Background
Methods
Respondents
Questionnaire
Background variables
Items on patient safety culture
Data screening and pre-analyses
Statistical analyses
Results
Confirmative factor analysis
Confirmative factor analysis | Explorative factor analysis | |||||
---|---|---|---|---|---|---|
Factor | No of items | Chron-bach α American data | Chron-bach α Dutch data | Factor | No of items | Chron-bach α |
Teamwork across hospital units | 4 | 0.80 | 0.59 | Teamwork across hospital units | 5 | 0.72 |
Teamwork within units | 4 | 0.83 | 0.66 | Teamwork within units | 4 | 0.66 |
Hospital handoffs and transitions | 4 | 0.80 | 0.68 | Adequate shift changes | 2 | 0.65 |
Frequency of event reporting | 3 | 0.84 | 0.79 | Frequency of event reporting | 3 | 0.79 |
Nonpunitive response to error | 3 | 0.79 | 0.69 | Nonpunitive response to error | 3 | 0.69 |
Communication openness | 3 | 0.72 | 0.72 | Communication openness | 3 | 0.72 |
Feedback and communication about error | 3 | 0.78 | 0.75 | Feedback about and learning from error | 6 | 0.78 |
Organisational learning – Continuous improvement | 3 | 0.76 | 0.57 | * | * | * |
Supervisor/manager expectations/actions | 4 | 0.75 | 0.70 | Supervisor/manager expectations/actions | 4 | 0.70 |
Hospital management support for safety | 3 | 0.83 | 0.68 | Hospital management support for safety | 3 | 0.68 |
Staffing | 4 | 0.63 | 0.49 | Adequate staffing | 3 | 0.58 |
Overall perceptions of safety | 4 | 0.74 | 0.62 | Overall perceptions of safety | 4 | 0.64 |
Explorative factor analysis
Item | Mean | SD | F1 | F2 | F3 | F4 | F5 | F6 | F7 | F8 | F9 | F10 | F11 | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
F4 | There is good cooperation among hospital units that need to work together | 3.04 | 0.79 | 0.73 | ||||||||||
F10 | Hospital units work well together to provide the best care for patients | 3.05 | 0.80 | 0.72 | ||||||||||
F2n | Hospital units do not coordinate well with each other | 3.51 | 0.75 | -0.60 | ||||||||||
F3n | Things "fall between the cracks" when transferring patients from one unit to another | 3.49 | 0.80 | -0.52 |
0.51
| |||||||||
F7n | Problems often occur in the exchange of information across hospital units | 3.04 | 0.80 | -0.47 |
0.47
| |||||||||
A3 | When a lot of work needs to be done quickly, we work together as a team to get the work done | 3.91 | 0.59 | 0.73 | ||||||||||
A1 | People support one another in this unit | 4.00 | 0.60 | 0.71 | ||||||||||
A11 | When one area in this unit gets really busy, others help out | 3.78 | 0.68 | 0.63 | ||||||||||
A4 | In this unit, people treat each other with respect | 3.87 | 0.62 | 0.59 | ||||||||||
F11n | Shift changes are problematic for patients in this hospital | 2.45 | 0.72 | 0.76 | ||||||||||
F5n | Important patient care information is often lost during shift changes | 2.59 | 0.85 | 0.71 | ||||||||||
D2 | When a mistake is made, but has no potential to harm the patient, how often is this reported? | 2.89 | 1.07 | 0.88 | ||||||||||
D3 | When a mistake is made that could harm the patient, but does not, how often is this reported? | 3.42 | 1.00 | 0.79 | ||||||||||
D1 | When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported? | 2.40 | 1.06 | 0.67 | ||||||||||
A16n | Staff worry that mistakes they make are kept in their personnel file | 2.37 | 0.77 | 0.74 | ||||||||||
A12n | When an event is reported, it feels like the person is being written up, not the problem | 2.58 | 0.83 | 0.74 | ||||||||||
A8n | Staff feel like their mistakes are held against them | 2.22 | 0.81 | 0.68 | ||||||||||
F6n | It is often unpleasant to work with staff from other hospital units | 2.43 | 0.67 | -0.62 | ||||||||||
C2 | Staff will freely speak up if they see something that may negatively affect patient care | 3.95 | 0.67 | 0.59 | ||||||||||
C4 | Staff feel free to question the decisions or actions of those with more authority | 3.56 | 0.77 | 0.58 | ||||||||||
C6n | Staff are afraid to ask questions when something does not seem right | 2.26 | 0.73 | -0.56 | ||||||||||
