWs) as a result of being involved in an adverse event (AE). Research on the prevalence of SVS and the support needed for HCWs who experience it is limited. A cross-sectional study was conducted at the Health Local Unit of Lecce, in Puglia, to identify the phenomenon of SVS among HCWs and recognize the forms of support received and desired. A validated questionnaire, IT-SVEST, was administered to doctors and nurses. The survey received responses from 250 HCWs, and 41% of respondents reported being involved in an AE that could cause SVS. Among the seven dimensions measuring the effects of the SVS and two outcome variables, the highest percentage of agreement was found for psychological distress (23.5%), followed by turnover intentions (19.8%) and physical distress (9.9%); 23.8% of the interviewees declared that they did not receive institutional support, and 9.9% identified help resources mostly in non-work-related support (9.9%), followed by supervisor support (9.3%). The multivariable binary logistic regression analysis showed a positive association between the occurrence of an AE and the medical doctor profession (OR = 4.267, p ≤ 0.0001), and affiliation to intensive care departments (OR = 5.133, p ≤ 0.0001) and male gender (OR = 2.069, p = 0.033). SVS is a serious problem that affects the entire health system, systematic surveys and appropriate institutional responses including formal support programs for affected HCWs are a priority.

The handover has relevant implications in terms of patient safety. An effective handover requires the use of a standardized and shared communication tool. This observational study explored the nursing handover at shift change in order to detect eventual omissions. Furthermore, it investigated the quality perceived by the nurses involved. At each shift change, an external observer detected the referred and omitted information by the delivering nurse, through the use of a direct observational grid (modified ISBAR). The percentage of the omitted information was calculated excluding any unforeseen information, not linked to the patient care pathway and detected through the consultation of the nursing record. The quality perceived by the nurses involved was investigated through the use of the Handoff CEX tool. The data was processed through a descriptive and inferential statistical analysis. 256 handovers were observed and 256 nursing records were reviewed. The omissions were detected in 43.17% of the cases. The results highlight a propensity for a prospective approach. A high statistical significance emerges in relation to the modality of handover, the type of patient, the nurse/patients ratio and the number of interruptions. Referring to the perceived quality, 40 Handoff CEX evaluation forms were completed. The results show a more than satisfactory perception. However, the thematic analysis highlights scarcely detailed and dispersive handovers as well as the difficulty to focus on the information to deliver. According to the findings of this research, it is necessary to implement a standardized tool which supports the handover process.

This chapter describes a comprehensive approach to adverse event investigation and risk assessment, as well as the characteristics of an integrated system for patient safety and clinical risk management. Drawing on evidence from other industries and healthcare organizations across the globe, the author’s report how such a system can be developed with the active involvement of policy-makers, healthcare managers, health professionals, and patients. Human factors and ergonomics provide the theoretical framework in which the guiding principles, methods, and tools are selected and applied to identify, analyze, and prevent risks related to unsafe care in any healthcare setting.

Patient suicide is one of the most frequent incidents in healthcare facilities to be reported to the National Observatory of Sentinel Events in Italy. Despite national initiatives, in Tuscany potentially preventable patient suicides still occur in both acute and community care settings. We describe here an aggregated qualitative analysis of 14 patient suicides that took place in public health services between 2017 and 2018. We outline the methodology and results of an improvement action we enacted in the healthcare system that involved reviewing and reinforcing relevant managerial strategies and clinical activities, with the aim of reducing potentially preventable patient suicides.