Measuring Patient Safety Culture Research Articles

Measuring safety culture in belgian psychiatric hospitals: validation of the dutch and French translations of the hospital survey on patient safety culture.

To measure safety culture in Belgian psychiatric hospitals on 12 dimensions and to examine the psychometric properties of the Dutch and French translations of the Hospital Survey on Patient Safety Culture (HSPSC) for use in psychiatric hospitals. The authors analyzed 6,658 completed questionnaires (70.5% response rate) from a baseline measurement (2007-2009) in 44 psychiatric hospitals and 8,353 questionnaires (71.5% response rate) from a follow-up measurement (2011) in 46 psychiatric hospitals. Psychometric properties of the questionnaire were evaluated using item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability analysis (Cronbach's alpha), and analysis of composite scores and inter-correlations. For both translations, CFA showed an acceptable fit with the original 12-dimensional model. For the Dutch and French translations, EFA showed a 10-factor and a 9-factor optimal measurement model, respectively. Cronbach's alpha indicated an acceptable level of reliability (≥ 0.70) for 7 of 12 dimensions. Most pair-wise correlations were significant and <0.5, implying good construct validity. The Dutch and French translations of the HSPSC were found tobe valid and reliable for measuring patient safety culture in psychiatric hospitals. Our results also suggest the use of combinations of specific dimensions as recommended in previous research.

Patient safety culture and nurse-reported adverse events in outpatient hemodialysis units.

Patient safety culture is an important quality indicator in health care facilities and has been associated with key patient outcomes in hospitals. The purpose of this analysis was to examine relationships between patient safety culture and nurse-reported adverse patient events in outpatient hemodialysis facilities. A cross-sectional correlational, mailed survey design was used. The analytic sample consisted of 422 registered nurses who worked in outpatient dialysis facilities in the United States. The Handoff and Transitions and the Overall Patient Safety Grade scales of the Agency for Healthcare Research and Quality's (AHRQ) Hospital Patient on Safety Survey were modified and used to measure patient safety culture in outpatient dialysis facilities. Nurse-reported adverse patient events was measured as a series of questions designed to capture the frequency with which nurses report that 13 adverse events occur in the outpatient dialysis facility setting. Handoff and transitions safety during patient shift change in dialysis centers was perceived negatively by a majority of nurses. On the other hand, a majority of nurses rated the overall patient safety culture in their dialysis facility as good to excellent. All relationships between patient safety culture items and adverse patient events were in the expected direction. Negative ratings of handoffs and transitions safety were independently associated with increased odds of frequent occurrences of vascular access thrombosis and patient complaints. Negative ratings of overall patient safety culture in dialysis units were independently associated with increased odds of frequent occurrences of medication errors by nurses, patient hospitalization, vascular access infection, and patient complaints. Findings from this analysis indicate that a positive patient safety culture is an important antecedent for optimal patient outcomes in ambulatory care settings.

Measuring safety culture in Dutch primary care: psychometric characteristics of the SCOPE-PC questionnaire.

BackgroundPatient safety has been a priority in primary healthcare in the last years. The prevailing culture is seen as an important condition for patient safety in practice and several tools to measure patient safety culture have therefore been developed. Although Dutch primary care consists of different professions, such as general practice, dental care, dietetics, physiotherapy and midwifery, a safety culture questionnaire was only available for general practices. The purpose of this study was to modify and validate this existing questionnaire to a generic questionnaire for all professions in Dutch primary care.MethodsA validated Dutch questionnaire for general practices was modified to make it usable for all Dutch primary care professions. Subsequently, this questionnaire was administered to a random sample of 2400 practices from eleven primary care professions. The instrument’s factor structure, reliability and validity were examined using confirmatory and explorative factor analyses.Results921 questionnaires were returned. Of these, 615 were eligible for factor analysis. The resulting SCOPE-PC questionnaire consisted of seven dimensions: ‘open communication and learning from errors’, ‘handover and teamwork’, ‘adequate procedures and working conditions’, ‘patient safety management’, ‘support and fellowship’, ‘intention to report events’ and ‘organisational learning’ with a total of 41 items. All dimensions had good reliability with Cronbach’s alphas ranging from 0.70 – 0.90, and the questionnaire had a good construct validity.ConclusionsThe SCOPE-PC questionnaire has sound psychometric characteristics for use by the different professions in Dutch primary care to gain insight in their safety culture.

Measuring Patient Safety Culture in Korean Nursing Homes

Measuring Patient Safety Culture in Korean Nursing Homes

Swedish Hospital Survey on Patient Safety Culture— Psychometric properties and health care staff’s perception

This study examined the psychometric properties of the Swedish and the original version of the Hospital Survey on Patient Safety Culture within a Swedish hospital setting and described health care staff’s perceptions of patient safety culture. A web-survey was used to obtain data from registered nurses, enrolled nurses and physicians (N = 1023). Psychometric properties were tested using Confirmatory Factor Analysis and internal consistency using Cronbach’s alpha coefficient. Root mean square error of approximation and other fit indices indicated psychoFmetric properties for both versions to be acceptable. Internal consistency for the dimensions varied between 0.60 and 0.87. Staff scored the dimension “Teamwork Within Units” highest and the dimension “Hospital Management Support” the lowest. The safety was graded as very good or excellent by 58.9% of the respondents and one third had reported more than one event in the past 12 months. The questionnaire is considered to be useful for measuring patient safety culture in Swedish hospital settings. Managers have a great responsibility to work with improving patient safety culture.

