Measuring Patient Safety Culture Research Articles

Psychometric Evaluation of the Korean Version of Hospital Survey on Patient Safety Culture.

This study evaluated the psychometric properties of the Korean-language version of the Hospital Survey on Patient Safety Culture (HSOPSC) among Korean nurses. We analyzed secondary data from 801 direct care nurses working at a tertiary, private, nonprofit, teaching hospital in South Korea. Descriptive statistics, internal consistency coefficients, and intercorrelations were calculated. The latent factor structure of the HSOPSC was examined using exploratory structural equation modeling techniques, which account for the noncontinuous nature of ordinal data. Although a majority of subscales showed acceptable to good internal consistency, 4 dimensions (staffing, overall perceptions of patient safety, organizational learning-continuous improvement, and nonpunitive response to errors) had reliability levels less than 0.6. The HSOPSC items loaded somewhat diffusely on 3 subscales: staffing, teamwork across units, and organizational learning-continuous improvement. Correlations between the 12 HSOPSC factors indicated discriminant validity. Convergent validity was supported by correlations between the 12 subscales and a single-item outcome variable, namely, patient safety grade. Several items did not load well on their respective subscales, but most items fit the underlying theoretical model implied by the HSOPSC, resulting in an acceptable model fit (confirmatory fit index = 0.985, root mean square error of approximation = 0.034, weighted root mean square residual = 0.54). Despite the acceptable model fit of the Korean version of HSOPSC, the psychometric properties of this instrument require further investigation to ensure it is an effective tool to measure patient safety culture and identify areas for improvement in the Korean health care system.

Measuring patient safety culture: A study at a teaching hospital in Ghana

Objective This study examined the current patient safety culture from the perspective of healthcare workers in a teaching hospital in Ghana and drew comparison with the Agency for Healthcare Research and Quality 2018 Patient Safety Culture Comparative Database Report. Methods A cross-sectional survey was conducted using the Hospital Survey on Patient Safety Culture developed by the Agency for Healthcare Research and Quality. A total of 435 questionnaires were distributed and 322 valid responses were received (a response rate of 74%). The study sample included 178 nurses, 59 doctors, 19 pharmacists, 35 technicians ((laboratory and radiology), and 31 management staff. The Hospital Survey Excel Tool 1.6 and the Statistical Package for the Social Sciences (SPSS) version 20 were used to analyze the data. Results The overall average score for the 12 dimensions of patient safety culture was 53% which is 12% lower than the Agency for Healthcare Research and Quality 2018 benchmark report of 65%. The dimension with the highest positive mean score was “Teamwork within Hospital Units” (77%) while the one with the lowest score was “Frequency of Event Reporting” (33%). All 12 domains except for Frequency of Event Reporting ( p = 0.414), Management Support for Patient Safety ( p = 0.823), and Teamwork within Units ( p = 0.070) have significant relationship with patient safety culture. Conclusions Generally, the patient safety culture dimension in the teaching hospital was low. Training of healthcare workers on patient safety and a broad based research including all categories of healthcare staff is highly needed in other to fully understand and change the patient safety culture in Ghanaian Hospitals.

Relationship of patient safety culture with factors influencing working environment such as working hours, the number of night shifts, and the number of days off among healthcare workers in Japan: a cross-sectional study

