Introduction
Method
Literature search
Inclusion and exclusion criteria
Synthesis of study results and framework for analysis
Results
Literature search, selection and classification
Framework for analysis and outcomes
Validation analysis
First author (year) | 1. Country 2. Setting 3. Participants | SAQ version | 1. Sample size 2. Completed questionnaires 3. Response rate | 1. Psychometric test results (Cutoff values) 2. Reliability 3. EFA 4. CFA | 1. Analyses 2. Factor structure 3. Confirmed (Yes/No) |
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Gabrani (2016) [35] | 1. Albania 2. Primary health care centers 3. Specialist physicians, general physicians and nurses | SAQ-A | 1. NA 2. 526 3. 99.4% | 1. Cronbach’s α=0.62-0.82 (0.7) 2. NA 3. SRMR=0.078, RMSEA=0.049 (0.10), CFI=0.98 (0.90) | 1. CFA 2. 6 factors 3. Yes |
Mesaric (2020) [36] | 1. Croatia 2. Out-of-hours primary care service 3. Medical doctors and support medical staff (including registered nurses and administrative staff) | SAQ-AV | 1. 358 2. 185 3. 51.7% | 1. Cronbach’s α=0.79-0.93, Cronbach’s α-total=0.95 (0.7) 2. Kaiser-Meyer-Olkin measure=0.82 (0.5), McDonalds’ ω=0.13-0.56, CITC=0.11-0.72 (0.3) 3. NA | 1. EFA 2. 6 factors 3. NA |
Hussein (2022) [37] | 1. Egypt 2. Primary health care units and general Hospital (tertiary level of care) 3. Physicians, dentists, pharmacists, nurses and technicians | CSAQ | 1. 240 2. NA 3. NA | 1. Cronbach’s α-total=0.915 (NA) 2. NA 3. NA | 1. NA 2. 7 factors 3. NA |
Demurtas (2020) [38] | 1. Italy 2. Out-of-hours service 3. Out-of-hours doctors | SAQ-AV | 1. 692 2. 491 3. 71% | 1. Cronbach’s α=0.710-0.917 (NA) 2. Kaiser-Meyer-Olkin measure=0.843 3. CFI=0.815 (close to 1), TLI=0.799 (close to 1), RMSEA=0.077 (0.10) | 1. EFA and CFA 2. 4 factors 3. Yes |
Khamaiseh (2020) [39] | 1. Jordan 2. Primary health care centers 3. Registered nurses, assistant nurses and associated nurses | SAQ-SF | 1. NA 2. 644 3. NA | 1. Cronbach’s α-total=0.90 (NA) 2. NA 3.NA | 1. NA 2. 6 factors 3. NA |
Bondevik (2014) [11] | 1. Norway 2. Clinics: Out-of-hours casualty clinics and regular general practices 3. Nurses, medical doctors and “unknown” | 1. SAQ-AV | 1. 510 2. 266 3. 52% | 1. Cronbach’s α=0.67-0.83, Cronbach’s α-total=0.886 (0.70) 2. NA 3. CFI=0.86, P-value <0.001, RMSEA=0.07, χ2/df=1.82 | 1. CFA. 2. 5 factors 3. Yes |
Bondevik (2019) [41] | 1. Norway 2. Nursing homes 3. Registered nurses, nursing assistants, health workers, kitchen personnel, laundry personnel, secretary and other personnel | SAQ-A | 1. 463 2. 288 3. 62.2% | 1. Cronbach’s α=0.655-0.786 (good if between 0.70 and 0.90, and acceptable if above 0.60) 2. NA 3. CFI=0.891 (0.90), P-value<0.001, χ2/df=1.846 (0.05), RMSEA=0.054 (0.08), Pclose=0.144 (>0.05), Hoelter 0.05=176 (200) | 1. CFA 2. 6 factors 3. Yes |
Ogaji (2021) [29] | 1. Nigeria 2. Primary and tertiary level of care: The Federal Medical Center and selected health centers 3. Doctors, nurses, laboratory staff, pharmacy staff, community health practitioners and support staff | SAQ-AV | 1. 812 2. 436 3. 53.7% | 1. Cronbach’s α=0.62-0.76, Cronbach’s α-total=0.91 (0.70) 2. NA 3. NA | 1. NA 2. 8 factors 3. NA |
Ferreira (2022) [34] | 1. Portugal 2. Primary health care units 3. Physicians, doctors in pre-career training, nurses and technical assistants | SAQ-SF | 1. 7427 2. 649 3. 8.7% | 1. Cronbach’s α=0.069-0.788, Cronbach’s α(tot)=0.86 (0.70) 2. Na 3. NA | 1. NA 2. 6 factors 3. NA |
AlMaani (2021) [30] | 1. Saudi Arabia 2. Primary health-care centers distributed among one region in three sectors 3. Physicians, nurses, pharmacists, and allied health personnel employees | SAQ | 1. 344 2. 288 3. NA | 1. Cronbach’s α=0.73-0.85, Cronbach’s α-total=0.86 (0.70) 2. NA 3. NA | 1. NA 2. 6 factors 3. NA |
Klemenc-Ketis (2017) [31] | 1. Slovenia 2. Out-of-hours primary care clinics 3. Physicians, graduate nurses, nurse managers, trainees, nurses, radiology technicians and office managers | SAQ-AV | 1. 438 2. 250 3. 57.1% | 1. Cronbach’s α=0.587-0.791, Cronbach’s α-total=0.922 (NA) 2. Kaiser-Meyer-Olkin measure = 0.897 (NA), Bartlett test<0.001 (NA) 3. NA | 1. EFA 2. 5 factors 3. NA |
