Measuring safety climate in health care

Patient safety culture in Hungarian hospitals

PURPOSE

The 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/APPROACH

The 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.

FINDINGS

Positive 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 IMPLICATIONS

The results provide valuable information for promoting a more positive patient safety culture in Hungary and for evaluating future strategies to improve patient safety.

ORIGINALITY/VALUE

Introducing a validated scale to measure patient safety culture in Hungary improves healthcare quality.

Assessing the Perceptions of the Health Care Workforce Toward the Patient Safety Culture in Vietnamese Hospitals

The main objective of this study was to use the translated version of Hospital Survey on Patient Safety Culture, the English-Vietnamese Hospital Survey on Patient Safety Culture (E-V HSOPSC), to assess the patient safety culture in Vietnamese hospitals and examine the extent to which safety attitudes vary between staff, hospitals, and health care systems. In addition, this study aimed to evaluate the psychometric properties of the instrument in Vietnamese dataset. We evaluated whether patient safety culture contributes to establish a positive patient safety culture—the cornerstone of a quality health care. In May 2015, the E-V HSOPSC was conducted with 1500 staff from 10 hospitals in Vietnam. The respondents were asked to return the completed surveys after a 3-month period. Before assessing the perceptions of health care workforce toward organizational safety culture, a confirmatory factor analysis, construct validity, and reliability were performed using SPSS and Amos 23.0. A total of 1116 questionnaires were eligible for data analysis. The outcomes from factor analysis verified the fitness and validity of the instrument. The positive response rate across 12 safety culture dimensions in the questionnaire ranged from 30% (Hospital Handoffs and Transitions) to 77% (Teamwork within Hospital Units). Overall, the mean positive score was 58.9%, which was slightly lower than of the United States. The safety was graded as “Very Good” by 52.6% of respondents in Vietnam. The E-V HSOPSC was appropriate to assess the patient safety culture in Vietnam, because the instrument provided adequate evidence of validity and reliability and patient safety culture strengths and deficiencies.

Hospital Survey on Patient Safety Culture (HSPSC): a systematic review of the psychometric properties of 62 international studies

OBJECTIVE

To carry out a systematic review of the psychometric properties of international studies that have used the Hospital Survey on Patient Safety Culture (HSPSC).

DESIGN

Literature review and an analysis framework to review studies.

SETTING

Hospitals and other healthcare settings in North and South America, Europe, the Near East, the Middle East and the Far East.

DATA SOURCES

A total of 62 studies and 67 datasets made up of journal papers, book chapters and PhD theses were included in the review.

PRIMARY AND SECONDARY OUTCOME MEASURES

Psychometric properties (eg, internal consistency) and sample characteristics (eg, country of use, participant job roles and changes made to the original version of the HSPSC).

RESULTS

Just over half (52%) of the studies in our sample reported internal reliabilities lower than 0.7 for at least six HSPSC dimensions. The dimensions 'staffing', 'communication openness', 'non-punitive response to error', 'organisational learning' and 'overall perceptions of safety' resulted in low internal consistencies in a majority of studies. The outcomes from assessing construct validity were reported in 60% of the studies. Most studies took place in a hospital setting (84%); the majority of survey participants (62%) were drawn from nursing and technical staff. Forty-two per cent of the studies did not state what modifications, if any, were made to the original US version of the instrument.

CONCLUSIONS

While there is evidence of a growing worldwide trend in the use of the HSPSC, particularly within Europe and the Near/Middle East, our review underlines the need for caution in using the instrument. Future use of the HSPSC needs to be sensitive to the demands of care settings, the target population and other aspects of the national and local healthcare contexts. There is a need to develop guidelines covering procedures for using, adapting and translating the HSPSC, as well as reporting findings based on its use.

Patient safety: knowledge, influence and attitude among physicians: an exploratory study

BACKGROUND

Patient safety is regarded as a global problem by which both developed and developing worlds are affected. It is defined as avoidance and prevention of patient injuries or adverse events, which could result during health care delivery. This study aimed to identify physicians' knowledge, influence, and attitude toward patient's safety in the faculty of medicine, Cairo university.

MATERIALS AND METHODS

A cross-sectional study was conducted on 187 postgraduate physicians of different specialties working in the faculty of medicine, Cairo University. Anonymous self-administered questionnaires were distributed. The questionnaire is one of a series of tools designed for evaluation of the pilot implementation of the World Health Organization patient safety curriculum for medical schools.

RESULTS

Calculated attitude score was relatively higher than influence, then knowledge score (median scores were 4.25, 3.1, and 2.5 respectively). There was no difference in knowledge, attitude, and influence scores by different personal characteristics as gender, specialty, workplace, graduation year except for higher influence score among physician who received inpatient safety training (p = 0.016). There was a weak positive significant correlation between knowledge and influence scores and between influence and attitude scores (r = 0.25, p = 0.002; r = 0.27, p < 0.001 respectively).

CONCLUSION

Higher patient safety positive attitude than influence and knowledge is pinpointed in physicians of different specialties in the faculty of medicine, Cairo University. This raises the attention to the importance of implementation of continuing patient safety education programs.

Measurement equivalence of patient safety climate in Chinese hospitals: can we compare across physicians and nurses?

OBJECTIVE

Self-report instruments have been widely used to better understand variations in patient safety climate between physicians and nurses. Research is needed to determine whether differences in patient safety climate reflect true differences in the underlying concepts. This is known as measurement equivalence, which is a prerequisite for meaningful group comparisons. This study aims to examine the degree of measurement equivalence of the responses to a patient safety climate survey of Chinese hospitals and to demonstrate how the measurement equivalence method can be applied to self-report climate surveys for patient safety research.

METHODS

Using data from the Chinese Hospital Survey of Patient Safety Climate from six Chinese hospitals in 2011, we constructed two groups: physicians and nurses (346 per group). We used multiple-group confirmatory factor analyses to examine progressively more stringent restrictions for measurement equivalence.

RESULTS

We identified weak factorial equivalence across the two groups. Strong factorial equivalence was found for Organizational Learning, Unit Management Support for Safety, Adequacy of Safety Arrangements, Institutional Commitment to Safety, Error Reporting and Teamwork. Strong factorial equivalence, however, was not found for Safety System, Communication and Peer Support and Staffing. Nevertheless, further analyses suggested that nonequivalence did not meaningfully affect the conclusions regarding physician-nurse differences in patient safety climate.

CONCLUSIONS

Our results provide evidence of at least partial equivalence of the survey responses between nurses and physicians, supporting mean comparisons of its constructs between the two groups. The measurement equivalence approach is essential to ensure that conclusions about group differences are valid.

