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Assessing Patients' Perceptions of Safety Culture in the Hospital Setting

Development and Initial Evaluation of the Patients' Perceptions of Safety Culture Scale

Monaca, Clara, RN, BA, MSc*; Bestmann, Beate, MA, PhD; Kattein, Martina, Dipl.-Soz*; Langner, Daria, BA, MSc; Müller, Hardy, MA; Manser, Tanja, MSc, PhD*

doi: 10.1097/PTS.0000000000000436
Original Article: PDF Only

Objectives Both, patient satisfaction and hospital safety culture have been recognized as key characteristics of healthcare quality and patient safety. Thus, both characteristics are measured widely to support quality and safety improvement efforts. However, because safety culture surveys focus exclusively on the perspective of hospital staff, the complimentary information to be gained from patients' perceptions of safety culture has received little research attention so far. We aimed to develop a measure explicitly focusing on patients' perceptions of safety culture in the hospital setting and perform an initial evaluation of its measurement properties.

Methods We employed a multistep development approach including (a) literature review of survey instruments for patient experience and safety culture and (b) item categorization and selection. We evaluated the measurement properties of the final item set focusing on factor structure, internal consistency, item difficulty, and discrimination. Data were collected from June to December 2015 via an online patient survey conducted routinely by a health insurer.

Results Overall, 112,814 insured persons participated in the online survey (response rate = 19.7%). The final 11-item set formed a single scale that was named Patients' Perceptions of Safety Culture scale. Its measurement properties were deemed satisfactory based on this initial evaluation.

Conclusions The Patients' Perceptions of Safety Culture scale contributes to both a more comprehensive view of patients' experience of healthcare and a more balanced approach to safety culture measurement in healthcare. It contributes to an increased recognition of patients' views on safety-relevant aspects of their care that provide important inputs to patient safety improvement.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Institute for Patient Safety, University Hospital Bonn, Bonn, Germany; and †WINEG, Scientific Institute of TK for Benefit and Efficiency in Health Care, Hamburg, Germany.

Correspondence: Tanja Manser, MSc, PhD, University Hospital Bonn, Institute for Patient Safety, Sigmund-Freud-Straße 25; 53127 Bonn, Germany (e-mail:

The authors disclose no conflict of interest.

This work was supported in part by a small research development grant awarded by the TK/WINEG. The contributions of TM to this project were funded through the endowed chair for patient safety at the University Hospital Bonn funded by the German Alliance for Patient Safety.

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