BackgroundPatient safety culture is defined as a product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management. Factors influencing healthcare workers’ working environment such as working hours, the number of night shifts, and the number of days off may be associated with patient safety culture, and the association pattern may differ by profession. This study aimed to examine the relationship between patient safety culture and working environment.MethodsQuestionnaire surveys were conducted in 2015 and 2016. The first survey was conducted in hospitals in Japan to investigate their patient safety management system and activities and intention to participate in the second survey. The second survey was conducted in 40 hospitals; 100 healthcare workers from each hospital answered a questionnaire that was the Japanese version of the Hospital Survey on Patient Safety Culture for measuring patient safety culture. The relationship of patient safety culture with working hours in a week, the number of night shifts in a month, and the number of days off in a month was analyzed.ResultsResponse rates for the first and second surveys were 22.4% (731/3270) and 94.2% (3768/4000), respectively. Long working hours, numerous night shifts, and few days off were associated with low patient safety culture. Despite adjusting the working hours, the number of event reports increased with an increase in the number of night shifts. Physicians worked longer and had fewer days off than nurses. However, physicians had fewer composites of patient safety culture score related to working hours, the number of night shifts, and the number of days off than nurses.ConclusionsThis study suggested a possibility of improving the patient safety culture by managing the working environment of healthcare workers. High number of night shifts may lead to high number of event reports. Working hours, the number of night shifts, and the number of days off may differently influence patient safety culture in physicians and nurses.

The Perception of Patient Safety Culture among Physicians at an Academic Tunisian Hospital

Patient safety has become a priority issue in health policy and healthcare management around the world. Assessing physician’s attitudes about issues relevant to patient safety is the first stage of developing a safety culture. This study aimed to measure patient safety culture among physicians in Abderrahman Mami hospital, Ariana, Tunisia.

Patient safety culture in Oman: A national study.

A positive patient safety culture in maternity units is linked to higher quality of care and better outcomes for mothers. However, safety culture varies across maternity units. Analyses of variation in safety culture using statistical process control (SPC) methods may help provider units to learn from each other's performance. This study aims to measure patient safety culture across maternity units in Oman using SPC methods. The 36-item Safety Attitude Questionnaire (SAQ) was distributed to all doctors, nurses, and midwifes working in ten maternity care units in Oman's hospitals and analysed using SPC methods. The SAQ considers six domains: job satisfaction, perception of management, safety climate, stress recognition, teamwork, and work condition. Of the 892 targeted participants, 735 (82%) questionnaires were returned. The overall percentage of positive safety responses in all hospitals ranged from 53% to 66%, but no hospital had the targeted response of above 75%. Job satisfaction had the highest safety score (4.10) while stress recognition was the lowest (3.17). SPC charts showed that the overall percentage of positive responses in three maternity units (H1, H7, and H10) was above and one (H4) was below the control limits that represent special cause variation that merits further investigation. Generally, the safety culture in maternity units in Oman is below target and suggests that considerable work is required to enhance safety culture. Several maternity units showed evidence of high/low special cause variation that may offer a useful starting point for understanding and enhancing safety culture.

Refining the medical student safety attitudes and professionalism survey (MSSAPS): adaptation and assessment of patient safety perception of French medical residents

BackgroundImplementing a patient safety curriculum for medical students requires to identify their needs and current awareness of the topic. Several tools have been developed to measure patient safety culture, but none of them have been developed in the French context.Our objective was to adapt and refine the psychometric properties of the MSSAPS, developed by Liao et al, to use it among general practice (GP) residents.Methods1-We conducted a translation and transcultural adaptation of the MSSAPS questionnaire (28 items, 5 dimensions: safety culture, teamwork culture, experiences with professionalism, error disclosure culture and comfort expressing professional concerns) in accordance with the international recommendations.2-We studied the new questionnaire’ psychometric properties on a sample of GP residency students in 2016. This validation comprised 2 steps: a confirmatory factor analysis (CFA) for each dimension of the MSAPPS to explore the adequacy of the structure of the questionnaire; an exploratory factor analysis to refine the instrument, using a principal component analysis and Cronbach’s α-coefficients calculation. A final CFA examined the structure validity of the refined questionnaire.3-We described the items and the safety cultural scores in our sample of residents.ResultsAmong 391 eligible students, 213 responded (54%).The initial structure was not confirmed by CFAs, showing a poor fit for 3 of the 5 dimensions: safety culture, teamwork culture and professionalism. Exploratory PCA led to 3 dimensions: Safety culture (PVE: 18.5% and 7 of 8 initial items), Experiences with professionalism (PVE: 17.8% and 5 of 7 initial items) and Error disclosure culture (PVE: 13.6% and 3 of 4 original items). Cronbach’s α-coefficients were 0.74, 0.78 and 0.76 respectively. The final CFA confirmed the existence of the 3 latent dimensions with a good fit to the and highly significant structural coefficients (P < 0.001). Mean scores were equal to 65.4 [63.6; 67.6] for the safety culture, 66.9 [63.8; 70.1] for the experience with professionalism, and 54.4 [51.6; 57.2] for the error disclosure culture.ConclusionThis study reports satisfactory psychometrics properties of the French version of the MSAPPS and provides evidence of important training needs for GP residents in the field of patient safety culture.

