Healthcare Workers’ Perspectives on Improving Patient Safety: A Thematic Analysis of Open-Ended Survey Responses from Public Hospitals in Tshwane District, South Africa
Abstract:
Resource constraints in the healthcare system environment present a serious encounter that impact negatively on patient safety. Although quantitative indicators provide measurable evidence of patient care outcomes, employees’ suggestions provide perspectives from the lived experiences. This study explored healthcare workers’ recommendations for strengthening the safety of patients within Tshwane District public hospitals. The methodology applied in the analysis of the open responses is qualitative and descriptive in nature. These responses are component of the answers of the questionnaire tool of the broader cross-sectional survey on service quality dimensions and safety in public hospitals within Tshwane district. The responses from 108 participants were examined through thematic analysis. The investigation encompassed coding, categorization including recuring themes identification. Eight themes emerged from the findings included the following constraints: staffing, infrastructure, accommodation space, equipment availability including supplies, governance including organizational weaknesses, professional skills proficiency, Hospital safety culture, Communication obstructions, patient overflow including high numbers, health information limitations. Personnel shortages, inadequate infrastructure, as well as insufficient resources were most frequently reported concerns. The findings indicate that safety challenges experienced in the public hospitals in Tshwane health district are fundamentally systemic in nature and require coordinated interventions focusing on workforce strengthening, improving infrastructure including positive safety culture enforcement.References:
[1]. World Health Organisation (WHO). Patient safety. 2023. Patient safety
[2]. RSA. National Guideline for Patient Safety Incident Reporting and
Learning in the Health Sector of South Africa. Version 2. 2022. https://knowledgehub.health.gov.za/system/files/elibdownloads/2022-03/National%20Guideline%20for%20Patient%20Safety%20Incident%20Reporting%20and%20Learning%20in%20South%20Africa%20Version%202_2022.pdf
[3]. Government Gazette 38486, R. G. Norms and Standards. Regulations in
terms of Section 90 (1)(b) and (c) of the National Health Act, 2003 (Act no. 61
of 2003), applicable to certain categories of health establishments. Pretoria,
RSA; 2015. www.gpwonline.co.za
[4]. Manzanera R, Moya D, Guilabert M, Plana M, Gálvez G,
Ortner J, et al. Quality Assurance and Patient Safety
Measures: A Comparative Longitudinal Analysis. Int J Environ Res Public Health.
2018;15(8):1568. https://doi.org/10.3390/ijerph15081568
[5]. Sharma B, Gadenne D. An investigation of the perceived importance and
effectiveness of quality management approaches. TQM Mag. 2001;13(6):411–20.
[6]. George AZ. Research frameworks: Critical components for reporting
qualitative health care research. J Patient Cent Res Rev. 2024;11(1):4–7.
[7]. World Health Organisation (WHO). Global Patient Safety Action Plan 2021-2030. WHO Press. Www.who.int. 2021. https://www.who.int/publications/i/item/9789240032705
[8]. Creswell JW, Creswell JD. Research design: Qualitative, quantitative,
and mixed methods approaches. 5th ed. Sage; 2018.
[9]. Braun V, Clarke V. What Can “Thematic Analysis” Offer Health and
Wellbeing researchers. Int J Qual Stud Health Well-being. 2014;9(1). https://doi.org/10.3402/qhw.v9.26152
[10]. Saunders CH, Sierpe A, Plessen CV, Kennedy AM, Leviton LC, Bernstein SL,
Goldwag J, King JR, Marx CM, Pogue JA, Saunders RK, Citters AV, Yen RW, Elwyn
G, Leyenaar JK. Practical thematic analysis: A guide for multidisciplinary
health services research teams engaging in qualitative analysis. BMJ.
2023;381(381):1–10. https://doi.org/10.1136/bmj-2022-074256
[11]. Roberts K, Dowell A, Nie J. Attempting Rigour and Replicability in
Thematic Analysis of Qualitative Research Data; a Case Study of Codebook
Development. Nih.gov. 2026.
pmc.ncbi.nlm.nih.gov/articles/PMC6437927/pdf/12874_2019_Article_707.pdf.
Accessed 1 May 2026.
[12]. World Health Organization (WHO). Patient safety: Global action on
patient safety. 2019.
[13]. Aiken LH, Sloane DM, Ball J, Bruyneel L, Rafferty AM, Griffiths P.
Patient satisfaction with hospital care and nurses in England: An observational
study. BMJ Open. 2018;8(1). https://doi.org/10.1136/bmjopen-2017-019189
[14]. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, Pate
M. High-quality health systems in the Sustainable Development Goals era. Lancet
Glob Health. 2018;6(11)–e1252.
[15]. Mayosi BM, Benatar SR. Health and health care in South Africa-20 years
after Mandela. N Engl J Med. 2014;371(14):1344–1353.
