Workforce perceptions of hospital safety culture: development and validation of the patient safety climate in healthcare organizations survey.
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.
Singer
Sara
S
Center for Health Policy, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019, USA.
Meterko
Mark
M
Baker
Laurence
L
Gaba
David
D
Falwell
Alyson
A
Rosen
Amy
A
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