Staff perceptions of patient safety culture in general surgery departments in Turkey.

The first step towards establishing and improving patient safety culture in hospitals is measuring patient safety culture perceptions of staff. Few studies have examined the perception of patient safety culture in general surgery departments. The objective of this study was to evaluate patient safety culture and patient safety grade in general surgery departments and to examine the relation between the patient safety culture and the patient safety grade. This study examined patient safety culture and patient safety grades of 124 staff in seven surgery departments of a hospital in Turkey. The staff completed the hospital survey on patient safety culture and answered questions about their professional characteristics. One-way ANOVA, Independent-samples t test, corrected chi-square test, multiple correspondence analysis and Eta co-efficient were used in statistical analyses. The patient safety dimension of "teamwork within units" had the highest mean and percentage of positive responses. The "frequency of events reported" and "non-punitive response to errors" had the lowest means and percentages of positive responses. Participants with resident or nurse positions, < age 31 years, with < 6 years of professional experience, and 60 or more work hours/week, had significantly more negative perceptions of patient safety culture than other participants. Patient safety grades and the dimensions of "management support for patient safety" and "overall perceptions of patient safety" had significantly high Eta coefficients. Frequency of events reported and non-punitive responses to errors should be improved, and participants' characteristics should be considered at improvement efforts in general surgery departments. The dimesions with low means suggest opportunities for improvement.

Improving Hospital Safety Culture for Falls Prevention Through Interdisciplinary Health Education.

Falls are a serious public health problem, with an estimated 37.3 million falls a year requiring medical assistance. Improving hospital culture to address safety and falls prevention is a major organizational challenge that requires interdisciplinary teams and evidence-based education to change individual behaviors and improve outcomes. We collaborated with an interdisciplinary team of health practitioners at a critical access hospital to develop a health education program tailored to their internal assessment of falls and safety issues. The resulting program used the Five As behavior change model and evidence-based health education. Education session activities and posttests were used to measure participant outcomes, and the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture was distributed hospital-wide to measure patient safety culture pre- and postintervention. Participants reported increased knowledge, attitudes, and motivations with attendance at education sessions. The AHRQ Hospital Survey showed positive improvements in 10 of the 11 composite categories, 4 of which were statistically significant. The use of the Five As, along with an interdisciplinary health education approach, can improve individual hospital employee falls prevention knowledge, attitudes, and motivations. That individual-level change can improve patient safety culture at the organizational level.

Influence of Gender, Profession, and Managerial Function on Clinicians' Perceptions of Patient Safety Culture: A Cross-National Cross-Sectional Study.

ObjectivesIn recent years, several instruments for measuring patient safety culture (PSC) have been developed and implemented. Correct interpretation of survey findings is crucial for understanding PSC locally, for comparisons across settings or time, as well as for planning effective interventions. We aimed to evaluate the influence of gender, profession, and managerial function on perceptions of PSC and on the interplay between various dimensions and perceptions of PSC.MethodsWe used German and Swiss survey data of frontline physicians and nurses (n = 1786). Data analysis was performed for the two samples separately using multivariate analysis of variance, comparisons of adjusted means, and series of multiple regressions.ResultsParticipants’ profession and managerial function had significant direct effect on perceptions of PSC. Although there was no significant direct effect of gender for most of the PSC dimensions, it had an indirect effect on PSC dimensions through statistically significant direct effects on profession and managerial function. We identified similarities and differences across participant groups concerning the impact of various PSC dimensions on Overall Perception of Patient Safety. Staffing and Organizational Learning had positive influence in most groups without managerial function, whereas Teamwork Within Unit, Feedback & Communication About Error, and Communication Openness had no significant effect. For female participants without managerial functions, Management Support for Patient Safety had a significant positive effect.ConclusionsParticipant characteristics have significant effects on perceptions of PSC and thus should be accounted for in reporting, interpreting, and comparing results from different samples.

