An-Najah National University 

Faculty of Graduate Studies 

 

 

 

 

 

OPERATING ROOM PROFESSIONALS’ 

ATTITUDES TOWARDS PATIENT SAFETY 

AND THE INFLUENCING FACTORS IN 

GOVERNMENTAL HOSPITALS IN NORTH  

OF THE WEST BANK, PALESTINE 
 

 

 

 

By 

Raed Abed Hassan Al-Hashash 
 

 

 
Supervisor 

Dr. Mohammad Hayek 

 

 
This Thesis is Submitted in Partial Fulfillment of the Requirements for The Degree 

of Master of Public Health Management, Faculty of Graduate Studies, An Najah 

National University, Nablus-Palestine. 
 

2024 



ii 

 

 

 

 

 

 

 

 

 

 
 

OPERATING ROOM PROFESSIONALS’ 

ATTITUDES TOWARDS PATIENT SAFETY 

AND THE INFLUENCING FACTORS IN 

GOVERNMENTAL HOSPITALS IN NORTH  

OF THE WEST BANK, PALESTINE 
 

 

 

 

By 

Raed Abed Hassan Al-Hashash 

 

 
This thesis was Defended successfully on 14/10/2024, and approved by: 

 
 

 Dr. Mohammad Hayek 
Supervisor 

 
Signature 

Dr. Ahmad Aeed 
External Examiner 

 
Signature 

Dr. Nizar Saeed  
Internal Examiner 

 
Signature 



iii 

Acknowledgement 

I am deeply grateful for the guidance and support that illuminated my path throughout 

this research endeavor. This paper stands as a testament to the collective effort and 

encouragement of cherished family and friends, whose unwavering support propelled us 

forward. 

First and foremost, my heartfelt appreciation goes to Dr. (Mohammad Hayek) invaluable 

mentorship and meticulous feedback significantly shaped this paper's content, structure, 

and direction. 

We sincerely thank the esteemed faculty members and advisors at AL-Najah University 

who contributed their expertise and insights to enrich our thesis. 

Lastly, I extend my gratitude to all who lent their support and encouragement, 

contributing to the completion of this thesis. 

  



iv 

Declaration 

I, the undersigned, declare that I submitted the thesis entitled: 

OPERATING ROOM PROFESSIONALS’ 

ATTITUDES TOWARDS PATIENT SAFETY 

AND THE INFLUENCING FACTORS IN 

GOVERNMENTAL HOSPITALS IN NORTH  

OF THE WEST BANK, PALESTINE 
 

I declare that the work provided in this thesis, unless otherwise referenced, is the 

researcher’s own work, and has not been submitted elsewhere for any other degree or 

qualification. 

 

 

 

 

  



v 

List of Contents 

 

Acknowledgement ........................................................................................................... iii 

Declaration ....................................................................................................................... iv 

List of Contents ................................................................................................................. v 

List of Tables .................................................................................................................. vii 

List of Figures ................................................................................................................ viii 

List of Appendixes ........................................................................................................... ix 

Abstract ............................................................................................................................. x 

Chapter One: Introduction and Review of Related Literature .......................................... 1 

1.1 Introduction ................................................................................................................. 1 

1.2 Problem Statement ...................................................................................................... 6 

1.3 Aim of the Study ......................................................................................................... 7 

1.4 Objectives of Research ............................................................................................... 8 

1.5 Research hypothesis: ................................................................................................... 8 

1.6 Conceptual Framework ............................................................................................... 9 

1.7 Review of Related Literature .................................................................................... 11 

1.7.1 Global View ........................................................................................................... 11 

1.7.2 Regional Perspective .............................................................................................. 16 

1.7.3 Local Perspective ................................................................................................... 20 

1.8 Summary ................................................................................................................... 24 

Chapter Two: Methodology ............................................................................................ 25 

2.1 Introduction ............................................................................................................... 25 

2.2 Study Design ............................................................................................................. 25 

2.3 Sample Size and Sampling ....................................................................................... 25 

2.4 Pilot Study ................................................................................................................. 25 

2.5 Data Collection ......................................................................................................... 26 

2.6 Research Process ....................................................................................................... 26 

2.7 Statistical Analysis .................................................................................................... 27 

2.8 Reliability and Validity ............................................................................................. 28 

2.9 Inclusion Criterion: ................................................................................................... 29 



vi 

2.10 Exclusion Criterion: ................................................................................................ 29 

2.11 Summary ................................................................................................................. 29 

Chapter Three: Results .................................................................................................... 30 

3.1 Introduction ............................................................................................................... 30 

3.2 Test of Normality ...................................................................................................... 34 

3.3 Inferential statistics ................................................................................................... 35 

3.4 Summary ................................................................................................................... 38 

Chapter Four: Discussions and Conclusions and Recommendations .................. 39 

4.1 Discussion ................................................................................................................. 39 

4.1.1 Demographic and Working Characteristics ........................................................... 39 

4.1.2 Attitude to Patient Safety ....................................................................................... 40 

4.1.3 Scores Harmonizing with Marital Status ............................................................... 42 

4.1.4 Age-Related Scores ................................................................................................ 43 

4.1.5 Human Levels of Education and Safety Ratings ................................................... 44 

4.1.6 Scores Related to Working Experience ................................................................. 44 

4.2 Conclusion ................................................................................................................ 46 

4.3 Recommendation ...................................................................................................... 47 

List of abbreviations ....................................................................................................... 49 

References ..................................................................................................................... 50 

Appendices ...................................................................................................................... 52 

BCDEFب ............................................................................................................................... ا 

 

 

  



vii 

List of Tables 

 

Table 1 Demographic Characteristics of the participants (n = 117) ............................... 31 

Table 2: Working Characteristics of the participants (n = 117)...................................... 32 

Table 3: Patient safety subscales’ mean score ................................................................ 33 

 

 

 

 

 

  



viii 

List of Figures 

 

Figure 1: Average of percentage positive responses of patient safety scales’ ................ 33 

 

 

 

 

 

  



ix 

List of Appendixes 

 

Appendix A: Patient safety scales’ mean score .............................................................. 52 

Appendix B: IRB Approval ............................................................................................ 55 

 

 

 

 

 

 

  



x 

OPERATING ROOM PROFESSIONALS’ ATTITUDES TOWARDS 

PATIENT SAFETY AND THE INFLUENCING FACTORS IN 

GOVERNMENTAL HOSPITALS IN NORTH OF THE WEST 

BANK, PALESTINE 

By 

Raed Abed Hassan Al-Hashash 

Supervisor 

Dr. Mohammad Hayek 

Abstract 

Background: Patient safety has evolved to be the overriding focus in health care systems, 

prodded by milestone reports and frameworks calling for safety actions across the whole 

system. This study will investigate attitudes towards, and factors that influence attitudes 

to, patient safety among operating room professionals working in governmental hospitals 

in northern West Bank, Palestine. 

Methodology: The study design was cross-sectional and involved targeting 150 operating 

room practitioners, both physicians and nurses, in six hospitals belonging to the northern 

West Bank governments. In the current study, attitude of participants was measured by 

using a Patient Safety Attitude Questionnaire referred to as PSAQ, based on attitude 

dimensions targeting team-work climate, safety climate, management perception, among 

others. Descriptive statistics using Cronbach's Alpha SPSS software was used for data 

analysis and reliability testing. 

Results: A total of 117 questionnaires was successfully administered, bringing the 

response rate to 82%. Most of them were between 31 and 40 years of age, male, married, 

and bachelor's degree holders. The total mean attitude score was 114.26 out of 180. The 

highest positive response obtained in the subscale of "teamwork climate" was 54.4%. The 

other subscale scores showed that the subjects had intermediate levels of job satisfaction, 

safety climate perception, and management perception. 

Conclusions: The results were revealing in a positive attitude toward the teamwork 

climate and at the same time identifying the weaknesses in the safety climate and 

management perception from the professionals working in the operating room. These 

findings must be useful to design focus intervention with the aim of instilling a safety 

culture among these hospitals, which shall benefit the patients in the region. More 



xi 

research is needed to establish the root causes behind such an attitude and probable 

impacts of professional development activities. 

Keywords: Operation Room, Attitude, Patient, Safety, Hospitals, Palestine. 



1 

Chapter One 

Introduction and Review of Related Literature 

This chapter specifically discusses the problem that this research looked at in details. 

which includes an introduction to the study. statement of the study problem, a discussion 

of the importance of this study, purpose and objectives. Tackles research questions and 

hypothesis of the study. And this chapter presented the problem the current study sought 

to examine. It also stated what other studies suspected to have a connection with the 

research problem had to report. 

1.1 Introduction 

Regarding patient safety; it is an important care quality element especially in O.Rs 

(operating rooms) with high risk settings. Attitudes and perceptions about patient safety 

from OR workers are vital in setting up safety culture while influencing client results. 

Knowing these attitudes and their influencers is essential for coming up with protocols 

that improve patients’ safety as well as health care by (Sexton et al., 2006). It aims to 

determine the perspectives of OR professionals towards patient safety who work for 

governmental hospitals located North West Bank- Palestine, as well as outline its 

influencing factors. 

In recent years, there has been growing recognition of the importance of safety culture in 

healthcare settings. It refers to shared values, beliefs and norms about safety within an 

organization. Strong safety culture is characterized by open communication where people 

are able to talk freely and honestly with each other; a sense of trust prevailing among all 

members of the team; along with understanding that together they are learning from errors 

and near misses. According to Sexton et al. (2006), tools like Safety Attitudes 

Questionnaire (SAQ) can help enhance awareness on healthcare teams’ safety climate 

and determine areas that need improvement. This research examines OR professionals’ 

attitude towards safety in an effort to contribute to the overall push for a safer healthcare. 

