title: Comparing NICU teamwork and safety climate across two commonly used survey instruments.
abstract: Measurement and our understanding of safety culture are still evolving. The objectives of this study were to assess variation in safety and teamwork climate and in the neonatal intensive care unit (NICU) setting, and compare measurement of safety culture scales using two different instruments (Safety Attitudes Questionnaire (SAQ) and Hospital Survey on Patient Safety Culture (HSOPSC)).
  
  
  
  Cross-sectional survey study of a voluntary sample of 2073 (response rate 62.9%) health professionals in 44 NICUs. To compare survey instruments, we used Spearman's rank correlation coefficients. We also compared similar scales and items across the instruments using t tests and changes in quartile-level performance.
  
  
  
  We found significant variation across NICUs in safety and teamwork climate scales of SAQ and HSOPSC (p<0.001). Safety scales (safety climate and overall perception of safety) and teamwork scales (teamwork climate and teamwork within units) of the two instruments correlated strongly (safety r=0.72, p<0.001; teamwork r=0.67, p<0.001). However, the means and per cent agreements for all scale scores and even seemingly similar item scores were significantly different. In addition, comparisons of scale score quartiles between the two instruments revealed that half of the NICUs fell into different quartiles when translating between the instruments.
  
  
  
  Large variation and opportunities for improvement in patient safety culture exist across NICUs. Important systematic differences exist between SAQ and HSOPSC such that these instruments should not be used interchangeably.
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital; Palo Alto, CA, USA.|California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.
authors.forename: Jochen
authors.initials: J
authors.lastname: Profit
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital; Palo Alto, CA, USA.|California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
authors.affiliation: California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.|Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA, USA.|Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital; Palo Alto, CA, USA.|California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.
authors.forename: Peggy
authors.initials: P
authors.lastname: Kan
authors.affiliation: California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Nisbet
authors.affiliation: University of Texas at Houston - Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, TX, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.affiliation: The Rand Corporation, Santa Monica, CA, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Etchegaray
authors.affiliation: Department of Psychiatry, Duke University School of Medicine; Duke University Health System, Durham, NC, USA.|Duke Patient Safety Center, Duke University Health System, Durham, NC, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Sexton
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D008297:Male; D015279:Organizational Culture; D010348:Patient Care Team / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards
keywords: Critical care; Safety culture; Surveys