Patient safety culture in Hungarian hospitals

PurposeThe Hospital Survey on Patient Safety Culture (HSOPSC) is a rigorously designed tool for measuring inpatient safety culture. The purpose of this paper is to develop a cross-cultural HSOPSC for Hungary and determine its strengths and weaknesses.Design/methodology/approachThe original US version was translated and adapted using existing guidelines. Healthcare workers (n=371) including nurses, physicians and other healthcare staff from six Hungarian hospitals participated. Answers were analyzed using exploratory factor analyses and reliability tests.FindingsPositive responses in all dimensions were lower in Hungary than in the USA. Half the participants considered their work area “acceptable” regarding patient safety. Healthcare staff worked in “crisis mode,” trying to accomplish too much and too quickly. The authors note that a “blame culture” does not facilitate patient safety improvements in Hungary.Practical implicationsThe results provide valuable information for promoting a more positive patient safety culture in Hungary and for evaluating future strategies to improve patient safety.Originality/valueIntroducing a validated scale to measure patient safety culture in Hungary improves healthcare quality.

Creación y validación de una nueva escala para medir cultura de seguridad del paciente en el medio hispano hablante

ObjectiveCreation and validation of a new in-house synthetic scale to measure patient safety culture. Material and methodCross-sectional and descriptive study in which the results of the assessment of the level of safety culture in health and non-health professionals of a university hospital are collected using a new in-house synthetic scale as a measurement tool. It is called ‘Questionnaire on patient safety culture in a Spanish speaking environment’. The construction process was carried out in six phases: Bibliographic search; Validation of the structure and content of the questionnaire by a group of experts in patient safety using a nominal group technique; Assumptions verification and exploratory factor analysis; Pilot test to ensure its compression by a convenience sample of expert professionals; Modification of version 1.1 after the relevant analyses and analysis of the reliability of the questionnaire. ResultsThe final version of the questionnaire had nine items, grouped into three factors a priori: Hospital Management support in patient safety, Perception of Safety, and Expectations and actions of the Managers/Supervisors that favour safety. The items were structured using a 5-point Likert scale. A general assessment item on patient safety at the Centre was also included, as well as five open questions to identify actions on patient safety undertaken by the Centre. Finally, the possibility of making observations in a section of free text was included. The comprehension analysis did not recommend, in any case, the revision of the wording or modification of the items. The Spearman and Pearson indices were similar, which allowed us to assume the linearity in the relationships proposed. The Kolmogorov-Smirnov test was satisfactory in all cases, which guaranteed the normal distribution of the variables. The sample was adequate to perform the factorial analysis. Both the Bartlett’ sphericity test and the Kaiser-Meyer-Olkin (KMO) index showed sample quality to perform the analysis. The recommendation of the exploratory factor analysis that advised eliminating 1 item was followed. Specifically, item 9 was eliminated: ‘It is only a matter of luck that in my Centre no more errors occur that affect patients’. The analysis of our scale has shown that all the factorial loads were greater than 0.5, which indicates good explanatory capacity of the item for the Dimension. In total, the scale manages to explain more than 60% of the perception by professionals in patient safety, considering an acceptable loss of information. ConclusionsA new and validated in-house scale has been created to measure patient safety culture in the Spanish speaking healthcare environment.

Linguistic Validation and Cultural Adaptation of Bulgarian Version of Hospital Survey on Patient Safety Culture (HSOPSC).