There have been various key studies and initiatives highlighting patient safety’s 

significance. The Institute of Medicine report “To Err is Human” disclosed huge numbers 

of medical errors happening every year accompanied by calls for systemic changes aimed 



2 

at improving patient safety in health care (St.Pierre et al., 2022). Several frameworks and 

guidelines including WHO Guidelines for Safe Surgery were subsequently developed as 

a way of improving on global surgical practices (World Health Organization, 2009).These 

global efforts highlight the universal relevance of patient safety and the need for localized 

research to address specific contextual challenges. 

Variability of safety attitudes across various cultural and institutional settings has been 

highlighted by some studies. For instance, research conducted in Turkey and the 

Philippines has shown that different areas of local healthcare significantly determine 

perception and practice of safety (Bahar & Önler, 2020). This shows the importance of 

understanding what makes safety attitudes in certain areas unique. The role played by 

team communication and adherence to safe protocols as measures preventing adverse 

events are among the results reached out in Middle East based studies (Haugen et al., 

2013; Ock et al., 2017). 

Palestine’s healthcare system is fraught with a number of challenges including tight 

budgets and high disease burden. Nonetheless, there is an emerging focus on improving 

healthcare quality and patient safety. Enhancing health service delivery as well as the 

overall outcome is being done through active participation of Palestinian Central Bureau 

of statistics (PCBS), (2017) and Ministry of Health (MoH) However, there lacks definite 

studies concerning OR professionals’ attitudes towards patient safety. Consequently this 

study sets out to address this particular issue through comprehensive analysis so as to 

identify factors that influence these attitudes. 

Also, it is essential to address this issue for enhancing patient safety in different local 

settings such as North of West Bank. Health delivery and protocols can be influenced by 

geopolitical and socio-economic conditions in Palestine in a way that may not be found 

anywhere else. These factors include limited resources, political instability and regional 

healthcare policies which can create unique challenges and opportunities for shaping the 

culture of safety within the operation rooms (St.Pierre et al., 2022). This scientific work 

will examine how these factors affect patient safety in Palestine not only in terms of the 

local health system but also contribute to global debates on patient safety. 



3 

Additionally, there is a need for involvement of OR professionals to advance patient 

safety initiatives. These professionals including surgeons, anesthologists (anesthesia 

practitioners) and surgical nurses have direct responsibilities for implementing safe 

practices and protocols. Their perception towards patient’s security is very important 

since it affects adoption and compliance with necessary safe measures. Therefore 

knowing their perspectives makes it possible to develop targeted interventions that have 

a higher chance of being accepted by them and working effectively. 

This will further help in making the safety interventions more tailored and context-

specific by integrating feedback from professionals in ORs. In using tools such as the 

SAQ, this study will be in a position to outline areas where attitude shifts could be 

necessary or where additional training might prove useful. All of these findings will 

greatly contribute to the healthcare administrators and policy-decision makers in 

developing strategies that deal with specific problems of teams working in ORs within 

Palestinian hospitals (Ock et al., 2017). 

Last but not least, the intention is to add some diversification to the already existing body 

of literature by lending finer nuances in safety attitudes, framed within a specific regional 

context. Global guidelines and frameworks are useful, but there is a dire need for localized 

research in order to engage healthcare systems in other regions with their particular 

challenges. This study will focus on the North of the West Bank in order to provide ideas 

that may help inform future research and interventions in similar contexts, contributing 

to the broader goal of improving patient safety globally. 

The delivery of healthcare and the culture of safety not only influence but are also 

influenced by regional challenges, requiring a multidimensional approach to understand 

and enhance patient safety. In a region like the North of the West Bank, patient safety 

would have to address not only global best practices but also local realities of its unique 

socio-political and economic conditions (Ock et al., 2017). This work recognizes the need 

to integrate local knowledge into established safety frameworks in the design of strategies 

that are pragmatic and effective within the particular context of Palestinian hospitals. 

  



4 

This perspective is fundamental to an understanding of how cultural values and practices 

shape attitudes and behaviors towards safety. Cultural norms and the remnants of 

traditional practices are likely to impact healthcare delivery and safety attitudes in most 

regions of the world. These cultures need to be understood so that barriers to improvement 

in safety and developing a culture that sustains open communication and continuous 

learning can be recognized (St.Pierre et al., 2022). The study contributes to this budding 

repository of knowledge by uncovering how cultural factors shape the attitudes toward 

safety held by professionals working in the ORs of the North of the West Bank. 

Most importantly, leadership can play the most crucial role in shaping safety culture. 

Organizations of healthcare in the societies in transition, therefore, are effectively led by 

those who espouse and foster a safety culture because the leaders set the tone concerning 

the practices and priorities for safety (St.Pierre et al., 2022). This research, therefore, 

seeks to investigate the impact that varying leadership styles and practices have on the 

attitude of OR professionals towards safety in Palestinian hospitals. The paper, therefore, 

seeks to identify the relationship between leadership and safety attitude to provide ways 

in which leadership could be harnessed to engender a much safer and more supportive 

environment not only for healthcare professionals but also for their patients. 

Finally, training and education are also very important areas for enhancing safety attitude 

and practices. This study shall also determine if adequate and quality safety training 

programs are available to OR professionals working in the northern part of the West Bank. 

The availability of the programs will also be evaluated to establish if it addresses the 

needs of the OR staff and if there are any gaps (Sexton et al., 2006). Effective training 

programs may improve awareness of safety issues, enhance adherence to protocols, and 

in the long term, lead to improved patient outcomes (St.Pierre et al., 2022). The findings 

from this study will be channeled to the development of targeted training initiatives taking 

into account specific safety concerns in the region. 

This will be further put to perspective with an analysis of the impact that technological 

advances have had on safety attitudes and practice. The new technologies introduced into 

the OR environment will affect safety, ranging from improving surgical precision to 

facilitating better team communication. Challenges related to the uptake of technology 



5 

include sufficient training and errors by the users of the technology. The study about 

perception and use of technology by OR professionals in Palestinian hospitals will be 

important in understanding how best to harness innovations in technology to improve 

patient safety. 

Therefore, this study synthesizes these factors: cultural dimensions, leadership, training, 

and technology, through trying to provide as best as possible a full view of the attitudes 

of OR professionals toward patient safety (Sexton et al., 2006). In addition to inquiring 

about the prevailing attitudes and practices, the study attempts to come up with practical 

recommendations for the improvement of safety culture and practices in the North of the 

West Bank. These will hence be informed by the local context and international best 

practices so that the recommendations are relevant and feasible for the healthcare system 

in this region. 

Building on the foundational work of Sexton et al., (2006) and the Institute of Medicine's 

"To Err is Human" report (St.Pierre et al., 2022), it becomes very important to note how 

the concept of safety culture in healthcare continues to evolve. Embedding concepts of 

patient safety into everyday practices means there is work to do and adaptation that must 

happen. Recent studies have shown how constant assessment and safety procedure 

improvement are a prerequisite for maintaining a sound safety culture (Sexton et al., 

2006). The administration of an SAQ, or some other forms of these tools, to evaluate 

shortcomings in safety perceptions and practices has proven to be an invaluable approach. 

Such instruments are supposed to give vital guidelines to many possible action points, 

hence making it possible to effect subsequent safety change towards OR professionals in 

North of the West Bank. 

Even regional studies from Turkey and the Philippines have pointed out that it is 

necessary to adopt guidelines relating to safety with regard to the local situation. In the 

Palestinian context, where geopolitical and socioeconomic factors are going to 

significantly—indeed, vastly—shape the delivery of health care, it will be very important 

to understand the local nuances. Variability of safety attitudes between cultures and 

institutions underlines that regional interventions are necessary. The current study will 

also explore how peculiar local challenges influence safety attitudes and practices, and 



6 

foster a way of developing tailored strategies that take into consideration these unique 

contextual factors. 

That is why this effective leadership, as Haugen et al., (2013); Ock et al.,(2017), 

mentioned, in shaping the safety culture would be very interesting to be implemented in 

Palestinian hospitals. This is a safety culture paper that respects effective leadership to 

help create an environment in which safety is valued and improved all the time. The 

implication of this study is that actionable insight into ways in which leadership can drive 

positive change is going to be derived because of how different the leadership styles have 

an effect on the attitude of OR professionals towards safety. This means one has to 

practice good leadership and a culture where associates communicate freely and deeply 

trust one another. 

1.2 Problem Statement  

Safety for patients is an in-built dimension of health care quality, but at the same time, an 

operating room is certainly a very risky environment. Knowing the behaviors of health 

professionals' attitudes toward patient safety is very important in coming up with effective 

patient safety protocols and recording better patient outcomes as well (Haugen et al., 

2013). Despite the much preaching on patient safety that has been done the world over, 

the literature notes that there exists a gap that has not been covered on the specific 

attitudes and behaviors that guide operations in the operating rooms in Palestine. 

A health system is characterized by systemic analysis and proactive risk management, 

although little research is initiated regarding attitudes toward OR safety within Palestine. 

The Safety Attitudes Questionnaire is just one such tool that has seen wide success in 

measuring safety culture within healthcare teams, against benchmarking data from which 

improvements in patient safety may be led. However, little is is known about application 

and results of such tools within the Palestinian context. 

To this regard, studies from other regions obviously prove that the cultural and 

institutional factors influence safety attitude. For instance, research conducted among the 

Turkish surgical nurses and the nurses of the Philippines stereotypes the importance of 

regional contexts in relation to the interposition design for regional contexts to better 



7 

patient safety (Ock et al., 2017). It also emphasizes, besides the research findings, that 

team communication, institutional support, and implementation of standardized protocols 

are effective in obtaining safety outcomes. 