Klemenc-Ketis (2018) [17] | 1. Slovenia 2. Community health centers covering one municipality 3. All employees with a leadership role (e.g., physicians, dentists, registered nurses, nurse assistants, administrative staff etc.) | SAQ-SF | 1. 211 2. 154 3. 73.0% | 1. Cronbach’s α=0.781-0.874, Cronbach’s α-total=0.963 (0.7=acceptable, 0.8=good and 0.9=excellent) 2. Kaiser-Meyer-Olkin measure=0.824 (0.8), Bartlett test<0.001 (0.001) 3. P value < 0.001 relative chi-square= 1.636, CFI = 0.874 (0.90-1.00), NFI = 0.737 (0.90), RMSEA= 0.064 (0.05) | 1. EFA and CFA 2. 6 factors 3. No |
Nordén-Hägg (2010) [32] | 1. Sweden 2. Pharmacies 3. Pharmacists, prescriptionists, pharmacy technicians, pharmacy assistants and "Others" | SAQ-SF | 1. 6683 2. 4090 3. 61.2% | 1. Cronbach’s α=0.72-0.89 (NA) 2. NA 3. CFI=0.886-0.903 (0.90), RMSEA=0.050-0.060 (0.08) | 1. CFA 2. 6 factors 3. Yes |
Buljac-Samardzic (2016) [18] | 1. The Netherlands 2. Nursing and residential homes 3. Employees who provide direct care to clients. Teams of nurse’s aides, registered nurses and a geriatric specialist (doctor). Occupational, speech and physical therapist and licensed practical nurses | SAQ-AV | 1. NA 2. 521 3. 53% | 1. Cronbach’s α=0.56-0.80 (0.70/0.50) 2. Kaiser-Meyer-Olkin measure=NA (0.60), Bartlett’s test=NA (0.40) 3. NA | 1. EFA 2. 6 factors 3. NA |
Smits (2017) [28] | 1. The Netherlands 2. Out-of-hours general practitioner cooperatives and call centers 3. General practitioners, triage nurses and other personnel | SAQ-AV | 1. 1974 2. 853 3. 43.2% | 1. Cronbach’s α=0.49-0.86 (0.70) 2. Kaiser-Meyer-Olkin measure=0.90 (0.5), Bartlett’s test: χ2=478.3; df= 351; p < .001. 3. Details not reported | 1. EFA and CFA 2. 5 factors 3. No |
Singh (2008) [33] | 1. USA 2. Primary care offices 3. Physicians, nursing staff, admin staff, unknown position | SAQ-A | 1. 252 2. 160 3. 63% | 1. Cronbach’s α=0.58-0.77 (0.70) 2. NA 3. NA | 1. NA 2. 6 factors 3. NA |
Modak (2007) [10] | 1. USA 2. Academic, urban, outpatient practices 3. Physicians, nurses, managers, medical assistants | SAQ-A | 1. 282 2. 2513. 69% | 1. Cronbach’s α=0.68-0.86 (NA) 2. NA 3. CFI=0.973 (0.90), TLI=0.977 (0.90), RMSEA=0.067 (0.08) | 1. CFA 2. 6 factors 3. Yes |
Descriptive analysis
First author (year) | 1. Country 2. Setting 3. Participants | SAQ version | 1. Sample size 2. Completed questionnaires 3. Response rate | Results – short summary |
---|---|---|---|---|
Paese (2013) [42] | 1. Brazil 2. Primary health centres 3. Community health agents, nursing technicians, nurses | SAQ | 1. NA 2. 96 3. NA | No difference between the three professional categories regarding perceived attitudes toward safety when analysed in a general context. Working conditions, patient safety culture, communication and management of the healthcare centre safety attitudes were perceived differently by the community health agents compared to nursing technicians and nurses. |
Mazzuco de Souza (2019) [43] | 1. Brazil 2. Primary health care 3. Nurses, nursing technicians, community health agent, doctors, dentists, oral health assistants, nursing auxiliaries, physiotherapists, physical educators, doctors, psychologists, pharmacists, nutritionists, social workers, speech therapists | SAQ-AV | 1. 342 2. 254 3. 74.3% | No associations were found between positive culture and gender, age, degree of education or professional group. Positive culture was related to sector of performance and having five to 12 years of work. |
Lousada (2020) [44] | 1. Brazil 2. Primary health care centres and home care settings 3. Community health agents, nursing technicians, physicians, nurses, physiotherapists, administrative supporters, psychologists, social workers, speech therapist, other | SAQ | 1. 164 2. 147 3. 86.1-86.6% | Job satisfaction obtained the highest value. Perception of management and working conditions had the lowest scores, and this result was related with long time of experience. Males gave higher scores for safety climate, perception of stress, management perception and total SAQ than women. Home care professionals gave higher scores than primary care professionals for all domains, except perception of stress. |
El Shafei (2019) [45] | 1. Egypt 2. Primary health care facilities 3. Physicians, nurses, pharmacists, managers | SAQ-AV | 1. 204 2. 130 3. 63.7% | Participants belonging to age group older than or equal to 50 scored higher in both job satisfaction and working conditions. Managers showed the highest response rate (100%). |