[16]. Tolobisa P, Naranjee N, Moonsamy S. Factors affecting reporting of
patient safety incidents in the Eastern Cape primary health care. Afr J Prim
Health Care Fam Med. 2026;18(1). https://doi.org/10.4102/phcfm.v18i1.4993
[17]. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Zurayk H. Health
professionals for a new century: Transforming education to strengthen health
systems. Lancet. 2010;376(9756):1923–1958.
[18]. Agency for Healthcare Research and Quality. Hospital survey on patient
safety culture user database report. AHRQ. 2019.
[19]. Sun BC, Hsia RY, Weiss RE, Zingmond D, Liang LJ, Han W, Asch SM. Effect
of emergency department crowding on outcomes of admitted patients. Ann Emerg
Med. 2013;61(6):605–611.
[20]. Bates DW, Singh H. Two decades since To Err Is Human: An assessment of
progress and emerging priorities in patient safety. Health Aff.
2018;37(11):1736–1743. https://doi.org/10.1377/hlthaff.2018.0738
[21]. Armstrong M, Taylor S. Armstrong’s handbook of human resource management
practice. 16th ed. Kogan Page Publishing; 2023. Kogan Page
Publishing
[22]. Buchan J, Catton H, Shaffer F. Sustain and retain in 2022 and beyond:
The global nursing workforce and the COVID-19 pandemic. International Council
of Nurses; 2022.
[23]. Institute of Medicine. Assessing progress on the Institute of Medicine
report: The future of nursing. National Academies Press; 2016. National Academies Press
[24]. Agency for Healthcare Research and Quality (AHRQ). Patient safety
culture surveys. AHRQ; 2023. AHRQ Official
Website
[25]. Boamah SA, Laschinger H, Wong C, Clarke S. Effect of transformational
leadership on job satisfaction and patient safety outcomes. Nurs Outlook.
2018;66(2):180–189.
[26]. Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLoS One. 2016;11(7).
[27]. Brook J, Aitken L, Webb R, MacLaren J, Salmon D. Characteristics of
successful interventions to reduce turnover and increase retention of early
career nurses: A systematic review. Int J Nurs Stud. 2019;91:47–59.
[28]. Sammer CE, Lykens K, Singh KP, Mains DA, Lackan NA. What is Patient Safety Culture? A Review of the Literature. J Nurs
Scholarsh. 2010;42(2):156–165. https://doi.org/10.1111/j.1547-5069.2009.01330.x
[29]. Wu AW. Medical error: the second victim. BMJ. 2000;320(7237):726–727. https://doi.org/10.1136/bmj.320.7237.726
[30]. World Health Organization & UNICEF. Global progress report on WASH
in health care facilities. 2021. WHO and UNICEF Report
[31]. Kruse CS, Kristof C, Jones B, Mitchell E, Martinez A. Barriers to
electronic health record adoption: A systematic literature review. J Med Syst.
2017;40(12):252.
[32]. Shields MA, Ward M. Improving nurse retention in the National Health
Service in England: The impact of job satisfaction on intentions to quit. J
Health Econ. 2001;20(5):677–701.
[33]. Leonard M, Graham S, Bonacum D. The human factor: The critical
importance of effective teamwork and communication in providing safe care. Qual
Saf Health Care. 2004;13(suppl 1)–i90.
[34]. Allegranzi B, Donaldson L, Kilpatrick C, Storr J, Kelly
E, Park BJ. Global infection prevention and control priorities
2022–2030. Lancet Glob Health. 2022;10(6)–e804.
[35]. Yadav P. Health product supply chains in developing countries: Diagnosis
of the root causes of underperformance and an agenda for reform. Health Syst
Reform. 2015;1(2):142–154.
[36]. Kohler JC, Bowra A, Smalley K. Strengthening pharmaceutical systems to
improve patient safety and access to medicines. Glob Health. 2020;16(1):1–9.
[37]. Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak
RN, Kroeker KI. An overview of clinical decision support systems:
Benefits, risks, and strategies for success. NPJ Digit Med. 2020;3(17):1–10.
[38]. Healthcare Information and Management Systems Society (HIMSS).
Interoperability in Healthcare. 2020.
[39]. Lincoln YS, Guba EG. Trustworthiness. Research theory, design, and
methods. Walden University; 2016. https://studyhall.waldenu.edu/dpsy2017/wp-content/uploads/sites/5/2017/04/Trustworthiness.pdf
[40]. Ul Z, Kakar H, Rasheed R, Rashid A, College Y, Akhter S. Criteria for Assessing and Ensuring the Trustworthiness in Criteria for Assessing and Ensuring the Trustworthiness in Qualitative Research Qualitative Research criteria for assessing and ensuring the trustworthiness in qualitative research. Int J Bus Reflections. 2023;4(2). https://doi.org/10.56249/ijbr.00.00.00