Very few studies have shown previous interest regarding the attitude of OR professionals 

toward the safety of patients in governmental hospitals in the northern West Bank of 

Palestine. This therefore is a gap in research that the current study anticipates filling by 

identification of some factors that influence the attitudes of professionals working in the 

sector. This study hopes to provide some input for developing targeted strategies for 

improvement of patient safety and outcomes in ORs through understanding these attitudes 

and factors that impact them. 

1.3 Aim of the Study 

This study is hence a fundamental step in understanding and improving patient safety 

within a specific and challenging context. In this way, the study of the different attitudes 

of OR professionals within Palestinian hospitals and the determinants of their attitudes 

will help to give a bigger contribution to advancing patient safety (Haugen et al., 2013). 

These insights are going to be of importance to healthcare providers and more especially 

to administrators and policymakers in general, but most importantly to those working in 

Palestine and places with similar characteristics toward creating a safe and effective 

healthcare environment for all their patients. 

This is an attempt to project patient safety attitudes from the perspective of operating 

room health care professionals in governmental hospitals in the northern West Bank of 

Palestine. This, in a way, sets out how demographic variables, such as age, sex, marital 

status, and educational level, and working characteristics such as work experience, 

position, and departmental settings, have an influence on the perception of teamwork 

climate, safety climate, management, job satisfaction, working conditions, and stress 

recognition. Such conditions remain not well known; hence the research program aims to 

evaluate attitudes that can secure better safety of patients and a general culture of safety 

at large in all the health care settings within the region. 

  



8 

1.4 Objectives of Research 

• Analyze how patient safety in the operating room is influenced by demographic factors 

of healthcare professionals, such as age and gender. 

• Investigate variations in attitudes and behaviors among healthcare professionals 

toward patient safety in the operating room based on their training. 

• Assess whether the level of education and experience as a nurse have a significant 

relationship with patient safety practices in the operating room. 

These objectives aim to pinpoint the key factors affecting patient safety in the operating 

room, providing valuable insights for developing targeted actions and policies to enhance 

patient safety in governmental hospitals in the northern West Bank, Palestine. 

1.5 Research hypothesis 

Main Hypothesis 

There is a significant relationship between many factors and the outcome of patient safety 

in the operating room among health professionals working in governmental hospitals in 

the North of West Bank. 

Sub-Hypotheses 

• Demographics Hypothesis: The demographic characteristics of health professionals, 

for example, age and gender, among others, will be relevant to the good association 

between health professionals and their perceptions of patient safety in the operating 

room. 

• Safety Training Hypothesis: Encountering patient safety training has a significant 

positive effect on health professionals in the operating theater. 

• Level of Education and Experience Hypothesis: The more educated and experienced 

health professionals are, particularly in nursing, the more positively their perceptions 

and practices will be regarding patient's safety in the operating room. 

  



9 

1.6 Conceptual Framework 

1.6.1 Introduction 

By this conceptual framework, operating room professionals' attitudes have been 

explored regarding a patient's safety and determining factors that affect these attitudes in 

governmental hospitals in the North of the West Bank. 

Theoretical Definitions 

Attitude: It is the evaluative judgment or feeling of OR professionals regarding patient 

safety. Beliefs, feelings, and intention regarding behavior are associated with safety 

practices in the OR. 

Safety refers to measures, protocols, and best practices that can be said to incorporate 

error prevention, risk reduction, and ensuring patient safety in respect to procedures done 

in the operating room within the terms of this document. 

Implementation To execute and apply the safety protocols and procedures by the OR 

professionals during their routine operating work. 

1.6.2 Measure 

For measuring safety attitudes of the professionals about the patient, practices, and other 

related factors, it can be done through administering the questionnaires.  

Attitudes About Patient Safety 

1. Subscales 

• Teamwork Climate: Collaboration and coordination among the OR professionals 

• Safety Climate: perception regarding safety and management of errors within the OR 

• Perception of Management: management support and their communication. 

• •Job Satisfaction: Overall satisfaction with work and the work conditions. 

• •Stress Awareness: Awareness for what stress can do to performance. 

• •Working Conditions: The physical and organizational work environment. 

  



10 

Variable Influences 

2. Demographics 

• Age 

• Gender 

• Marital Status 

• Education 

• Job-Specifics: 

• Work Experience (overall, in the department) 

• Job Title (i.e., resident, staff nurse) 

• Job Department (i.e., open unit, ICU) 

1.6.3 Bonds and assumptions 

1. Demographics 

• Gender: Male and female professionals may have diverse attitudes about a safety 

climate. 

• Marital Status: A desirability bias in the perception of working conditions may be seen 

among singled and married professionals. 

• Level of Education: A higher level of education may appear to influence one aspect 

over another; the likelihood of influence would be more towards safety attitudes or 

management. 

2. Working attributes 

• Work experience: More experienced professionals may have a more nuanced 

perception of safety and the terms of working conditions. 

• Work position: Different positions in the OR may have an influence on the perceptions 

of teamwork and management support. 

• Working Department: The attitudes will have the interdepartmental differences, say 

for instance open ward, and ICU 

  



11 

1.6.4 Summary of Framework 

The research framework describes the relationships and influences of employees' attitudes 

toward patient safety_program. The influence reflected as demographic characteristics 

includes such factors as age, gender, marital status, education, working characteristics 

such as experience, and the position and the department where the nurses work. It 

determines the influence of such factors on the attitude towards different subscales of the 

safety of patients. It therefore provides a framework for the process through which these 

factors was examined with respect to how they influence attitudes and behaviors 

regarding patient safety in the perceptions of a working environment of an operating 

theatre. 

This is a critical research based on the subject of patient safety in governmental hospitals' 

operating rooms (ORs) from the point of view of the attitudes and perceptions of the OR 

practitioners in the North of the West Bank, Palestine. Confrimedly, the assurance of the 

safety of patients is a great critical dimension of quality of care, and in setups such as 

operating rooms where a number of procedures may take place, great protocols need to 

be assured for the positive outcome of patients. The present research attempt has been 

made to unearth how variables such as demographic features, safety training, education, 

and experiential background of healthcare professionals support their attitudes and 

practices toward patient safety. Sexton et al., (2006) and the work of the IOM in To Err 

is Human by St.Pierre et al., (2022), Corrigan and Donaldson has been critical review and 

the need for further, more specific work that addresses the uniqueness of the features of 

the socio-political and economic context that is part and parcel of a Palestinian setting in 

order to contribute to world attention as concerns the safety culture.  

1.7 Review of Related Literature 

1.7.1 Global View 

Interest in patient safety has developed over the last twenty years on works which, though 

seminal, have contributed to defining the understanding and practice of this significantly 

modern period. Ian et al., (2001) published a theoretical framework for analyzing risk and 

safety in clinical medicine, emphasizing a systemic analysis with proactive risk 



12 

management. In that regard, it was seminal work that underlay further research and, 

indeed, interventions in the cry for patient safety. It was a response to understand that 

errors are within the health system, and it was a response to the contexts within the health 

system, not the flaws of the practitioners, and it really rocked the boat on contemporary 

paradigms of patient safety. 

The landmark Institute of Medicine report "To Err is Human" drew attention to the rates 

and consequences of medical errors in health care and current approaches to a "culture of 

safety" in health care. It is a report that acts as a trigger toward developing each and every 

effort that could be made from the side of the human being in developed efforts to improve 

patient safety and reduce errors through the world. According to the report, up to 98,000 

deaths per annum in the United States alone had been due to error in the medical allopathic 

response. Such incidents have required a lot to demand the health care systems across the 

globe for the development of strong orientation toward safety and comprehensive 

strategies for threatening risks. Even today, this report had impact, where most of the 

current safety precautions and programs for enhancement of quality are based back on 

this seminal work. 

In a high percentage of cases, the measure of safety culture within healthcare teams has 

been conducted using the Safety Attitudes Questionnaire developed by Sexton et al., 

(2006). The SAQ provides benchmarking data and psychometric validation among a vast 

range of settings that permit the identification of areas that need improvement in 

healthcare organizations by the implementation of focused interventions. The University 

of Texas at Austin's Center for Healthcare Quality and Safety is also available to assist 

individuals in the assessment of safety attitude and climate of those trialing the SAQ. This 

is in tandem with the fact that the SAQ measures many dimensions associated with safety 

culture. These include teamwork climate, safety climate, perceptions of management, job 

satisfaction, working conditions, and stress recognition. In essence, it is an all-rounded 

measure on the dimension of safety culture. 

According to Wahr et al., (2013), teamwork and human factors are taken into 

consideration for ensuring safety in a cardiac operating room. The authors found that a 

high-risk setting, such as the operating room, in which mistakes are bound to threaten, if 



13 

not take, lives, cannot afford ineffective teamwork and communication. Their research 

proved in reality that indeed, multidisciplinary teamwork and curiosity into human factors 

can be helpful in improving safety and reducing events. 

Risk factors for retained surgical items must be known with a risk-stratification system in 

place to mitigate risks, according to Moffatt-Bruce et al., (2014) A systematic way of 

identifying and managing such risk factors had been suggested in the meta-analysis they 

had carried out. Such risks vary from emergency surgeries to body mass index and 

surgical complexity. Moreover, it discussed pre-surgical briefs and their impact on the 

safety climate. In doing so, Allard et al., (2011) highlighted the importance of proper 

briefing and communication within the OR. This research highlights that pre-operative 

briefings, supplemented by this standardized format, help to communicate team-based 

information during surgery and provide clarity on who is responsible for what within this 

setting, ultimately boosting the safety of the place. 

Likewise, The World Health Organization reiterates that there be a robust culture of 

safety; hence, it too campaigns for the availability of safety standards that are 

comprehensive that would guarantee safety of all surgical practices in the entire world. 