Hussein (2022) [37] | 1. Egypt 2. Primary health care units and general hospital (tertiary level). 3. Physicians, dentists, pharmacists, nurses, technicians | CSAQ | 1. NA 2. 240 (120/120) 3. NA | The total mean score of patient safety attitude was higher among those aged ≥ 40 years, male respondents, married, MD educated, nurses and those who had patient safety training. Tertiary health care workers had higher mean scores of teamwork climate, perception of management, job satisfaction, working conditions, and stress recognition’ and the overall CSAQ score. |
Demurtas (2020) [38] | 1. Italy 2. Out-of-hours service setting 3. Physicians | SAQ-AV | 1. 692 2. 491 3. 71% | Males scores were higher than females scores for communication, safety climate, Perception of management and burnout risk. Providers in the 31-40 age group had lower factor mean score for communication, safety climate and perception of management than younger and older providers. Providers with more years of working experience had higher mean score for communication and safety climate than those with less experience. Providers with more than 20 years of work in the same clinic had higher mean score of perception of management than providers working fewer years. |
Khamaiseh (2020) [39] | 1. Jordan 2. Primary health-care centres 3. Nurses | SAQ-SF | 1. NA 2. 644 3. NA | No significant difference in the perception of patient safety was found between genders or age groups. Educational level was associated to safety climate and perception of management and job position was associated to perceptions of management. |
Alameddine (2015) [46] | 1. Lebanon 2. Primary health-care centres 3. Physicians, dentists, nurses, technicians, nutritionists, pharmacists, social workers, midwives | SAQ-A | 1. NA 2. 943 3. 44% | The highest response rate was from nurses (82 %) followed by specialists (43 %). Dentists, general practitioners, and allied health professionals had response rates of 34-36%. Providers with the highest SAQ score had higher odds to report a higher readiness on the appropriateness, efficacy, management, and personal valence Readiness for Organization Change subscales |
Samsuri (2015) [47] | 1. Malaysia 2. Public hospitals and health clinics 3. Pharmacists | SAQ (Pharmacy version) | 1. 140 2. 117 3. 83.6% | Apart from stress recognition, those who worked in health clinics scored higher than those in hospitals. Higher scores (overall score as well as score for each domain except for stress recognition) were associated with fewer numbers of medication errors reported. In contrast stress recognition was associated with increased number of medication errors reported. |
Ogaji (2021) [29] | 1. Nigeria 2. The Federal Medical Centre and health centres (primary and tertiary) 3. Doctors, nurses, laboratory staff, pharmacy staff, community health practitioners, support staff | SAQ-AV | 1. 812 2. 436 3. 53.7% | 76.5% from the primary health care facilities and 40.2% from the tertiary responded to the questionnaire. Scores were significantly higher in primary health care facilities compared to tertiary health care facilities except for job satisfaction. |
Bondevik (2014) [40] | 1. Norway 2. Out-of-hours casualty clinics and general practices 3. Doctors, nurses (incl. registered nurses, medical secretaries, and bioengineers) | SAQ-AV | 1. 510 2. 266 3. 52% | 72% of the nurses and 39% of the doctors answered the questionnaire. Health care providers in general practitioner practices had significant higher mean scores on the factors safety climate and working conditions, compared with those working in the out-of-hours clinics. In general practitioner practices, male health professionals scored significantly higher than female on teamwork climate, safety climate, perceptions of management and working conditions. Older health care providers scored significantly higher than younger on safety climate and working conditions. In the out-of-hours clinics, nurses scored significantly higher than doctors on Safety climate and Job satisfaction. |
