Death by a thousand cuts

Abstract

<h3>Objectives</h3> Measure patient safety culture in homecare services; test the psychometric properties of the Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument; and propose a short-version Homecare Services Survey on Patient Safety Culture instrument for use in homecare services. <h3>Design</h3> Cross-sectional survey with psychometric testing. <h3>Setting</h3> Twenty-seven publicly funded homecare units in eight municipalities (six counties) in Norway. <h3>Participants</h3> Five-hundred and forty health personnel working in homecare services. <h3>Interventions</h3> Not applicable. <h3>Primary and secondary outcome measures</h3> Primary: Patient safety culture assessed using the NHSOPSC instrument. Secondary: Overall perception of service users’ safety, service safety and overall care. <h3>Methods</h3> Psychometric testing of the NHSOPSC instrument using factor analysis and optimal test assembly with generalised partial credit model to develop a short-version instrument proposal. <h3>Results</h3> Most healthcare personnel rated patient safety culture in homecare services positively. A 19-item short-version instrument for assessing patient safety culture had high internal consistency, and was considered to have sufficient concurrent and convergent validity. It explained a greater proportion of variance (59%) than the full version (50%). Short-version factors included safety improvement actions, teamwork, information flow and management support. <h3>Conclusion</h3> This study provides a first proposal for a short-version Homecare Services Survey on Patient Safety Culture instrument to assess patient safety culture within homecare services. It needs further improvement, but provides a starting point for developing an improved valid and reliable short-version instrument as part of assessment of patient safety and quality improvement processes.