BACKGROUND:Patient safety (PS) is one of the essential elements of health care quality and a priority of healthcare systems in most countries. Thus the creation of validated instruments and the implementation of systems that measure patient safety are considered to be of great importance worldwide.AIM:The present paper aims to illustrate the process of linguistic validation, cross-cultural verification and adaptation of the Bulgarian version of the Hospital Survey on Patient Safety Culture (B-HSOPSC) and its test-retest reliability.METHODS:The study design is cross-sectional. The HSOPSC questionnaire consists of 42 questions, grouped in 12 different subscales that measure patient safety culture. Internal con­sistency was assessed using Cronbach’s alpha. The Wilcoxon signed-rank test and the split-half method were used; the Spear­man-Brown coefficient was calculated.RESULTS:The overall Cronbach’s alpha for B-HSOPSC is 0.918. Subscales 7 Staffing and 12 Overall perceptions of safety had the lowest coefficients. The high reliability of the instrument was confirmed by the Split-half method (0.97) and ICC-coefficient (0.95). The lowest values of Spearmen-Broun coefficients were found in items A13 and A14.CONCLUSION:The study offers an analysis of the results of the linguistic validation of the B-HSOPSC and its test-retest reliability. The psychometric characteristics of the questions revealed good validity and reliability, except two questions. In the future, the instrument will be administered to the target population in the main study so that the psychometric properties of the instrument can be verified.

Exploring and Evaluating Patient Safety Culture in a Community-Based Primary Care Setting.

The primary aim was to measure patient safety culture in two home care services in Belgium (Flanders). In addition, variability based on respondents' profession was examined. A cross-sectional study was conducted by administering the SCOPE-Primary Care questionnaire in two home care service organizations. In total, 1875 valid questionnaires were returned from 2930 employees, representing a response rate of 64%. The highest mean patient safety culture score was found for "organizational learning" (mean [SD] = 3.81 [0.53]), followed by "support and fellowship" (mean [SD] = 3.76 [0.61]), "open communication and learning from error" (mean [SD] = 3.73 [0.64]), and "patient safety management" (mean [SD] = 3.71 [0.60]). The lowest mean scores were found for "handover and teamwork" (mean [SD] = 3.28 [0.58]) and "adequate procedures and working conditions" (mean [SD] = 3.30 [0.56]). Moreover, managers/supervisors scored significantly higher on the dimensions "open communication and learning from error," "adequate procedures and working conditions," "patient safety management," "support and fellowship," and "organizational learning" than clinical and nonclinical staff. In conclusion, organizational learning is perceived as most positive. However, large gaps remain in the continuity of care as "handover and teamwork" is perceived as the most negative safety culture dimension. With knowledge of the current patient safety culture, organizations can redesign processes or implement improvement strategies to avoid patient safety incidents and patient harm in the future.

Systematic psychometric review of self-reported instruments to assess patient safety culture in primary care.

To give an overview of empirical studies using self-reported instruments to assess patient safety culture in primary care and to synthesize psychometric properties of these instruments. A key condition for improving patient safety is creating a supportive safety culture to identify weaknesses and to develop improvement strategies so recurrence of incidents can be minimized. However, most tools to measure and strengthen safety culture have been developed and tested in hospitals. Nevertheless, primary care is facing greater risks and a greater likelihood of causing unintentional harm to patients. A systematic literature review of research evidence and psychometric properties of self-reported instruments to assess patient safety culture in primary care. Three databases until November 2016. The review was carried out according to the protocol for systematic reviews of measurement properties recommended by the COSMIN panel and the PRISMA reporting guidelines. In total, 1.229 records were retrieved from multiple database searches (Medline=865, Web of Science=362 and Embase=2). Resulting from an in-depth literature search, 14 published studies were identified, mostly originated from Western high-income countries. As these studies come with great diversity in tools used and outcomes reported, comparability of the results is compromised. Based on the psychometric review, the SCOPE-Primary Care survey was chosen as the most appropriate instrument to measure patient safety culture in primary care as the instrument had excellent internal consistency with Cronbach's alphas ranging from 0.70-0.90 and itemfactor loadings ranging from 0.40-0.96, indicating a good structural validity. The findings of the present review suggest that the SCOPE-Primary Care survey is the most appropriate tool to assess patient safety culture in primary care. Further psychometric techniques are now essential to ensure that the instrument provides meaningful information regarding safety culture.

