Table 8 'Surveying the Development of the Patient Safety Culture'

PSI 8: Surveying the Development of the Patient Safety Culture
Origin: PSI by SimPatIE
Dimension Description
Description of Specific
Aspects of Patient Safety
Patient safety culture has been shown to be related to health care
performance. A more positive/developed safety culture is
associated with fewer incidents. Classification of patient safety
culture can be seen in terms of steps on an evolutionary ladder.
Each level has distinct characteristics and is a progression on the
one before. The more developed the culture the higher on the
ladder (28;29).
A recent study revealed that the overall unit based safety climate
significantly predicted nurse back injuries, medication errors and
urinary tract infections (30). A systematic literature review also
found evidence for a relationship between organisational culture
and health care performance in four of ten studies (19).
Thus the development of the patient safety culture is an
appropriate measure of patient safety.
Aim of the PSI The PSI continuously surveys the development of the patient
safety culture.
Level of Determination of
Patient Safety
Safety culture is assessed at the aggregated unit level.
Source(s) PSI by SimPatIE. Choice of survey instrument is made by the
unit, department or institution.
Extent of Clinically Testing In recent years a large number of quantitative tools with differing
characteristics have been developed to access the generic concept
of culture within health care (22;25-27).
The instruments vary in focus, aim, method, application and
validity. Not surprisingly, there is not one best instrument, as they
all have strengths and weaknesses. The important thing is for
organisations to select the instrument that is most appropriate for
their purposes and validated in relevant setting. The enclosed
overview shows the subjects covered for some well known
internationally used patient safety culture assessment instruments.
Three systematic literature reviews concerning quantitative
instruments for measuring culture were identified.
The first review compared nine different surveys according to
their general characteristics, dimensions covered, psychometric
performance, and their use in studies of patient safety
culture/climate surveys. It was found, that all surveys used Likert
scales, mostly to measure attitudes of individuals. Nearly all
covered five common dimensions of patient safety climate:
leadership, policies and procedures, staffing, communication, and
reporting. The strength of psychometric testing varied. While all
SImPatIE WP4 – Catalogue of Patients Safety Indicators
22
had been used to compare units within or between hospitals, only
one described the association between organisational climate and
patient outcomes (31).
The second review of 13 instruments focused on the cultural
dimensions addressed, the number of items for each questionnaire,
the measurement scale adopted, examples of studies that had used
the tool, the scientific properties of the instrument, and its
strengths and limitations. The instruments varied considerably in
terms of their grounding in theory, format, length, scope, and
scientific properties. The reviewers concluded, that the choice of
instrument should be determined by how organisational culture is
conceptualised, the purpose of surveying, intended use of the
results, and availability of resources (19).
The third systematic review of 12 studies was undertaken to study
sample and questionnaire design characteristics (source, no of
items, scale type), construct validity (content validity, factor
structure and internal reliability, concurrent validity), within
group agreement, and level of analysis. There was a lack of
explicit theoretical framework for most instruments; some did not
even report standard psychometric criteria. The reviewers
concluded: “More consideration should be given to psychometric
factors in the design of healthcare safety climate instruments,
especially as these are beginning to be used in large scale surveys
across healthcare organisations” (32).
Evidence of Clinically use of
Standards
Though surveying the patient safety culture systematically is done
in numerous hospitals in Europe, we have not found specific
scientific evidence describing clinical use of the measures as a
PSI.
PSI category Institution-Wide PSI.
Data definitions The development in the unit wise overall mean score of patient
safety culture described as a percentage of improvement/relapse in
relation to last measure.
Numerator Description The unit wise difference in the present and the previous overall
mean score of patient safety culture times 100
Denominator Description The previous overall mean score of patient safety culture for the
unit
Data Source Quantitative measure of patient safety culture. The instrument
chosen must be chosen according to the organisations resources,
aims, needs and other patient safety and quality improvement
activities, and the instrument chosen must be validated in a
relevant setting.
Identifying the institutional
context
The development of the patient safety culture makes this PSI
important regarding improvement policies.
Care Setting The PSI applies for institution-wide culture related to patient
safety.
SImPatIE WP4 – Catalogue of Patients Safety Indicators
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Professionals Responsible for
heath care
Not applicable as all hospital staff form, interact and influence the
safety culture.
Lowest Level of Health Care
Delivery Addressed
Unit.
Allowance for Patient
Factors
Not applicable.
Stratification by Vulnerable
Populations
Not applicable.
Standard of Comparison Yearly monitoring. Comparison of the development can be made
between units within the hospital.
Scoring Scoring on the assessment instrument is made according to the
manual of the chosen instrument.