Measuring safety climate in health care: The current evidence base and future challenges

Interest in Patient Safety Climate (PSC) research has grown in the last few years. One area which has received particular attention is the design of survey instruments for measuring patient safety climate. For example, the European Network for Patient Safety Project (EUNetPaS, 2010) identified 19 different PSC instruments in use throughout the EU member states. The most frequently used of these instruments are the Hospital Survey on Patient Safety Climate (HSOPSC) (Nieva and Sorra, 2003), the Manchester Patient Safety Framework (MaPSaF) (Parker et al., 2008) and the Safety Attitudes Questionnaire (SAQ) (Sexton et al., 2006). Research carried out using these instruments points to a number of issues and questions concerning their ability to measure safety climate in healthcare. This raises theoretical and methodological considerations as well as more practical implications such as understanding the results of the survey in a health service setting. These challenges include, for instance, whether the results of the instruments are comparable when used across different settings such as the health services in different countries. The aim of the workshop will be to explore these issues further and to focus in particular on the following research questions: What components of PSC should we be measuring (i.e., items, larger factor structures)? What do PSC instruments actually measure (e.g., individual or organisational perceptions regarding safety)? Do differences exist in terms of perceptions of PSC for different healthcare groups (e.g., managers, physicians, nurses)? How well do PSC instruments apply to different work settings and practices? How psychometrically robust are current PSC instruments? What criteria should we apply when evaluating PSC psychometrics? What evidence is there to suggest that PSC instruments developed in other countries (e.g., the USA) and healthcare contexts can be used successfully in other national and/or healthcare contexts (e.g., within Europe or other countries such as Saudi Arabia or Japan)? How do we explain differences in terms of using the same PSC instrument across various national contexts? What issues are raised in translating PSC instruments and using them in other contexts (e.g., language translation, use of additional or fewer items from the original versions of the instrument)? What alternative methodologies and theoretical approaches can be used to measure PSC (e.g., item response theory)? What are the major future challenges for PSC instruments, both in methodological and implementation terms?