Workforce Perceptions of Hospital Safety Culture: Development and Validation of the Patient Safety Climate in Healthcare Organizations Survey

Abstract

Objective. To describe the development of an instrument for assessing workforce perceptions of hospital safety culture and to assess its reliability and validity. Data Sources/Study Setting. Primary data collected between March 2004 and May 2005. Personnel from 105 U.S. hospitals completed a 38-item paper and pencil survey. We received 21,496 completed questionnaires, representing a 51 percent response rate. Study Design. Based on review of existing safety climate surveys, we developed a list of key topics pertinent to maintaining a culture of safety in high-reliability organizations. We developed a draft questionnaire to address these topics and pilot tested it in four preliminary studies of hospital personnel. We modified the questionnaire based on experience and respondent feedback, and distributed the revised version to 42,249 hospital workers. Data Collection. We randomly divided respondents into derivation and validation samples. We applied exploratory factor analysis to responses in the derivation sample. We used those results to create scales in the validation sample, which we subjected to multitrait analysis (MTA). Principal Findings. We identified nine constructs, three organizational factors, two unit factors, three individual factors, and one additional factor. Constructs demonstrated substantial convergent and discriminant validity in the MTA. Cronbach's a coefficients ranged from 0.50 to 0.89. Conclusions. It is possible to measure key salient features of hospital safety climate using a valid and reliable 38-item survey and appropriate hospital sample sizes. This instrument may be used in further studies to better understand the impact of safety climate on patient safety outcomes.Key Words. Safety culture, safety climate, survey, psychometric evaluation r Health Research and Educational Trust DOI: 10.1111/j. 1475-6773.2007.00706.x 1999 Since the Institute of Medicine's identification of safety culture as a key determinant of the ability of health care organizations to address and reduce risks to patients due to medical care (Institute of Medicine 2001), initiatives to improve and measure safety culture have proliferated (McCarthy and Blumenthal 2006). Recognition of the critical need to assess safety culture and the impact of innovative interventions aimed at improving it has led to the development of surveys designed to measure hospital worker perceptions of safety culture or ''safety climate.'' Instruments vary according to length, dimensions covered, intended sample population (hospital-wide or unit-level personnel), and extent of psychometric evaluation. Assessments of these early attempts to measure safety climate agree that more consideration of the psychometric factors in the design and selection of health care safety climate instruments is appropriate (Nieva and Sorra 2003;Colla et al. 2005;Flin et al. 2006;Singla et al. 2006). This paper describes the development and psychometric evaluation of the Patient Safety Climate in Healthcare Organizations (PSCHO) survey (appendix A), which ha...

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