WHO Safe Surgery Saves Lives mandates for critical practices those that would make 

surgical fallacies visible and achieve optimal results on patients. These are universally 

practiced, and hence a sheer dedication to ensuring patient safety in the operation theatre. 

Carney et al., (2010) has examined sex differences in patient safety attitudes. Perceptions 

of patient safety differed depending on the sex of the clinicians or of those on whose 

behalf they were made. In this regard, a pilot study by the Veterans Health Administration 

Medical Team Training Program concluded that female caregivers are likely to perceive 

more safety risks compared to their male counterparts. All this goes to indicate why an 

understanding of differences is very relevant to making inclusive strategies and paying 

attention to the needs of health professionals on an individual level. 

Despite all that, interest in patient safety has only marked formative works that have 

helped in shaping the understanding and practice of this relatively modern era in the last 

two decades. However, the framing work for analyzing risk and safety in clinical 



14 

medicine, which will bring forward systemic analysis and proactive risks management, 

came only in 1998 with the efforts of (Ian et al., 2001). This classic piece thus set the 

stage for more works in this field as it made it possible to take up the challenge of the 

previous approach toward errors in healthcare systems than from an individual's account 

at a failure level of the system and shaped contemporary approaches toward patient safety. 

Significantly, the high incidence of medical error and clear need to develop a "culture of 

safety" within healthcare environments were glimpsed in the 1999 Institute of Medicine 

report, popularly known as "To Err is Human". This urging document indicated that 

98,000 people each year die because of medical error in the United States alone, which 

galvanized imperatives the world over to the restructuring arrangements whereby safety 

could be advanced and risk reduced. The legacy of this has continued to resonate in many 

aspects with modern-day practices of safety and quality improvement. 

The questionnaire was developed by Sexton et al., (2006) and colleagues as a measure for 

quantifying safety culture within healthcare teams, thereby providing a dimension and a 

tool for monitoring safety practice towards its improvement and betterment. The seven 

other dimensions of the Safety Attitudes Questionnaire, namely teamwork climate, safety 

climate, perception of management, job satisfaction, working conditions, and stress 

recognition, are increasingly being put to use for detecting the shortcomings that can be 

rectified and giving room for remedial interventions. 

This survey would be of paramount importance in the development of a generic 

assessment aspect in the context of analyzing the safety culture in a healthcare 

organization. 

Equally, Wahr et al., (2013) also gave importance to the human factors and teamwork 

that must be built to achieve patient safety coming from within the cardiac operating 

room. Just the same, the human factors approach and the actual implementation of clinical 

teamwork have survived to provide importance in the reduction of adverse events and the 

promotion of safety results in the special context of the flying deck -. 

Identification of the risk, henceforth surgical items remaining inside by Moffatt-Bruce et 

al., (2014), therefore the importance of systematic approach in dealing with risks. Their 



15 

premium was on thorough systematic approaches in identification of risks and finally the 

mitigation, which is seen in emergency procedures and surgical complexity. In addition, 

Allard et al., (2011) shed light on the problems of pre-surgical briefings and 

standardization of communications. 

The declaration says that the World Health Organization initiative, Safe Surgery Saves 

Lives, urges strict standards and practice involving the safety of surgery in order to avoid 

surgical errors and such that better outcomes accumulate to patients. Most vividly brought 

out in this story is the strict standards and practice that is called for in the safety of surgery. 

The WHO guidelines have been applied in most places, showing a sense of commitment 

and responsibility to ensure security while improving surgical practices globally. 

In considering the differences among carers, the perception of safety with female carers 

is more sensitive than that with male carers. This has been concurred with by (Carney et 

al., 2010). in respect of safety related to the patient side. This, therefore, calls for different 

and better gender-sensitive safety training and interventions that would respond to this 

difference in perspective. 

Hull et al., (2011), in their research found that very high levels of stress affect the 

performance of the team and the safety of the patient; hence, very high stress diminishes 

the clarity of communication and quality of decision-making in an operating room. Their 

study concludes by calling for the incorporation of the now-required safety curricula in 

stress management and resilience training to help further support the psychological needs 

of the health workforce toward better care for patients. 

The review by Hull et al., (2011) into stress and teamwork also resonates with the level 

of potency that stress exhibits over team performance and patient safety. In their study, it 

emerged that high-stress levels resulted in decreased communication and poor decision-

making by members of the OR team, thus amplifying the chances of error. It is for similar 

reasons that stress and resilience training should make up part of the hospital patient 

safety curricula. The Psychological well being of the healthcare professionals is one of 

the factors concerning care delivery and should be addressed in order to ensure the high 

standard about safety and optimize the outcomes of patients. 



16 

1.7.2 Regional Perspective 

Mostly this has been confronted on the level of regional research leading in issues around 

the healthcare professional's safety attitude representing diverse cultural and institutional 

settings. The study of Bahar & Önler, ( 2020)about the attitudes of Turkish surgical nurses 

toward patient safety. They reported critical research findings on unique difficulties and 

perceptions in the region. For their survey, stated a culture, very often, in which 

occupational boundaries within Turkish hospitals obstruct open communication by 

hierarchical lines; such culture means problems related to safety are poorly articulated. 

This therefore implicates that strategies targeted to create more egalitarian culture of 

communication among surgical teams should be implemented to improve the patient 

safety. 

On the other hand, Ramos & Calidgid, (2018) surveyed the patient safety culture of nurses 

from a tertiary government hospital in the Philippines taking into account the role of 

institutional support and trainings in fostering positive safety culture. Their study found 

that nurses who receive continued training and support from their leadership would be 

likely to adopt the safety practices and report any occurrence to do with the danger of the 

safety of others. Resource limitation and high workload became significant hindrances to 

strong safety culture. These barriers will only be addressed if adequate staffing, resources, 

and continuous professional development are available. Their continued availability 

would also have to be ensured in order to enhance patient safety. 

Other contributions to the knowledge came from the studies conducted in the Middle East. 

Haugen et al., (2013) conducted a wider swath of the subject by eliciting opinions from 

surgical team members in Norway regarding perceptions of near misses and attitudes 

toward time-out, thus succinctly advancing issues of communication within a team and 

adherence to a safety protocol—all to be designed to avoid an adverse event. The practice 

of the time-out process in a consistent way can therefore reduce the number of near 

misses. This proves that the role of the standardization of communication and safety 

checks is very important in a surgical environment. There is every need to improve 

standardized safety protocols for any surgical procedure in order to improve timely 

communication and coordination between members belonging to a surgical team. 



17 

Ock et al., (2017), suggested that a systematic review indicated various barriers and 

facilitators of importance to enhance transparency and increase accountability in 

healthcare with relevance to disclosure of safety incidences. Fear of litigation and other 

professional repercussions often hindered the disclosure of safety incidents. This current 

study has identified organizational support, clear guidance, and a non-punitive culture 

only as facilitators for the act of disclosure. Such findings would have been very relevant 

to strategies towards changing the patient safety culture of developing regions with 

equally challenging approaches. 

Other studies have been done in the Middle East, including one by Bahar & Önler, (2020), 

that researched attitudes toward patient safety in Turkish surgical nurses. They defined 

"cultural factors such as attitudes to hierarchy, and norms about communication are 

strongly associated with safety attitudes". The suggestions that the authors have made 

pertain to the need for context-sensitive interventions, for example, in training for 

leadership or in the creation of open lines of communication in the realization of safety 

for patients. 

Haugen et al., (2013) also researched impacts and perceptions of the Norwegian surgical 

team members. Consequently, the main findings drawn out are that, the time-out prevents 

error and ensures the team is in unison. It developed that time-outs will improve the safety 

performance through the practice of regular execution and following. Moreover, it 

showed that such practices need to be constantly trained and refreshed in order to be 

considered effective in maintaining effectiveness over many years. 

They found the safety culture that ascertained the safety culture of the nurses in a 

government-owned hospital in the country. The related findings also revealed that 

hospitals which exhibited good safety culture should be characterized by strong training 

programs and supportive leadership. Other barriers are a high patient-to-nurse ratio at 

times, inadequate resources, or not being able to translate the practices of safety into 

action. Such barriers need to be done away with in order to better safety for the patient. 

This can only be done by changing policy and more investment in the infrastructure of 

healthcare. 



18 

The study by Ock et al., (2017) reported a comprehensive review of disclosure practices 

in incidents related to patient safety, where major factors were specified, such as fear of 

blame and the lack of top management support. Their review pointed out facilitators that 

would support transparency: provision of guidance, learning from practice in a supportive 

organizational culture. It simply comes down to the fact that there is a need to build an 

environment in which health professionals feel safe and learn from incidents so that errors 

can hopefully be avoided in the future. 

This is captured in much more general regional work into health care professionals' 

attitude to patient safety, finding out that the cultural, institutional, and systemic factors 

all interact and enter very complexly into the interactions. Indeed, in all instances, there 

were shared challenges bound with issues of varying setting influence and those of more-

bounded influence to shape safety attitudes and practices. For example, Bahar & Önler, 

(2020), in their study of surgical nurses in Turkey. It is an extremely explanatory and 

informative piece and elaborates well on how deeply hierarchical structures within 

Turkish hospitals hamper open communication that is needed for patient safety. Their 

findings are a study on the systemic need for changes toward egalitarianism and 

communicativeness with surgical teams. Articulation of safety concerns and the safety 

culture in a clinical setting are greatly increased through the implementation of strategies 

such as leadership training, which promotes communication and obviates all barriers 

caused by hierarchy. 

