Cultura organizacional para segurança do paciente em farmácias da atenção primária em Belo Horizonte

Abstract

In recent years, worldwide concern about patient safety has increased and, for initiatives that prioritize patient safety to be carried out, knowledge regarding safety management related to organizational culture is relevant. In this sense, one of the important instruments to assess the individual view of professionals about safety in their organization, at a particular moment in time, is the assessment of the safety climate. The objective of this work was to analyze the safety attitudes in the work environment that evidence the patient safety climate, from the perspective of professionals who work in the pharmacies of the Basic Health Units of a region in Belo Horizonte. This is a cross-sectional study, with a qualitative approach, whose method was the descriptive case study. The study sample consisted of 94 high school/technical professionals and 10 pharmacists who work at the pharmacies of the Basic Health Units of the Northeast Region of Belo Horizonte, who agreed to voluntarily participate in the research, after signing the Informed Consent Form. High school/technical professionals are assigned to a pharmacy on a rotating basis, according to a schedule prepared by nurses, and pharmacists are part of the Family Health Support Group and have management, technical and assistance assignments. Data collection was carried out through the Personal and Professional Characterization Questionnaire and the Safety Attitudes Questionnaire (SAQ), in its short version, adapted and validated for the Portuguese language, with adaptation to the reality of the pharmacies. This questionnaire is composed of six domains, which are: (1) Teamwork Climate; (2) Job Satisfaction; (3) Management Perception; (4) Safety climate, (5) Working Conditions and (6) Stress Perception. Semi-structured interviews were also carried out with the 10 pharmacists about the management of pharmacies, difficulties and easiness in supporting a safety culture in the department. Data collected through Personal and Professional Characterization Questionnaires and SAQ were subjected to descriptive statistical analysis, in addition to statistical analysis for correlations between variables. The general mean of the questionnaire and the mean score per domain were calculated, with reliability assessment using Cronbach's Alpha Coefficient. Sociodemographic data were correlated with SAQ scores. The data obtained through interviews with pharmacists were submitted to thematic categorical content analysis. The group studied was predominantly female (94.2%), 71.2% of the participants were nursing technicians, 11.5% nursing assistants, 9.6% pharmacists, 5.8% pharmacy technicians and 1, 9% others and the predominant type of bond was the temporary administrative contract, which shows precarization of work. The general assessment of the SAQ shows a low perception of the safety climate in pharmacies, with a score of 74.7. Of the 6 SAQ domains, only 2 were considered positive: Job Satisfaction (81.7) and Teamwork Climate (77.2). In contrast, the domains with the lowest scores were Working Conditions (70.1), followed by Management Perception (71.7). The overall mean of the SAQ and of all domains was lower for the pharmacists group, except for the Perception of Stress. The Job Satisfaction domain showed a negative correlation with time of experience. The data collected through interviews with pharmacists were organized into 5 categories: Profile of professionals working in pharmacies, Difficulties in managing pharmacies and sustaining a safety culture in the department; Easiness in the management of pharmacies and support of a safety culture in the department, Participants' understanding of the patient safety culture; Suggestions for improvements in the work process and safety culture in the pharmacy. The difficulties perceived by pharmacists in sustaining a safety culture in the department are related to the simplistic view of the work developed in the pharmacy, which is often not seen as a health service, the absence of a fixed team and professionals with specific technical training in the department, high turnover of professionals, pharmacist's workload and lack of support from the health unit manager. We concluded that the safety climate of pharmacies in basic health units needs to be improved and providing safe care means changing attitudes and practices of all professionals involved in patient care, through the development of a non-punitive culture and investment in instruction, meetings and training. As a technical product of this study, a technical report was prepared to be presented to the Municipal Health Department of Belo Horizonte in order to promote the improvement of the safety culture of pharmacies.