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A Systematic Review of Primary Care Safety Climate Survey Instruments: Their Origins, Psychometric Properties, Quality, and Usage

Curran, Ciara, MB, BCh, BAO; Lydon, Sinéad, PhD; Kelly, Maureen, PhD; Murphy, Andrew, MD; Walsh, Chloe, MSc; O'Connor, Paul, PhD

doi: 10.1097/PTS.0000000000000393
Original Articles

Importance Safety climate (SC) measurement is a common and feasible method of proactive safety assessment in primary care. However, there is no consensus on which instrument is “best” to use.

Objective The aim of the study was to identify the origins, psychometric properties, quality, and SC domains measured by survey instruments used to assess SC in primary care settings.

Data Sources Systematic searches were conducted using Medline, Embase, CINAHL, and PsycInfo in February 2016.

Study Selection English-language, peer-reviewed studies that reported the development and/or use of a SC survey in a primary care setting were included.

Data Extraction and Synthesis Two reviewers independently extracted data (survey characteristics, origins, and psychometric properties) from studies and applied the Quality Assessment Tool for Studies with Diverse Designs to assess methodological rigour. Safety climate domains within surveys were deductively analyzed and categorized into common healthcare SC themes.

Results Seventeen SC surveys were identified, of which 16 had been adapted from 2 main U.S. hospital-based surveys. Only 1 survey was developed de novo for a primary care setting. The quantity and quality of psychometric testing varied considerably across the surveys. Management commitment to safety was the most frequently measured SC theme (87.5%). Workload was infrequently measured (25%).

Conclusions and Relevance Valid and reliable instruments, which are context specific to the healthcare environment for intentional use, are essential to accurately assess SC. Key recommendations include further establishing the construct and criterion-related validity of existing instruments as opposed to developing additional surveys.

From the Department of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland.

Correspondence: Ciara Curran, MB, BCh, BAO, Department of General Practice, National University of Ireland Galway, 1, Distillery Rd, Newcastle, Galway, Ireland (e-mail:

The authors disclose no conflict of interest.

This project was supported by funding obtained from the Health Service Executive, Irish College of General Practitioners, Association of University Departments of General Practice in Ireland and the Irish Health Research Board.

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