On a different note, the study by Ramos & Calidgid, (2018) in the Philippines describes 

how safety culture for nurses is regulated with institutional support and continuously 

taught. Against this, however, are the quotes of key barriers to a supportive environment 

that involves effective leadership and continuous professional development—an area that 

significantly influences the adoption of safety practices and capacity to report safety 

threats. Resource constraint and high perceived workload are also key barriers, as 

identified, known to implement proactive safety strategies similarly. In fact, policy 

reforms that specifically seek to increase the levels of staffing and resources in the 

country, therefore, would call for investment in policies that aim at attaining a safety 

culture in the health system. These would be in trying to keep the standards high in terms 

of continuous training. 



19 

A cross-section of studies has, therefore, found that some standardized procedures and 

team communication enhance the safety in patients. For example, Haugen et al., (2013) 

evaluated how using protocols for time-out builds safety in the operation teams in 

Norway. The evidence shows that training and rigorous adherence to the protocols 

decrease the number of near misses and increase in coordination among team members. 

This paper indicates how the standard of a safety checklist and rehearsing is a method 

used to get the highest possible safety levels. It proved that adequate utilization of time-

out when need and continuous education boosted the safety and communication 

performance during surgery among crew members. 

Ock et al., (2017), also did evidence-based analysis on the advantages and barriers of 

reporting on incidents of patient safety. It noted that the major barrier that withholds the 

health workers reporting the incident regarding patients' safety or security is fear of 

getting captured in the process of provisioning and litigation. However, organizational 

support, clear guidance, and a non-punitive culture towards error disclose will facilitate 

the disclosure process. Such findings, therefore, would be of great importance to 

developing regions that will face more or less similar challenges. It is firms where 

employees feel safe to report, learn, and revise from incidents, rather than punished or 

blamed within a supportive surrounding, that will generate transparency and 

accountability for patient safety. 

Other tests in Middle East also support the fact that cultural tuned measures are required 

to further improve the safety attitudes in the current environment and for the future. 

Another test recognized some other important determinants such as cultural norms and 

organizational setup, in terms of hierarchies; it was found to influence to some extent the 

safety attitudes. It is therefore necessary to have really context-based strategies, including 

the designing of free lines of communication along with leadership training based on 

regional culture. These practices will make better safety, not for just its sake but they shall 

make the tries for the establishment of the environment more supporting and open-ended 

work concerning patient safety. 

Resighini was quoted that in general, there is the need to grapple with hierarchical barriers 

in order that there be a stronger institutional support for developing a culture wherein a 



20 

possibility of betterment rests continuously. Making use of contextually relevant 

interventions and investment resources in training, then, the systems of health in the 

region should become more safety culture and thereby reap improved patient outcomes. 

The overall general inference drawn from all studies in total promises very useful 

guidance in developing interventions that are effective towards the promotion of patient 

safety in varied settings. 

1.7.3 Local Perspective 

The establishment of the domain of patient safety research in Palestine is still developing, 

and few studies investigate the attitude of OR professionals. Data from the Palestinian 

Central Bureau of Statistics and the Ministry of Health give a background understanding 

of the healthcare landscape in the area under study. According to the Palestinian Central 

Bureau of statistics (PCBS), (2017) World Health Day report, while there are constant 

efforts put in to enhance health care quality and safety, very few records on precise OR 

safety attitudes exist. This report gives general health improvements and still-standing 

difficulties in the Palestinian healthcare system against which specific issues of patient 

safety in the OR can be examined. 

Some studies have been made on stress and poor teamwork, as seen in the study by Hull 

et al., which has shed more light on some of the challenges that exist for the OR teams in 

their attempt to maintain safety in their environment. Hull et al. evaluated the considerable 

effect of stress and bad teamwork on the safety of patients. Effective communication and 

collaboration are integral parts of reducing medical errors and promoting patient safety 

in the high-pressure setting of the OR. This was a study to emphasize how interventions 

should focus on both psychological well-being in the OR and the team dynamics. 

The Minnesota Department of Health, 2016, and the Joint Commission, 1995-2016, have 

documented past records of adverse health events and sentinel events, hence providing 

measures of safety performance to benchmark against local practice. These reports 

present important data about the types and frequency of adverse events in healthcare 

settings and therefore would serve as a benchmark for measuring and comparing the 

safety performance of Palestinian hospitals. These benchmarks can be compared with 



21 

local data for areas of improvement and identification of targeted interventions toward 

improving patient safety for Palestinian hospitals. 

Furthermore, Carney et al., (2010) examined differences in sex regarding OR caregiver 

perceptions of patient safety, hence underlining issues of attitude diversity in different 

contexts. The results of Carney et al., (2010) suggest that there are different perceptions 

and concerns in relation to patient safety among female OR caregivers in comparison with 

their male counterparts. Recognizing these differences is important in the formulation of 

inclusive safety strategies so that the processes ensure such strategies answer the needs 

and views of all professionals in the OR chain to achieve an integrated and very effective 

safety culture. 

Though limited, local studies show that stress, teamwork, and gender difference are the 

most significant factors that affect attitudes towards patient safety among OR 

professionals. This study helps in filling this gap by providing an in-depth analysis of the 

attitudes of the OR professionals towards patient safety in governmental hospitals in the 

North of the West Bank. This will be informed by pre-existing frameworks and tools, 

such as the SAQ. Informed by previous frameworks and tools, such as the SAQ, this study 

sets out to establish influential factors and recommends improvement strategies in this 

key environment. 

Instruments like the Safety Attitudes Questionnaire will be applied to pinpoint areas for 

safety culture improvement (Sexton et al., 2006). In this study, the value of SAQ will be 

derived from its ability to offer detailed insight into a number of dimensions of safety 

attitudes: teamwork, communication, and management support. The present study shall, 

therefore, go ahead to explore the responses of the OR professionals working in hospitals 

in the North of the West Bank with regard to some of the underlying factors influencing 

safety attitudes, with an objective to further develop appropriately tailored interventions 

for such issues. 

Though research into patient safety in Palestine is at its infancy, this study massively 

contributes to the understanding of attitudes towards patient safety among OR 

professionals. The research draws on global and regional studies but utilizes local data 



22 

and tools to come up with a package of locally appropriate actionable insights to help 

formulate policies and practices relevant to the enhancement of patient safety in the 

Palestinian governmental hospitals. The results of this study will not only fill a serious 

literature gap but also support the ongoing efforts to promote quality and safety in health 

care in Palestine. 

The domain of patient safety research in Palestine is an area that has not yet been 

sufficiently addressed, particularly with regard to developing aspects related to attitudes 

toward patient safety among OR professionals. While there have been serious attempts at 

improving quality in healthcare, very few records exist with regard to attitudes toward 

OR safety in Palestinian hospitals from the PCBS or the Ministry of Health. The absence 

of data on these indicators only serves to underscore the need for in-depth studies geared 

toward facilitating better understanding and finding solutions to problems that are 

peculiarly relevant to OR teams serving in Palestinian hospitals. Indeed, such research is 

incumbent in light of calls for local practices to be aligned with global safety standards 

and the gaps revealed by the Palestinian Central Bureau of statistics (PCBS), (2017) 

World Health Day report, which indicates that despite health indicators' improvement 

over the years, numerous problems still beset the healthcare system. 

Stress and ineffective teamwork are significant contributors to the safety of the OR and 

have been identified in world studies, like Hull et al., (2011). They had positively 

diagnosed the deadly results of such an outcome on patient safety about how effective 

communication and teamwork was vital in a challenging environment of the OR. This 

finding is particularly relevant to Palestinian hospitals, where high stress levels and 

suboptimal team dynamics could be further raising the currently prevalent safety 

challenges.  

Targeted interventions to improve psychological well-being and team cohesiveness are 

efforts that can help ameliorate safety practices within the Palestinian OR context. 

Historical data from Minnesota Department of Health, 2016, and the Joint Commission, 

1995-2016, provide important benchmark data for comparison of safety performance. 

Such records of adverse health events and sentinel events offer comparative backdrop 

upon which local safety practices can be measured. The application of such benchmarks 



23 

to Palestinian hospitals will help in knowing which areas need improvement and focus on 

improving patient safety with targeted strategies. Comparative analysis with this nature 

is very crucial in setting realistic goals on safety interventions and assessing their 

effectiveness within the local setting. 

In this respect, Carney et al., (2010) examined sex-based differences of perception toward 

safety and the conclusion was that OR caregivers of the female gender usually have 

concerns about safety that are very different from the male caregivers. This indicates that 

inclusive strategies that are designed for safety should take into account the wide range 

of perspectives within the OR team. This necessitates a better understanding of these 

differences while developing overall safety interventions that are sensitive to the varying 

needs and views of all OR professionals, with the hope of fostering a more integrated and 

effective culture of safety in Palestinian hospitals. 

While the available local studies are still fairly small in size, they situate stress, teamwork, 

and gender differences as the major factors affecting attitudes toward patient safety 

among OR professionals. This is where the current study comes in: the in-depth analysis 

of attitudes in a very important and crucial setting, that of governmental hospitals in the 

North of the West Bank. Among other frameworks, using the Safety Attitudes 

Questionnaire, the research attempts to unravel the underlying factors that affect safety 

attitudes and thus make recommendations for targeted interventions toward problems in 

this area. This will help to develop a localized approach for the strategies relevant to 

Palestinian hospitals. Therefore, this study aims to evaluate the attitudes of the 

professionals working in the operating rooms toward patient safety in governmental 

hospitals in the North of the West Bank, Palestine. This research avails the use of the 

Safety Attitudes Questionnaire in assessing critical determinants that affect safety 

attitudes by evaluating such things as stress and teamwork, looking at gender differences, 

and developing tailored interventions that will enhance patient safety practices to improve 

the quality of health care in the region. 

