Poku et al. BMC Health Services Research (2023) 23:1072 BMC Health Services Research https://doi.org/10.1186/s12913-023-10000-0 R E S E A R C H Open Access Response to patient safety incidents in healthcare settings in Ghana: the role of teamwork, communication openness, and handoffs Collins Atta Poku1, Priscilla Yeye Adumoah Attafuah2*, Emmanuel Anongeba Anaba3, Patience Aseweh Abor4, Edward Nketiah-Amponsah5 and Aaron Asibi Abuosi4 Abstract Background Patient safety incidents (PSIs) in healthcare settings are a critical concern globally, and Ghana is no exception. Addressing PSIs to improve health outcomes requires various initiatives to be implemented including improving patient safety culture, teamwork and communication between healthcare providers during handoffs. It is essential to acknowledge the significance of teamwork, communication openness, and effective handoffs in preventing and managing such incidents. These factors play a pivotal role in ensuring the well-being of patients and the overall quality of healthcare services. Aim This study assessed the occurrence and types of PSIs in health facilities in Ghana. It also examined the role of teamwork, handoffs and information exchange, and communication openness in response to PSIs by health professionals. Methods A cross-sectional study was conducted among 1651 health workers in three regions of Ghana. Using a multi-staged sampling technique, the Survey on Patient Safety Culture Hospital Survey questionnaire and the nurse- reported scale were used to collect the data and it was analysed by descriptive statistics, Pearson correlation, and linear multiple regression model at a significance of 0.05. Results There was a reported prevalence of PSIs including medication errors (30.4%), wound infections (23.3%), infusion reactions (24.7%), pressure sores (21.3%), and falls (18.7%) at least once a month. There was a satisfactory mean score for responses to adverse events (3.40), teamwork (4.18), handoffs and information exchange (3.88), and communication openness (3.84) among healthcare professionals. Teamwork, handoffs and information exchange and communication openness were significant predictors of response to PSIs, accounting for 28.3% of the variance. Conclusions Effective teamwork, handoffs and information exchange, and communication openness in the healthcare environment are critical strategies to enhance PSI response. Creating a culture that encourages error response through teamwork, communication and handoffs provides healthcare professionals with opportunities for *Correspondence: Priscilla Yeye Adumoah Attafuah pyaattafuah@ug.edu.gh Full list of author information is available at the end of the article © The Author(s) 2023. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Poku et al. BMC Health Services Research (2023) 23:1072 Page 2 of 9 learning and improving patient outcomes. Training programs should therefore target health professionals to improve patient safety and competency. Through the implementation of evidence-based practices and learning from past incidents, the healthcare system will be able to deliver safe and high-quality care to patients nationwide. Patient safety must be recognized as an ongoing process. Therefore, a meaningful improvement in patient outcomes requires all stakeholders’ commitment. Keywords Communication openness, Handoffs, Patient safety incidents, Response, Teamwork Introduction [12, 13]. One way to do this is by implementing a quick Patient safety incidents (PSIs) are unintended and harm- response system to PSIs and conducting retrospective ful consequences of medical treatment or care. In high- analyses to understand the root causes of these events. income countries (HICs), an estimated 10% of patients This can help healthcare providers identify patterns and experience PSIs while in low- and middle-income coun- trends and mitigate risks of similar events in the future tries (LMICs), the rates may be even higher due to a lack [14, 15]. of adequate resources and systems for patient safety [1]. Additionally, measuring and reporting PSIs can help It ranges from minor side effects to serious injuries and raise awareness of potential errors and promote a safety even death. It is regarded as a major concern because it culture within the healthcare system. By paying attention may adversely impact hospitals’ patient safety and the to PSIs, healthcare systems can address problems as they quality of healthcare delivery [2, 3]. arise. Moreover, healthcare organizations can also iden- Incidents from iatrogenicity rank among the three tify and assess patient and staff risks of PSIs and mini- leading causes of death in HICs [4]. It can also have seri- mize them [16]. ous consequences for patients, including prolonged hos- It has been established