The safety attitudes questionnaire - ambulatory version: psychometric properties of the Norwegian version for nursing homes

BACKGROUND

Patient safety culture involves leader and staff interaction, routines, attitudes, practices and awareness that influence risks of adverse events in patient care. The Safety Attitudes Questionnaire (SAQ) is an instrument to measure safety attitudes among health care providers. The instrument aims to identify possible weaknesses in clinical settings and motivate quality improvement interventions leading to reductions in medical errors. The Ambulatory Version of the SAQ (SAQ-A) was developed to measure safety climate in the primary care setting. The original version of the SAQ includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition. Patients in nursing homes are particularly vulnerable to adverse events. We present the psychometric properties of the Norwegian translation of the SAQ-A for the nursing home setting.

METHODS

The study was conducted in five nursing homes in Tønsberg, Norway, in February 2016. A total of 463 employees working more than 20% received a paper version of the translated SAQ-A adapted to the Norwegian nursing home setting and responded anonymously. Filled-in questionnaires were scanned and transferred to an SPSS file. SPSS was used to estimate Cronbach alphas, corrected item-total correlations, item-to-own and item-to-other correlations, and item-descriptive statistics. The confirmatory factor analysis was done by AMOS.

RESULTS

Of the 463 health care providers, 288 (62.2%) responded to the questionnaire. The confirmatory factor analysis showed that the total model of the six factors Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions, and Stress recognition had acceptable goodness-of-fit values in the nursing home setting.

CONCLUSIONS

The results of our study indicate that the Norwegian translated version of the SAQ-A, with the confirmed six factor model, is an appropriate tool for measuring patient safety climate in the nursing home setting. Future research should study whether there is an association between patient safety climate in nursing homes and occurrence of adverse events among the patients.

Key Issues in the Development of an Evidence-Based Stratified Surgical Patient Safety Improvement Information System: Experience From a Multicenter Surgical Safety Program

Surgery is still far from being completely safe and reliable. Surgical safety has, therefore, been the focus of considerable attention over the last few decades, and there are a growing number of national drives to improve it. There are also a number of large surgical complication reporting systems and system-based interventions, both of which have made remarkable progress in the past two decades. These systems, however, have either mainly focused on reporting complications and played a limited role in guiding practice or have provided nonselective interventions to all patients, perhaps imposing unnecessary burdens on frontline medical staff. We have, therefore, developed an evidence-based stratified surgical safety information system based on a multicenter surgical safety improvement program. This study discusses some critical issues in the process of developing this information system, including (1) decisions about data gathering, (2) establishing and sharing knowledge, (3) developing functions for the system, (4) system implementation, and (5) evaluation and continuous improvement. Using examples drawn from the surgical safety improvement program, we have shown how this type of system can be fitted into day-to-day clinical practice and how it can guide medical practice by incorporating inherent patient-related risk and providing tailored interventions for patients with different levels of risk. We concluded that multidisciplinary collaboration, involving experts in health care (including senior staff in surgery, nursing, and anesthesia), data science, health care management, and health information technology, can help build an evidence-based stratified surgical patient safety improvement system. This can provide an information-intensified surgical safety learning platform and, therefore, benefit surgical patients by delivering tailored interventions and an integrated workflow.

Assessment of safety culture in a public hospital in the Federal District, Brazil

OBJECTIVE

to assess the perception of health professionals regarding safety culture of a high complexity public hospital of the Federal District, Brazil.

METHOD

cross-sectional and descriptive study. The Safety Attitudes Questionnaire was used in electronic format. Descriptive and inferential analyses were carried out.

RESULTS

358 professionals participated, with 242 (67.6%) being female. Of these, 224 (62.6%) worked directly or indirectly with patients in assistance activities; 79 (22.1%) in administrative activities; 14 (3.9%) in management; and 41 (11.5%) in others. The total score was 57.1. Job satisfaction factors and stress perception had the most expressive results, 76.2 and 68.8, respectively. The category "working conditions" presented the lowest result, 40.7.

CONCLUSION

the results are below the score of 75, value recommended as indicative of a positive safety atmosphere. We suggest the implementation of actions for the promotion of safety culture and new studies with representative samples of all segments of workers.

The German version of the high-performance work systems questionnaire (HPWS-G) in the context of patient safety: a validation study in a Swiss university hospital

BACKGROUND

High performance work systems (HPWSs) are successful work systems in the context of safety climate and patient safety. The 10-item HPWS questionnaire is a validated instrument developed to assess existing HPWS structures in hospitals. The objectives of this cross-sectional study were to translate the English HPWS questionnaire into German (HPWS-G), to rate its content validity, and to examine its psychometric properties.

METHODS

Content validity was examined by a panel of 12 physicians and nurses, and I-CVI and S-CVI calculated. For internal consistency, Cronbach's α and item-scale correlations were determined. Construct validity was measured via confirmatory factor analysis. A convenience sample of 782 nurses and physicians in a University hospital setting in Switzerland's German-speaking region was surveyed. Four inclusion criteria were applied: working in intensive care, emergency department or operating room; having daily patient contact; having worked in the current clinical area for more than three months; and more than 40% employment.

RESULTS

A total of 281 questionnaires were completed (response rate: 35.9%). Overall, the 10-item HPWS-G questionnaire showed good content validity (I-CVI = .83-1; S-CVI = .86) and internal consistency (Cronbach's α = .853). HPWS-G scores correlated significantly with safety climate (rs = .657, p < .01) and teamwork climate (rs = .615, p < .01). The proposed 1-factor model was accepted considering results of applied minimum rank factor analysis; a confirmatory factor analysis indicated an acceptable to good model fit (GFI = .968; CFI = .902; RMSEA = .043).

CONCLUSIONS

The HPWS-G showed good psychometric properties. In clinical practice it can be used to assess HPWS practices and for intra- and inter-hospital benchmarking. Some minor adaptions to the wording could be made as well as reassessing the psychometric properties at other clinical sites.

Hospital Survey on Patient Safety Culture: psychometric evaluation in Kuwaiti public healthcare settings

OBJECTIVE

As healthcare organisations endeavour to improve the quality and safety of their services, there is increasing recognition of the importance of building a culture of safety to promote patient safety and improve the outcomes of patient care. Surveys of safety culture/climate have not knowingly been conducted in Kuwait public hospitals, nor are valid or reliable survey instruments available for this context. This study aims to investigate the psychometric properties of the HSOPSC (Hospital Survey on Patient Safety Culture) tool in Kuwaiti public hospitals in addition to constructing an optimal model to assess the level of safety climate in this setting.