Measurement of Patient Safety Culture in Iranian hospitals: A National Baseline Study

Purpose: Iran has initiated Patient Safety Friendly Initiatives (PSFHI) in 10 hospitals since 2010, and now aims to expand it to 50 more hospitals. The aim of this study was to systematically measure patient safety culture in Iranian hospitals as the first national baseline measure. Methods: A cross-sectional study, using Farsi version of the popular Hospital Survey on Patient Safety Culture (HSOPSC) was done in 11 public teaching general hospitals in three major province centers in Iran. About 1000 questionnaires were randomly distributed staff across four selected strata (physicians, nurses, laboratory and radiology staff). Finally, percent positive scores were calculated. Results: A total of 725 respondents had successfully completed the questionnaire (response rate: 75.44%). Overall patient safety culture percent positive scores was 47%. Teamwork within units and organizational learning -continuous improvement, got the highest scores, while non-punitive response to error and staffing had the lowest ratings. About 58% of study participants reported not completing any event reports during the previous 12 months and only 22.5% gave their hospitals an ‘excellent or very good’ patient safety grade. Conclusion: Study findings provided a good baseline data about the current status of patient safety culture in Iranian hospitals, their strengths and potentials for improvement in this field, as well as the status in each dimension of safety culture among other countries from different WHO regions.

Validación de un cuestionario para evaluar la cultura de seguridad del paciente de los profesionales de atención primaria en España

ObjetiveTo validate a tool to measure patient safety culture in Spanish primary care professionals. MethodsMedical Office Survey on Patient Safety Culture (MOSPSC), from the Agency for Healthcare and Research in Quality (AHRQ). The process has been performed in five steps: original version traslation, conceptual equivalence evaluation, acceptability and viability assessment, content validity and questionnaire test and response analysis and psichometric properties assessment. SettingPrimary care. Subjects185 Primary care professionals from different Spanish regions represented the sample test. Main outcome measuresFrecuency, response pattern and discrimination power of each item.Cronbach's alpha coefficient and dimensions obtained through factor analysis. Results17, 8% of respondents answered all the items and 28, 7% of them did not answer, or answered the option “Don’t know/Does not apply”, to one to four items. All the sentences, with only one exception, present discrimination capacity. Cronbach's alpha coefficient results 0,96 and information is sumarized in 15 factors obtaining the same items in 7 of the total 12 factors in the original questionnaire. ConclusionsTraslated, adapted, extended and validated AHRQ questionnaire is, in this setting, a reliable and useful instrument and it must be used for international comparisons.

What constitutes patient safety culture in Chinese hospitals?

To develop a patient safety culture instrument for use in Chinese hospitals, we assessed the appropriateness of existing safety culture questionnaires used in the USA and Japan for Chinese respondents and identified new items and domains suitable to Chinese hospitals. Focus group study. Twenty-four physicians, nurses and other health-care workers from 11 hospitals in three Chinese cities. Three focus groups were conducted in 2010 to elicit information from hospital workers about their perceptions of the appropriateness and importance of each of 97 questionnaire items, derived from a literature review and an expert panel, characterizing hospital safety culture. understood the concepts of patient safety and safety culture and identified features associated with safe care. They judged that numerous questions from existing surveys were inappropriate, including 39 items that were dropped because they were judged unimportant, semantically redundant, confusing, ambiguous or inapplicable in Chinese settings. Participants endorsed eight new items and three additional dimensions addressing staff training, mentoring of new hires, compliance with rules and procedures, equipment availability and leadership walk-rounds they judged appropriate to assessing safety culture in Chinese hospitals. This process resulted in a 66-item instrument for testing in cognitive interviews, the next stage of survey development. Focus group participants provided important insights into the refinement of existing items and the construction of new items for measuring patient safety culture in Chinese hospitals. This is a necessary first step in producing a culturally appropriate instrument applicable to specific local contexts.

