Perioperative patient safety management activities: A modified theory of planned behavior

Nam Yi Kim; Sun Young Jeong

doi:10.1371/journal.pone.0252648

Peer Review History

Original SubmissionOctober 3, 2020
15 Feb 2021 Decision Letter - Camelia Delcea, Editor PONE-D-20-31121 Perioperative patient safety management activities: A modified theory of planned behavior PLOS ONE Dear Dr. Jeong, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The paper addresses an interesting topic. In the revised version of the paper please consider the reviewers' comments listed in the following. Additionally, please consider adding a similar analysis in which you are considering smaller groups created based on the general characteristics in Table 1 and discuss whether there are differences when certain groups are analyzed compared to the whole sample. Please submit your revised manuscript by Apr 01 2021 11:59PM. 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To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: No ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The research question is interesting and cogent, and the research is based on a sound literature ground concerning safety behaviors. I think the research is worth publishing, but I address some aspects that could be clarified by the authors. 1. Line 83: the authors make reference to the safety management system. It si not clearly explained how these aspects could hinder safety. The authors do not explicitly refer to organizational culture factors, like the kind of leadership, the blame culture, the safety climate (which are implicit in the safety management tool used in the research). 2. Line 125: The authors should explain why they chose the Job Content Questionnaire developed by Karasek et al. \\n and no other tools. What is the rationale of this choice? 3. Line 138: The 12-item scale is based on an unpublished study by Moon. The authors should provide evidence of the validity of the scale 4. Line 155. Also, the safety management activity instrument, developed by Jeong, is an unpublished research and the authors should provide evidence of its validity 5. Line 279: The issue of behavioral control is controversial. The internal locus of control is generally considered to be a better predictor of safe performance, but in extreme situations it could also represent an excessive trust in one’s own skills and a deliberate exposure to reckless actions. The authors could provide a deeper explanation of these results. Line 302: the authors mention among the limitations of the research the fact that it was based on self-report data. Self-report tools may be biased by social desirability, especially when they are related to errors, violations, and safety issues. The authors mention objective measurements such as observational surveys, however, I think it could have been useful to add other kind of objective data to the analysis, for instance concerning the rate of adverse events, injuries, near misses, etc. Reviewer #2: The current article attempts to tackle the important topic of OR safety from the view of OR RNs. The authors provided OR RNs with surveys and matched the results to the TPB model. However the authors' concluded cause and effect from the survey data, rather than acknowledging that survey correlations cannot imply causation and TPB model fit. The authors need re-structure their conclusions to reflect this, rather than assume the survey results fit the TPB model. Essentially, their conclusions outreach the survey data results. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Fabrizio Bracco Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: Reviewer Recommendation and Comments for Manuscript Number PONE.docx https://doi.org/10.1371/journal.pone.0252648.r001
Revision 1
9 May 2021 Author Response Response to Reviewer’s Comments Reviewer(s)' Comments to Author: Reviewer #1: The research question is interesting and cogent, and the research is based on a sound literature ground concerning safety behaviors. I think the research is worth publishing, but I address some aspects that could be clarified by the authors. 1. Line 83: the authors make reference to the safety management system. It si not clearly explained how these aspects could hinder safety. The authors do not explicitly refer to organizational culture factors, like the kind of leadership, the blame culture, the safety climate (which are implicit in the safety management tool used in the research). Reply: Thank you for your comments. Corrected the sentence. It has been described how the safety management system relates to safety management activities. � Line 90: The safety management system includes training and participation in safety policy, management supervision, communication, and feedback. Therefore, when the level of safety management system is insufficient, accurate information on safety is not delivered, and education and management are neglected, thus resulting in lower awareness and performance of patient safety management activities [15-17]. 2. Line 125: The authors should explain why they chose the Job Content Questionnaire developed by Karasek et al. and not other tools. What is the rationale of this choice? Reply: Thank you for your comments. Corrected the sentence. It was used in a study on the job factors of Korean nurses in previous studies, and the validity and reliability were verified and used in this study. In Song's study, the fitness index of the confirmatory factor analysis for job factors was χ2=88.949 (df=5, p<.001), TLI=.84, CFI=.92, RMSEA=.21, and SRMR=.05. � Line 131: The Job Content Questionnaire developed by Karasek et al. [20] is a commonly used instrument to assess organizational job factors, and its validity and reliability were verified in a previous study by Song [21], which examined job factors for Korean nurses. Therefore, in this study, the instrument modified by Song [21] for perioperative nurses was used. 3. Line 138: The 12-item scale is based on an unpublished study by Moon. The authors should provide evidence of the validity of the scale. Reply: Thank you for your comments. Corrected the sentence. In the paper published by Moon and Song, the validity of the tool was verified, so the references were revised. � Line 146: A 12-item scale was developed based on Ajzen's [23] study and a scale developed by Moon and Song [24] for hospital nurses. 4. Line 155. Also the safety management activity instrument, developed by Jeong, is an unpublished research and the authors should provide evidence of its validity Reply: Thank you for your comments. Corrected the sentence. The reference was changed to a published article. � Line 164: Safety management activities were measured using an instrument developed by Kim and Jeong [25] based on six international patient safety goals [26]. 