that having an effective response pital stays and complications including disabilities. The system in place for reporting and addressing vulnerabili- PSI incidence is alarming in that up to 1.1% of hospital ties in healthcare systems can promote resilience and admissions result in death [2, 5]. Moreover, the high prevent further harm [17]. Nevertheless, such a response financial costs associated with PSIs burden the health- system can harm the positive campaign on PSIs by reduc- care system and can lead to increased healthcare costs ing open reporting and discussion of mistakes. This can for everyone. According to Mikos et al. [6], the estimated hinder efforts to improve care quality. In effect, negative annual cost of PSIs is 17.1 billion dollars. The two most responses from managers to PSIs occurrence can also frequent types of PSIs (pressure sores and post-operative create a culture of fear around reporting and discussing infections) alone account for the largest portion of the mistakes. This can hinder patient safety efforts [18, 19]. costs at 6.5 billion dollars. Catheter infections, infections It is important to encourage open and honest discussion resulting from transfusion and infusion sites, injections, of PSIs to continuously improve patient care. This can be and similar procedures also result in significant extra achieved through effective healthcare systems to respond healthcare costs, totalling over one billion dollars [7, 8]. to vulnerabilities and incidents through incident report- Healthcare providers must be conscious of PSI risks ing policies and tools. This will help identify and address and take steps to prevent them as much as possible. Most problems as they arise [20]. These proactive efforts when healthcare organizations have, therefore, initiated and implemented can also optimize care delivery to promote prioritised patient safety strategies to prevent PSIs from resilient healthcare systems [21]. occurring. This includes implementing evidence-based Teamwork has been identified as indispensable for practices, improving communication among healthcare safeguarding patient safety and promoting healthcare team members, and investing in quality improvement quality [12]. This can involve implementing strategies efforts [9]. Providing staff training, and continuously such as regular team meetings, effective communication monitoring and reviewing care processes have also been practices, and shared decision-making processes to pro- highlighted as ways to improve patient safety efforts [10, mote collaboration and coordination among healthcare 11]. staff [22, 23]. Besides these strategies, health systems play a crucial It is also vital to ensure healthcare team members feel role in reducing PSIs in patients. This is done by invest- comfortable speaking up and voicing concerns. This ing in resources and implementing systems to quickly can help identify and address potential problems before respond to patient harm. Measuring and reporting PSIs they lead to adverse events. Overall, promoting a culture raises awareness of potential errors and promotes a safety of teamwork and continuous improvement enhances culture. An effective response to PSIs not only remedies patient safety practices, especially reporting incidents problems but also provides a surveillance process that [24–26]. helps identify risks and improve patient and staff safety Poku et al. BMC Health Services Research (2023) 23:1072 Page 3 of 9 Teamwork among healthcare staff is critical to improv- Until this study, PSIs have not been studied extensively ing PSI response. Teamwork perceptions of healthcare in healthcare settings, as well as teamwork, effective professionals play a significant role in improving adverse handoffs, and communication openness among health events reporting rates [27], patient outcomes [28], professionals in Ghana. The study’s findings will help enhancing job performance in healthcare teams [29–31], identify innovative protocols and best practices to mini- and overall patient safety in healthcare facilities [31, 32]. mize adverse events. Moreover, it will provide healthcare A human factors approach, which considers healthcare organizations with strategies for optimizing teamwork professionals’ physical, cognitive, and social characteris- and communication. Healthcare networks can share tics, helps to identify and address potential obstacles to these findings to improve patient safety practices con- teamwork. This ensures that all team members can effec- tinuously. The study, therefore, assessed PSI occurrence tively contribute to patient care [33]. in healthcare facilities. It examined the role teamwork, Additionally, in a system as multifaceted as healthcare, handoffs and communication openness play in health- collaboration within and