Abstract
ABSTRACTOBJECTIVE This study aims to assess the development and the validity analysis of the Assessment of Risk Management in Health Care Questionnaire (AGRASS).METHODS This is a validation study of a measurement instrument following the stages: 1) Development of conceptual model and items; 2) Formal multidisciplinary assessment; 3) Nominal group for validity analysis with national specialists; 4) Development of software and national pilot study in 62 Brazilian hospitals 5) Delphi for validity analysis with the users of the questionnaire. In stages 3 and 5, the items were judged based on face validity, content validity, and utility and viability, by a 1-7 Likert scale (cut-off point: median < 6). Accuracy and reliability of the questionnaire were analyzed with the Confirmatory Factor Analysis and the Cronbach’s alpha.RESULTS The initial version of the instrument (98 items) was adapted during stages 1 to 3 for the final version with 40 items, which were considered relevant, of adequate content, useful, and viable. The instrument has 2 dimensions and 9 subdimensions, and the items have closed-ended questions (yes or no). The software for the automatic collection and analysis generates indicators, tables, and automatic graphs for the assessed institution and aggregated data. The adjustment indices confirmed a bi-dimensional model composed of structure and process (X2/gl = 1.070, RMSEA ≤ 0.05 = 0.847, TLI = 0.972), with high reliability for the AGRASS Questionnaire (α = 0.94) and process dimension (α = 0.93), and adequate for the structural dimension (α = 0.70).CONCLUSIONS The AGRASS Questionnaire is a potentially useful instrument for the surveillance and monitoring of the risk management and patient safety in health services.
Highlights
The quality of health care is on the global health agenda, and patient safety is one of its critical components[1]
In order to improve the quality of health care by increasing the patient safety, health care systems are suggested to implement risk management practices[2,3,4] and quality management/improvement methods applied to the health care safety[5,6,7]
In the Brazilian health policy context, risk management in health facilities is the first objective of the Programa Nacional de Segurança do Paciente (PNSP – National Patient Safety Program)[4]
Summary
The quality of health care is on the global health agenda, and patient safety is one of its critical components[1]. In order to improve the quality of health care by increasing the patient safety, health care systems are suggested to implement risk management practices[2,3,4] and quality management/improvement methods applied to the health care safety[5,6,7]. The risk management in health care is highlighted as one of the seven stages towards patient safety in the National Patient Safety Agency in the UK2. In the Brazilian health policy context, risk management in health facilities is the first objective of the Programa Nacional de Segurança do Paciente (PNSP – National Patient Safety Program)[4]. In Brazil, the quality management focused on risk reduction is present in the regulation of health care[7,11]
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