  



24 

1.8 Summary  

This chapter reviews existing literature related to patient safety, focusing on global, 

regional, and local perspectives to contextualize the study on the attitudes of operating 

room (OR) professionals in the North of the West Bank, Palestine. The global perspective 

includes foundational frameworks by Kohn et al., (2000) and the landmark "To Err is 

Human" report by St.Pierre et al., (2022), which emphasized the need for systemic risk 

management and cultural shifts towards safety. Tools such as the Safety Attitudes 

Questionnaire (SAQ) by Sexton et al., (2006) and studies on human factors and teamwork 

Wahr et al., (2013) highlight the importance of structured safety protocols and effective 

communication. Regional studies reveal cultural and institutional challenges, with 

findings from Turkey and the Philippines illustrating the impact of hierarchical structures 

and institutional support on safety culture (Bahar & Önler, 2020; Ramos & Calidgid, 

2018). Middle Eastern research further underscores the need for culturally sensitive 

interventions and effective leadership (Haugen et al., 2013; Ock et al., 2017). Locally, 

Palestinian research on stress, teamwork, and gender differences provides a backdrop for 

understanding the unique safety challenges in this context (Carney et al., 2010; Hull et 

al., 2011; Palestinian Central Bureau of statistics (PCBS), 2017). This study aims to 

address the gap in literature by evaluate the attitudes of OR professionals towards patient 

safety in Palestinian governmental hospitals, using established frameworks like the SAQ 

to identify key factors influencing safety attitudes and develop targeted interventions. By 

synthesizing global insights with local data, the research seeks to enhance patient safety 

practices in the North of the West Bank and contribute to broader efforts in improving 

healthcare quality and safety. 

 

 

 

  



25 

Chapter Two 

Methodology 

2.1 Introduction  

In this section, we will deal with a description of the study method, as well as the study 

sample and population, the study tool. It also includes a description of the procedures that 

were done to codify the study tool and its application, describing the statistical procedures 

used in analyzing data and extracting results. 

2.2 Study Design 

This research was designed as a cross-sectional study to assess the attitudes of operating 

room professionals towards patient safety and identify the influencing factors in 

governmental hospitals. 

2.3 Sample Size and Sampling 

The Palestinian Central Bureau of statistics (PCBS), (2017) Palestinian Central Bureau 

of Statistics (PCBS) and the annual report of the Palestinian Ministry of Health in the 

West Bank reported a total of 10,004 nurses and 5,001 doctors working in healthcare 

settings (Palestinian Central Bureau of statistics (PCBS), 2017). Considering that 

approximately half of these professionals were either working in the central and southern 

regions of the West Bank or traveling outside Palestine, the study focused on the 

professionals working in the North of the West Bank. Using the sample size formula and 

assuming a 95% Confidence Level with a 5% Margin of Error, a total of 150 male and 

female OR professionals were convincingly recruited from governmental hospitals in the 

North of the West Bank (Nablus, Tulkarm, Jenin, Qalqilia, Salfit, and Tubas). 

2.4 Pilot Study 

A distributed the questionnaire to 10% of the total sample size from Thabet Thabet 

hospital to test its clarity and reliability. The individuals involved in this phase were 

excluded from the final sample to avoid any bias. then Statistical Package for Social 

Sciences (SPSS) was used to calculate Cronbach’s Alpha for reliability analysis, with an 



26 

acceptable threshold set at 0.7 (70%). as established in the original study. This ensured 

that the questionnaire was reliable and ready for use in the main study. 

2.5 Data Collection 

In this study, a cross-sectional design will be applied. Data was collected using a self-

administrated questionnaire from physicians and nurses working in governmental 

hospitals' operating rooms in the North of the West Bank. The sample size will be 

determined in order to achieve a 95% level of significance and at least 80% statistical 

power. 

In the present research, the attitudes was measured using the Patient Safety Attitude, 

PSAQ has 46 items representing the following six sub-dimensions: job satisfaction with 

11 items, teamwork climate with 12 items, safety climate with 5 items, perception of 

management with 7 items, stress recognition with 5 items, and work conditions with 6 

items. Responses were recorded on a 5-point Likert scale, ranging from '5, strongly agree' 

to '1, strongly disagree'. Cronbach Alpha values for the subscales were: 0.85 job 

satisfaction; 0.86 teamwork climate; 0.83 safety climate; 0.77 perception of management; 

0.74 stress recognition; and 0.72 work conditions, with an overall Cronbach Alpha of 

0.915. 

2.6 Research Process 

The research process started by designing a comprehensive questionnaire, one that was 

supposed to measure healthcare professionals' attitudes toward patient safety. 

Particularly, the intent was to use the Sexton et al., (2006), Patient Safety Attitude 

Questionnaire, 2006, and then modify and tailor it according to the local healthcare 

context of the North of the West Bank. The questionnaire was then tested for its content 

validity with a panel of experts in healthcare and patient safety, with subsequent changes 

being done in order to better tailor it into the specific environment of operating room 

professionals within governmental hospitals. A pilot study of 10% of the intended sample 

size was conducted to test the reliability of the questionnaire using Cronbach's Alpha. Its 

participants were excluded from the final analysis to avert bias. Thereafter, ethical 

approval from the respective IRBs and hospital administrations concerned was sought to 



27 

guarantee the application of appropriate ethics on issues of consent by participants and 

data confidentiality. 

Governmental hospitals in the north of the West Bank, such as those in Nablus, Tulkarm, 

Jenin, Qalqilia, Salfit, and Tubas, were coordinated after securing approvals. The visits 

to hospital administrators arranged meetings to ensure their cooperation and enable access 

to the operating room professionals. The study began by distributing self-administered 

questionnaires to working doctors and nurses in the selected hospitals, together with clear 

instructions and a guarantee of anonymity to participants in responding honestly and 

without bias. Collected data were systematically managed and entered into SPSS version 

24.0 for analysis. Missing data was handled appropriately by the imputation method to 

retain the integrity of the dataset. 

In the analysis, both descriptive and inferential statistics—like t-tests, ANOVA, and 

regression analysis—were applied to test for relationships between demographic 

variables, work experience, and attitudes toward patient safety. The results were 

interpreted within the context of existing literature and specific conditions of government 

hospitals in the North of the West Bank. The findings were documented in a structured 

report, with recommendations for improving patient safety attitudes and practices based 

on the study's insights. In doing so, this will represent a comprehensive study to the 

attitude towards PS among operating room professionals in the targeted region. 

2.7 Statistical Analysis 

Statistical analysis was performed using SPSS version 24.0. Both descriptive and 

inferential statistics were employed to analyze the data: 

Descriptive Statistics 

Frequency and Percentage Distributions: For demographic characteristics such as age, 

gender, marital status, educational level, and working experience, as well as working 

characteristics including job position and years of experience. 

Measures of Central Tendency and Variability: Mean and standard deviation for 

continuous variables like PSAQ scores and subscale scores. 



28 

Inferential Statistics 

Parametric Tests 

Independent t-test: To compare mean PSAQ scores between two groups (e.g., male vs. 

female, married vs. single). 

One-way ANOVA: To compare mean PSAQ scores across multiple groups (e.g., different 

age categories, educational levels, and job positions). 

Post-hoc Analysis (Tukey's HSD): To identify specific group differences following 

significant ANOVA results. 

Non-parametric Tests 

Kruskal-Wallis H test: To compare PSAQ scores across multiple groups when normality 

assumptions were not met. 

Correlation Analysis 

Pearson correlation coefficients: To explore relationships between continuous variables 

such as age, years of experience, and PSAQ scores. 

2.8 Reliability and Validity 

• Reliability: The reliability of the questionnaire was assessed using Cronbach’s Alpha, 

calculated from a small experimental sample of participants from Thabet-Thabet 

Governmental Hospital in Tulkarm. A Cronbach’s Alpha coefficient of 0.70 or higher 

was considered acceptable. 

• Validity: Content validity was ensured by having the questionnaire reviewed by a 

panel of experts. Their feedback was used to refine the questionnaire, ensuring it 

covered all relevant aspects of patient safety attitudes and was appropriate for the study 

context. 

Handling Missing Data 

Missing data were analyzed to determine whether it was random or systematic. 

Depending on the extent and nature of missing values, appropriate methods such as mean 

imputation or multiple imputations were used. 



29 

2.9 Inclusion Criterion 

• All participants who were willing to participate and gave oral consent. 

• All participants working in the operating room. 

• All participants who were health professionals. 

2.10 Exclusion Criterion 

• All participants who refused to participate in the study. 

• All participants not working in the operating room. 

• All participants who were not health professionals. 

This methodology ensured a comprehensive approach to examining the attitudes of OR 

professionals towards patient safety and identifying influencing factors in governmental 

hospitals in the North of the West Bank. 

2.11 Summary  

This section outlines the methodology for assessing operating room (OR) professionals' 

attitudes toward patient safety in the North of the West Bank. The cross-sectional study 

targeted 150 OR professionals, selected from a population of nurses and doctors in 

governmental hospitals, using a sample size formula with a 95% confidence level and 5% 

margin of error. A pilot study ensured the reliability of the Patient Safety Attitude 

Questionnaire (PSAQ), which was administered in a self-reported format. The PSAQ, 

translated into Turkish and comprising six subscales, demonstrated strong internal 

consistency with an overall Cronbach Alpha of 0.915. Data were collected and analyzed 

using SPSS version 24.0, employing both descriptive and inferential statistics, including 

t-tests, ANOVA, Kruskal-Wallis H tests, and correlation analysis. Reliability was 

assessed via Cronbach’s Alpha, and content validity was verified by expert review. 

Missing data were managed through appropriate imputation techniques. Inclusion and 

exclusion criteria ensured that participants were current OR professionals who consented 

to participate. This methodology aims to provide a robust analysis of patient safety 

attitudes and influencing factors within the specified context. 