across organizations through care professionals’ responses to PSIs. The findings from teamwork and communication has reduced the amount the study may be used to improve the safety culture in of the health workforce’s contribution to PSIs in about Ghana’s healthcare system by reducing PSIs to improve 20% of cases [34, 35]. This is achieved by ensuring that quality care. all parties involved in a patient’s care know the patient’s medical history and treatment plan. This can reduce the Methods risk of misdiagnosis, medication errors, and others [36, Study design and setting 37]. A cross-sectional survey using health professionals in Handoffs make information and responsibilities 13 healthcare facilities in Ghana was employed. This between healthcare practitioners possible, which are approach provided a snapshot of health professional a crucial part of the healthcare industry [38]. Because views on the phenomena under study at the period of inadequate communication leads to multiple difficulties, the study. It also offered a valuable understanding of the it has long been recognized that the transfer of patient current state or prevalence of PSIs in hospitals and the knowledge, professional responsibility, and accountability factors that affect them, which provided valuable insights between caregivers presents a potentially difficult period into relationships and disparities among the health work- for patient safety [39]. The second Institute of Medicine force [44]. The study was conducted in three regions in (IOM) report, Crossing the Quality Chasm, highlighted Ghana (Bono, Greater Accra, and Upper East) selected the need for standardization and accountability in hand- randomly from the southern, middle, and northern eco- offs to ensure that the transfer of care is smooth and that logical zones. The total number of healthcare facilities in patient safety is not compromised [40]. Standardiza- Ghana is 1044 and the total health workforce is 122,182 tion can be achieved through structured handoff proto- [45]. The healthcare facilities in Ghana include hospi- cols and tools, such as checklists and electronic medical tals, health centres, clinics, and community-based health records. These protocols help to ensure that all necessary planning and services (CHPs) compounds [45, 46]. Of the information is shared and responsibilities. When com- selected regions, the Greater Accra region has the high- bined with accountability, standardization helps mini- est number of health facilities (438) with the correspond- mize communication errors during transfers of care. This ing highest number of health professionals, followed by has been shown to promote patient safety through posi- the Upper East region (211) and the Bono region (120). tive responses to PSIs [41]. A total of 13 healthcare facilities were selected for the Hospitals and other healthcare organizations need study, with four facilities each chosen from the Bono open communication and a safety culture to promote and Upper East regions and five facilities chosen from PSI reporting. When staff feel able to speak openly about the Greater Accra region. The selection of these facilities safety concerns and PSIs, it can help create an environ- was based on the diversity of the working environment ment where issues can be addressed promptly. This can across different levels of care. A teaching hospital was lead to improved patient safety [42]. This can be achieved also included in the study due to the availability of spe- through a variety of strategies, including promoting open cialized services. communication at the unit level. In addition, it provides opportunities for staff to report concerns and creates a Study population culture of transparency and accountability. By fostering The population included a variety of healthcare pro- an open communication and safety culture, healthcare fessionals from different disciplines, including nurses, organizations can prevent PSIs and improve patient out- doctors, pharmacists, laboratory technicians, and admin- comes [43]. istrative staff from the study sites. To be eligible for inclu- sion, participants had to be full-time health workers with Poku et al. BMC Health Services Research (2023) 23:1072 Page 4 of 9 more than a year of working experience, and they had to and handoffs and information exchange (3 items). All the agree to participate. Healthcare workers who were on items were on a Likert scale ranging from 1 (strongly dis- leave were excluded from the study. agree) to 5 (strongly agree). The composite mean score of each dimension was computed with a score of ≥ 2.5 indi- Sample and sampling technique cates an adequate response to the dimensions. The scale A sample size of 1651 healthcare professionals was esti- has an acceptable reliability score of at