Bondevik (2017) [48] | 1. Norway 2. Nursing homes 3. Registered nurses, nursing assistants, health workers, kitchen personnel, other personnel | SAQ-AV | 1. 463 2. 288 3. 62.2% | Response rates varied between 56.9% and 72.2% across the five nursing homes. Increasing age and higher job position among the healthcare providers were associated with significantly increased mean scores for the patient safety factors teamwork climate, safety climate, job satisfaction and working conditions. Not being a Norwegian native speaker was associated with a significantly higher mean score for Job satisfaction and a significantly lower mean score for stress recognition. Neither professional background nor work experience were significantly associated with mean scores for any patient safety factor. |
Ferreira (2022) [34] | 1. Portugal 2. Primary health care units 3. Physicians, doctors in pre-career training, nurses and technical assistants working | SAQ-SF | 1. 7427 2. 676 3. 9.1% | The lowest scores in team environment were obtained for the categories of nurse, technical assistant, and customized healthcare units. The lowest median score in the safety climate domain was obtained in the customized healthcare units The lowest scores in the Job satisfaction domain were obtained among male respondents and in the customized healthcare units. The lowest median scores in management perception were obtained among male respondents and in the customized healthcare units. In the stress recognition domain, as the age of the respondent increased, the obtained SAQ-SF median score decreased, and as the length of service at the respondent’s current workplace increased, so did the obtained score. The total SAQ-SF median scores were higher among female respondents, in one workplace and in two types of primary care units. |
AlMaani (2021) [30] | 1. Saudi Arabia 2. Primary health-care centres 3. Nurses, technologists, physicians, pharmacists, others | SAQ | 1. NA 2. 288 3. NA | The score of teamwork and stress recognition was higher among females. Whereas perception of management was higher among males. All factors and the overall score were higher in providers less than 40 years compared to older providers. Perception of management was lower among physicians. The overall score for safety attitudes was higher among those with less than 10 years' experience. The overall safety culture score was significantly higher among managers. |
Elsayed (2020) [55] | 1. Saudi Arabia 2. Primary health-care centres 3. Nurses | SAQ | 1. NA 2. NA 3. 314 | A difference between nurses’ attitude and gender was found, also there was a difference between nurses’ attitude and years of experience. No difference between nurses’ attitude and their age, educational qualifications, and staff position. |
Klemenc-Ketis (2017) [49] | 1. Slovenia 2. Out-of-hours-health care clinics 3. Physicians, nurse practitioners, nurse managers, trainees, practice nurses, radiology technicians, office managers | SAQ-AV | 1. 438 2. 250 3. 57.1% | Differences were found across different Slovenian regions in perception of management, job satisfaction, communication, and the overall total SAQ-AV score. Physicians, practice nurses, those working in variable shifts and those working full-time had significantly higher total SAQ-AV scores when compared to the other categories. |
Klemenc-Ketis (2017) [50] | 1. Slovenia 2. Out-of-hours health care clinics 3. Physicians, nurse practitioners (nurses with a bachelor’s degree), practice nurses | SAQ-AV | 1. 438 2. 250 3. 57.1% | Overall perceived safety culture was not different between professional groups. Perceptions of management was scored significantly lower by nurse practitioners than by physicians and practice nurses, whereas physicians scored safety climate significantly lower than practice nurses and nurse practitioners |
Zúñiga(2015) [56] | 1. Switzerland 2. Nursing homes 3. Care workers of all educational levels (e.g., registered nurses (25%), licensed practical nurses, nurse aides) if they worked in direct care of the nursing home residents. | SAQ | 1. 4307 (from 402 care units and 74 additional teams in 156 nursing home facilities) 2. NA 3. 78% | A combined factor of Teamwork and Resident Safety Climate with a total of 10 items was used. The facility response rate ranged from 40% to 100%. Higher teamwork and safety climate were only related to lower rationing in the subscales activities of daily living and caring, rehabilitation, and monitoring. In contrast, better teamwork and safety climate was related to higher rationing in social care. |
