Health workers' perception on the safety and security policy of a tertiary hospital in Nigeria

[1]Etiobong A. Etukumana, [2]Jacob B. Orie

[1]Department of Family Medicine, Faculty of Clinical Sciences, University of Uyo, Akwa Ibom, Nigeria
[2]CEMPA/CEMBA Programme  School of Management Sciences, National Open University of Nigeria,
Lagos, Nigeria

ABSTRACT
Background: Health workers remain the panacea for hospital's performance in terms of service delivery and client satisfaction. However, the workers require quality environment for quality care to ensure client satisfaction .Thus, this study aims at determining the health workers' perception on the safety and security policy of University of Uyo Teaching Hospital, Uyo, Nigeria.
Method: A cross-sectional descriptive study was carried out. Using structured questionnaire and convenient sampling technique, data were collected from 250 hospital workers. Data entry and analysis were performed using Epi Info 3.2.2 (CDC, Atlanta, Georgia, USA)
Result: The minimum and maximum ages of the respondents were 21years and 60 years respectively. The mean, median and mode ages in the respondents were 34.6(±7.88) years, 33years, and 30 years respectively. Age group of 31-40 years had the highest frequency (30%). Majority of the study respondents were female (56.8%) while majority of the respondent (56%) had first degree as their educational level. Doctors (36%) formed majority of the respondents whereas Pharmacists (3.6%) accounted for the least. The respondents' perception on the policy that guarantees their safety and security at work was 37.2% (OR 0.35, 95%CI 0.24-0.51, P<0. 0001). Only 46% of the subjects accepted that the hospital has health, safety and security policy (OR 0.73, 95%CI 0.5-1.05 P=0.074). Thirty-six percentages (36%) accepted that the policy covers hazard related to their work (OR 0.32, 95%CI 0.22-0.46, P<0.0001). Majority of the Nurses, Pharmacists and non-clinical staff accepted that the hospital had health, safety and security policy. Only majority of the non-clinical staff accepted that the policy assured them of safety and security at work and also covered hazard related to their job.
Conclusion
The perception of health workers on the safety and security policy of the tertiary hospital was poor. Thus, there is need for a close look on the safety and security policy of the tertiary hospitals in Nigeria.

Key words: hospital, perception, safety, security, policy, health workers

INTRODUCTION
Health organization needs money, materials, supplies, equipment and workers to function effectively. However, since people dominate the central features of organizational life, effective management of workers remains the panaceas for the organizational performance.[1] Therefore, human resources unit of health organizations are expected to evolve polices and strategies to effectively manage the workers to allow for efficient running of the organization.[2] One of such polices is safety and security policy. It is interesting to note that in most hospitals in the world, the central focus is patients' satisfaction and service delivery.[3] In fact, client satisfaction has gained recognition as an outcome of quality care.
However, there must be quality workplaces for quality care to ensure client satisfaction; thus, the establishment of positive practice environments has been advocated.[4] Positive practice environments are settings that support excellence and decent work. Positive practice environments strive to ensure the health, safety, security and personal well being of staff as well as support quality care and improve the motivation, productivity and performance of individuals and organization.[5] Positive changes in the environment of health organization result in a higher employee retention rate, which leads to better team work, increased continuity of patient care and ultimately improvement in patient outcomes.[6] World Health Organization (WHO) has identified an “enabling work environment” as one of the four components in strengthening management and leadership of health care services.[7] One of the important elements of positive practice environment is the issue pertaining to personal security and safety. The responsibility for security and safety in an organization rests on its management who usually formulates written policy on such issues.[8] Thus, this study aims at determining the heath workers' perception on the safety and security policy of University of Uyo Teaching hospital, Uyo, Nigeria.