least 0.84 and has mated using the Cochran formula [47]. This study used also reported good discriminant and convergent valid- a multi-stage sampling approach, which involves mul- ity in other studies [51, 52]. The Cronbach alpha value tiple levels of sampling to select a sample from the popu- for the scale in this present study was 0.81. Data from lation. In the first stage, a simple random sampling was hospital units were combined and examined by Agency used to select three  (3) regions from the 16 regions in for Healthcare Research and Quality (AHRQ) survey Ghana. Four  (4) hospitals were randomly selected from methods. each of the chosen regions, meanwhile, a Teaching hospi- tal in Greater Accra was added to the selected hospitals, Data collection totalling 13 hospitals. In the second stage, a proportion- This study collected data from the participants over ate stratified sampling was used to allocate the sam- three months, from July to September 2021. To ensure a ple for each of the 13 hospitals. The distribution of the maximum response rate, the researchers worked closely workforce was as follows Greater Accra region (73,309), with the hospital administration to plan and coordinate Upper East region (26,880) and Bono region (21,993). In data collection. We developed a comprehensive survey the third stage, the convenience sampling method was designed to meet the study’s purpose. Participants were used to select the participants from the study sites. This informed about the purpose and significance of the study approach was considered appropriate for the study. and written consent was obtained before administering the questionnaire to them during morning and afternoon Measures shifts. The participants were asked to fill out the ques- Socio-demographic characteristics tionnaire, either at home or at work at their convenience. This study collected information about the participants’ The distributed surveys were tracked and collected after socio-demographics: age, gender, education, marital participants had filled them. The daily received com- status, field of work, job title, working hours, and work pleted questionnaire was kept safely by researchers to experience. ensure confidentiality. Patient safety incidents Data analysis The frequency and occurrence of PSIs were assessed The SPSS (Version 26.0) was used for data analysis and using the Adverse Patient Events Scale (APES) [48]. The descriptive statistics were applied to examine the socio- Scale had the following types of PSIs: medication errors, demographic characteristics of the data, types and occur- pressure ulcers, patient falls, physical restraint for more rence of PSIs, and response to PSIs using frequencies, than 8  h, wound infections, infusions and transfusion mean and standard deviations. A linear regression analy- reactions and complaints from patients and/or family. sis model was used to determine the predictive effects of Participants rated each item according to the frequency teamwork, handoffs and information exchange and com- with which they occurred during their shifts using a five- munication openness on response to PSIs after a Pearson point Likert scale (0 = never to 4 = several times a year). Moment Product Correlation analysis was conducted Previous studies have revealed that this scale’s internal between the predictors and the dependent variable. The consistency has Cronbach alpha scores between 0.81 and test ensured that the assumption of homogeneity of vari- 0.93 [49]. The current study’s Cronbach alpha value was ance and multicollinearity was not violated. The analysis 0.91. was conducted at a p-value of 0.05. Patient safety culture dimensions Results The Survey on Patient Safety (SOPS) Culture, Hospital Socio-demographic and work characteristics of Survey questionnaire (version 2.0) was adapted from the participants Agency for Health Research and Quality for data collec- Of the 1701 health professionals who received the survey, tion [50]. Three (3)    dimensions were adapted from the 1651 (86.2%) responded as summarised in Table  1. An questionnaire to measure teamwork, communication average age of 33.60 years (SD: 6.38) was recorded with openness and handoffs and information exchange among more than half being females (55.2%, n = 912). More than healthcare professionals [50]. The new scale included: 40% worked in medical-surgical units while more than teamwork (3 items); communication openness (4 items) half (54.9%, n = 907) have worked between 2 and 6 years. Poku et al. BMC Health Services Research (2023) 23:1072 Page 5 of 9 Table 1 Socio-demographic and work characteristics of Table 2 Perceived occurrence of PSIs in the unit or work area participants Types of PSIs Occurrence n % Socio-demographic data n % Mean SD Medication error Never happened 348 