Safety Climate in Healthcare: A Review of Measurement Instruments

Abstract

A deficient safety culture has been implicated in industrial accidents. More recently, patient safety problems in hospital care have revealed a weak safety culture as a causal factor. As in the other industrial sectors, the level of safety for hospital patients and staff is likely to be determined largely by the hospital's safety culture. Measuring safety culture is a risk management technique widely used in high-reliability industries to identify safety problems before they become realised as accidents and near misses. The most common approach to measuring safety culture is to conduct a safety climate survey of the workforce. A safety climate survey typically assesses the workforce's attitudes and perceptions about work pressure, communication, reporting and safety systems, and supervision and management commitment to safety. Thus, safety climate surveys provide a range of leading indicators about an organisation's underlying safety culture, which need to be understood when designing and implementing safety interventions such as critical incident reporting systems. This paper reviews the construct validity of 13 instruments that have been used to assess safety climate in healthcare. An explanatory model linking safety climate and safety behaviours is proposed in order to develop more valid measures of safety climate in healthcare.