The safety attitudes questionnaire – ambulatory version: psychometric properties of the Norwegian translated version for the primary care setting

BMC Health Services Research

Ellen Catharina Tveter Deilkås³  Elisabeth Holm Hansen¹  Dag Hofoss⁴  Gunnar Tschudi Bondevik² 

[1] Haraldsplass Deaconess University College, Bergen, Norway;National Centre for Emergency Primary Health Care, Uni Health, Uni Research, Bergen, Norway;Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway;Institute of Health and Society, University of Oslo, Oslo, Norway

关键词: Safety attitudes questionnaire;    Quality improvement;    Primary care;    Patient safety culture;    Out-of-hours;    Medical errors;    General practice;    Adverse events;   

Others  :  1133037
DOI  :  10.1186/1472-6963-14-139

 received in 2013-11-11, accepted in 2014-03-26,  发布年份 2014

【 摘 要 】

Background

Patient safety culture is how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. The Safety Attitudes Questionnaire is the most widely used instrument to measure safety attitudes among health care providers. The instrument may identify possible weaknesses in clinical settings, and motivate and guide quality improvement interventions and reductions in medical errors. The Safety Attitudes Questionnaire – Ambulatory Version was developed for measuring safety culture in the primary care setting. The original version includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions and Stress recognition. We describe the results of a validation study using the Norwegian translation of the questionnaire in the primary care setting, and present the psychometric properties of this version.

Methods

The study was done in seven Out-of-hours casualty clinics and 17 regular GP practices employing a total of 510 primary health care providers (194 nurses and 316 medical doctors). In October and November 2012, the translated Safety Attitudes Questionnaire – Ambulatory Version was distributed by e-mail. Data were collected electronically using the program QuestBack, whereby the participants responded anonymously. SPSS was used to estimate the Cronbach’s alphas, item-to-own-factor correlations, intercorrelations of factors and item-descriptive statistics. The confirmatory factor analysis was done by AMOS.

Results

Of the 510 invited health care providers, 266 (52%) answered the questionnaire - 72% of the registered nurses (n = 139) and 39% of the medical doctors (n = 124). In the confirmatory factor analysis, the following five factor model was shown to have acceptable goodness-of-fit values in the Norwegian primary care setting: Teamwork climate, Safety climate, Job satisfaction, Working conditions and Perceptions of management.

Conclusions

The results of our study indicate that the Norwegian translated version of the Safety Attitudes Questionnaire – Ambulatory Version, with the five confirmed factors, might be a useful tool for measuring several aspects of patient safety culture in the primary care setting. Further research should investigate whether there is an association between patient safety culture in primary care, as measured by the Safety Attitudes Questionnaire – Ambulatory Version, and occurrence of medical errors and negative patient outcome.

