title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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 alpha 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.
authors.affiliation: Center for Health Policy, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Singer
authors.forename: Mark
authors.initials: M
authors.lastname: Meterko
authors.forename: Laurence
authors.initials: L
authors.lastname: Baker
authors.forename: David
authors.initials: D
authors.lastname: Gaba
authors.forename: Alyson
authors.initials: A
authors.lastname: Falwell
authors.forename: Amy
authors.initials: A
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D010564:Personnel, Hospital / Q000523:psychology*; D011594:Psychometrics; D017751:Safety Management; D011795:Surveys and Questionnaires; D014481:United States