Measuring patient safety culture

Murphy, J., Hignett, S., Griffiths, P. and Duibridge, M. 2007. Measuring patient safety culture in a UKNHS hospital with an American assessment tool. 

Smits, M., Wagner, C., Spreeuwenberg, R, van der Wal, G. and Groenewegen, P.P. 2009. Measuring patient safety culture An assessment of the clustering of responses at unit level and hospital level. Quality and Safety in Health Care, 18(4), 292-6. 

Waterson, RE. 2012. Measuring patient safety culture How far have we come and where do we need to go InM. Anderson (ed.), Contemporary Ergonomics and Human Factors 2012. London Taylor and Francis, 19-26. 

The First Patient Safety Culture Measurement Tools... 

Ginsburg, L., Gilin, D., Tregutmo, D., Norton, PG., Flemons, W. and Fleming, M. 2009. Advancing measurement of patient safety culture. Health Services Research, 44(1), 205-24. 

Safety climate has also been measured using safety culture maturity matrixes (Ashcroft et al. 2005 Dingsdag et al. 2006, 2008 Hayes et al. 2007, 2008 Kirk et al. 2007). Safety culture maturity matrices display a set of key indicators on the y axis and an evolutionary measure of cultiual maturity on the x axis. Originally developed as part of the Hearts and Minds project for Shell pic, one such matrix, the Manchester Patient Safety Framework (MaPSaF) was adapted for use in primary care settings and has since been developed into versions for mental health, acute and ambulance trusts (Kirk et al. 2007). 

In IRT, on the other hand, a latent trait, such as patient safety culture , is an unobserved construct measured by a set of observed items. The unobserved construct, in this case patient safety culture , has a causal relationship to the observed scores . Thus, CTT tends to focus more on total test scores, whereas IRT focuses on the items and their characteristics (Borsboom 2005). CTT is useful when the test score is of central interest, while IRT is most useful in examining the individual building blocks (items) of the total test scores. Both have their strengths and both are needed to form a complete picture of the properties of a set of items. 

The amount of measurement information can be derived from the item characteristic curves by providing a number that represents an item s ability to assess individual differences at each level of patient safety culture. In particular, items with location parameters spread across the full range of the underlying safety culture scale provide measurement information throughout the measured construct. Moreover, items with higher discrimination power provide more measurement information than those with lower slope parameters. 

In conclusion, this chapter demonstrates that the IRT approach can provide additional insights to psychometric properties of the HSOPSC. Both, the classical and modem approaches, are needed to form a complete picture of the properties of a set of items. Understanding the basic principles of IRT will hopefully foster its use more widely within the field of patient safety culture assessment. This will ultimately enhance our ability to measure this important constmct accurately. 

Chen, I.-C. and Li, H.-H. 2010. Measuring patient safely culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMC Health Service Research, 10, 152. 

Fhn, R., Bums, C., Meams, K., Yule, S. and Robertson, E.M. 2006. Measuring safety c iva.dXem iea i hcaie. Quality and Safety in Health Care, 15(2), 109-15. Hays, R.D., Morales, L.S. and Reise, S.P. 2000. Item response theory and health outcomes measurement in the 21st century. Medical Care, 38(9), 28-42. Helhngs, J., Schrooten, W., Klazinga, N. and Vleugels, A. 2007. Challenging patient safety culture Sitrvey resirlts. International Journal of Health Care Quality Assurance, 20, 620-32. 

One means of gathering data for monitor indicators is patient safety culture questionnaires. We have developed a patient safety culture questionnaire, TUKU, that measures employees perceptions of the organisational functions depicted in Table 9.4 as well as employees psychological states, such as sense of control and worry about patient safety (Reiman et al. 2013). In one hospital, the results of the questionnaire were compared with the ratio of patient safety incidents at the hospital s 40 units 16 months after the safety culture questionnaire was administered. The results, which must be treated with caution due to the small sample size, indicated that perceptions of work process management , work conditions management . 

In order to identify areas of organisational culture that could be targeted to improve patient safety in Scottish hospitals, a safety culture survey was conducted. The aims of the study were first, to obtain a measure of safety culture from a sample of NHS acute hospitals in Scotland and then to test whether these culture scores were associated with clinical workers safety behaviours and patient and worker injuries. This would also provide a measure of safety culture within the Scottish acute hospital sector and contribute an organisational cultural perspective to the... 

Zwart, D., Langelaan, M., van de Vooren, R.C., Kuyvenhoven, M.M., Kalkman, C.J., Verheij, T.J.M. and Wagner, C. 2011. Patient safety culture measurement in general practice Clinimetric properties of SCOPE. BMC Family Practice, 12(1), 117. 

Based on the literature review, key dimensions of hospital patient safety culture were identified and items drafted to measure those dimensions. Items were written to obtain a staff-level perspeetive of the extent to which a hospital organisation s culture supports patient safety and event reporting. In addition, most of the items were foeused on the respondent s own work area or unit beeause unit-level eulture is more salient and relevant and has the most immediate influenee on staff attitudes and behaviors. Sinee eulture varies aeross units, it was important to foeus respondents on their own unit s eulture by asking them to identify and seleet their unit first and then answer the questions in the survey about that unit. However, some patient safety eulture issues cut across units, so the last part of the survey foeused specifically on hospital-wide patient safety eulture, ineluding handoffs and transitions, pereeptions of management support and teamwork aeross units. 

As further baekgroimd for the survey, Westat eondueted telephone and in-person interviews with hospital nurses, staff and physieians to assess whether the survey dimensions eovered all relevant aspects of patient safety culture or whether any new dimensions were needed. Based on these interviews, there was a general eonsensus that the draft dimensions and items appeared to measure key patient safety eoneepts. 

Relationships between Patient Safety Culture and Other Measures... 

The measurement of safety culture has now become a core component of patient safety and additional patient safety culture assessment instruments will be needed to accommodate organisational sehings that cover the continuum of care in multiple settings. It will also be necessaiy to examine differences, as well as similarities, in staff perceptions of patient safety culture across different settings of care. In addition, it is necessary to examine in these other healthcare settings the relationships between patient safety culture and patient perceptions of care, as well as clinical outcome measures, as has been done in the hospital setting. 

Patient safety researchers have developed several surveys to assess patient safety climate, including the Safety Attitudes Questionnaire (SAQ), AHRQ s Hospital Survey on Patient Safety Culture (SOPS see Chapter 12 for more detailed information), and Patient Safety Climate in Healthcare Organizations. Our chapter provides an in-depth examination of the SAQ in terms of what it measures, key findings and limitations and future areas in need of research. 

Measuring safety culture (e.g. using the Hospital Survey on Patient safety Culture, HSOPS)... 

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