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AHRQ's Hospital Survey on Patient Safety Culture: Psychometric Analyses

Blegen, Mary A. RN, PhD*; Gearhart, Susan RN, MSN, PhD*; O'Brien, Roxanne RN, MSN, PhD*; Sehgal, Niraj L. MD, MPH; Alldredge, Brian K. PharmD

doi: 10.1097/PTS.0b013e3181b53f6e
Original Articles

Objective: This project analyzed the psychometric properties of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (HSOPSC) including factor structure, interitem reliability and intraclass correlations, usefulness for assessment, predictive validity, and sensitivity.

Methods: The survey was administered to 454 health care staff in 3 hospitals before and after a series of multidisciplinary interventions designed to improve safety culture. Respondents (before, 434; after, 368) included nurses, physicians, pharmacists, and other hospital staff members.

Results: Factor analysis partially confirmed the validity of the HSOPSC subscales. Interitem consistency reliability was above 0.7 for 5 subscales; the staffing subscale had the lowest reliability coefficients. The intraclass correlation coefficients, agreement among the members of each unit, were within recommended ranges. The pattern of high and low scores across the subscales of the HSOPSC in the study hospitals were similar to the sample of Pacific region hospitals reported by the Agency for Healthcare Research and Quality and corresponded to the proportion of items in each subscale that are worded negatively (reverse scored). Most of the unit and hospital dimensions were correlated with the Safety Grade outcome measure in the tool.

Conclusion: Overall, the tool was shown to have moderate-to-strong validity and reliability, with the exception of the staffing subscale. The usefulness in assessing areas of strength and weakness for hospitals or units among the culture subscales is questionable. The culture subscales were shown to correlate with the perceived outcomes, but further study is needed to determine true predictive validity.

From the *School of Nursing, †Division of Hospital Medicine, and ‡School of Pharmacy, University of California, San Francisco.

Correspondence: Mary A. Blegen, RN, PhD, Community Health Systems Department, School of Nursing, 2 Koret 0608, University of California, San Francisco, CA 94143 (e-mail:

The project was supported by the Gordon and Betty Moore Foundation.

© 2009 Lippincott Williams & Wilkins, Inc.