Influências do clima de segurança do paciente sobre o desempenho individual no trabalho, em organizações hospitalares: uma análise utilizando o modelo de equações estruturais.

Abstract

Inserted in a sector with high intrinsic risk, the management of hospital organizations becomes increasingly complex and challenging. In this environment, unfortunately, unsafe practices are not infrequent, and lead to the occurrence of adverse events that affect different stakeholders and harm the business, causing individual and collective disruptions, economic or otherwise, that are significant for society. At the beginning of the 21st century, patient safety has gained global emphasis as a fundamental dimension of healthcare quality, and safety culture has been identified as a priority. For administration theory, organizational culture and climate stand out as phenomena of great interest and importance, which outline and guide the behavior of individuals in organizations. Culture and patient safety climate present themselves as a particular aspect of the cultural phenomenon in hospital organizations, being empirically recognized as indispensable elements for structuring services. From this perspective, greater involvement and commitment from health professionals is necessary, thus highlighting the importance of individual work performance at work (IWP). In the scientific sphere, studies on patient safety climate (PSC) are primarily dedicated to reviews on the topic and measurements of this construct, with gaps in the objective analysis of its potential impacts. Therefore, better understanding the relationships of influence between the PSC and the IWP emerges as a preponderant need for organizations in the health sector and a relevant topic for the scientific academic world. General objective: to understand the influences of PSC on IWP, in hospital organizations, in the city of Salvador-Ba, in 2023. Specific objectives: verify PSC as a second-order construct, based on its dimensions, and evaluate the influences of affective commitment at work (AFW), in mediating the relationships between PSC and IWP. Methodology: descriptive research, with a quantitative approach, which uses Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM) to investigate the relationships between the constructs of interest, in three analytical models dedicated to each dimension of the IWP. A questionnaire with individual components and the organizational system was used to measure the constructs under investigation, with participation being voluntary and freely consented. Results: with 1,163 observations, the CFA demonstrated consistency and reliability of the measured variables. CSP was confirmed as a second-order construct, considering its measured dimensions (p-value <0.001). The SEM demonstrated significant correlations between the constructs (p-value <0.001), with a positive direct effect of CSP on DIT in the task (β +0.620) and contextual (β +0.446) dimensions, and a negative direct effect on counterproductive behavior (β +0.456, in inverted analysis). A direct positive effect of CSP on CAT was found in the three models studied (β between +1.487 and +1.792, p-value <0.001). CAT mediation was favorable only in the task and contextual dimension models (p-value <0.001). In relation to counterproductive behavior, CAT influenced unfavorably, with a positive indirect effect, in an inverted analysis (β -0.120, p-value <0.05), despite the total effect of the model maintaining a negative effect (β +0.337, in inverted analysis, p-value <0.001), because of the direct inhibitory role of CSP. The total effects, in the models studied, were favorable to a greater DIT (p-value < 0.001). Conclusion: PSC was confirmed as an extremely important construct for the management of hospital organizations, capable of favorably influencing the Affective Commitment and Individual Work Performance of professionals, with positive effects on the task and context dimensions, and discouraging counterproductive behavior. The mediating effect of Affective Commitment was confirmed, being favorable only in the task and contextual dimensions.