Assessing the patient safety culture and ward error reporting in public sector hospitals of Pakistan

BackgroundVery little research and practical efforts have been undertaken in public sector hospitals of Pakistan to promote error reporting and patient safety culture. Nurses in the country are key informants about the climate of error reporting and patient safety standards across wards in the hospital settings.MethodsA questionnaire based on the Hospital Survey on Patient Safety Culture has been used to measure patient safety culture across 18 different wards in two public sector hospitals of Pakistan. Descriptive statistics have been used to analyze the perceptions of 309 nurse practitioners.ResultsResults show that more than 80% of nurses felt that their ward did not respond to reported errors and that excessive workload interfered in their ability to practice patient safety. Similarly, more than 70% of the nurses felt they were not supported for reporting errors and that their ward placed blame on them for reporting. An overwhelming majority of nurses felt that patient safety standards and error reporting were unfavorable across high-turnover wards like the Emergency, Gynecology and Maternity, General Medicine, Cardiology, Surgery, Nephrology, and Orthopedics wards.ConclusionResults imply that public hospitals, ward administrators, and health governing bodies in the country must take initiatives to introduce and monitor patient safety and error reporting systems in a more systematic and stringent manner.

Measuring patient safety culture in maternal and child health institutions in China: a qualitative study

IntroductionPatient safety culture (PSC) plays a critical role in ensuring safe and quality care. Extensive PSC studies have been undertaken in hospitals. However, little is known about PSC in maternal...

The psychometric properties of the 'safety attitudes questionnaire' in out-of-hours primary care services in the Netherlands.

BackgroundThe Safety Attitudes Questionnaire (SAQ) is one of the most widely used instruments to assess safety culture among healthcare providers. The ambulatory version of the SAQ (SAQ-AV) can be used in the primary care setting. Our study objective was to examine the underlying factors and psychometric properties of the Dutch translation of the SAQ-AV in out-of-hours primary care services.DesignCross-sectional observational study using a web-survey.SettingSixteen out-of-hours general practitioner cooperatives and two call centers in the Netherlands.ParticipantsPrimary healthcare providers in out-of-hours services.Main outcome measuresItem-descriptive statistics, factor loadings, Cronbach’s alpha scores, corrected item-total correlations, scale correlations.ResultsThe questionnaire was answered by 853 (43.2%) healthcare professionals. In the factor analyses, 784 respondents were included; mainly general practitioners (N = 470) and triage nurses (N = 189). Items were included in the analyses based on question type and results from previous studies. Five factors were drawn with reliability scores between .49 and .86 and a good construct validity. The five factors covered 27 of the 62 questionnaire items, with three to five items per factor.ConclusionsThe Dutch translation of the SAQ-AV, with five factors, seems to be a reliable tool for measuring patient safety culture and guide quality improvement interventions in out-of-hours primary care services. The Dutch factor structure differed from the original SAQ-AV and other translated versions. In future studies, the questionnaire should be validated further by examining if there is a relationship between the responses on the SAQ-AV, patient experiences, and the occurrence of adverse events.

Measuring Patient Safety Culture in Romania Using the Hospital Survey on Patient Safety Culture (HSOPSC).