Buljac-Samardzic et al. 2015 [18] | 1. The Netherlands 2. Nursing and residential homes 3. Employees who provide direct care to clients. Licensed nurses, aides, registered nurses | SAQ-AV | 1. 983 2. 521 3. 53% | The response rate per organisation varied from 40.2% to 81.4% Overall, the scores from the nursing and residential homes differed significantly from the benchmark settings. The safety climate and working conditions in nursing and residential homes were significantly higher rated than in the inpatient setting, but significantly lower than in the intensive care unit and ambulatory setting. Nursing homes scored significantly higher on teamwork climate, job satisfaction and perception of management in comparison with residential homes. |
Smits (2018) [51] | 1. The Netherlands 2. Out-of-hours general practitioner cooperatives 3. GPs, triage nurses | SAQ-AV | 1. 1974 2. 853 3. 43% | Gender was not associated with any of the patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. More working experience was positively related to higher team- work climate and communication openness. |
Modak (2007) [10] | 1. USA 2. Academic, urban, outpatient practice 3. Physicians, nurses, manager, medical assistants, support staff | SAQ-A | 1. 409 2. 282 3. 69% | Physicians had the least favourable attitudes about perceptions of management while managers had the most favourable attitudes. Nurses had the most positive stress recognition. All providers had similar attitudes toward teamwork climate, safety climate, job satisfaction, and working conditions. |
Singh (2008) [33] | 1. USA 2. Primary care offices 3. Physician, nursing staff, administrative staff, unknown position | SAQ-A | 1. 252 2. 160 3. 63% | Comparing eight practices, differences were found among sites on all subscales except stress recognition. No differences among respondent groups on any subscale were found. |
Holden (2009) [52] | 1. USA 2. Air Force ambulatory care facilities 3. Physicians, nurse practitioners, physician assistants, registered nurses, pharmacists, technicians | SAQ | 1. 328 2. 213 3. 65% | Differences on total safety scores based on age, with staff members younger than 31 years scoring lower on the overall safety score as compared with the 32- to 41-year age group and those 42- to 63-year age group. No significant differences among the professional groups on the total patient safety scores or on 5 of the 6 subscales. Significant difference on the Stress recognition subscale, with technicians scoring less than 4 of the 5 other professional groups. |
Holden (2010) [53] | 1. USA 2. Military ambulatory care clinics 3. Nurses, nurse practitioners, pharmacists, physicians | SAQ | 1. NA 2. 107 3. 65% | No significant difference among professional groups on the total weighted safety score or any of the subscales. There were, however, five specific questions with significant group differences: Pharmacists reported higher support to care for patients, morale, and knowledge of the names of their co-workers. Additionally, they were less likely to recognise the impact of fatigue on routine performance and more likely to report making errors that had potential to harm patients. Nurse practitioners and nurses were comparable to pharmacists, with the former also scoring high on the teamwork question related to name recognition and the latter scoring low in recognizing the impact of fatigue on performance. |
Miller (2019) [54] | 1. USA 2. Academically affiliated ambulatory care 3. Administrative support staff, clinical support staff, managers, providers | SAQ | 1. 828 2. 722 3. 87% | Associations were found between safety reporting rates and SAQ scores for overall culture and four safety culture domains: Teamwork climate, safety climate, working conditions, and perceptions of local management. Thus, for every 1-percentage-point increase in overall culture score, there was a 1.9% increase in monthly safety reports. The stress recognition and perceptions of senior management domains did not show a significant correlation with event reporting |
Variance assessment
First author (year) | 1. Country 2. Setting 3. Participants | SAQ version | Sample size | Results – ICC values | Variation |
---|---|---|---|---|---|