5. Line 279: The issue of behavioral control is controversial. The internal locus of control is generally considered to be a better predictor of safe performance, but in extreme situations it could also represent an excessive trust in one’s own skills and a deliberate exposure to reckless actions. The authors could provide a deeper explanation of these results. Reply: Thank you for your comments. Additional discussion was written. � Line 294: Nurses expect to be able to control patient safety management activities, but they may not be able to do so if there are uncontrollable environmental factors such as a heavy workload and a lack of necessary supplies. Conversely, since they may not deliberately perform safety management activities as a result of excessive trust in their skills or reckless behavior, an analysis of the specific path between attitudes, subjective norms, and perceived behavior control needs to be researched. 6. Line 302: the authors mention among the limitations of the research the fact that it was based on self-report data. Self-report tools may be biased by social desirability, especially when they are related to errors, violations, and safety issues. The authors mention objective measurements such as observational surveys, however, I think it could have be useful to add other kind of objective data to the analysis, for instance concerning the rate of adverse events, injuries, near misses, etc. Reply: Thank you for your comments. Corrected the sentence. � Line 313: In addition, since the research was conducted using self-reported subjective data, casual effects between variables could not be confirmed. Therefore, further research using objective data on factors such as reporting of patient safety accidents (near miss, adverse events, sentinel events) is necessary. 7. The paper addresses an interesting topic. In the revised version of the paper please consider the reviewers' comments listed in the following. Additionally, please consider adding a similar analysis in which you are considering smaller groups created based on the general characteristics in Table 1 and discuss whether there are differences when certain groups are analyzed compared to the whole sample. Reply: Thank you for your comments. Further analysis and presented in the results and tables 1. � Line 198: There was a difference in the mean of patient safety management activities between the group with less than 5 years of career experience and the group with more than 5 years of career experience (F=5.98, p=.001). No other statistical significance of the small group mean according to general characteristics was confirmed (Table 1). Reviewer #2: 1. The current article attempts to tackle the important topic of OR safety from the view of OR RNs. The authors provided OR RNs with surveys and matched the results to the TPB model. However the authors' concluded cause and effect from the survey data, rather than acknowledging that survey correlations cannot imply causation and TPB model fit. The authors need re-structure their conclusions to reflect this, rather than assume the survey results fit the TPB model. Essentially, their conclusions outreach the survey data results. Reply: Thank you for your comments. The comment part was added as a limitation of the study, and the discussion and conclusion parts were entirely revised and described. � Line 276: Perceived behavioral control was the most influential factor on the behavioral intention for patient safety management activities in the operating room, followed by subjective norms and attitudes. These results were contrary to a study examining alcohol abstinence in patients with chronic liver disease [30] and one that examined hidden agendas in the use of mental health services for depression [31]. In these two studies, attitude appeared to have the greatest influence on behavior. In predicting behavioral intention, the influence of attitude, subjective norms, and perceived behavioral control could vary depending on the extent to which behavior and situations are controlled by an individual [32]. In previous studies, factors influencing behavioral intentions showed varying results depending on the characteristics and type of behavior [33]. Unlike individual behavior, perceived behavioral control and subjective norms could be key factors in behavioral intention related to social behavior; these factors are difficult to control through an individual’s will alone. � Line 289: Moreover, the results showed that perceived behavioral control did not directly relate to patient safety management. Thus, perceived behavioral control may not be directly related to behavior if one's perception is not consistent with actual behavioral control; hence, the relationship between behavioral control and behavior is indicated by dotted lines in the TPB [32]. A meta-analysis of the TPB also showed conflicting results for perceived behavioral control depending on the type of behavior involved [28]. Nurses expect to be able to control patient safety management activities, but they may not be able to do so if there are uncontrollable environmental factors such as a heavy workload and a lack of necessary supplies. Conversely, since they may not deliberately perform safety management activities as a result of excessive trust in their skills or reckless behavior, an analysis of the specific path between attitudes, subjective norms, and perceived behavior control needs to be researched. � Line 313: In addition, since the research was conducted using self-reported subjective data, casual effects between variables could not be confirmed. Therefore, further research using objective data on factors such as reporting of patient safety accidents (near miss, adverse events, sentinel events) is necessary. � Line 322: Crucial influencing factors on patient safety management activities in the OR were the safety management system, subjective norms, perceived behavior control, and behavior intention. Therefore, it is necessary to prepare hospital-level support and nursing policies to reinforce these factors. Organizations as well as individuals and medical staff should work together to strengthen OR patient safety management activities. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0252648.r002
20 May 2021 Decision Letter - Camelia Delcea, Editor Perioperative patient safety management activities: A modified theory of planned behavior PONE-D-20-31121R1 Dear Dr. Jeong, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Camelia Delcea Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: (No Response) ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: (No Response) ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Fabrizio Bracco https://doi.org/10.1371/journal.pone.0252648.r003
Formally Accepted
18 Jun 2021 Acceptance Letter - Camelia Delcea, Editor PONE-D-20-31121R1 Perioperative patient safety management activities: A modified theory of planned behavior Dear Dr. Jeong: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Camelia Delcea Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0252648.r004

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