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Development of the Just Culture Assessment Tool: Measuring the Perceptions of Health-Care Professionals in Hospitals

Petschonek, Sarah PhD*†; Burlison, Jonathan MS*†; Cross, Carl EdD; Martin, Kathy BSN; Laver, Joseph MD§; Landis, Ronald S. PhD; Hoffman, James M. PharmD†¶

doi: 10.1097/PTS.0b013e31828fff34
Original Articles

Objectives Given the growing support for establishing a just patient safety culture in health-care settings, a valid tool is needed to assess and improve just patient safety culture. The purpose of this study was to develop a measure of individual perceptions of just culture for a hospital setting.

Methods The 27-item survey was administered to 998 members of a health-care staff in a pediatric research hospital as part of the hospital’s ongoing patient safety culture assessment process. Subscales included balancing a blame-free approach with accountability, feedback and communication, openness of communication, quality of the event reporting process, continuous improvement, and trust. The final sample of 404 participants (40% response rate) included nurses, physicians, pharmacists, and other hospital staff members involved in patient care. Confirmatory factor analysis was used to test the internal structure of the measure and reliability analyses were conducted on the subscales.

Results Moderate support for the factor structure was established with confirmatory factor analysis. After modifications were made to improve statistical fit, the final version of the measure included 6 subscales loading onto one higher-order dimension. Additionally, Cronbach α reliability scores for the subscales were positive, with each dimension being above 0.7 with the exception of one.

Conclusions The instrument designed and tested in this study demonstrated adequate structure and reliability. Given the uniqueness of the current sample, further verification of the JCAT is needed from hospitals that serve broader populations. A validated tool could also be used to evaluate the relation between just culture and patient safety outcomes.

From the *Department of Psychology, The University of Memphis; †Department of Pharmaceutical Sciences, ‡Department of Quality Management, and §Administration, St. Jude Children’s Research Hospital, Memphis, Tennessee; ∥College of Psychology, Illinois Institute of Technology, Chicago, Illinois; and ¶Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Sciences Center, Memphis, Tennessee.

Correspondence: James M. Hoffman, PharmD, 262 Danny Thomas Place, MS 150, Memphis, TN 38105 (e-mail:

This study was supported by the Cancer Center Core Grant No. NIH CA 21765 and the American Lebanese Syrian Associated Charities.

The authors disclose no conflict of interest.

© 2013 by Lippincott Williams & Wilkins