What are the main patient safety concerns of healthcare stakeholders: a mixed-method study of Web-based text

Abstract

Objectives: Various healthcare stakeholders define quality of care in different ways. Public policy could advocate all these concerns. This study was conducted to identify the main themes on patient safety of stakeholders expressed before and after the Patient Safety Act was enacted in Korea in 2015.

Design: Longitudinal observational study of the interests of healthcare stakeholders generated between January 2014 and September 2018.

Materials and methods: Text data were collected from 2,487 documents on 18 websites that were identified as representative healthcare stakeholder groups of consumers, providers, government, and researchers. A Korean natural language processing (NLP) package, manual review, and synonym dictionary were used for data preprocessing, and we adopted the unsupervised NLP method of probabilistic topic modeling and latent Dirichlet allocation. A linear trend analysis over time, a qualitative step involving two external experts, and original text reviews were performed to validate the identified topics.

Results: Forty-one topics were identified, and the most common concerns of stakeholders were institutional infection control as triggered by the Middle East respiratory syndrome outbreak in early 2015, and infusion-related infection from late 2017 until the middle of 2018. The other top-three concerns of the stakeholder groups were highly similar, while research topics were limited to the perceptions of providers and the activities and culture of hospitals. Five topics showed statistically significant increasing trends over time, while another five showed decreasing trends (both P < 0.05). In the qualitative step, we confirmed 35 themes and revised the other 6.

Conclusions: A common concern among stakeholders was hospital infection control, ranging from nosocomial infections to those brought in by family visiting patients. Government policies and systemic approaches to patient safety were highlighted by different stakeholders. Researchers were focused on hospital sociocultural factors at both the organizational and clinician levels. These identified concerns all should be advocated by the public health policy.

Keywords: Healthcare stakeholders; Natural language processing; Patient safety; Topic modeling; Web-based text.

Fig. 1

Numbers of documents and words used by healthcare stakeholder groups over time.

Fig. 2

Plots showing the trends of the five most- and least-popular topics from 2014 to 2018, defined as those topics that showed the strongest positive and negative trends. The most-probable words in those topics are shown below the plots. The orange color vertical bars indicate the time points when the Patient Safety Act was set out, when the act was enforced, and when the comprehensive strategic planning was released over 5 years. (A) The five hot topics: blue dashed line is ‘management of regular check-ups’ (topic 1: check-ups, management, ward, medical device, safety education, staff, medical imaging, status report); gray solid line is ‘newborn death at a neonatal ICU’ [topic 3: pediatrics, (bacterial) infection, death, ICU, infusion fluid, aseptic, injection, management, drug, mass media]; pink dashed line is ‘institutional infection control’ (topic 6: infection, management, case, prevention, explain, risk, comprehensive countermeasure, communication, behavior, report); pink dotted line is ‘infusion-related infection’ (topic 22: bacteria, injection, hepatitis, prevention, epidemiologic investigation, nutritional fluid, supervision, contamination, treatment, procedure); red dashed line is ‘patient safety precaution alert’ (topic 32: report, action, alert, errors, precaution, prevention, medication, evaluation case). (B) The five cold topics: Red solid line is ‘adverse drug reaction(s)’ (topic 5: symptom, drug, disease, medical diagnosis, admission, surgery, emergency, treatment, falls); blue dashed line is ‘government policy’ (topic 11: government, management, revision bill, development, law, violation, system, regulation, team, errors); pink dashed line is ‘nursing service’ (topic 24: work-in, communication, policy, medical law, duty, falls, prevention, mistakes); green dotted line is ‘illegal surgeries’ (topic 30: clinician, surgery, manager, plastic surgery, suspension of qualification, anesthesia, medical law, commit, explain, protest); pink dotted line is ‘fall risk assessment’ (topic 33: evaluation, falls, department safety, accident, prevention, mandatory prescription).