DESIGN

Cross-sectional study.

SETTING

Three public hospitals in Kuwait.

PARTICIPANTS

About 1317 healthcare professionals.

MAIN OUTCOME MEASURE

An adapted and contextualised version of HSOPSC was used to conduct psychometric evaluation including exploratory factor analysis, confirmatory factor analysis reliability and correlation analysis.

RESULTS

1317 questionnaires (87%) were returned. Psychometric evaluation, showed an optimal model of eight factors and 22 safety climate items. All items have strong factor loadings (0.42-0.86) and are theoretically related. Reliability analysis showed satisfactory results (α >0.60).

CONCLUSIONS

This is the first validation study of a standardised safety climate measure in a Kuwaiti healthcare setting. An optimal model for assessing patient safety climate was produced that mirrors other international studies and which can be used for measuring the prevailing safety climate. More importance should be attached to the psychometric fidelity of safety climate questionnaires before extending their use in other healthcare culture and contexts internationally.

Development and psychometric evaluation of a safety climate scale for vineyards

BACKGROUND

This study aimed to develop a questionnaire-based tool measuring the safety climate in vineyards and to assess its psychometric properties.

METHODS

A literature search was conducted to identify the dimensions and items that constitute the safety culture construct in various occupational sectors and to draft a conceptual framework. Content validity appraisal was performed by 16 farm managers or pesticide operators. The resulting preliminary conceptual framework consisted of 9 dimensions and 42 questions. Then, a telephone survey was conducted in the French Aquitaine (Bordeaux) region with 312 vineyard workers. Item-total correlation tests, Cronbach's alpha analysis and a principal component analysis were performed to confirm the unidimensionality of the scale under construction. Structural equation modeling (SEM) techniques were used to verify the model hypothesized from the exploratory analyses and to determine how well it fits the data.

RESULTS

Exploratory analyses resulted initially in a 9-dimension, 20-item safety climate questionnaire. Internal consistency proved good with a Cronbach's alpha equal to 0.81. The SEM approach suggested two dimension groupings for a better fit of the data (7 dimensions operationalized through the same 20 items). Internal model parameters showed that the more influential dimensions of safety climate were Management commitment, Communication and feedback, Rules and practices, and Knowledge (all standardized path coefficients ≥ 0.7).

CONCLUSIONS

Owing to its good psychometric properties, we hope this score will help in drawing up relevant interventions aimed at improving safety culture, raising pesticide risk awareness, and hopefully inducing more sustainable practices in the medium-term future.

The patient safety culture: a systematic review by characteristics of Hospital Survey on Patient Safety Culture dimensions

Purpose

To learn the weaknesses and strengths of safety culture as expressed by the dimensions measured by the Hospital Survey on Patient Safety Culture (HSOPSC) at hospitals in the various cultural contexts. The aim of this study was to identify studies that have used the HSOPSC to collect data on safety culture at hospitals; to survey their findings in the safety culture dimensions and possible contributions to improving the quality and safety of hospital care.

Data sources

Medline (via PubMed), Web of Science and Scopus were searched from 2005 to July 2016 in English, Portuguese and Spanish.

Study selection

Studies were identified using specific search terms and inclusion criteria. A total of 33 articles, reporting on 21 countries, was included.

Data extraction

Scores were extracted by patient safety culture dimensions assessed by the HSOPSC. The quality of the studies was evaluated by the STROBE Statement.

Results

The dimensions that proved strongest were 'Teamwork within units' and 'Organisational learning-continuous improvement'. Particularly weak dimensions were 'Non-punitive response to error', 'Staffing', 'Handoffs and transitions' and 'Teamwork across units'.

Conclusion

The studies revealed a predominance of hospital organisational cultures that were underdeveloped or weak as regards patient safety. For them to be effective, safety culture evaluation should be tied to strategies designed to develop safety culture hospital-wide.

Investigating the Impact of Establishing Integrated Management Systems on Accidents and Safety Performance Indices: A Case Study

Background

Increasing the establishment of integrated management systems (IMSs) is done with the purpose of leaving traditional management methods and replacing them with modern management methods. Thus, the present study sought to analyze the events and investigate the impact of IMS on health and safety performance indices in an Iranian combined cycle power plants.

Methods

This case study was conducted in 2012 in all units of the Yazd Combined Cycle Power Plant on accident victims before and after the implementation of IMS. For data analysis and prediction of indices after the implementation of IMS, descriptive statistics and Kolmogorov-Smirnov test, Chi-square, linear regression, and Cubic tests were conducted using SPSS software.

Results

The number of people employed in the power plant in an 8-year period (2004-2011) was 1,189, and 287 cases of work-related accidents were recorded. The highest accident frequency rate and accident severity rate were in 2004 (32.65) and 2008 (209), respectively. Safe T-score reached to below -3 during 2010-2011. In addition, given the regression results, the relation between all predictor variables with outcomes was significant (p < 0.05), except for the variable X¹ belonging to the accident severity rate index.

Conclusion

The implementation of safety programs especially that of IMS and its annual audits has had a significant impact on reducing accident indices and improving safety within the study period. Accordingly, health and safety management systems are appropriate tools for reducing accident rate, and the use of regression models and accident indices is also a suitable way for monitoring safety performance.

Adapting and validating the Hospital Survey on Patient Safety Culture (HSOPS) for nursing students (HSOPS-NS): A new measure of Patient Safety Climate

BACKGROUND

Patient Safety Culture and Patient Safety Climate (PSC) are different factors. PSC is the shared perception that is held within a hospital's area or unit at a specific moment in time. This measure is necessary for designing activities for promoting and improving safety. It must include the perception of all the agents involved, including future nurses throughout their patient safety education.

OBJECTIVES

The aim was to adapt and validate a new version of the Hospital Survey on Patient Safety Culture (HSOPS), targeted specifically at nursing students. It provides a new comprehensive and more complete measure of PSC that contributes to improving patient safety.

METHODS

Data were obtained from 654 undergraduate and postgraduate nursing students. PSC was tested using factor analyses and structural equation modeling. In order to facilitate the improvement of PSC, we examined differences in climate strength across different academic groups using the Rwg(j) and ICC measures of inter-rater agreement.