21.1 Age 33.60 6.38 Everyday 102 6.2 Female sex 912 55.2 Several times a week 118 7.1 Primary Unit/Department Once a month 502 30.4 Several times a year 238 14.4 Medical-Surgical 678 41.1 Don’t know 343 20.8 Obstetrics and Gynaecology 292 17.7 Pressure ulcer Never happened 556 33.7 Emergency and ICU 108 6.5 Everyday 35 2.1 Paediatric/Child Health 141 8.5 Several times a week 87 5.3 Psychiatry/Behavioural Health 184 11.1 Once a month 351 21.3 Diagnostics and Pharmacy 128 7.8 Several times a year 162 9.8 Administration and Support Staff 120 7.3 Don’t know 460 27.8 Duration at the unit Patient falls Never happened 642 38.8 Everyday 97 5.8 Less than 2 years 452 27.4 Several times a week 54 3.3 2–6 years 907 54.9 Once a month 308 18.7 More than 6 years 292 17.7 Several times a year 161 9.8 Profession group Don’t know 390 23.6 Nursing staff 1197 72.5 Physical restraints for more than 8 h Never happened 823 49.8 Medical officers 175 10.6 Everyday 46 2.8 Others Clinicians (pharmacist, lab etc) 141 8.5 Several times a week 51 3.1 Once a month 191 11.6 Managerial, Admin. and Support Staff 138 8.4 Several times a year 60 3.6 Hours of hours per week Don’t know 480 29.1 30 to 40 hours per week 910 55.1 Wound infections Never happened 370 22.4 More than 40 hours per week 741 44.9 Everyday 102 6.2 Several times a week 67 4.1 The majority of the participants (72.5%, n = 1197) were Once a month 384 23.3 nursing staff. Approximately half of the participants work Several times a year 255 15.4 30 to 40 h per week. Don’t know 473 28.6 Infusions or transfusion reactions Never happened 288 17.4 Everyday 235 14.2 Perceived occurrence of Patient Safety incidents Several times a week 58 3.5 As reported in Table 2, there was a prevalence of PSIs in Once a month 407 24.7 Ghanaian hospitals, as close to a third of the participants Several times a year 333 20.2 (30.4%, n = 502) reported experiencing medication errors Don’t know 330 20.0 at least once a month. Though more than a third (33.7%, Patients or their families’ complaints Never happened 128 7.8 Everyday 545 33.0 n = 556) of the participants have not had their patients Several times a week 434 26.3 experiencing pressure ulcers at their unit, an estimated Once a month 223 13.5 21.3% (n = 351) reported experiencing patients with pres- Several times a year 167 10.1 sure sores once a month. About a third (n = 523, 31.8%) Don’t know 154 9.3 have experienced patient fall in their unit at least several times in a year. Though the use of restraints in healthcare Table 3 Descriptive statistics of the participants’ Response to facilities is not a common occurrence in Ghana, none- PSIs and other variables theless, approximately half (n = 823, 49.8%) of the par- Variable Mean SD ticipants reported never experiencing it in their units. Response to PSIs 3.40 0.742 About 384 (23.3%) and 407 (24.7%) of the participants Teamwork 4.18 0.566 Handoffs and information exchange Communication 3.88 0.671 reported wound infections and infusion /transfusion openness 3.84 0.667 reactions respectively in their units at least once every month. Patient and/or relative complaints were the com- monest PSIs as 33% (n = 545) of the participants reported 0.742) whereas teamwork, handoffs and information it occurrence every day. exchange, and communication openness among health- care professionals recorded scores of 4.18 (0.566), 3.88 Response to patient safety incidents, teamwork, handoffs (0.671) and 3.84 (0.667) respectively. information exchange and communication openness As detailed in Table  3, the mean score and standard deviation of participants’ responses to PSIs was 3.40 (SD: Poku et al. BMC Health Services Research (2023) 23:1072 Page 6 of 9 Influence of teamwork, communication openness safety practices as a key component [56, 57]. Vincent et and handoffs and information exchange on health al. [58] argue that to improve healthcare safety, compre- professional’s response to PSIs hensive and balanced frameworks should be utilized to Table  4 shows the linear regression analyses of the pre- measure, monitor, and improve care safety. This includes dictive effects of teamwork, handoffs and information fostering a safety culture about the most common types exchange and communications openness on the response of PSIs. It is, therefore, important to put in place accurate to PSIs by health professionals. The model was signifi- monitoring of PSIs in healthcare facilities, and retrospec- cant, predicting 28.3% of the response to PSIs among tive record reviews as evidence-based strategies to evalu- healthcare professionals (R2 = 0.283, F(3, 1648) = 180.264, ate PSIs occurrence to reduce patient harm. p < 0.05). When the various variables were examined for The finding of higher teamwork scores manifested in their contribution to the model, teamwork (β = 0.270, this current study is similar to other studies. This sug- p < 0.05), handoffs and information exchange (β = 0.180, gests that healthcare professionals work together con- p < 0.05), and communication openness (β = 0.310, sistently and are stable over time. With their significant p < 0.05) were significant predictors of the model. An role in healthcare delivery, teams with high levels of col- increase in teamwork (0.270 points) was noticed for a laboration and communication have better patient safety unit of increase in the mean score of response to PSIs scores and patient outcomes [59]. Further research may, by healthcare professionals. A unit increase in the mean however, be needed to determine if these scores reflect score of handoffs and information exchange was associ- actual teamwork behaviours and if they impact patient ated with an increased response to PSIs by healthcare outcomes. In healthcare, recent initiatives have been professionals by 0.180 points. Similarly, healthcare pro- adopted globally to train providers on critical skills, such fessionals who perceived an increased level of commu- as communication, and team collaboration [60]. nication openness were 0.310 points likely to respond to The findings of the study revealed handoffs and the PSIs. exchange of information to be satisfactory in health- care facilities. This is similar to the report in Jordan [61] Discussion and South Korea [62]. A human-centred approach that This study aimed to identify the occurrence of PSIs, the focuses on teamwork and communication can help to level of teamwork, handoffs and information exchange, improve the efficiency and effectiveness of the handoff and communication openness among health profession- process [63]. These can include strategies such as regular als, and to examine predictors of response to PSIs. The training and practice in effective handoff communication. daily frequencies of PSIs varied from 2.1% (pressure They can also include creating a culture of openness and ulcers) to 33.0% (patient/family complaints) in healthcare encouraging healthcare team members to speak up when facilities. This finding is similar to the results presented they have concerns. Implementing these tools and tech- by Schwendimann et al. [53]. Despite variations in fre- nologies can support effective handoff communication quencies between in-hospital PSIs, they certainly have [64]. harmful impacts on patient outcomes and therefore the Though the study reported satisfactory teamwork and need for effective strategies to curtail them. open communication which is supported by studies in The study asserted that the main types of PSIs reported Belgium [65], South Africa [66] and the USA [67], there were associated with medication errors, surgery, and was ironically a higher reported rate for some of the PSIs. healthcare-related infections. Studies have shown that This paradox of the “double-edged sword” of teamwork quality improvement interventions can lead to signifi- in healthcare possess a challenge to patient safety in PSIs cant patient safety progress [54], and evidence of effective reporting. This statement highlights the importance of strategies is widely available [55]. For instance, hospitals transparency and learning cultures in healthcare organi- can adopt individual or bundled interventions from other zations. This is where PSIs are seen as opportunities for sectors, such as aviation, to reduce PSIs, and use patient growth and improvement, rather than evidence of failure. Table 4  A linear regression model testing the relationship between Teamwork, Handoffs and information exchange, Communication openness and Response to PSIs B SE Beta t Sig. (Constant) − 0.181 0.158 -1.152 0.250 Teamwork 0.353 0.031 0.270 11.330 0.000 Handoffs and information exchange 0.198 0.026 0.180 7.603 0.000 Communication openness 0.348 0.027 0.310 13.005 0.000 R2 = 0.283, F(3, 1648) = 180.264, p < 0.05 a. Dependent Variable: Response to PSIs Poku et al. BMC Health Services Research (2023) 23:1072 Page 7 of 9 High-functioning teams are characterized by their abil- are essential steps to reducing such incidents. Investing ity to openly discuss and learn from errors, which leads in training, protocols, and systems that facilitate smooth to better patient outcomes. This concept is supported handoffs must be a priority for hospitals and healthcare by research that shows the positive impact of systematic organizations. They must also create an environment team training on patient safety, teamwork, and commu- where healthcare workers feel empowered to commu- nication. By fostering a blame-free environment, health- nicate openly about potential risks and concerns. It is care organizations can create a culture of continuous through addressing these root causes