Assessing safety culture in NICU: psychometric properties of the Italian version of Safety Attitude Questionnaire and result implications.
OBJECTIVE
Neonatal intensive care units (NICUs) are a high-risk setting. The Safety Attitude Questionnaire (SAQ) is a widely used tool to measure safety culture. The aims of the study are to verify the psychometric properties of the Italian version of SAQ, to evaluate safety culture in the NICUs and to identify improvement interventions.


METHODS
A cross-sectional study was conducted in 6 level III NICUs. The SAQ was translated into Italian and adapted to the context, a confirmatory factor analysis (CFA) was performed to validate the questionnaire.


RESULTS
193 questionnaires were collected. The mean response rate was 59.7% (range 44.5%-95.7%). The answers were analysed according to six factors: f1 - teamwork climate, f2 - safety climate, f3 - job satisfaction, f4 - stress recognition, f5 - perception of management, f6 - working conditions. The CFA indexes were adequate (McDonald's omega indexes varied from 0.74 to 0.94, the SRMR index was equal to 0.79 and the RMSEA index was 0.070, 95% CI = 0.063-0.078). The mean composite score was 57.6 (SD 17.9), ranging between 42.3 and 69.7 on a standardized 100-point scale. We highlighted significant differences among units and professions (P < 0.05).


CONCLUSIONS
The Italian version of the SAQ proved to be an effective tool to evaluate and compare the safety culture in the NICUs. The obtained scores significantly varied both within and among the NICUs. The organizational and structural characteristics of the involved hospitals probably affect the safety culture perception by the staff.
Unit of Hygiene and Preventive, Environmental and Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Alessandra
A
Zenere
Unit of Epidemiology & Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
M Elisabetta
http://orcid.org/0000-0003-3021-2269
ME
Zanolin
Neonatology and Neonatal Intensive Care Unit, Mantua Hospital 'C. Poma', Mantua, Italy.
Roberta
R
Negri
Unit of Hygiene and Preventive, Environmental and Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Francesca
F
Moretti
Unit of Medical Statistics & Epidemiology, Department of Health Science, University of Pavia, Pavia, Italy.
Mario
M
Grassi
Unit of Hygiene and Preventive, Environmental and Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Stefano
S
Tardivo
D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D007558:Italy; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D011594:Psychometrics; D017751:Safety Management / Q000458:organization & administration*; D013315:Stress, Psychological / Q000453:epidemiology*; D014177:Translations
Safety Attitude Questionnaire; neonatal intensive care unit; patient safety; questionnaire validation