RESULTS

Factor analyses confirmed a five-factor solution that explained between 52.45% and 54.75% of the variance. The model was found to have adequate fit χ² (5) = 14.333, p = .014; CFI = 0.99; RMSEA = 0.05. Cronbach's alphas for PSC were between 0.74 and 0.77. "Teamwork within units" was the highest rated dimension, and "Staffing" the lowest rated. Medium-to-high scores were obtained for PSC. The median of Rwg (j) was high in the five dimensions of the PSC survey, supporting the idea of shared climate perceptions (0.81-0.96) among undergraduate and postgraduate nursing students.

CONCLUSIONS

HSOPS-NS is a useful and versatile tool for measuring the level and strength of PSC. It screens knowledge regarding patient safety in clinical practice placements and compares nursing students' perceptions of the strength of PSC. Weaknesses perceived in relation to PSC help implement changes in patient safety learning.

Safety culture in intensive care internationally and in Australia: A narrative review of the literature

OBJECTIVE

Assessment of safety culture in health care is of particular relevance in the complex intensive care setting, where the effects of human error can have catastrophic consequences. The aim of this review was to examine the literature on safety culture in intensive care units (ICUs) and specifically, to explore the state of knowledge regarding safety culture in the context of Australian ICUs.

METHODS

A search was conducted of key databases for studies published in English between January 2008 and December 2017 using terms 'safety culture', 'safety climate', 'safety attitude', 'intensive care', 'ICU' and 'critical care'. Studies were included if they presented original research, utilised the teamwork and safety climate factors of a quantitative survey tool to assess safety culture, the sample population included participants working in an adult intensive care, and the findings were reported in the context of intensive care.

RESULTS

Of the 36 studies identified, two were conducted in Australia. The studies demonstrate a rapid expansion in safety culture assessment globally. Three levels of safety culture application in intensive care were identified, including safety culture assessment, effect of an intervention on safety culture, and evaluation of the association between safety culture and structural, process and outcomes measures. The use of targeted safety culture domains is emerging. Common findings included variation in perceptions of safety culture between ICUs, unit and hospital management, and professional groups.

CONCLUSION

Though the assessment of safety culture in ICUs has been an area of prolific research internationally over the past ten years, the Australian context is limited and could be advanced through further research, including the effect on safety culture of interventions, and to establish the association between safety culture and patient safety outcomes. Longitudinal studies to demonstrate sustained intervention effects on safety culture should be considered.

When safety climate is not enough: Examining the moderating effects of psychosocial hazards on nurse safety performance

AIM

To examine the association between components of safety climate and psychosocial hazards with safe work behaviours and test the moderating effects of psychosocial hazards on the safety climate-safety performance relationships.

BACKGROUND

The effects of a strong safety climate on safety performance are well cited, however, the conditions that have an impact on this relationship warrant attention. While the psychosocial hazards commonly reported by nurses are predictors of well-being and job attitudes, evidence suggests that these may also place boundaries on the effects of safety climate on safe work practices.

DESIGN

This study used a cross-sectional design to collect data from 146 nurses.

METHODS

Participants were recruited through convenience sampling and snowball sampling methods in 2017. Nurses completed an online questionnaire and received a $5 e-gift card as compensation. SPSS v.23 and PROCESS v3.0 were used to analyse the data.

RESULTS/FINDINGS

A strong safety climate was positively associated with nurses' safety performance. While psychosocial hazards did not predict safety performance, they did moderate the safety climate-performance relationship. High levels of perceived stressors weakened the association between promoting two-way safety communication, the use and implementation of procedures to promote safe work practices and management's endorsement of health and safety with safe work performance.

CONCLUSION

The positive effects of safety climate on nurses' safety performance are contingent on the levels of psychosocial hazards nurses experience. When aiming to improve safety performance among nurses, it is important for efforts to also focus on the psychosocial conditions of the work environment.

[Creation and validation of a new in-house synthetic scale to measure patient safety culture]

OBJECTIVE

Creation and validation of a new in-house synthetic scale to measure patient safety culture.

MATERIAL AND METHOD

Cross-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.

RESULTS

The 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.

CONCLUSIONS

A new and validated in-house scale has been created to measure patient safety culture in the Spanish speaking healthcare environment.

Teamwork and Safety Climate in Homecare: A Mixed Method Study

A rapidly changing homecare service sector implies difficulties to control safety and health risks for staff and to guarantee standardised deliveries of services to recipients. This study aimed to describe staff perceptions of safety climate and practices in homecare service teams, and suggestions for improvements. A second aim was to identify if and how the appraisals of safety climate were related to individual perceptions of safety, mental strain and adverse events/injury. A convergent parallel mixed methods design was used. Nursing assistants and care aides (133 in total, representing 11 work teams) in the north of Sweden replied to a survey and participated in focus group interviews. Results were analysed with ANOVA (inter-team differences) and by qualitative content analysis. Significant diversity was identified between the teams in five of seven dimensions of safety climate. Important areas for improvement were: a need to define and agree on criteria for a safe working environment; leadership prioritising safety at work; and management able to provide trust, support and time. A prerequisite for these agreements was improved authority and communication between all parties involved. The safety climate dimensions were related to personal perceptions of safety and mental strain and, partly, to adverse events/injuries.

The mediating effect of traffic safety climate between pedestrian inconvenience and pedestrian behavior

Because most people are pedestrians at some point on any given day and walking is the most indispensable means of transportation, pedestrian safety should be investigated. The primary aim of this study was to investigate the relationships among the inconveniences that pedestrians perceive in city traffic, the traffic safety climate and pedestrian behavior. A total of 311 participants voluntarily and validly completed a survey that included the Pedestrian Inconvenience Questionnaire (PIQ), the Traffic Climate Scale (TCS) and the Pedestrian Behavior Scale (PBS). We discovered that pedestrians' perceived inconvenience was positively correlated with transgression and positive behavior by pedestrians and it also positively correlated with the external affective demands (emotional engagement facet of TCS) while negatively correlated with the functionality (functional traffic system facet of TCS). We determined that the external affective demands were positively correlated with pedestrian risk behaviors (i.e., transgression, aggressive behaviors and lapses), internal requirements (traffic participants' skills facet of TCS) were positively correlated with positive behaviors, and functionality was negatively correlated with transgression and lapses. Moreover, the results indicate that the relationship between the inconveniences pedestrians perceive in city traffic and pedestrians' transgressive behavior was fully mediated by the functionality dimension of the traffic safety climate. Pedestrians' perceived inconvenience is an important factor that affects pedestrian behavior, and the influence of pedestrians' perceptions of the traffic safety climate cannot be disregarded.

Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence (PRACTICE) tool©. A development and content validation study

INTRODUCTION

Psychotropic medicines are often prescribed in nursing homes to manage behavioral and psychological symptoms of dementia despite marginal clinical effects alongside harmful adverse events. Organizational culture has been identified as a key factor that contributes to the high-level prescribing of psychotropic medicines in nursing homes. There are gaps in existing tools used to link organizational culture to the use of psychotropic medicines. The aim of this research was to develop and content validate a tool that evaluates organizational culture specific to the use of psychotropic medicines, named the Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence (PRACTICE) tool^©.

METHODS

Schein's theory of organizational culture was used to guide the development and content validation of the PRACTICE tool^©. The PRACTICE tool^© was developed based on a comprehensive systematic review, qualitative research and generated by the research team. Content validity was assessed using the CVI (Content Validity Index). The content relevance and importance of the PRACTICE tool^© items were rated by an expert panel with relevant knowledge and experience. Any modified or re-worded items were presented to the panel members in a subsequent survey for re-rating.

RESULTS

Across the two rounds, the PRACTICE tool^© had 68 items that assessed all aspects of culture according to Schein's theory. Sixty-two items out of 68 (91%) met predefined cut-off values (≥0.78) for the I -CVI. The remaining six items (9%) did not fully meet the cut-off values but were deemed important to be included in the tool based on the systematic review, qualitative research and discussions with the research team.

CONCLUSIONS

The PRACTICE tool^© is a step forward in validating an instrument that will help inform managers and policy makers to identify target areas for improvement to create a culture of appropriate psychotropic prescribing in nursing homes.

A review, simple meta-analysis and future directions of safety climate research in manufacturing organizations

This article reviews 60 studies examining safety climates related to manufacturing. The study identifies several conceptual and methodological limitations associated with developing safety climate measurements, such as lack of a rigorous validation process, problematic sample sizes and composition. Within the reviewed studies, several factors were used to measure safety climates. Management commitment to safety and associated training and procedures were most common, followed by workers' attitudes and commitment. The most frequently used factors should reflect the fact that prevention of work-related accidents and injuries depends on both the organization's and workers' actions. Most studies made no attempt to establish discriminate and convergent validities of the tools used. We recommend that rather than construct more questionnaires, researchers should correlate safety climate constructs with existing safety performance metrics to establish convergent and discriminate validities. The accident rate in manufacturing industries is sufficient to measure safety performance and assess the discriminate validity of these tools.

Is team-based perception of safety in the operating room associated with self-reported wrong-site surgery? An exploratory cross-sectional survey among physicians

AIMS

Participation in wrong-site surgery may negatively influence the perception of safety by the health care professionals in the operating room (OR). The objective was to explore if perception of safety in the OR was seen as a team-based or individualist concern and whether having participated in wrong-site surgery was associated with perception of safety.

METHOD AND RESULTS

Cross-sectional survey at 2 annual meetings of surgery, in Switzerland, 2010. We used multivariate generalized models to assess the association of perception of safety in the OR (1 item) with self-reported participation in wrong-site surgery-overall, past (more than 3 y ago), or recent (last 3 y) participations-controlling for sociodemographic characteristics and opinion of the surgical safety checklist. One hundred ninety respondents answered the questionnaire (participation rate of 22.6%). Respondents mostly had a team-based, rather than an individualistic, perception of safety in the OR. In multivariate analyses, the influence of ever participation in wrong-site surgery was not significant. However, past participation in wrong-site surgery (more than 3 y ago) was associated with perception of safety as team based, whereas recent participation (last 3 y) was associated-despite not significant at α ≤ 5%-with perception of safety as individualistic.

CONCLUSION

In this sample, safety in the OR is most often seen as team based rather than individualistic. Perceiving safety in the OR as team based varies according to recent or past participation in wrong-site surgery. Longitudinal research is needed to assess causality between participation in wrong-site surgery and change in perception of safety.

Influence from organisational factors on patient safety and safety behaviour among nurses and hospital staff

Purpose

Hospital systems are expected to influence patient safety outcomes. The purpose of this study is to explore organisational factors influencing patient safety and safety behaviour among nurses and other hospital staff.

Design/methodology/approach

Based on a theoretical model, six dimensions were selected from the hospital survey on patient safety culture. Moreover, one standardized dimension measuring safety behaviour was included. The data were collected from 1,703 hospital workers completing a cross-sectional survey.

Findings

Confirmatory factor analysis and supplementary statistics supported the use of measurement concepts applied in the study. A two-step statistical approach using structural equation modelling resulted in a satisfactory final model illustrating direct and indirect influence of the explanatory factors used.

Research limitations/implications

The limitation of this study is the use of a cross-sectional survey design.

Practical implications

The study illustrates how organisational factors are interconnected. The theoretical model developed and tested can be applied to improve safety behaviour and patient safety in hospital settings.

Social implications

The social implications of this study include the social relationships within the hospital setting, illustrating how organisational factors influence both safety behaviour and perception of patient safety levels.

Originality/value

A new theoretical model is developed and tested among hospital staff. The paper adds a new perspective on how organisational factors influence perceived safety outcomes in hospital settings.

Assessing safety climate in acute hospital settings: a systematic review of the adequacy of the psychometric properties of survey measurement tools

BACKGROUND

The perceived importance of safety culture in improving patient safety and its impact on patient outcomes has led to a growing interest in the assessment of safety climate in healthcare organizations; however, the rigour with which safety climate tools were developed and psychometrically tested was shown to be variable. This paper aims to identify and review questionnaire studies designed to measure safety climate in acute hospital settings, in order to assess the adequacy of reported psychometric properties of identified tools.

METHODS

A systematic review of published empirical literature was undertaken to examine sample characteristics and instrument details including safety climate dimensions, origin and theoretical basis, and extent of psychometric evaluation (content validity, criterion validity, construct validity and internal reliability).

RESULTS

Five questionnaire tools, designed for general evaluation of safety climate in acute hospital settings, were included. Detailed inspection revealed ambiguity around concepts of safety culture and climate, safety climate dimensions and the methodological rigour associated with the design of these measures. Standard reporting of the psychometric properties of developed questionnaires was variable, although evidence of an improving trend in the quality of the reported psychometric properties of studies was noted. Evidence of the theoretical underpinnings of climate tools was limited, while a lack of clarity in the relationship between safety culture and patient outcome measures still exists.

CONCLUSIONS

Evidence of the adequacy of the psychometric development of safety climate questionnaire tools is still limited. Research is necessary to resolve the controversies in the definitions and dimensions of safety culture and climate in healthcare and identify related inconsistencies. More importance should be given to the appropriate validation of safety climate questionnaires before extending their usage in healthcare contexts different from those in which they were originally developed. Mixed methods research to understand why psychometric assessment and measurement reporting practices can be inadequate and lacking in a theoretical basis is also necessary.