C3 | We are informed about errors that happen in this unit | 3.39 | 0.98 | 0.73 | ||||||||||
C1 | We are given feedback about changes put into place based on event reports | 2.99 | 1.06 | 0.70 | ||||||||||
C5 | In this unit, we discuss ways to prevent errors from happening again | 3.69 | 0.80 | 0.65 | ||||||||||
A9 | Mistakes have led to positive changes here | 3.38 | 0.72 | 0.53 | ||||||||||
A13 | After we make changes to improve patient safety, we evaluate their effectiveness | 3.13 | 0.84 | 0.52 | ||||||||||
A6 | We are actively doing things to improve patient safety | 3.45 | 0.81 | 0.47 | ||||||||||
B3n | Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts | 2.21 | 0.72 | -0.69 | ||||||||||
B2 | My supervisor/manager seriously considers staff suggestions for improving patient safety. | 3.79 | 0.61 | 0.67 | ||||||||||
B4n | My supervisor/manager overlooks patient safety problems that happen over and over | 2.25 | 0.74 | -0.64 | ||||||||||
B1 | My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures | 3.02 | 0.92 | 0.59 | ||||||||||
F8 | The actions of hospital management show that patient safety is a top priority | 2.73 | 0.81 | 0.74 | ||||||||||
F9n | Hospital management seems interested in patient safety only after an adverse event happens | 3.07 | 0.82 | -0.71 | ||||||||||
F1 | Hospital management provides a work climate that promotes patient safety | 3.21 | 0.81 | 0.53 | ||||||||||
A5n | Staff in this unit work longer hours than is best for patient care | 2.22 | 0.73 | 0.72 | ||||||||||
A2 | We have enough staff to handle the workload | 3.40 | 0.92 | -0.67 | ||||||||||
A7n | We use more agency/temporary staff than is best for patient care | 2.00 | 0.86 | 0.66 | ||||||||||
A17n | We have patient safety problems in this unit | 2.60 | 0.87 | 0.68 | ||||||||||
A18 | Our procedures and systems are good at preventing errors from happening | 2.97 | 0.83 | -0.61 | ||||||||||
A10n | It is just by chance that more serious mistakes don't happen around here | 2.47 | 0.81 | 0.60 | ||||||||||
A14n | We work in "crisis mode" trying to do too much, too quickly | 2.57 | 0.79 | 0.48 | ||||||||||
A15 | Patient safety is never sacrificed to get more work done | 3.19 | 0.95 | -0.36 |
Construct validity
Factor | Mean | SD | Patient safety grade | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Teamwork across hospital units | 2.82 | 0.54 | 0.29 | ||||||||||
2 | Teamwork within units | 3.89 | 0.44 | 0.22 | 0.14 | |||||||||
3 | Adequate shift changes | 3.48 | 0.68 | 0.25 | 0.39 | 0.20 | ||||||||
4 | Frequency of event reporting | 2.91 | 0.88 | 0.26 | 0.16 | 0.11 | 0.15 | |||||||
5 | Nonpunitive response to error | 3.61 | 0.63 | 0.19 | 0.15 | 0.29 | 0.20 | 0.22 | ||||||
6 | Communication openness | 3.76 | 0.58 | 0.34 | 0.22 | 0.34 | 0.30 | 0.24 | 0.37 | |||||
7 | Feedback about and learning from error | 3.34 | 0.61 | 0.40 | 0.28 | 0.25 | 0.20 | 0.43 | 0.30 | 0.46 | ||||
8 | Supervisor/manager expectations/actions | 3.58 | 0.55 | 0.37 | 0.17 | 0.35 | 0.19 | 0.19 | 0.36 | 0.46 | 0.47 | |||
9 | Hospital management support for patient safety | 2.96 | 0.64 | 0.36 | 0.35 | 0.15 | 0.25 | 0.29 | 0.22 | 0.34 | 0.47 | 0.36 | ||
10 | Adequate staffing | 3.73 | 0.62 | 0.16 | 0.10 | 0.10 | 0.09 | 0.01†
| 0.24 | 0.15 | 0.01†
| 0.22 | 0.16 | |
11 | Overall perceptions of safety | 3.33 | 0.57 | 0.56 | 0.31 | 0.24 | 0.27 | 0.22 | 0.32 | 0.32 | 0.36 | 0.38 | 0.38 | 0.33 |
Discussion
American factor structure | Dutch factor structure | ||
---|---|---|---|
Factor | Items | Factor | Items |
Feedback about and communication about error | C1, C3, C5 |
Feedback about and learning from error
| C1, C3, C5, A6, A9, A13 |
Organisational learning – Continuous improvement | A6, A9, A13 | * | * |
Overall perceptions of safety | A10, A15, A17, A18 | Overall perceptions of safety | A10, A14, A17, A18 |
Teamwork across hospital units | F2, F4, F6, F10 | Teamwork across hospital units | F2, F3, F4, F7, F10 |
Hospital handoffs and transitions |
F3, F5, F7, F11 |
Adequate shift changes
| F5, F11 |
Staffing | A2, A5, A7, A14
|
Adequate staffing
| A2, A5, A7 |