title: A measurement tool to assess culture change regarding patient safety in hospital obstetrical units.
abstract: OBJECTIVE
  Clinical error in acute care hospitals can only be addressed by developing a culture of safety. We sought to develop a cultural assessment survey (CAS) to assess patient safety culture change in obstetrical units.
  
  
  METHODS
  Interview prompts and a preliminary questionnaire were developed through a literature review of patient safety and "high reliability organizations," followed by interviews with members of the Managing Obstetrical Risk Efficiently (MOREOB) Program of the Society of Obstetricians and Gynaecologists of Canada. Three hundred preliminary questionnaires were mailed, and 21 interviews and 9 focus groups were conducted with the staff of 11 hospital sites participating in the program. To pilot test the CAS, 350 surveys were mailed to staff in participating hospitals, and interviews were conducted with seven nurses and five physicians who had completed the survey. Reliability analysis was conducted on four units that completed the CAS prior to and following the implementation of the first MOREOB module.
  
  
  RESULTS
  Nineteen values and 105 behaviours, practices, and perceptions relating to patient safety were identified and included in the preliminary questionnaire, of which 143 of 300 (47.4%) were returned. Among the 220 cultural assessment surveys returned (62.9%), six cultural scales emerged: (1) patient safety as everyone's priority; (2) teamwork; (3) valuing individuals; (4) open communication; (5) learning; and (6) empowering individuals. The reliability analysis found all six scales to have internal reliability (Cronbach alpha), ranging from 0.72 (open communication) to 0.84 (valuing individuals).
  
  
  CONCLUSIONS
  The CAS developed for this study may enable obstetrical units to assess change in patient safety culture.
authors.affiliation: Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London ON.
authors.forename: J
authors.initials: J
authors.lastname: Kenneth Milne
authors.affiliation: Kinect Inc., Toronto ON.
authors.forename: Nicole
authors.initials: N
authors.lastname: Bendaly
authors.affiliation: Kinect Inc., Toronto ON.
authors.forename: Leslie
authors.initials: L
authors.lastname: Bendaly
authors.affiliation: Department of Obstetrics and Gynaecology and Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London ON.
authors.forename: Jill
authors.initials: J
authors.lastname: Worsley
authors.affiliation: Department of Obstetrics and Gynaecology and Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London ON.
authors.forename: John
authors.initials: J
authors.lastname: FitzGerald
authors.affiliation: Department of Obstetrics and Gynaecology and Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London ON.
authors.forename: Jeff
authors.initials: J
authors.lastname: Nisker
mesh_terms: D006757:Hospital Units; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D009775:Obstetrics and Gynecology Department, Hospital; D009864:Ontario; D015279:Organizational Culture; D010865:Pilot Projects; D012449:Safety; D011795:Surveys and Questionnaires