Framework for Patient Safety Research and Improvement

Pronovost, Peter J.; Goeschel, Christine A.; Marsteller, Jill A.; Pham, Julius Cuong; Berenholtz, Sean M.

doi:10.1161/circulationaha.107.729848

Cited by 165 publications

(127 citation statements)

References 69 publications

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“…The variation suggests different incident culture across the units within this hospital trust. This result supports the belief that safety improvements should be carried out at unit level [23].…”

Section: The Incident Culturesupporting

confidence: 85%

The Culture of Incident Reporting and Feedback: A Cross-Sectional Study in a Hospital Setting

Vifladt¹,

Simonsen²,

Lydersen³

et al. 2015

OJN

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Section: The Incident Culturesupporting

confidence: 85%

The Culture of Incident Reporting and Feedback: A Cross-Sectional Study in a Hospital Setting

Vifladt¹,

Simonsen²,

Lydersen³

et al. 2015

OJN

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“…4 Recently, workplace safety culture has gained prominence as a crucial ingredient in patients' outcomes and is increasingly being explored as a guide for quality improvement efforts. 2,5,6 in the chosen units were invited to participate in the study if they were working full-or part-time, so long as they had worked in the unit for at least 2 shifts or a mean of 15 h/wk per the SAQ recommendations. 23 Staff members who had worked in the ICU less than 1 month were excluded because limited exposure to the culture of the unit would preclude them from responding adequately to the survey.…”

mentioning

confidence: 99%

CNE Article: Safety Culture In Australian Intensive Care Units: Establishing A Baseline For Quality Improvement

Chaboyer

Chamberlain

Hewson-Conroy

et al. 2013

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Identify the importance of and interest in safety culture in the health care system. 2. Describe how workplace safety culture contributes to patient outcomes. 3. Define strategies that may improve safety and patient outcomes. Background Workplace safety culture is a crucial ingredient in patients' outcomes and is increasingly being explored as a guide for quality improvement efforts. Objectives To establish a baseline understanding of the safety culture in Australian intensive care units. Methods In a nationwide study of physicians and nurses in 10 Australian intensive care units, the Safety Attitudes Questionnaire intensive care unit version was used to measure safety culture. Descriptive statistics were used to summarize the mean scores for the 6 subscales of the questionnaire, and generalized-estimation-equations models were used to test the hypotheses that safety culture differed between physicians and nurses and between nurse leaders and bedside nurses.Results A total of 672 responses (50.6% response rate) were received: 513 (76.3%) from nurses, 89 (13.2%) from physicians, and 70 (10.4%) from respondents who did not specify their professional group. Ratings were highest for teamwork climate and lowest for perceptions of hospital management and working conditions. Four subscales, job satisfaction, teamwork climate, safety climate, and working conditions, were rated significantly higher by physicians than by nurses. Two subscales, working conditions and perceptions of hospital management, were rated significantly lower by nurse leaders than by bedside nurses. Conclusions Measuring the baseline safety culture of an intensive care unit allows leaders to implement targeted strategies to improve specific dimensions of safety culture. These strategies ultimately may improve the working conditions of staff and the care that patients receive. (American Journal of Critical Care. 2013;22:93-103)

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“…Therefore, what we thought of as hospitals' safety culture profile may actually come from instrument characteristics, not from respondents' characteristics. In addition, many hospitals including Johns Hopkins, trace the temporal changes in SAQ scores [31]. They frequently set a certain threshold value of change, such as 20, and if a certain domain score drops more than that, it is interpreted as a red flag.…”

Section: Discussionmentioning

confidence: 99%

Item Response Theory-Based Evaluation of Psychometric Properties of the Safety Attitudes Questionnaire—Korean Version (SAQ-K)

Jeong¹

2016

BBIJ

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Years have passed since patient safety culture began to be measured. Several measurement instruments have been developed and used in the field, including the Safety Attitudes Questionnaire (SAQ). Validation is an essential step when administering these instruments to health care professionals. The problem is that confirmatory factory analysis (CFA) has mainly been used for the validation, despite the fact that CFA only works well with continuous responses. Yet SAQ and its variants, including the Korean version, use a 5-point Likert scale, which is by definition not a continuous, but a categorical measure. To resolve this conflict, we used item response theory (IRT) graded response model (GRM), an extension of CFA to categorical variables, to revalidate the SAQ-K and unravel the properties of each item and the SAQ-K instrument as a whole. We calculated difficulty and discriminating parameters for all items first. Then, based on the results, we estimated the expected score of each domain along the latent trait continuum, showing how the current SAQ behaves. We also used the itemlevel and domain-level information function, which can enlighten us on how to improve the precision of the current instrument. Most importantly, we obtained IRT-based empirical Bayes estimates of the latent trait level of each person and compared them with the traditional 0 to 100 SAQ arithmetic mean domain score scale. The correlation coefficients were very high, but when plotted we observed a considerable discrepancy between them. This finding led to the validity of the traditional scoring method in question. We expect the results and methodology of this study to bring about active discussions on the use of such safety culture instruments and help future studies on improving patient safety. Despite the successful application of such instruments in gauging patient safety culture in health care, we have to admit that those safety culture instruments, including SAQ-K, should be revalidated for several reasons. In most cases, the critical part of the survey questionnaire validation process has been conducted using confirmatory factor analysis (CFA) [19]. The problem here is that CFA can and should only be used for continuous responses, not for categorical responses such as a 5-point Likert scale, because CFA is basically a linear regression model. Therefore, it cannot appropriately deal with the errors in a measurement model for dichotomous or categorical responses-errors that can neither be normally distributed nor have constant variance. In addition, in the CFA paradigm, the probability of choosing an option for an item can go out of bounds [20]. Simply put, validating a Likert scale-based instrument with CFA is theoretically incorrect. Unfortunately, however, the original SAQ and all its variants, including SAQ-K, measure responses on a 5-point Likert scale (1= disagree strongly, 2= disagree slightly, 3= neutral, 4= agree slightly, 5= agree strongly) and then convert them to a scale from 0 to 100, with 25-point intervals. In all ho...

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Framework for Patient Safety Research and Improvement

Cited by 165 publications

References 69 publications

The Culture of Incident Reporting and Feedback: A Cross-Sectional Study in a Hospital Setting

The Culture of Incident Reporting and Feedback: A Cross-Sectional Study in a Hospital Setting

CNE Article: Safety Culture In Australian Intensive Care Units: Establishing A Baseline For Quality Improvement

Item Response Theory-Based Evaluation of Psychometric Properties of the Safety Attitudes Questionnaire—Korean Version (SAQ-K)

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