Address correspondence to Sara Singer, M.B.A., Center for Health Policy, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019. Ms. Singer is also with the Ph.D. Program in Health Policy Management, Harvard University, Center for Public Leadership, Kennedy School of Government, Cambridge, MA. Mark Meterko, Ph.D., is with the Center for Organization, Leadership, and Management Research, VA Medical Center (152-M), Boston, MA. Laurence Baker, Ph.D., is with the Department of Health Research and Policy, Stanford University, Stanford, CA. David Gaba, M.D., is with the Department of Anesthesia, VA Palo Alto Health Care System, Anesthesia Service, Stanford University, Palo Alto, CA. Alyson Falwell, M.P.H., is with the Center for Health Policy/Primary Care and Outcomes Research, Stanford University, Stanford, CA. Amy Rosen, Ph.D., is with Risk Assessment and Patient Safety, Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA.
Workforce Perceptions of Hospital Safety Culture: Development and Validation of the Patient Safety Climate in Healthcare Organizations Survey
Article first published online: 26 FEB 2007
Health Services Research
Volume 42, Issue 5, pages 1999–2021, October 2007
How to Cite
Singer, S., Meterko, M., Baker, L., Gaba, D., Falwell, A. and Rosen, A. (2007), Workforce Perceptions of Hospital Safety Culture: Development and Validation of the Patient Safety Climate in Healthcare Organizations Survey. Health Services Research, 42: 1999–2021. doi: 10.1111/j.1475-6773.2007.00706.x
- Issue published online: 26 FEB 2007
- Article first published online: 26 FEB 2007
- Safety culture;
- safety climate;
- psychometric evaluation
Objective. To describe the development of an instrument for assessing workforce perceptions of hospital safety culture and to assess its reliability and validity.
Data Sources/Study Setting. Primary data collected between March 2004 and May 2005. Personnel from 105 U.S. hospitals completed a 38-item paper and pencil survey. We received 21,496 completed questionnaires, representing a 51 percent response rate.
Study Design. Based on review of existing safety climate surveys, we developed a list of key topics pertinent to maintaining a culture of safety in high-reliability organizations. We developed a draft questionnaire to address these topics and pilot tested it in four preliminary studies of hospital personnel. We modified the questionnaire based on experience and respondent feedback, and distributed the revised version to 42,249 hospital workers.
Data Collection. We randomly divided respondents into derivation and validation samples. We applied exploratory factor analysis to responses in the derivation sample. We used those results to create scales in the validation sample, which we subjected to multitrait analysis (MTA).
Principal Findings. We identified nine constructs, three organizational factors, two unit factors, three individual factors, and one additional factor. Constructs demonstrated substantial convergent and discriminant validity in the MTA. Cronbach's α coefficients ranged from 0.50 to 0.89.
Conclusions. It is possible to measure key salient features of hospital safety climate using a valid and reliable 38-item survey and appropriate hospital sample sizes. This instrument may be used in further studies to better understand the impact of safety climate on patient safety outcomes.