  



30 

Chapter Three 

Results 

In this chapter, the study's outcomes are showcased through addressing its research 

inquiries and testing its hypotheses. The data underwent processing and coding, followed 

by the implementation of both simple and multiple linear regression analyses using SPSS 

software. 

3.1 Introduction 

The study revealed that 54.4% of healthcare professionals had a positive attitude towards 

teamwork climate, while 52.6% showed positive stress recognition. However, only 38% 

expressed favorable perceptions of management, highlighting potential areas for 

improvement in communication and leadership within the healthcare settings. 

Demographic Characteristics  

A total of 117 completed questionnaires were returned, which represented a response rate 

of 82%. About 41.9% aged between 31-40 years old, also 56.4% of the participants were 

males, 64.1% were married, and 45.3% holding bachelor’s degree (Table 1). 

  



31 

Table 1 

Demographic Characteristics of the participants (n = 117). 

Variable Frequency Percent 

Age   

Less than 30 Years Old 45 38.5 

31-40 Years Old 49 41.9 

More than 41 Years Old 23 19.7 

Gender   

Male 66 56.4 

Female 51 43.6 

Marital Status   

Married 75 64.1 

Single 42 35.9 

Education Level   

Diploma Degree 15 12.8 

Bachelor’s Degree 53 45.3 

Master’s Degree 31 26.5 

Others 18 15.4 

Working Characteristics 

More than two-thirds of participants (40.2%) had more than ten years of working 

experience, about 37.6% were physician and 35.9% were registered nurses, few as 12% 

working in intensive care unit (ICU), nearly one-third (31.6%) had more than 11 years of 

working experience in the same department participants work. Further information is 

shown in table 2. 

  



32 

Table 2 

Working Characteristics of the participants (n = 117). 

Variable Frequency Percent 

Work experience   

Less than 3 years 23 19.7 

3-6 years 26 22.2 

6-10 years 21 17.9 

10 years or above 47 40.2 

Work position   

Assistant Nurse 10 8.5 

Registered Nurse 42 35.9 

Head nurse 21 17.9 

Physician 44 37.6 

Working Department   

Open ward 30 25.6 

Intensive care unit 14 12.0 

Others 73 62.4 

Work experience in the same department   

Less than 1 year 24 20.5 

1-5 years 35 29.9 

6-10 years 21 17.9 

More than 11 years 37 31.6 

Patient safety attitude 

The scale has six subscales (Table 3). The mean score of the total score was 114.26 ± 

22.81 out of 180. The teamwork climate subscale mean score was 19.91 ± 4.60, Safety 

climate mean score was 22.31 ± 7.69, the mean score for Perception of management was 

30.35 ± 7.52. Job satisfaction mean score was 16.68 ± 4.77, working conditions mean 

score was 12.27 ± 3.82, and Stress recognition mean score was 13.44 ± 3.67. 



33 

Table 3 

Patient safety subscales’ mean score 

Subscale Minimum Maximum Mean SD 

Teamwork Climate 10.00 28.00 19.91 4.60 

Safety climate 11.00 79.00 22.31 7.69 

Perception of management 10.00 75.00 30.35 7.52 

Job Satisfaction 5.00 25.00 16.68 4.77 

Working conditions 4.00 20.00 12.27 3.82 

Stress recognition 4.00 20.00 13.44 3.67 

Total 54.00 180.00 114.26 22.81 

SD: Standard Deviation  

The scale with the most positive responses was teamwork climate 54.4%, followed by 

stress recognition 52.6%, job satisfaction 50.4%, working conditions 43.3%, and 

perception of management 38%. The average percentage of positive responses is shown 

in Figure 1. 

Figure 1 

Average of percentage positive responses of patient safety scales’ 

 

P
e
r
c
e
n
t
a
g
e

Safety attitude scales 



34 

In teamwork climate, the highest mean score (3.44 ± 1.18) was for “The physicians and 

nurses here work together as a well-coordinated team”, and the lowest mean score (3.21 

± 1.17) was for “Nurse input is well received in this clinical area”. 

In safety climate, the highest mean score (3.50 ± 4.97) was for “I would feel safe being 

treated here as a patient”, and the lowest mean score (2.97 ± 1.19) was for “I receive 

appropriate feedback about my performance”. 

For Job satisfaction, the highest mean score (3.55 ± 1.33) was for “I like my job”, and the 

lowest mean score (3.18 ± 1.16) was for “This is a good place to work”. 

In stress recognition, the highest mean score (3.49 ± 1.14) was for “When my workload 

becomes excessive, my performance is impaired”, also, for “I am less effective at work 

when fatigued” with a mean score of 3.49 ± 1.10, and the lowest mean score (3.14 ± 1.14) 

was for “Fatigue impairs my performance during emergency situations (e.g. emergency 

resuscitation, seizure)”. 

For Perception of management, the highest mean score (3.41 ± 3.85) was for “Unit 

Management supports my daily efforts”, and the lowest mean score (2.84 ± 1.09) was for 

“I get adequate, timely info about events that might affect my work, from Hospital 

Management”. 

In working conditions, the highest mean score (3.22 ± 1.04) was for “Trainees in my 

discipline are adequately supervised”, and the lowest mean score (2.98 ± 1.18) was for 

“All the necessary information for diagnostic and therapeutic decisions is routinely 

available to me”. 

Appendix A shows all mean scores related to patient’ safety attitude questions. 

3.2 Test of Normality 

To evaluate the normality, Shapiro-Wilk test was performed. The analysis showed that 

Shapiro-Wilk had p =.058, which indicates that the data are within normal distribution. 

Therefore, parametric tests were used in analyses. 

  



35 

3.3 Inferential statistics 

SAQ Gender-related scores 

An Independent t-test was used to assess the relationship between gender and patient 

safety subscales. The test was statistically significant between gender and safety climate 

t(115) = -2.124, p =.036, 95%CI = -5.80, -0.20. Females had higher mean of safety climate 

compared to males (24.76 ± 9.76, 21.00 ± 5.32, respectively). Similarly, patient safety 

total score did not show statistically significant relationship with gender t(114) = -1.531, 

p =.051. The effect of gender on [Teamwork climate, perception of management, job 

satisfaction, working conditions, and stress recognition] was not statistically significant 

different (p >.05). 

SAQ Marital status-related scores 

An Independent t-test was used to assess the relationship between marital status and 

patient safety subscales. The test was statistically significant between marital status and 

working conditions t(114) = -2.42, p =.017, 95%CI = -3.17, -0.31. Single participants had 

higher mean of working conditions compared to married participants (13.38 ± 3.22, 11.64 

± 4.00, respectively). Similarly, patient safety total score did not show statistically 

significant relationship with marital status t(114) = -1.257, p =.211. The effect of marital 

status conditions on [Teamwork Climate, Safety climate, Perception of management, Job 

Satisfaction, and Stress recognition] were not statistically significant different (p >.05). 

SAQ Age-related scores 

A one-way ANOVA was performed to compare the effect of different age categories on 

overall patient safety score and its six subscales. A one-way ANOVA revealed that there 

was not a statistically significant difference in mean patient safety score between at least 

two groups (F(2, 9) = 1.702, p =.187). However, there was a statistically significant 

difference in working conditions score between at least two groups (F(2, 113) = 3.459, p 

=.035).  

Tukey’s HSD Test for multiple comparisons found that the mean value of working 

conditions was significantly different between participants aged less than 30 years old 



36 

(13.31 ± 3.18) and those aged 31-40 years old (11.27 ± 3.95) (p =.026, 95% C.I. =.20, 

3.88).  

The effect of age on [Teamwork Climate, Safety climate, Perception of management, Job 

Satisfaction, and Stress recognition] was not statistically significant different (p >.05). 

SAQ Education level-related scores 

A one-way ANOVA was performed to compare the effect of different educational levels 

on overall patient safety score and its six subscales. A one-way ANOVA revealed that 

there was not a statistically significant difference in mean patient safety score between at 

least two groups (F(3, 112) =.081, p =.970). The effect of education level on [teamwork 

climate, safety climate, perception of management, job satisfaction, working conditions, 

and stress recognition] was not statistically significant different (p >.05). 

SAQ Working experience-related scores 

To compare the effect of working experience on overall patient safety score and its six 

subscales, a one-way ANOVA test was used. The results showed that there was not a 

statistically significant difference in mean patient safety score between at least two groups 

(F(3, 112) =.785, p =.505). The test was then used to compare the effect of working 

experience on [Teamwork Climate, Safety climate, Perception of management, Job 

Satisfaction, Working conditions, and Stress recognition]. The one-way ANOVA 

revealed that there was a statistically significant difference in working conditions score 

between at least two groups (F(2, 112) = 3.604, p =.016). 

Tukey’s HSD Test for multiple comparisons found that the mean value of working 

conditions was significantly different between participants experienced less than 3 years 

(13.48 ± 3.23) and those with 6-10 years’ experience (10.52 ± 3.41) (p =.045, 95% C.I. 

=.05, 5.86). Additionally, between participants experienced 3-6 years (13.52 ± 3.28) and 

those with 6-10 years’ experience (10.52 ± 3.41) (p =.036, 95% C.I. =.14, 5.85). 

The effect of working experience on [Teamwork climate, safety climate, perception of 

management, job satisfaction, and stress recognition] was not statistically significant 

different (P >.05). 



37 

SAQ working position-related scores 

A one-way ANOVA was performed to compare the effect of different working positions 

on overall patient safety score and its six subscales [Teamwork climate, safety climate, 

perception of management, job satisfaction, working conditions, and stress recognition]. 