Patient safety climate in general public hospitals in China: differences associated with department and job type based on a cross-sectional survey

OBJECTIVE

This study analysed differences in the perceived patient safety climate among different working departments and job types in public general hospitals in China.

DESIGN

Cross-sectional survey.

SETTING

Eighteen tertiary hospitals and 36 secondary hospitals from 10 areas in Shanghai, Hubei Province and Gansu Province, China.

PARTICIPANTS

Overall, 4753 staff, including physicians, nurses, medical technicians and managers, were recruited from March to June 2015.

MAIN OUTCOME MEASURE

The Patient Safety Climate in Healthcare Organisations (PSCHO) tool and the percentages of 'problematic responses' (PPRs) were used as outcome measures. Multivariable two-level random intercept models were applied in the analysis.

RESULTS

A total of 4121 valid questionnaires were collected. Perceptions regarding the patient safety climate varied among departments and job types. Physicians responded with relatively more negative evaluations of 'organisational resources for safety', 'unit recognition and support for safety efforts', 'psychological safety', 'problem responsiveness' and overall safety climate. Paediatrics departments, intensive care units, emergency departments and clinical auxiliary departments require more attention. The PPRs for 'fear of blame and punishment' were universally significantly high, and the PPRs for 'fear of shame' and 'provision of safe care' were remarkably high, especially in some departments. Departmental differences across all dimensions and the overall safety climate primarily depended on job type.

CONCLUSIONS

The differences suggest that strategies and measures for improving the patient safety climate should be tailored by working department and job type.

Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey

OBJECTIVE

To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness.

DESIGN

Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience.

RESULTS

Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N = 470) and triage nurses (N = 189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors.

CONCLUSIONS

Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents' profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture. Key Points Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that: • healthcare providers in Dutch GP cooperatives perceive patient safety culture positively; • triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals - on several patient safety culture factors; and • within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.

The Swedish Safety Attitudes Questionnaire-Operating Room Version: Psychometric Properties in the Surgical Team

PURPOSE

To validate the Swedish Safety Attitudes Questionnaire-operating room (SAQ-OR) version by re-evaluating its psychometric properties for the surgical team.

DESIGN

Cross-sectional questionnaire study.

METHODS

541 surgical team members including perioperative nurses, physicians, and licensed practical nurses at three Swedish hospitals were included.

FINDINGS

For the total sample, the Cronbach's α for the six factors ranged from 0.51 to 0.76. Goodness-of-fit analyses indicated that the six-factor model was acceptable and the factor loadings were statistically significant. The test of the hypothesized relationships among the factors showed a correlation from 0.936 to 0.042.

CONCLUSIONS

The refined Swedish version of the SAQ-OR is a reasonably reliable and acceptably valid instrument for the measurement of patient safety climate in the surgical team. However, the results related to the different analyses varied among the different professionals and further research, using larger samples, is needed to explore these differences, especially among the physicians.

Development and testing of Baylor Scott & White Health's "Attitudes and Practices of Patient Safety Survey"

Improving the quality of patient care requires a culture attuned to safety. We describe the development, implementation, and psychometric evaluation of the Attitudes and Practices of Patient Safety Survey (APPSS) within the Baylor Scott & White Health system. The APPSS was designed to enable safety culture data to be collected and aggregated at the unit level to identify high-priority needs. The survey, with 27 Likert-scale core questions divided into 4 concept domains and 2 open-ended questions, was administered electronically to employees with direct patient care responsibilities (n = 16,950). The 2015 response rate was 50.4%. The Cronbach's α values for the four domains ranged from 0.78 to 0.90, indicating strong internal consistency. Confirmatory factor analysis results were mixed but were comparable to those of established safety culture surveys. Over the years, the adaptability of the APPSS has proven helpful to administrative and clinical leaders alike, and the survey responses have led to the creation of programs to improve the organization's patient safety culture. In conclusion, the APPSS provides a reliable measure of patient safety culture and may be useful to other health care organizations seeking to improve the quality and safety of the care they provide.

The patient safety climate in healthcare organizations (PSCHO) survey: Short-form development

RATIONALE, AIMS, AND OBJECTIVES

Measures of safety climate are increasingly used to guide safety improvement initiatives. However, cost and respondent burden may limit the use of safety climate surveys. The purpose of this study was to develop a 15- to 20-item safety climate survey based on the Patient Safety Climate in Healthcare Organizations survey, a well-validated 38-item measure of safety climate.

METHODS

The Patient Safety Climate in Healthcare Organizations was administered to all senior managers, all physicians, and a 10% random sample of all other hospital personnel in 69 private sector hospitals and 30 Veterans Health Administration hospitals. Both samples were randomly divided into a derivation sample to identify a short-form subset and a confirmation sample to assess the psychometric properties of the proposed short form.

RESULTS

The short form consists of 15 items represented 3 overarching domains in the long-form scale-organization, work unit, and interpersonal.

CONCLUSION

The proposed short form efficiently captures 3 important sources of variance in safety climate: organizational, work-unit, and interpersonal. The short-form development process was a practical method that can be applied to other safety climate surveys. This safety climate short form may increase response rates in studies that involve busy clinicians or repeated measures.

Ethnic Disparities of Perceived Safety Climate Among Construction Workers in Georgia, 2015

BACKGROUND

Safety climate involves worker perception about the relative importance where they work and safety climate and has been shown to be a reliable predictor of safety-related outcomes.

METHODS

The primary objective of this study is to investigate ethnic differences in perceived safety climate among construction workers. Surveys (n = 179) that included a 10-item safety climate scale were administered in Athens, Georgia (GA), at local construction sites and home improvement stores during June-August, 2015.

RESULTS

The majority of respondents were carpenters or roofers (39%), followed by laborers (22%), painters and dry wall workers (14%), other skilled trades (14%), and supervisors (11%); 32% were Hispanic. Hispanic ethnicity (p < 0.0001), drinking two or more alcoholic beverages per day (p < 0.0001), working for a company that does not provide health insurance (p = 0.0022), and working for a company with fewer than ten employees (p < 0.0001) were significantly associated with lower perceived safety climate scores.

CONCLUSION

The lower perceived safety climate scores among Hispanic workers indicate that the perception of the importance of safety on the job site is lower among Hispanics construction workers than non-Hispanics construction workers.