Deilkås (2019) [23] | 1. Norway 2. General practices and out-of-hours clinics 3. Medical doctors, registered nurses, medical secretaries, and bioengineers | SAQ-A | 510 primary health care providers were invited. 17 GP practices and 7 Out-of-hours clinics. 266 answered | Teamwork climate | 14.4% |
Safety climate | 16.4% | ||||
Job satisfaction | 7.1% | ||||
Working condition | 14.6% | ||||
Perception of management | 12.1% | ||||
Stress recognition | NA | ||||
Deilkås (2019) [22] | 1. Norway 2. Nursing homes 3. Most of invited employees were registered nurses or nursing assistants | SAQ-A | 5 nursing homes where 765 employees were nested in 34 wards | Teamwork climate | 2.76% |
Safety climate | 11.60% | ||||
Job satisfaction | 7.61% | ||||
Working condition | 12.81% | ||||
Perception of management | 14.07% | ||||
Stress recognition | 0.00% | ||||
Buljac-Samardzic (2016) [18] | 1. The Netherlands 2. Nursing and residential homes 3. Nurse’s aides, registered nurses, and a geriatric specialist (doctor) | SAQ-A | 521 caregivers representing 53 teams and 9 units | Teamwork climate | Unit level: 6%, Team level: 15% |
Safety climate | Unit level: 8%, Team level: 11% | ||||
Job satisfaction | Unit level: 10%, Team level: 19% | ||||
Working condition | Unit level: 12%, Team level: 20% | ||||
Perception of management | Unit level: 10%, Team level: 21% | ||||
Stress recognition | Unit level: 1%, Team level: 3% |
Intervention evaluation
First author (year) | 1. Country 2. Setting 3. Participants | SAQ version | 1. Sample size 2. Completed questionnaires 3. Response rate | Intervention/event | Method for analysis | Results |
---|---|---|---|---|---|---|
Tan (2020) [60] | 1. Singapore 2. Public hospitals and primary health care services involved in the care of Covid-19 cases 3. Doctors, nurses, allied health professionals, support staff, administrative and managerial staff | SAQ | 1. 11286 2. 3075 3. 27.2% | COVID-19 | Crude and adjusted predictors were performed using mixed linear models with institution as a random effect | High SAQ scores were significantly associated with lower scores of Oldenburg Burnout Inventory |
Abhiram (2022) [57] | 1. Singapore 2. Public hospitals and primary health care services involved in the care of Covid-19 cases 3. Doctors, nurses, allied health professionals, support staff, and administrative staff | SAQ | 1. 10.172 (not provided but calculated) 2. 1475 3. 14.5% | COVID-19 | Predictors were investigated using generalized linear mixed model with institution as a random effect | Higher proportion of respondents who scored 75% or above for the safety culture score in each domain when comparing mental well-being in 2021 against the previously published cohort in 2020. Achieving a percentage agree in several SAQ domains had a significant negative association with the primary outcomes |
Alboksmaty (2021) [58] | 1. UK 2. General practice 3. General practitioners | Interviews based on a framework adapted from the SAQ | 1. 14 2. NA 3. NA | COVID-19 | A directed content analysis approach was adopted to analyse the interview transcripts | The COVID-19 pandemic affected all levels of the health system in the UK, particularly primary care. |
McGuire (2012) [16] | 1. USA 2. Medical group practice 3. Primary care providers no further information not provided | SAQ-A | 1. T1:123; T2:143; T3:181 2. T1:103; T2:122; T3:142 3. T1: 83.7%; T2: 85.3%; T3:78.5% | Electronic medical record implementation | Chi-square test to calculate P-values assuming independent samples from all three years | All patient safety climate factors improved significantly over the period after implementation of electronic medical record, except for stress recognition |
Pitts (2017) [59] | 1. USA 2. General internal medicine academic practice 3. Physicians, nurse practitioner, medical assistants, medical office coordinators, front-desk staff member | SAQ | 1. 26 2. 25 3. 96.2% | Comprehensive Unit-based Safety Program (CUSP) | Information not provided but providers and staff completed the survey three months before CUSP implementation and six months following the kick-off of CUSP | Following CUSP implementation, respondents were more likely to report knowledge of the proper channels for questions about patient safety, feel encouraged to report safety concerns and believe that the work setting made it easy to learn from the errors of others, although these differences did not reach statistical significance |