METHODS
This study was carried out on the hospital workers of the University of Uyo Teaching Hospital over 3 months in 2012. The hospital is owned by the Federal Government of Nigeria and supervised by the Federal Ministry of Health, Abuja, Nigeria. The hospital had 1,114 employees that render various services to the hospital and its clients according to 2011 annual report of the hospital.[9] Using convenient sampling technique, structured questionnaire on the objective of the study was used for data collection from the 250 hospital workers. The questionnaire was used to elicit age, sex, profession, level of education and whether the hospital has effective safety and security policy.  The responses on questions to elicit the hospital's policy on safety and security were rated on a five-point Likert Scale as follows; Strongly Agree (SA), Agree(A), Neutral(N), Disagree(D) and Strongly Disagree(SD). Written informed consent was obtained from each worker while study was approved by the Research and Ethical Committee of the University of Uyo Teaching Hospital.  Data entry and analysis were done using Epi Info 3.2.2 (CDC, Atlanta, Georgia, USA). The frequencies of category variables, means of continuous variables and Odd ratio were determined. All P-values less than 0.05 were considered as significant.

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demographic characteristics of the respondents were as shown in table 1. The minimum and maximum ages of the respondents were 21years and 60 years respectively. The mean, median and mode ages in the respondents were 34.6(±7.88) years, 33years, and 30 years respectively. Age group of 31-40 years had the highest frequency (30%). Majority of the study respondents were female (56.8%) while majority of the respondent (56%) had first degree as their educational level. Doctors (36%) formed majority of the respondents whereas Pharmacists (3.6%) accounted for the least.
The respondents' perception on safety and security was as shown in table 2.  The respondents' perception on the policy that guarantees them of safety and security at work was 37.2% (OR 0.35, 95%CI 0.24-0.51, P<0. 0001). Only 46% of the subjects accepted that the hospital has health, safety and security policy (OR 0.73, 95%CI 0.5-1.05, P=0.074). Thirty-six percentages (36%) accepted that the policy covers hazard related to their work (OR 0.32, 95%CI 0.22-0.46), P<0.0001).
The respondents' perception on safety and security by profession was as shown in table 3. Majority of the Nurses, Pharmacists and non-clinical staff accepted that the hospital had health, safety and security policy. Only majority of the non-clinical staff accepted that the policy assured them of safety and security at work and also covered hazard related to their job.

DISCUSSION
Health workers' perception on the policy that guarantees safety and security at work in this study was 37.2%. Interestingly, the health workers' perception on whether the hospital has policies on safety, security and health hazards related to their job was 46%. These unsatisfactory perceptions cut across the various professionals in the hospital except among non-clinical staff. These findings are worrisome since the safety and security of health workers are required to ensure efficient rendering of hospital services.4-6 Health organizations are encouraged to evolve polices and adopt measures to ensure safety and security of their workers in line with World Health Organization requirement for positive practice environment.7,10 These policies and measures should be communicated to the health workers and its compliance ensured by the hospital's management. The health workers are expected to familiarize themselves with their workplace polices on safety and security so as to encourage a place of employment that is free from recognized hazards' and threats.
A combination of workplace insecurity/hazards and the current security threats in Nigeria can lead to the migration of health workers especially the professionals to foreign countries.11 This migration would worsen the inadequate health workforce in the labour market in the country. Therefore, Nigerian Government should direct tertiary hospital to have policies on safety and security as it affects staff and the hospital. Such policies should ensure the provisions of maximum security of life and properties of health workers.
This study was carried out in one of the centers of the tertiary hospital service in Nigeria and may not reflect a true representation of the entire health workers in tertiary hospitals in Nigeria. Convenient sampling technique was used and the responses of the subjects to the items in the questionnaire are subjective since it was self-reporting. These were the limitations of this study. However, there is need for similar studies in other centers in Nigeria.

CONCLUSION
The perception of health workers involved in this study on   the safety and security policy of University of Uyo Teaching Hospital was poor. It seems the health workers were not satisfied with the policy that guarantees their safety and security at work. Thus, there is need for a review of the safety and security policy of the tertiary hospitals in Nigeria so as to improve the safety and security of health workers. By so doing, the quality of care for patients, improve productivity and higher employee retention rate will be achieved.

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