The one-way ANOVA revealed that there was not a statistically significant difference in 

mean patient safety score between at least two groups (F(3, 112) =.478, p =.698). Other 

subscales [Teamwork climate, safety climate, perception of management, job satisfaction, 

working conditions, and stress recognition] were not statistically significant difference in 

working positions (p >.05).  

SAQ Working department-related scores 

A one-way ANOVA was performed to compare the effect of different working 

departments on overall patient safety score and its six subscales [Teamwork climate, 

safety climate, perception of management, job satisfaction, working conditions, and stress 

recognition]. The effect of working department on [overall patient safety score, teamwork 

climate, safety climate, perception of management, job satisfaction, working conditions, 

and stress recognition] was not statistically significant different (p >.05). 

SAQ Work experience in the same department-related scores 

A one-way ANOVA was performed to compare the effect of Work experience in the same 

department on overall patient safety score and its six subscales [Teamwork Climate, 

Safety climate, Perception of management, Job Satisfaction, Working conditions, and 

Stress recognition]. The one-way ANOVA revealed that there was a statistically 

significant difference in Teamwork Climate score between at least two groups (F(3, 113) 

= 3.178, p =.027). Tukey’s HSD Test for multiple comparisons found that the mean value 

of Teamwork Climate was significantly different between participants experienced 6-10 

years (17.81 ± 3.94) and those with more than 11 years’ experience (21.11 ± 4.88) (p 

=.040, 95% C.I. = -6.49, -.11).  

In addition, the one-way ANOVA revealed that there was a statistically significant 

difference in Safety climate score between at least two groups (F(3, 113) = 3.383, p 

=.021). 



38 

Tukey’s HSD Test for multiple comparisons found that the mean value of Safety climate 

was significantly different between participants experienced 6-10 years (19.14 ± 5.01) 

and those with more than 11 years’ experience (24.89 ± 10.73) (p =.029, 95% C.I. = -

11.10, -.43).  

The effect of Work experience in the same department on [Perception of management, 

job satisfaction, working conditions, stress recognition, and overall score] was not 

statistically significant different (P >.05). 

3.4 Summary 

A total of 117 questionnaires were completed, representing an 82% response rate. Most 

participants were males, 56.4% married, and 64.1% with a bachelor's degree. Again, most 

of the participants, 45.3%, held a bachelor's degree. About 41.9% of participants fell 

between the age bracket of 31-40 years. Over two-thirds of the respondents had more than 

ten years of experience, and 37.6% were physicians. The mean patient safety attitude total 

score was 114.26 with a maximum of 180, with the highest positive response rates to 

teamwork climate 54.4% and to stress recognition 52.6%, but perception of management 

was only 38%. There were noted differences by gender, the females scoring higher in 

safety climate, and by marital status, single scoring higher in working conditions. There 

were age-related differences: the younger participants reported better working conditions. 

Working experience differences showed less experienced participants rating working 

conditions as better. There were also important differences in teamwork and safety 

climate related to experience within the same department, the more experienced members 

rating these lower. Generally, individual response items to questions about teamwork and 

safety climate were quite positive, although demographic and working characteristics 

influence specific perceptions of different aspects of patient safety. 

  



39 

Chapter Four 

Discussions and Conclusions and Recommendations 

In this chapter, we discuss the result compared with other studies have been done globally 

and regionally alongside local if there is any, also we give recommendation with 

conclusion of the study.  

4.1 Discussion 

This study was intended to appraise the attitude of health professionals towards patients' 

safety while working in an operation theatre and identify factors that might affect it in 

governmental hospitals of Palestine. The results are of major importance in delineating 

demographic and working characteristics and an attitude of the surveyed population 

towards patients' safety. 

4.1.1 Demographic and Working Characteristics 

The demographic characteristics showed that relatively high percentages of respondents 

fell within the 31-40-year age group, mostly males, married, and with a bachelor's degree 

as the highest level of education achieved. On work characteristics, a substantive 

percentage had above ten years of experience in the profession; most study participants 

in this category were doctors and registered nurses. 

These findings indicate that demographic variables, such as age, gender, and experience, 

might strongly influence the attitude toward patient safety. For instance, this survey found 

females receiving a higher mean value of safety climate; this is similar to the results of a 

few studies, indicating that gender may influence perception about patient safety. In fact, 

these demographic variables merit further regard while designing and implementing 

protocols for patient safety. 

The great percentage of these with over ten years of experience attests to the experience 

factor whereby long-term experience contributes a lot to the exposure and commitment 

to issues of patient safety. This, therefore, renders such a high degree of experience ripe 

and expounds on the understanding and adherence to the laid-down safety protocols, 

hence making the experience important to the work environment. This is even supported 



40 

more by previous studies like Davis et al., (2007); Salih et al., (2021), where professional 

role and departmental experience proved a critical factor in the formulation of safety 

attitudes. 

Accordingly, the involvement of experienced healthcare professionals in the patient 

safety practices may result in more standardized and consistent approaches to securing 

the safety of patients. The standardization of approach that grows out of departmental 

experience may also encourage more team effort and communication, two of the key 

elements for an effective safety culture, has been confirmed by Lee et al., (2022). 

4.1.2 Attitude to Patient Safety 

The Patient Safety Attitude Questionnaire had a mean score of 114.26 out of the 

maximum possible score of 180, and the subscales revealed different magnitudes to a 

positive response. The mean of the subscale scores ranged from a low of 52.6% for the 

stress recognition sub-scale to a high of 54.4% for the teamwork climate sub-scale, with 

job satisfaction having a percentage of 50.4%. Such findings often support those of Allard 

et al., (2011), who stressed that a collaborative work environment is very much needed in 

developing a positive safety climate. 

A combined total mean score of 114.26 should serve to underscore the point that while 

attitudes are generally very positive, there may be quite a lot of room for improvement. 

In this regard, the high percentage of positive responses in the teamwork climate subscale 

further underscores the idea that effective teamwork is one critical factor in setting up 

robust patient safety culture. This agrees with work done by Biresaw et al., (2020), 

whereby, among elements, one that emerged to be an independent predictor of a strong 

patient safety culture was teamwork. The high average score in the subscale of teamwork 

climate indicates the efficiency of health professionals' collaboration in ensuring that 

patients are protected from harm. 

The high prevalence of the positive reaction in the subscale of stress recognition, with a 

positive response rate of 90%, would show high effect stress management has on patient 

safety. It supports what Bhatti et al., (2021) established: that healthcare professionals are 

highly aware of the stress, undermining patient safety. One can recognize herein the 



41 

manner in which stress, under conditions of undue workload or fatigue, influences 

performance, which sharpens the need for the implementation of strategies aimed at 

reducing stress while keeping a high standard of care for patients. 

The second important theme influencing attitudes towards patient safety was job 

satisfaction. The results of this subscale show that many of the respondents are very 

satisfied with their work, which is very important in the maintenance of motivation and 

adherence to protocols regarding the safety of patients. Specifically, this study agrees with 

the work of Park et al., (2023), revealing that operating room nurses who are highly 

satisfied with their job demonstrate a stronger compliance towards patient safety 

protocols as well as the perception for a strong culture of patient safety. A high mean 

score is also noted on the 'I like my job' item; hence, job satisfaction further underpins the 

nature of value in which it holds within the maintenance of a positive culture of safety. 

Consequently, the findings add weight to the importance of teamwork, stress recognition, 

and job satisfaction in relation to attitudes toward patient safety. Strategies aimed at 

enhancing such dimensions could make a big difference in improving the safety climate 

in healthcare settings. Healthcare organizations could work toward a culture of patient 

safety and minimum possible risks by engendering a collaborative environment at work 

and managing stress with effective job satisfaction solutions. 

Gender-Related Scores 

A significant relationship between gender and the safety climate was found, with females 

having a higher score than males. Each female usually was related to higher scores for 

the perceptions regarding patient safety. This finding is consistent with the study by 

Carney et al., (2010) who found that females usually report higher perceptions of patient 

safety. In this study, the mean safety climate score was 24.76 for females and 21.00 for 

males, which means female healthcare professionals are more cautious or sensitive about 

safety matters or more likely to perceive and report about the concerns. 

However, the researchers did not establish a significant relationship between gender and 

other subscales under the teamwork climate, perception of management, job satisfaction, 

and working conditions. This is in agreement with Bahar & Önler, (2020), which has 



42 

reported the effect of gender differences not significant on the perception towards the 

teamwork, management, or job satisfaction settings in the healthcare settings. The 

findings indicate that in patient safety perceptions, gender might influence only certain 

dimensions of the aspect being measured—for example, the safety climate—but this does 

not imply that it influences all dimensions of the attitude toward patient safety. 

Furthermore, the gender differences are insignificant in subscales other than safety 

climate, which probably indicates that gender should not be a key variable in designing 

improvement interventions for patient safety culture; rather, these interventions should be 

broad-based and focus on organizational and operational factors. Indeed, this fact is 

corroborated by the recent findings of Lee et al., (2022), who emphasized the need for 

patient safety intervention programs with comprehensive training related to various 

patient safety culture factors instead of concentrating on demographic factors for specific 

groups, such as females. 

4.1.3 Scores Harmonizing with Marital Status 

This would suggest that working conditions were greatly influenced by marital status. 

Respondents who were single reported enjoying working conditions much more than 

those who were married. For instance, singles had an average working condition score of 

13.38, whereas those people who were married averaged 11.64. This might be read to 

mean that those who were single perceived their working environment slightly 

differently, probably due to lessening extra responsibilities outside the working 

environment, which helps them focus a little bit more on the professional stance. 

This specific field, concerning the impact of the marital status in working environmental 

conditions, has been less covered by the literature domain and, for this reason particularly, 

seems t