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A Factorial Survey on Safety Behavior Providing Opportunities to Improve Safety

Simons, Pascale, PhD*; Houben, Ruud, MSc*; Reijnders, Petra, MBA*; Pijls-Johannesma, Madelon, PhD*†; Marneffe, Wim, PhD; Vlayen, Annemie, PhD; Hellings, Johan, PhD; Vandijck, Dominique, PhD‡§

doi: 10.1097/PTS.0000000000000192
Original Articles

Objectives To realize safe, high-quality treatment, employees should behave according to patient safety standards. Periodic measurement of safety behavior could provide management-relevant information to adjust the implementation of interventions and maximize improvement. Therefore, we constructed a factorial survey measuring safety awareness and intentions for behavior.

Methods Cross-sectional results of the factorial survey were compared with results from the Hospital Survey on Patient Safety Culture, distributed in MAASTRO radiotherapy in 2010 to 2011. Respondents were presented 20 scenarios about incidents, randomly varying on work pressure, person causing incident, whether patient level was reached, severity of harm, notification by patient, and management support. After each scenario, questions were asked about safety awareness and behavior. χ2 and multilevel regression analyses were used.

Results Response rates were 64% (n = 54) for the culture survey and 62% (n = 52) for the factorial survey on intentions. The culture survey reflected positive opinions regarding nonpunitive response and incident reporting, in accordance with high scores (factorial survey) on safety awareness (9.0; scale, 1-10) and reporting intentions (8.7). Whether an incident reached the patient level predicted safety awareness and intentions for safety behavior (β = −1.3/−3.08) most strongly. Severity of harm showed minimal additional effects (β = −0.24/−0.42).

Conclusions The factorial survey presented practical information on safety awareness and intentions for behavior. Therefore, it created additional opportunities for improving safety interventions. Because behavior is expected to change before values, one could hypothesize that factorial surveys would be more sensitive to change than culture surveys. Longitudinal research should further study the surveys’ sensitivity to measure changes.

From the *Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands;

CZ Insurances, Tilburg, The Netherlands;

Hasselt University, Hasselt, Belgium;

§Ghent University, Ghent, Belgium.

Correspondence: Pascale Simons, PhD, Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands (e-mail:

The authors disclose no conflict of interest.

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