Physicians' Practice of Dispensing Medicines: A Qualitative Study

OBJECTIVES

The physical act of giving medication to patients to administer away from a health care setting, dispensing, is normally performed by pharmacists. Dispensing of medication by physicians is a neglected patient safety issue, and having observed considerable variation in practice, the lead author sought to explore this issue further. A literature review yielded zero articles pertaining to this, so an exploratory study was commenced. The qualitative arm, relating to junior physicians' experience of, and training in, dispensing, is reported here.

METHODS

Focus groups were conducted to explore the beliefs, ideas, and experiences of physicians-in-training pertaining to dispensing of medication. These were recorded and transcribed. The transcriptions were thematically analyzed using the grounded theory.

RESULTS

The emergency department was the most common site of dispensing. No formal training in dispensing had been received. Informal training was variable in content and utility. The physicians felt that dispensing was part of their role.

CONCLUSIONS

Despite being expected to dispense, and the patient safety issues involved in giving drugs to patients to use at home, physicians do not feel that they have been trained to undertake this task. These findings from 1 hospital raise questions about the wider quality and safety of this practice.

[Effectiveness of an intervention to improve safety culture. Less is more?]

OBJECTIVE

To assess the impact of a long-term initiative to improve safety culture among professionals working in a Health Area, and to know their perceived usefulness.

MATERIAL AND METHODS

An uncontrolled intervention study was designed in a public health care organization including a 3rd level hospital and 5,000 professionals. To measure the impact, the AHRQ Survey was conducted by telephone. A total of 7 dimensions of culture were measured, before starting the project (2012, n=100) and 3 years later (2015, n=207). Variations between 2012 and the respondents aware of the project in 2015 (RAP) were compared, as also between this last group and the rest of respondents (RNAP). The utility was assessed using a 5-item Likert scale, defining higher utility by medians 4 or higher.

RESULTS

The response rates were above 80%. In 2015, the 41.5% of respondents were RAP (95%CI: 34.8-48.3), which was perceived as of high utility. Negative variations were detected in "sense of security" (-9.9%, P<.01, vs. 2012, and -4.2% between 2015 groups) and "feedback and communication errors" (-10.0% vs. 2012, and -8.9% between 2015 groups, P<.05). There was a not-significant positive variation in "openness in communication" (1.3% vs. 2012, and 6.9% between 2015 groups). The "management support" showed a not-significant improve in 2015 (37.0%, 95%CI: 30.9-43.1, in RAP; and 38.3%, 95%CI: 33.1-43.4, in RANP) in comparison to 2012 (31.4%, 95%CI: 28.4-39.7).

CONCLUSIONS

A paradoxical worsening is detected in several dimensions, this probably due to immaturity of the organization and the instrument used. Thus, tools explicitly considering the degree of maturity may be more appropriate to measure cultural changes, although more studies are needed.

[Analysis of the safety culture in a Cardiology Unit managed by processes]

Safety culture is one of the requirements for preventing the occurrence of adverse effects. However, this has not been studied in the field of cardiology. The aim of this study is to evaluate the safety culture in a cardiology unit that has implemented and certified an integrated quality and risk management system for patient safety.

METHODS

A cross-sectional observational study was conducted in 2 consecutive years, with all staff completing the Spanish version of the questionnaire, "Hospital Survey on Patient Safety Culture" of the "Agency for Healthcare Research and Quality", with 42 items grouped into 12 dimensions. The percentage of positive responses in each dimension in 2014 and 2015 were compared, as well as national data and United States data, following the established rules.

RESULTS

The overall assessment out of a possible 5, was 4.5 in 2014 and 4.7 in 2015. Seven dimensions were identified as strengths. The worst rated were: staffing, management support and teamwork between units. The comparison showed superiority in all dimensions compared to national data, and in 8 of them compared to American data.

CONCLUSIONS

The safety culture in a Cardiology Unit with an integrated quality and risk management patient safety system is high, and higher than nationally in all its dimensions and in most of them compared to the United States.

Concept analysis of safety climate in healthcare providers

AIM AND OBJECTIVE

To report an analysis of the concept of safety climate in healthcare providers.

BACKGROUND

Compliance with safe work practices is essential to patient safety and care outcomes. Analysing the concept of safety climate from the perspective of healthcare providers could improve understanding of the correlations between safety climate and healthcare provider compliance with safe work practices, thus enhancing quality of patient care.

DESIGN

Concept analysis.

DATA SOURCES

The electronic databases of CINAHL, MEDLINE, PubMed and Web of Science were searched for literature published between 1995-2015. Searches used the keywords 'safety climate' or 'safety culture' with 'hospital' or 'healthcare'.

METHOD

The concept analysis method of Walker and Avant analysed safety climate from the perspective of healthcare providers.

RESULTS

Three attributes defined how healthcare providers define safety climate: (1) creation of safe working environment by senior management in healthcare organisations; (2) shared perception of healthcare providers about safety of their work environment; and (3) the effective dissemination of safety information. Antecedents included the characteristics of healthcare providers and healthcare organisations as a whole, and the types of work in which they are engaged. Consequences consisted of safety performance and safety outcomes. Most studies developed and assessed the survey tools of safety climate or safety culture, with a minority consisting of interventional measures for improving safety climate.

CONCLUSION

More prospective studies are needed to create interventional measures for improving safety climate of healthcare providers. This study is provided as a reference for use in developing multidimensional safety climate assessment tools and interventional measures.

RELEVANCE TO CLINICAL PRACTICE

The values healthcare teams emphasise with regard to safety can serve to improve safety performance. Having an understanding of the concept of and interventional measures for safety climate allows healthcare providers to ensure the safety of their operations and their patients.

Dynamic workplace interactions for improving patient safety climate

Purpose

Employee engagement (EE), supervisor support (SS) and interprofessional collaboration (IPC) are important contributors to patient safety climate (PSC). The purpose of this paper is to propose and empirically test a model that suggests the presence of a three-way interaction effect between EE, IPC and SS in creating a stronger PSC.

Design/methodology/approach

Using validated tools to measure EE, SS, IPC and PSC data were collected from a questionnaire of 250 clinical and support staff in an Australian health service. Using a statistical package (SPSS) an exploratory factor analysis was conducted. Bivariate correlations between the derived variables were calculated and a hierarchical ordinary least squares analysis was used to examine the interaction between the variables.

Findings

This research finds that PSC emerges from synergies between EE, IPC and SS. Modelling demonstrates that the effect of IPC with PSC is the strongest when staff are highly engaged. While the authors expected SS to be an important predictor of PSC; EE has a stronger relationship to PSC.