that we can create learning and improvement. a safer healthcare environment for patients and support Moreover, while open and positive communication healthcare providers’ well-being as well. It is also impor- styles are critical for building trust and cohesion among tant to recognize by creating a culture that encourages team members, they can also lead to complacency and a the response to errors and views them as opportunities false sense of security. This results in increased PSI rates. for learning and improvement, rather than as failures, It is also necessary, therefore, to highlight the importance healthcare professionals can better identify and address of balancing open communication with rigorous systems, potential problems, leading to better patient outcomes. processes, and a culture of safety. This encourages report- It is also recommended that training on non-technical ing and learning from PSIs [68–70]. Additionally, health- skills (such as ways to prevent adverse events) begin dur- care teams must have an open and honest approach ing regular education and in-service training as a require- to PSI management and continuous learning. This is to ment for the renewal of a licence to practice in healthcare ensure that PSIs are recognized, reported, and used as facilities. opportunities for improvement [71]. The study posited that PSIs occur in any healthcare set- AbbreviationsAHRQ Agency for Healthcare Research and Quality ting, and open communication, efficient hand-over and APES Adverse Patient Event Scale teamwork enhance PSI response. This position is sup- CHPS Community-based Health Planning and Services ported by Amaniyan et al. [15] and Baik et al. [34] who GHS Ghana Health ServiceHICs H igh-income countries indicated that effective response to PSIs in healthcare HSOPS Hospital Survey on Patient Safety Culture requires a team effort and efficient communication. It has ICU Intensive care unit been noted that a high level of awareness and an “index IOM Institute of MedicineLMICs Low-and Middle-Income Countries of suspicion” when interpreting patient data is crucial in PSIs Patient Safety Incidents recognizing potential PSIs. Coordination and collabora- SSA Sub-Saharan Africa tion among team members can help manage PSIs and Acknowledgements ensure timely and effective responses [72, 73]. The authors wish to sincerely thank the staff of all the facilities used for the study. Limitations Authors’ contributions The study used a cross-sectional approach, which means CAP, AAA, PYAA and EN conceptualized and designed the study method. EAA, it only looks at data from one point in time and can- PAA, PYAA and AAA carried out the data collection, analysis, and interpretation not establish causality. Again, the study relied on self- of data. CAP, AAA and PYAA originally drafted the manuscript. All authors read, revised, and approved the final manuscript for submission. reported data from health professionals, which may not be completely accurate. There was, however, consis- Funding tency in the distribution of data with existing literature. This study received no funding. Additionally, the study used participant-reported mea- Data Availability sures of teamwork, handoffs, and communication open- The datasets used and/or analyzed during the current study are available from ness, which may not be as reliable as other types of data. the corresponding author on reasonable request. Finally, PSI rates may be low at the unit level to detect differences, even though they can have significant conse- Declarations quences for individual patients. Ethics approval and consent to participate Letters of the request were sent to the various management units of the Conclusion hospitals to seek permission to use the facilities. Ethical approvals for the study were sought from two Institutional Review Boards; the Ghana Health Service The results of this study highlight the critical impor- Ethics Review Committee (GHS-ERC: 007/04/21) and the Ethics Committee tance of effective communication, teamwork, and seam- for the Humanities, University of Ghana (ECH 109/ 20–21). In addition, written less handoffs in the hospital setting. There is no doubt informed consent was sought from all participants before data were collected. The research was done in accordance with the Declaration of Helsinki. It was that deficiencies in these areas are responsible for a sig- also explained to participants that participation in this study was voluntary. nificant portion of patient safety incidents. It is evident Anonymity and confidentially were ensured by using not requesting the that enhancing collaborative teamwork among health- names of participants. care professionals and fostering a culture of openness Poku et al. 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