Improving patient safety culture

Improving hospital patient safety means an open and stimulating culture is needed. This article aims to describe a patient safety culture improvement approach in five Belgian hospitals. Patient safety culture was measured using a validated Belgian adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Studies before (autumn 2005) and after (spring 2007) the improvement approach was implemented were completed. Using HSOPSC, safety culture was measured using 12 dimensions. Results are presented as evolving dimension scores. Overall, 3,940 and 3,626 individuals responded respectively to the first and second surveys (overall response rate was 77 and 68 percent respectively). After an 18 to 26 month period, significant improvement was observed for the "hospital management support for patient safety" dimension--all main effects were found to be significant. Regression analysis suggests there is a significant difference between professional subgroups. In one hospital the "supervisor expectations and actions promoting safety" improved. The dimension "teamwork within hospital units" received the highest scores in both surveys. There was no improvement and sometimes declining scores in the lowest scoring dimensions: "hospital transfers and transitions", "non-punitive response to error", and "staffing". The five participating hospitals were not randomly selected and therefore no representative conclusions can be made for the Belgian hospital sector as a whole. Only a quantitative approach to measuring safety culture was used. Qualitative approaches, focussing on specific safety cultures in specific parts of the participating hospitals, were not used. Although much needs to be done on the road towards better hospital patient safety, the study presents lessons from various perspectives. It illustrates that hospital staff are highly motivated to participate in measuring patient safety culture. Safety domains that urgently need improvement in these hospitals are identified: hospital transfers and transitions; non-punitive response to error; and staffing. It confirms that realising progress in patient safety culture, demonstrating at the same time that it is possible to improve management support, is complex. Safety is an important service quality aspect. By measuring safety culture in hospitals, with a validated questionnaire, dimensions that need improvement were revealed thereby contributing to an enhancement plan.

Measuring patient safety culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC)

BackgroundPatient safety is a critical component to the quality of health care. As health care organizations endeavour to improve their quality of care, there is a growing recognition of the importance of establishing a culture of patient safety. In this research, the authors use the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire to assess the culture of patient safety in Taiwan and attempt to provide an explanation for some of the phenomena that are unique in Taiwan.MethodsThe authors used HSOPSC to measure the 12 dimensions of the patient safety culture from 42 hospitals in Taiwan. The survey received 788 respondents including physicians, nurses, and non-clinical staff. This study used SPSS 15.0 for Windows and Amos 7 software tools to perform the statistical analysis on the survey data, including descriptive statistics and confirmatory factor analysis of the structural equation model.ResultsThe overall average positive response rate for the 12 patient safety culture dimensions of the HSOPSC survey was 64%, slightly higher than the average positive response rate for the AHRQ data (61%). The results showed that hospital staff in Taiwan feel positively toward patient safety culture in their organization. The dimension that received the highest positive response rate was "Teamwork within units", similar to the results reported in the US. The dimension with the lowest percentage of positive responses was "Staffing". Statistical analysis showed discrepancies between Taiwan and the US in three dimensions, including "Feedback and communication about error", "Communication openness", and "Frequency of event reporting".ConclusionsThe HSOPSC measurement provides evidence for assessing patient safety culture in Taiwan. The results show that in general, hospital staffs in Taiwan feel positively toward patient safety culture within their organization. The existence of discrepancies between the US data and the Taiwanese data suggest that cultural uniqueness should be taken into consideration whenever safety culture measurement tools are applied in different cultural settings.

Measuring patient safety culture: an assessment of the clustering of responses at unit level and hospital level

Objectives:To test the claim that the Hospital Survey on Patient Safety Culture (HSOPS) measures patient safety culture instead of mere individual attitudes and to determine the most appropriate level (individual,...

Challenging patient safety culture: survey results

The purpose of this paper is to measure patient safety culture in five Belgian general hospitals. Safety culture plays an important role in the approach towards greater patient safety in hospitals. The Patient Safety Culture Hospital questionnaire was distributed hospital-wide in five general hospitals. It evaluates ten patient safety culture dimensions and two outcomes. The scores were expressed as the percentage of positive answers towards patient safety for each dimension. The survey was conducted from March through November 2005. In total, 3,940 individuals responded (overall response rate = 77 per cent), including 2,813 nurses and assistants, 462 physicians, 397 physiotherapists, laboratory and radiology assistants, social workers and 64 pharmacists and pharmacy assistants. The dimensional positive scores were found to be low to average in all the hospitals. The lowest scores were "hospital management support for patient safety" (35 per cent), "non-punitive response to error" (36 per cent), "hospital transfers and transitions" (36 per cent), "staffing" (38 per cent), and "teamwork across hospital units" (40 per cent). The dimension "teamwork within hospital units" generated the highest score (70 per cent). Although the same dimensions were considered problematic in the different hospitals, important variations between the five hospitals were observed. A comprehensive and tailor-made plan to improve patient safety culture in these hospitals can now be developed. Results indicate that important aspects of the patient safety culture in these hospitals need improvement. This is an important challenge to all stakeholders wishing to improve patient safety.

Development of a patient safety culture measurement tool for ambulatory health care settings: analysis of content validity

The development of patient safety culture in health care organizations is a necessary precursor to patient safety improvement. However, existing tools to measure patient safety culture are intended for implementation in hospitals. A new, abbreviated patient safety culture survey was developed for use in ambulatory health care settings. This survey was tested for content validity utilizing a panel of six experts. It had a clarity interrater agreement (IR) of 0.75, a clarity content validity index (CVI) of 0.95, a representativeness IR of 0.75 and a representativeness CVI of 0.95. The content validity analysis served as a useful tool for assessing the relevance and comprehensiveness of this survey of patient safety culture in ambulatory care organizations.

Death by a thousand cuts

<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.