Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Professor Marleen Temmerman

Second Supervisor/Advisor

Dr Ferdinand Okwaro

Third Supervisor/Advisor

Eunice Tole


Obstetrics and Gynaecology (East Africa)


Introduction: The maternal mortality ratio (MMR) has declined across the world over the last 17 years. This has been attributed to more women delivering in health facilities with trained birth attendants. Despite this there is still a high maternal mortality rate with over 86% of the mortalities occurring in Sub-Saharan Africa and South East Asia. This has led to increased focus on improving quality of care and patient safety in the health facilities. A positive safety culture, which is the product of individual and group values, attitudes, perceptions and patterns of behaviour that determine the commitment to an organization’s safety management, has been demonstrated to contribute towards reduced patient harm, morbidity and mortality in the process of receiving healthcare.

Objective: To describe perceptions and attitudes towards patient safety utilizing the safety attitudes questionnaire (SAQ) and examine factors affecting patient safety among midwives and physicians at the maternity department of a tertiary teaching hospital.

Methodology: A mixed method study design. A cross-sectional census survey was conducted on midwives and physicians working at the maternity department using a validated safety attitudes questionnaire (SAQ) administered via electronic mail and mobile messaging. This was followed by a qualitative study involving in-depth interviews with midwives and physicians to triangulate the findings and learn more about barriers and challenges to achieving patient safety. Descriptive statistics were used to evaluate the findings from the survey and a framework approach used to manage, describe and explore the responses in relation to the underlying patient safety conceptual framework was used. Themes were coded as they emerged.

Results: Of the 103 respondents sent the survey, 66(64%) completed the survey. Among the respondents, 51.6%(n=34) were physicians while 48.4%(n=32) were midwives. With most respondents having worked between 5-10years in the specialty. The overall patient safety score of staff was 76.4(15.53) with the highest scores noted in teamwork climate 81(19.1) and the lowest in working conditions 71.4(20.6). The SAQ questionnaire demonstrated high reliability with an overall Cronbach Alpha score of 0.904. From the interviews, most staff were found to have a healthy perception of what keeping patients safe entailed and had positive perceptions about the level of team work and support by management to keep patients safe. Among the areas noted that needed improvement were: 1) creating a just and blame free environment to enable staff to report, 2) use of systems thinking to learn better from adverse events 3) Encourage reporting and review of near misses and 4) improve working conditions for staff 5) train staff on assertive communication

Conclusions: The above study demonstrates a high patient safety culture in the maternity department. Staff had a positive attitude towards patient safety with a shared mental model on what keeping patient safe entailed as articulated by the international patient safety goals championed by the Joint Commission International. Areas of improvement noted included providing a just, blame free, environment for staff to report adverse events and near misses, development of a commitment to learning from both near misses and adverse events using a systems thinking as opposed to linear thinking and improving working conditions for all staff