An Investigation into the Effect of Patient Safety Indicators on Patient Satisfaction: A Case Study of Shooshtar Maternity Hospital in Shiraz

Today, one of the main healthcare issues is maintaining the safety of patients in healthcare centers. Patient safety is a global health concern that affects patients in all countries, whether developed or developing countries. For this purpose, the present study investigates the effect of patient safety indicators on patient satisfaction at Shooshtar Maternity Hospital in Shiraz. Data obtained from monthly reports of the hospital during 2015-17 were used to study the research hypotheses. The hypotheses were analyzed using regression test and SPSS. Results showed that infection control parameters, anesthetic complications, blood transfusion complications, removal of surgical wound, post-surgery bleeding, accidental perforation, surgical wound infections, normal delivery with or without instrumentation and birthrate had a significant effect on patient satisfaction.


Introduction
Today, one of the main healthcare issues is maintaining the safety of patients in healthcare centers. Patient safety is a global health concern that affects patients in all countries, whether developed or developing countries. In fact, one of the priorities of the health system is to improve the quality of treatment, patient safety and other healthcare programs 1 . When we talk about patient safety, we're really talking about how hospitals and other health care organizations protect their patients from errors, injuries, accidents, and infections. While many hospitals are good at keeping their patients safe, some hospitals aren't. The International Agency for Patient Safety (2003) defined patient safety as a process by which the hospital provides more safe the patients. Therefore, patient safety includes: • Risk Assessment • Identification and management of patient-related risks • Reporting and analyzing the incidents The ability to learn and track incidents and implement solutions to minimize the error 2 .
Patient safety indicators are measures that directly or indirectly prevent adverse incidents and monitor the quality and outcomes. By monitoring these indicators, it would be possible to design a program to improve the safety and quality of services 3 . Patient safety practices have been defined as "those that reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions". This definition is concrete but quite incomplete, because so many practices have not been well studied with respect to their effectiveness in preventing or ameliorating harm. Healthcare is inevitably associated with an increased risk of patient safety and health threats. Patients need to be ensured that healthcare services will not endanger their health. These services should provide the best conditions and indicators, and the latest scientific and clinical evidence. Therefore, patient safety programs affect both physical and mental health of the patients and may either increase or decrease their satisfaction. Given the growing importance of customers in determining the quality of products and services offered in the market, many organizations have been paying increasing attention to customer satisfaction criteria. Organizations aim to provide better services for the patients. Organizations and hospitals *Author for correspondence Vol 19 (1&2) | January-June 2019 | http://www.informaticsjournals.com/index.php/JEOH/index Ayeh Negahbani, Shaghayegh Vahdat and Somayeh Hessam follow the same objectives and have taken some important measures in this regard. Accordingly, patient satisfaction is one of the important outcomes of healthcare quality. It is regarded as one of the most important indicators for the effectiveness of services provided in healthcare centers 4 . Given the patients' specific circumstances, it is inappropriate to call them customers when referring to a health facility or hospital. Patient satisfaction is to receive appropriate healthcare services in order to fulfill one's inner needs and desires 5 . In addition, satisfaction has a significant role in maintaining health and preventing diseases. Patient satisfaction has been a very important issue for researchers involved in health-care systems for the last few decades. This is because the patient is the most important person in the entire hospital setup. Thus, increasing satisfaction will improve the physical and mental health of the patient 6 . Accordingly, patient satisfaction is an important issue which improves the quality of health care in any country 7 .
In the present study, we have examined one of the important factors affecting patient satisfaction in order to determine to what extent patient safety can provide patient satisfaction.

Materials and Methods
This applied research used descriptive methods to collect the data. Given the relationship between the variables studied, this can be regarded as a correlational research. The data collection process was also based on library methods (papers, books and theses). In order to collect the data related to the research variables, information about satisfaction indicators and safety indicators of the patient in Shooshtar Maternity Hospital in Shiraz (2015-2017) was used. Descriptive and inferential methods were used to analyze the data. Descriptive methods provide a summary of measurements about the sample, while inferential methods allow us to judge the total population based on the results of the sample and come to a general conclusion. To investigate the relationship between the variables, regression test and SPSS were used.

Findings
According to the Table, bedsore index, falling from the bed, post-surgery complications index, mortality rate in postnatal hospital complications, venous thrombosis or post-surgery pulmonary embolism and MI mortality rate have no significant effect on patient satisfaction.
Infection control index, blood transfusion index, wound closure index, post-surgery complications index, mortality rate in hospital complications, MI mortality rate and birth index have a significant effect on patient satisfaction.

Discussion
Regarding the importance of patient safety and patient safety indicators in healthcare centers and hospitals, studies have shown that therapeutic measures are usually associated with dangerous situations. According to the World Health Organization (WHO), tens of millions of people die or become disabled annually due to clinical errors and unsafe healthcare processes. Clinical errors are one of the most important health In order to improve the patient safety based on the data analysis, the following recommendations can be considered: (A) It is necessary to take serious actions in order to encourage the nurses to perform their tasks efficiently, using in-service training. Nurses need to treat their colleagues with respect and help others. (B) In order to strengthen employee affairs, hospitals should have enough nurses who can perform efficiently under great pressure. To this end, managers should encourage the nurses to keep working. (C) To strengthen the processes, standardized procedures for patient care should be used. (D) In order to strengthen the education and skills, nurses should learn what they need in the hospital to care for patients through training so that they can improve their skills. More importantly, they have to get involved in the working processes in order to make appropriate decisions. (E) Nurses should not be afraid to report their mistakes and do not feel at risk when reporting. (F) The supervisors should examine all the factors to determine the root cause of the mistakes. One needs to avoid blaming and punishing nurses. (G) The supervisors should be mindful of patient safety issues, respect nurses' views on patient safety and use d encouraging methods as they do their job properly. (H) In order to enhance the overall patient safety perceptions, hospitals should provide an appropriate space and interior design and a safe environment for patients. (I) Managers should ask nurses to increase the patient safety culture in the hospital. In this regard, managers should consider nurses' suggestions for improving patient safety. They should also monitor the patient safety by continuously attending different departments of the hospital. (J) In order to enhance organizational learning, hospitals should continue to innovate in the workplace to improve patient safety and try to make changes easily to. In addition, the same mistakes should be avoided. (K) In order to enhance the patient delivery, let nurses know what they need before they first take care of patients. In addition, information should be provided to nurses when patients are transferred to hospitals. They will also be asked to make the right decision when a change is made in the patient safety program. (L) In order to improve the feedback, nurses should be advised to report timely when patients are injured. On the other hand, it is also necessary to talk about preventing what has happened over and over and how it protects patients from harm. (M) In order to improve the freedom of communication, nurses' feedback and suggestions should be evaluated. In this regard, nurses' opinions should be considered. In addition, they should talk freely about problems within the hospital. Patients should be encouraged to work in order to increase their job satisfaction. They have to feel that they are valuable not only for the units, but also the hospital they are working in. Not only do nurses themselves have to prioritize patients' safety, but also try to make their clinical teams and their work hospitals more aware of the patient safety. On the other hand, nurses should also have a positive view of the management's concern about budget constraints. In addition, they should be serious about expressing concerns about patient safety issues. Finally, nurses should believe that managers are sensitive to the reports.
The results show that there is a significant relationship between patients' job satisfaction and the patient safety indicators. Moreover, there is a direct relationship between patients' job satisfaction and patient safety. In other words, the greater the patients' job satisfaction, the better the patient safety culture. As a result, the patient safety culture increases to a great extent.