Abstract

BackgroundPatient safety culture is how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. The Safety Attitudes Questionnaire is the most widely used instrument to measure safety attitudes among health care providers. The instrument may identify possible weaknesses in clinical settings, and motivate and guide quality improvement interventions and reductions in medical errors. The Safety Attitudes Questionnaire – Ambulatory Version was developed for measuring safety culture in the primary care setting. The original version includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions and Stress recognition. We describe the results of a validation study using the Norwegian translation of the questionnaire in the primary care setting, and present the psychometric properties of this version.MethodsThe study was done in seven Out-of-hours casualty clinics and 17 regular GP practices employing a total of 510 primary health care providers (194 nurses and 316 medical doctors). In October and November 2012, the translated Safety Attitudes Questionnaire – Ambulatory Version was distributed by e-mail. Data were collected electronically using the program QuestBack, whereby the participants responded anonymously. SPSS was used to estimate the Cronbach’s alphas, item-to-own-factor correlations, intercorrelations of factors and item-descriptive statistics. The confirmatory factor analysis was done by AMOS.ResultsOf the 510 invited health care providers, 266 (52%) answered the questionnaire - 72% of the registered nurses (n = 139) and 39% of the medical doctors (n = 124). In the confirmatory factor analysis, the following five factor model was shown to have acceptable goodness-of-fit values in the Norwegian primary care setting: Teamwork climate, Safety climate, Job satisfaction, Working conditions and Perceptions of management.ConclusionsThe results of our study indicate that the Norwegian translated version of the Safety Attitudes Questionnaire – Ambulatory Version, with the five confirmed factors, might be a useful tool for measuring several aspects of patient safety culture in the primary care setting. Further research should investigate whether there is an association between patient safety culture in primary care, as measured by the Safety Attitudes Questionnaire – Ambulatory Version, and occurrence of medical errors and negative patient outcome.

Highlights

  • Patient safety culture is how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare

  • We describe the results of a validation study using the Norwegian translation of the Safety Attitudes Questionnaire (SAQ)-AV in the primary care setting, both in out-of-hours (OOH) casualty clinics and regular General Practitioner (GP) practices

  • One item (Q18) had been moved from the factor Perceptions of management to the factor Working conditions, in the validation of the Norwegian SAQ Short form 2006 [17]. We replicated this since we in the present study found that the item (Q18) fitted the Working condition factor better, indicating that respondents in primary care perceive that adequate staffing has less to do with leadership, it is strongly related to working conditions

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Summary

Introduction

Patient safety culture is how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. The Safety Attitudes Questionnaire is the most widely used instrument to measure safety attitudes among health care providers. The Safety Attitudes Questionnaire – Ambulatory Version was developed for measuring safety culture in the primary care setting. We describe the results of a validation study using the Norwegian translation of the questionnaire in the primary care setting, and present the psychometric properties of this version. There has been an increasing focus on medical errors and patient safety. Adverse events are common in primary care, where the largest volume of health care is delivered. For these reasons, there has been an increasing interest in factors related to patient safety outside the hospital setting. The concept is developed within the framework and research of organizational psychology, and is regarded as a group phenomenon rather than that of an individual

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