【 授权许可】

   
2014 Bondevik et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Modak I, Sexton JB, Lux TR, Helmreich RL, Thomas EJ: Measuring safety culture in the ambulatory setting: the safety attitudes questionnaire–ambulatory version. J Gen Intern Med 2007, 22:1-5.
• [2]Hammons T, Piland NF, Small SD, Hatlie MJ, Burstin HR: Ambulatory patient safety. What we know and need to know. J Ambul Care Manage 2003, 26:63-82.
• [3]Gandhi TK, Sitting DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW: Communication breakdown in the outpatient referral process. J Gen Intern Med 2000, 15:626-631.
• [4]Gandhi TK, Weingart SN, Leape LL, Seger DL, Rothschild JM, Borus J, Fleming J, Bates DW: Medication errors and potential adverse drug events among out patients. J Gen Intern Med 2000, 15(Suppl):116.
• [5]Gandhi TK, Burstin HR, Cook EF, Puopolo AL, Haas JS, Brennan TA, Bates DW: Drug complications in outpatients. J Gen Intern Med 2000, 15:149-154.
• [6]Weingart SN, Wilson RM, Gibberd RW, Harrison B: Epidemiology of medical error. BMJ 2000, 320:774-777.
• [7]Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, Seger DL, Shu K, Federico F, Leape LL, Bates DW: Adverse drug events in ambulatory care. N Engl J Med 2003, 348:1556-1564.
• [8]Deilkås ET: Patient safety culture - opportunities for healthcare management. Norway: University of Oslo; 2010. [PhD thesis]
• [9]Singer SJ, Gaba DM, Geppert JJ, Sinaiko AD, Howard SK, Park KC: The culture of safety: results of an organization-wide survey in 15 California hospitals. Qual Saf Health Care 2003, 12:112-118.
• [10]Weingart SN, Farbstein K, Davis RB, Phillips RS: Using a multihospital survey to examine the safety culture. Jt Comm J Qual Saf 2004, 30:125-132.
• [11]Sorra JS, Nieva VF: Hospital Survey on Patient Safety Culture. Rockville, MD: Agency for Healthcare Research and Quality; 2004. [(Prepared by Westat, Under Contract No. 290-96-0004). AHRQ Publication No. 04–0041]
• [12]Colla JB, Bracken AC, Kinney LM, Weeks WB: Measuring patient safety climate: a review of surveys. Qual Saf Health Care 2005, 14:364-366.
• [13]Flin R, Burns C, Mearns K, Yule S, Robertson EM: Measuring safety climate in health care. Qual Saf Health Care 2006, 15:109-115.
• [14]Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, Roberts PR, Thomas EJ: The safety attitudes questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 2006, 6:44. BioMed Central Full Text
• [15]Sexton JB: A matter of life and death: social psychological and organizational factors related to patient outcomes in the intensive care unit. University of Texas; 2002. [PhD thesis]
• [16]Sexton JB, Thomas EJ, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, Roberts PR: Frontline assessments of healthcare culture: Safety Attitudes Questionnaire norms and psychometric properties. Austin, TX: The University of Texas Center of Excellence for Patient Safety Research and Practice; 2004. Technical Report No. 04–01
• [17]Deilkås ET, Hofoss D: Psychometric properties of the Norwegian version of the Safety Attitudes Questionnaire (SAQ), generic version (short form 2006). BMC Health Serv Res 2008, 8:191. BioMed Central Full Text
• [18]Thomas EJ, Sexton JB, Neilands TB, Frankel A, Helmreich RL: The effect of executive walk rounds on nurse safety climate attitudes. A randomized trial of clinical units. BMC Health Serv Res 2005, 5:28. BioMed Central Full Text
• [19]Pronovost P, Weast B, Rosenstein BJ, Sexton B, Holzmueller CG, Paine L, Davis R, Rubin HR: Implementing and validating a comprehensive unit-based safety program. J Patient Saf 2005, 1:33-40.
• [20]Pronovost PJ, Berenholtz SM, Goeschel CA, Needham DM, Sexton JB, Thompson DA, Lubomski LH, Marsteller JA, Makary MA, Hunt E: Creating high reliability in health care organizations. Health Serv Res 2006, 41:1599-1617.
• [21]Deilkås ET, Hofoss D: Patient safety culture lives in departments and wards: multilevel partitioning of variance in patient safety culture. BMC Health Serv Res 2010, 10:85. BioMed Central Full Text
• [22]Sexton JB, Paine LA, Manfuso J, Holzmueller CG, Martinez EA, Moore D, Hunt DG, Pronovost PJ: A check-up for safety culture in “my patient care area”. Jt Comm J Qual Patient Saf 2007, 33:699-703.
• [23]Hansen EH, Hunskaar S: Development, implementation, and a pilot study of a sentinel network (“The Watchtowers”) for monitoring emergency primary health care activity in Norway. BMC Health Serv Res 2008, 8:62. BioMed Central Full Text
• [24]Hansen EH, Zakariassen E, Hunskaar S: Sentinal monitoring of activity of out-of-hours services in Norway in 2007: an observational study. BMC Health Serv Res 2009, 9:123. BioMed Central Full Text
• [25]Beaton DE, Bombardier C, Guillemin F, Ferraz MB: Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000, 25:3186-3191.
• [26]Schwendimann R, Zimmermann N, Küng K, Ausserhofer D, Sexton B: Variation in safety culture dimensions within and between US and Swiss Hospital Units: an exploratory study. BMJ Qual Saf 2013, 22:32-41.
• [27]Taylor JA, Pandian R: A dissonant scale: stress recognition in the SAQ. BMC Res Notes 2013, 6:302. BioMed Central Full Text
• [28]Zohar D: Safety Climate: conceptual and Measurement Issues. In Handbook of Occupational Health Psychology. Edited by Quick JC, Tetrick L. Washington, D.C: American Psychological Association; 2003:123-142.
• [29]Browne M, Cudeck R: Alternative Ways of Assessing Model fit. In Testing Structural Equation Models. Edited by Bollen KA, Long JS. Newbury Park, California: Sage; 1993:136-162.
• [30]Hooper D, Coughlan J, Mullen M: Structural equation modelling: guidelines for determining model fit. J Bus Res 2008, 6:53-60.
• [31]Hoelter JW: The analysis of covariance structures: goodness-of-fit indices. Sociol Methods Res 1983, 11:325-344.