title: Visualizing variations in organizational safety culture across an inter-hospital multifaceted workforce.
abstract: OBJECTIVE
  To develop a reliable and valid questionnaire that can distinguish features of organizational culture for patient safety across subgroups such as hospitals, professions, management/non-management positions and units/wards.
  
  
  METHODS
  We developed a Hospital Organizational Culture Questionnaire based on a conceptual framework incorporating items from a review of existing literature. The questionnaire was administered to hospital staff including doctors, nurses, allied health personnel, and administrative staff at six public hospitals in Japan. Reliability and validity were assessed through exploratory factor analysis, multitrait scaling analysis, Cronbach's alpha coefficient and multiple regression analysis using staff-perceived achievement of safety as the response variable. Discriminative power across subgroups was assessed with radar chart profiling.
  
  
  RESULTS
  Of the 3304 hospital staff surveyed, 2924 (88.5%) responded. After exploratory factor analysis and multitrait analysis, the finalized questionnaire was composed of 24 items in the following eight dimensions: improvement orientation, passion for mission, professional growth, resource allocation prioritization, inter-sectional collaboration, responsibility and authority, teamwork, and information sharing. Construct validity and internal consistency of dimensions were confirmed with multitrait analysis and Cronbach's alpha coefficients, respectively. Multiple regression analysis showed that improvement orientation, passion for mission, resource allocation prioritization and information sharing were significantly associated with higher achievement in safety practices. Our questionnaire tool was able to distinguish features of safety culture among different subgroups.
  
  
  CONCLUSIONS
  Our questionnaire demonstrated excellent validity and reliability, and revealed distinct cultural patterns among different subgroups. Quantitative assessment of organizational safety culture with this tool may further the understanding of associated characteristics of each subgroup and provide insight into organizational readiness for patient safety improvement.
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hiroe
authors.initials: H
authors.lastname: Kobuse
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Morishima
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tanaka
authors.forename: Genki
authors.initials: G
authors.lastname: Murakami
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hirose
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
mesh_terms: D001291:Attitude of Health Personnel; D005163:Factor Analysis, Statistical; D006801:Humans; D007564:Japan; D015279:Organizational Culture; D010564:Personnel, Hospital / Q000523:psychology; D012044:Regression Analysis; D015203:Reproducibility of Results; D017751:Safety Management; D011795:Surveys and Questionnaires
keywords: attitude of health personnel; organizational culture; patient safety; quality improvement; safety management; weights and measures