Purpose To explore patient safety culture among Romanian staff, using the U.S. Hospital Survey on Patient Safety Culture (HSOPSC). Material and Methods:A cross-sectional study was carried out in six hospitals, located in four Romanian regions (Craiova, Cluj-Napoca, Bucharest and Brasov), based on staff census in the Units/hospitals which volunteered to participate in the study (N=1,184). The response rate was 84%. The original questionnaire designed by the American Agency for Healthcare Research and Quality was translated into Romanian (with back translation), pre-tested before application and psychometrically checked. It consists of 42 questions grouped in 12categories, covering multiple aspects of patient safety culture (dimensions). Percentages of positive responses (PPRs) by question and category were analyzed overall and by staff profession. Results:Most respondents were nurses (69%). The main work areas were surgery (24%) and medicine (22%). The highest PPRs were for Supervisor/Manager Expectations & Actions Promoting Safety (88%), Teamwork Within Units (86%), Handoffs and Transitions (84%), Organizational Learning-Continuous Improvement (81%), Overall Perceptions of Safety (80%), Feedback & Communication About Error (75%). The lowest PPRs were for: Staffing (39%), Frequency of Events Reported (59%) and Non-punitive Response to Errors (61%). Nurses exhibited significantly higher PPRs than doctors.Conclusions:This small-scale study of staff’s attitude towards patient safety in Romanian hospitals suggests that there is room for future improvement, especially within the doctor category. Further research should assess the relationship between patient safety culture and frequency of adverse events.

"The level of collapse we are allowed: Comparison of different response scales in Safety Attitudes Questionnaire"

Various survey instruments have been used to measure patient safety culture. Many of these instruments use a (usually5-point) Likert scale. This studyused the Safety Attitudes Questionnaire-Korean version (SAQ-K), consisting of 34 items in six domains, to examine whether other scales, such as dichotomized and trichotomized scales, present equivalent estimates to the currently used 5-point Likert scale (1=disagree strongly, 2=disagree slightly, 3=neutral, 4=agree slightly, 5=agree strongly). For each item, we generated a 3-point scale by collapsing responsesfor 1 and 2 into one category and 4 and 5 into another category, yielding a scale of 1=disagree, 2=neutral, and 3=agree. A dichotomized scale was generated by collapsing responses for 1 through 3 from the original scale to 0=disagree and 4 and 5 to 1=agree. Correlations among the results from the five measurement scales for each respondent, as the unit of analysis, for each of the six domains were estimated: currently used simple mean of item scoreson a 5-point scale, empirical Bayes (EB) estimate from a 5-point graded response model (GRM), EB estimate from a 3-point GRM, EB estimate of a 2-parameter (2PL) item response theory (IRT) model, and EB mean of a 1-parameter (1PL) IRT model. All correlation coefficients were statistically significant (p<.01) and mostly exceeded 0.9 between the currently used simple mean and 3-point GRM estimates, although for dichotomized scales most coefficients were between 0.8 and 0.9. When we aggregated the responses to the clinical area level, the correlation became much higher, exceeding 0.9, except for those involving dichotomous scales in the stress recognition domain. This study found that dichotomous or trichotomous scales performed well compared to the current 5-point scale, suggesting such collapsing could replace the original scale at least in the analysis phase of collected data. Further study is needed to examine whether such simpler scales can be used in the survey-administering phase with sufficient validity.

Test-retest reliability of the VA National Center for Patient Safety culture questionnaire.

Patient safety culture may have a significant influence on safety processes and outcomes. Therefore, it is important to have valid tools to measure patient safety culture in order to identify potential levers for cultural change that could improve patient safety. The 65-item Department of Veterans Affairs Patient Safety Culture Survey (VA PSCS) consists of 14 dimensions and is administered biannually to VA employees. Test-retest reliability of the VA PSCS has not been established. We conducted repeated administrations of the VA PSCS among 28 VA employees. We measured intraclass correlation coefficients for each item and dimension. Test-retest intraclass correlation coefficient values were 0.7 or greater for 13 out of 14 dimensions of the VA PSCS. Employees had difficulty reliably reporting how others feel about patient safety. In general, the VA PSCS survey showed adequate test-retest reliability. Items asking what others think or feel showed lower reliability. Further work is needed to better understand the relationship between safety culture, safety processes and safety outcomes.