Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture

Joann S Sorra,Naomi Dyer

doi:10.1186/1472-6963-10-199

Abstract

BackgroundThe Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture was designed to assess staff views on patient safety culture in hospital settings. The purpose of this study was to examine the multilevel psychometric properties of the survey.MethodsSurvey data from 331 U.S. hospitals with 2,267 hospital units and 50,513 respondents were analyzed to examine the psychometric properties of the survey's items and composites. Item factor loadings, intraclass correlations (ICCs), design effects, internal consistency reliabilities, and multilevel confirmatory factor analyses (MCFA) were examined as well as intercorrelations among the survey's composites.ResultsPsychometric analyses confirmed the multilevel nature of the data at the individual, unit and hospital levels of analysis. Results provided overall evidence supporting the 12 dimensions and 42 items included in the AHRQ Hospital Survey on Patient Safety Culture as having acceptable psychometric properties at all levels of analysis, with a few exceptions. The Staffing composite fell slightly below cutoffs in a number of areas, but is conceptually important given its impact on patient safety. In addition, one hospital-level model fit indicator for the Supervisor/Manager Expectations & Actions Promoting Patient Safety composite was low (CFI = .82), but all other psychometrics for this scale were good. Average dimension intercorrelations were moderate at .42 at the individual level, .50 at the unit level, and .56 at the hospital level.ConclusionsPsychometric analyses conducted on a very large database of hospitals provided overall support for the patient safety culture dimensions and items included in the AHRQ Hospital Survey on Patient Safety Culture. The survey's items and dimensions overall are psychometrically sound at the individual, unit, and hospital levels of analysis and can be used by researchers and hospitals interested in assessing patient safety culture. Further research is needed to study the criterion-related validity of the survey by analysing the relationship between patient safety culture and patient outcomes and studying how to improve patient safety culture.

Highlights

The Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture was designed to assess staff views on patient safety culture in hospital settings
50,513 the groups), we examined design effects, which take into account within-group sample size (Design Effect = 1 + [Average within group sample size - 1] * intraclass correlations (ICCs))
This section describes the results of the psychometric analysis of the AHRQ Hospital Survey on Patient Safety

Summary

Introduction

The Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture was designed to assess staff views on patient safety culture in hospital settings. The concept of safety culture emerged from research focused on safety and accident prevention in high reliability, error-critical industries such as aviation, chemical and nuclear power plants, and manufacturing [1,2,3,4,5]. The actual implementation of these error management and reporting practices in healthcare organizations often runs into numerous barriers. Some of these barriers are fear of reprisals and lack of feedback after errors are reported [11], not fully distributing and working with error reports [12], and a perceived lack of resulting system changes [13]

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