Egypt Summer 2016

All the above photos belong to Sarah El-Gendi

Safety culture among Egyptian healthcare providers at a pediatric cancer center

Student: Sarah El-Gendi, School of Pharmacy

UMB Faculty Mentor: Agnes Ann Feemster, PharmD

Introduction: A limited amount of data exists from developing and underdeveloped nations related to patient safety. The Safety Attitudes Questionnaire (SAQ) is the most widely used, self- administered, validated questionnaire measuring patient safety. To date, one Egyptian hospital has published results from the SAQ administered to nurses. The study revealed that nurses were neutral regarding the safety of the work environment. Job satisfaction, team work climate, and stress recognition rated highest on the survey.  Perceptions of management and working conditions rated lowest. Baseline assessment of patient safety culture from other members of the healthcare team is lacking.

Research Questions: What are the healthcare professional’s perceptions of and attitudes towards patient safety? Will demographic characteristics influence responses to survey questions?

Study Design: Cross-sectional survey of healthcare professionals in an Egyptian pediatric cancer center

Methods: Providers will voluntarily participate in the SAQ questionnaire over a 14 day period. Data analysis will be completed using the Chi-square test or the Fisher’s exact test to detect potential differences between categorical variables for each demographic characteristic. ANOVA analysis will also be performed to detect differences in SAQ scores for each demographic variable in each domain.  Pearson’s correlation coefficient will be computed to detect correlations between the dimensions of safety domains. Safety scores will be compared with international benchmarks.

Results: The majority of participants were female (53%), pharmacists and nurses (64%), and caring for inpatients (56%) and had three years of experience or more (68%). The response rates for Children’s Cancer HospitalEgypt 57357 and 6th of OctoberHospital were 22/2% and 26.7%, respectively. Safety scores in five of the six domains were significantly higher among the Egyptian healthcare professionals was significantly lower than international benchmarking data. Significant positive correlations between each safety domain score were detected with the exception of stress recognition and teamwork and stress recognition and safety culture. Attending and staff physicians reported being more satisfied with their jobs than the culture. Attending and staff physicians reported being more satisfied with their jobs than the other study participants (p<0.05). A more positive perception of hospital management was reported by participants with less than six months in the specialty and a position type of other (p=0.033, 0.027, respectively). Participants working in a setting other than inpatient or outpatient reported a more favorable perception of unit management than the other study participants (p=0.046). Analysis of the collaboration and communication questionnaire items that were not assigned to one of the six domains revealed a difference in perception among caregiver type. Resident physicians scored collaboration with staff physicians higher than their nursing colleagues (p=0.033 and 0.001, respectively). Resident physicians also scored communication higher than the other positions did (p=0.001). Overall scores for collaboration and communication were higher among resident physicians (p=0.005).

Conclusion: To our knowledge, this study is the first in the Middle East to survey safety attitudes among multiple healthcare disciplines and hospitals using a validated survey tool. Egyptian healthcare providers reported an overall positive perception of the culture of safety. However, recognition of the negative implications of stress on patient safety among Egyptians was lower than the international benchmark. Further work is needed to understand the low mean scores in the stress recognition domain. Additionally, this area may represent an educational opportunity. Gender, years in the profession, and position type did not influence the respondent’s view of safety. Unfortunately, the survey response rate was low. Therefore, results may not be generalizable to all hospitals in Egypt. Additional studies are needed in other geographic regions and varied health- care setting in order to generalize the results to other hospitals in Egypt.

Reflection: "After a memorable experience at 57357 Children's Cancer Hospital in Cairo, Egypt this past summer, I was able to present my project findings at the American Clinical College of Pharmacy 2016 conference in Hollywood, Florida. By working with healthcare professionals in Egypt, I learned how to adapt to a completely different working environment and more importantly how to work with other cultures and backgrounds. This helped me become a more well-rounded and open-minded student pharmacist."


  1. Abou HA, Saber KM. A baseline assessment of patient safety culture among nurses at StudentUniversityHospital. World Journal of Medical Sciences. 2011; 6:1, 17-26.
  2. Sexton JB, Helmreich RL, Neilands TB, et al. The safety attitudes questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Services Research. 2006; 6:1, 44.

Sarah recently presented her research at the 2016 American College of Clinical Pharmacy's annual meeting. Read her poster presentation.