Practical implications

These findings have important implications for the development of patient safety programmes that focus on developing excellent supervisors and enabling IPC.

Originality/value

The authors provide quantitative evidence relating to three of the often mentioned constructs in the typology of patient safety and how they work together to improve PSC. The authors believe this to be the first empirically based study that confirms the importance of IPC as a lead marker for improved patient safety.

Safety culture: the Nottingham Veterinary Safety Culture Survey (NVSCS)

Safety culture is a vital concept in human healthcare because of its influence on staff behaviours in relation to patient safety. Understanding safety culture is essential to ensure the acceptance and sustainability of changes, such as the introduction of safe surgery checklists. While widely studied and assessed in human medicine, there is no tool for its assessment in veterinary medicine. This paper therefore presents initial data on such an assessment: the Nottingham Veterinary Safety Culture Survey (NVSCS). 350 pilot surveys were distributed to practising vets and nurses. The survey was also available online. 229 surveys were returned (65 per cent response rate) and 183 completed online, resulting in 412 surveys for analysis. Four domains were identified: (1) organisational safety systems and behaviours, (2) staff perceptions of management, (3) risk perceptions and (4) teamwork and communication. Initial indications of the reliability and the validity of the final survey are presented. Although early in development, the resulting 29-item NVSCS is presented as a tool for measuring safety culture in veterinary practices with implications for benchmarking, safety culture assessment and teamwork training.

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

BACKGROUND

The 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.

DESIGN

Cross-sectional observational study using a web-survey.

SETTING

Sixteen out-of-hours general practitioner cooperatives and two call centers in the Netherlands.

PARTICIPANTS

Primary healthcare providers in out-of-hours services.

MAIN OUTCOME MEASURES

Item-descriptive statistics, factor loadings, Cronbach's alpha scores, corrected item-total correlations, scale correlations.

RESULTS

The 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.

CONCLUSIONS

The 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.

Making an "Attitude Adjustment": Using a Simulation-Enhanced Interprofessional Education Strategy to Improve Attitudes Toward Teamwork and Communication

INTRODUCTION

Health care providers must effectively function in highly skilled teams in a collaborative manner, but there are few interprofessional training strategies in place. Interprofessional education (IPE) using simulation technology has gained popularity to address this need because of its inherent ability to impact learners' cognitive frames and promote peer-to-peer dialog. Provider attitudes toward teamwork have been directly linked to the quality of patient care. Investigators implemented a simulation-enhanced IPE intervention to improve staff attitudes toward teamwork and interprofessional communication in the emergency department setting.

METHODS

The 3-hour course consisted of a didactic session highlighting teamwork and communication strategies, 2 simulation scenarios on septic shock and cardiac arrest, and structured debriefing directed at impacting participant attitudes to teamwork and communication. This was a survey-based observational study. We used the TeamSTEPPS Teamwork Attitudes Questionnaire immediately before and after the session as a measurement of attitude change as well as the Hospital Survey on Patient Safety Culture before the session and 1 year after the intervention for program impact at the behavior level.

RESULTS

Seventy-two emergency department nurses and resident physicians participated in the course from July to September 2012. Of the 5 constructs in TeamSTEPPS Teamwork Attitudes Questionnaire, 4 had a significant improvement in scores-6.4%, 2.8%, 4.0%, and 4.0% for team structure, leadership, situation monitoring, and mutual support, respectively (P < 0.0001, P = 0.029, P = 0.014, and P = 0.003, respectively). For Hospital Survey on Patient Safety Culture, 3 of 6 composites directly related to teamwork and communication showed a significant improvement-20.6%, 20.5%, and 23.9%, for frequency of event reporting, teamwork within hospital units, and hospital handoffs and transitions, respectively (P = 0.028, P = 0.035, and P = 0.024, respectively).

CONCLUSIONS

A simulation-enhanced IPE curriculum was successful in improving participant attitudes toward teamwork and components of patient safety culture related to teamwork and communication.

The safety attitudes questionnaire - ambulatory version: psychometric properties of the Slovenian version for the out-of-hours primary care setting

Background

Several tools have been developed to measure safety attitudes of health care providers, out of which the Safety Attitudes Questionnaire (SAQ) is regarded as one of the most appropriate ones. In 2007, it was adapted to outpatient (primary health care) settings and in 2014 it was tested in out-of-hours health care settings in Norway. The purpose of this study was to translate the English version of the SAQ-Ambulatory Version (SAQ-AV) to Slovenian language; to test its reliability; and to explore its factor structure.

Methods

This was a cross-sectional study that took place in Slovenian out-of-hours primary care clinics in March-May 2015 as a part of an international study entitled Patient Safety Culture in European Out-of-hours services. The questionnaire consisted of the Slovenian version of the SAQ-AV. The link to the questionnaire was emailed to health care workers in the out-of-hours clinics. A total of 438 participants were invited. We performed exploratory factor analysis.

Results

Out of 438 invited participants, 250 answered the questionnaire (response rate 57.1%). Exploratory factor analysis put forward five factors: 1) Perceptions of management, 2) Job satisfaction, 3) Safety climate, 4) Teamwork climate, and 5) Communication. Cronbach’s alpha of the whole SAQ-AV was 0.922. Cronbach’s alpha of the five factors ranged from 0.587 to 0.791. Mean total score of the SAQ-AV was 56.6 ± 16.0 points. The factor with the highest average score was Teamwork climate and the factor with the lowest average was Job satisfaction.

Conclusions

Based on the results in our study, we cannot state that the SAQ-AV is a reliable tool for measuring safety culture in the Slovenian out-of-hours care setting. Our study also showed that there might be other safety culture factors in out-of-hours care not recognised before. We therefore recommend larger studies aiming to identify an alternative factor structure.

Reliability and validity of the Brazilian version of the Hospital Survey on Patient Safety Culture (HSOPSC): a pilot study

The evaluation of the culture of patient safety in hospitals is nowadays considered as a management too, since it helps to identify problem areas and provide valuable information for planning improvements. This study explored the reliability and validity of the Brazilian version of the Hospital Survey on Patient Safety Culture, an instrument that evaluates characteristics of patient safety culture among hospital staff. The reliability of the instrument was evaluated by analyzing the internal consistency of each dimension. The validity of the tool was carried out by means of exploratory and confirmatory factor analysis. The sample was made up of 322 questionnaires that were collected in two Brazilian hospitals in 2012. Cronbach's alpha ranged from 0.52 to 0.91 for the different dimensions, with the exception of two, for which it was much lower. After excluding four items, the exploratory factor analysis presented adjusted indices that were appropriate for a 10 factor model.