Abstract
BackgroundThe perceived importance of safety culture in improving patient safety and its impact on patient outcomes has led to a growing interest in the assessment of safety climate in healthcare organizations; however, the rigour with which safety climate tools were developed and psychometrically tested was shown to be variable. This paper aims to identify and review questionnaire studies designed to measure safety climate in acute hospital settings, in order to assess the adequacy of reported psychometric properties of identified tools.MethodsA systematic review of published empirical literature was undertaken to examine sample characteristics and instrument details including safety climate dimensions, origin and theoretical basis, and extent of psychometric evaluation (content validity, criterion validity, construct validity and internal reliability).ResultsFive questionnaire tools, designed for general evaluation of safety climate in acute hospital settings, were included. Detailed inspection revealed ambiguity around concepts of safety culture and climate, safety climate dimensions and the methodological rigour associated with the design of these measures. Standard reporting of the psychometric properties of developed questionnaires was variable, although evidence of an improving trend in the quality of the reported psychometric properties of studies was noted. Evidence of the theoretical underpinnings of climate tools was limited, while a lack of clarity in the relationship between safety culture and patient outcome measures still exists.ConclusionsEvidence of the adequacy of the psychometric development of safety climate questionnaire tools is still limited. Research is necessary to resolve the controversies in the definitions and dimensions of safety culture and climate in healthcare and identify related inconsistencies. More importance should be given to the appropriate validation of safety climate questionnaires before extending their usage in healthcare contexts different from those in which they were originally developed. Mixed methods research to understand why psychometric assessment and measurement reporting practices can be inadequate and lacking in a theoretical basis is also necessary.
Highlights
The perceived importance of safety culture in improving patient safety and its impact on patient outcomes has led to a growing interest in the assessment of safety climate in healthcare organizations; the rigour with which safety climate tools were developed and psychometrically tested was shown to be variable
Institute of Medicine (IOM) highlighted the magnitude of preventable adverse events and identified the underlying “safety culture” as a key element influencing the ability of healthcare organizations to learn effectively from these events and implement preventative measures to reduce related harm to patients [1]
The perceived importance of safety culture in improving patient safety and its impact on patient outcomes has led to an increasing number of studies that attempt to define and assess safety culture in healthcare settings
Summary
The perceived importance of safety culture in improving patient safety and its impact on patient outcomes has led to a growing interest in the assessment of safety climate in healthcare organizations; the rigour with which safety climate tools were developed and psychometrically tested was shown to be variable. According to Zohar [4], safety culture can be described as one aspect of an organization’s overall culture reflecting individual performance and organizational features that influence health and safety. Safety climate is often used interchangeably with safety culture [7] and can be perceived as “the measureable components of safety culture” ([8], p.364). It provides a “snapshot” of the perceptions and attitudes of the organization’s workforce about the surface-level aspects of culture during a particular point in time ([9], p.5). On the other hand, was described as a transient mood state as changes in response to external events and pressures
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