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

Objective. This study aimed to investigate patient safety attitudes amongst health care providers in Norwegian primary care by using the Safety Attitudes Questionnaire, in both out-of-hours (OOH) casualty clinics and GP practices. The questionnaire identifies five major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions. Design. Cross-sectional study. Statistical analysis included multiple linear regression and independent samples t-tests. Setting. Seven OOH casualty clinics and 17 GP practices in Norway. Subjects. In October and November 2012, 510 primary health care providers working in OOH casualty clinics and GP practices (316 doctors and 194 nurses) were invited to participate anonymously. Main outcome measures. To study whether patterns in patient safety attitudes were related to professional background, gender, age, and clinical setting. Results. The overall response rate was 52%; 72% of the nurses and 39% of the doctors answered the questionnaire. In the OOH clinics, nurses scored significantly higher than doctors on Safety climate and Job satisfaction. Older health care providers scored significantly higher than younger on Safety climate and Working conditions. In GP practices, male health professionals scored significantly higher than female on Teamwork climate, Safety climate, Perceptions of management and Working conditions. Health care providers in GP practices had significant higher mean scores on the factors Safety climate and Working conditions, compared with those working in the OOH clinics. Conclusion. Our study showed that nurses scored higher than doctors, older health professionals scored higher than younger, male GPs scored higher than female GPs, and health professionals in GP practices scored higher than those in OOH clinics – on several patient safety factors.

BackgroundLong travel distances limit the utilisation of health services. We wanted to examine the relationship between the utilisation of a Norwegian out-of-hours service and the distance from the municipality population centroid to the associated casualty clinic.MethodsAll first contacts from ten municipalities in Arendal out-of-hours district were registered from 2007 through 2011. The main outcomes were contact and consultation rates for each municipality for each year. The associations between main outcomes and distance from the population centroid of the participating municipalities to the casualty clinic and were examined by linear regression. Demographic and socioeconomic factors were included in multivariate linear regression. Secondary endpoints include association between distance and rates of different first actions taken and priority grades assessed by triage nurses. Age and gender specific subgroup analyses were performed.Results141 342 contacts were included in the analyses. Increasing distance was associated with marked lower rates of all contact types except telephone consultations by doctor. Moving 43 kilometres away from the casualty clinic led to a 50 per cent drop in the rate of face-to-face consultations with a doctor. Availability of primary care doctors and education level contributed to a limited extent to the variance in consultation rate. The rates of all priority grades decreased significantly with increasing distance. The rate of acute events was reduced by 22 per cent when moving 50 kilometres away. The proportion of patients above 66 years increased with increasing distance, while the proportion of 13- to 19 year olds decreased. The proportion of female patients decreased with increasing distance.ConclusionsThe results confirm that increasing distance is associated with lower utilisation of out-of-hours services, even for the most acute cases. Extremely long distances might compromise patient safety. This must be taken into consideration when organising future out-of-hours districts.