Safety Culture Dimensions and Reliabilities

User's Guide: Hospital Survey on Patient Safety Culture

I. Background Variables

  1. What is your primary work area or unit in this hospital?
    H1. How long have you worked in this hospital?
    H2. How long have you worked in your current hospital work area/unit?
    H3. Typically, how many hours per week do you work in this hospital?
    H4. What is your staff position in this hospital?
    H5. In your staff position, do you typically have direct interaction or contact with patients?
    H6. How long have you worked in your current specialty or profession?

II. Outcome Measures

  1. Frequency of Event Reporting
    D1. When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported?
    D2. When a mistake is made, but has no potential to harm the patient, how often is this reported?
    D3. When a mistake is made that could harm the patient, but does not, how often is this reported?

    Reliability of this dimension—Cronbach's alpha (3 items) = .84
  2. Overall Perceptions of Safety
    A15. Patient safety is never sacrificed to get more work done.
    A18. Our procedures and systems are good at preventing errors from happening.
    A10r. It is just by chance that more serious mistakes don't happen around here (reverse worded).
    A17r. We have patient safety problems in this unit (reverse worded).

    Reliability of this dimension—Cronbach's alpha (4 items) = .74
  3. Patient Safety Grade
    E1. Please give your work area/unit in this hospital an overall grade on patient safety.

    Single-item measure-grades A through E as response categories.
  4. Number of Events Reported
    G1. In the past 12 months, how many event reports have you filled out and submitted?

    Single-item measure-numeric response categories.

III. Safety Culture Dimensions (Unit level)

  1. Supervisor/manager expectations & actions promoting safety1
    B1. My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures.
    B2. My supervisor/manager seriously considers staff suggestions for improving patient safety.
    B3r. Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts (reverse worded).
    B4r. My supervisor/manager overlooks patient safety problems that happen over and over (reverse worded).

    Reliability of this dimension—Cronbach's alpha (4 items) = .75
  2. Organizational Learning-Continuous improvement
    A6. We are actively doing things to improve patient safety.
    A9. Mistakes have led to positive changes here.
    A13. After we make changes to improve patient safety, we evaluate their effectiveness.

    Reliability of this dimension—Cronbach's alpha (3 items) = .76
  3. Teamwork Within Hospital Units
    A1. People support one another in this unit.
    A3. When a lot of work needs to be done quickly, we work together as a team to get the work done.
    A4. In this unit, people treat each other with respect.
    A11. When one area in this unit gets really busy, others help out.

    Reliability of this dimension—Cronbach's alpha (4 items) = .83
  4. Communication Openness
    C2. Staff will freely speak up if they see something that may negatively affect patient care.
    C4. Staff feel free to question the decisions or actions of those with more authority.
    C6r. Staff are afraid to ask questions when something does not seem right (reverse worded).

    Reliability of this dimension—Cronbach's alpha (3 items) = .72
  5. Feedback and Communication About Error
    C1. We are given feedback about changes put into place based on event reports.
    C3. We are informed about errors that happen in this unit.
    C5. In this unit, we discuss ways to prevent errors from happening again.

    Reliability of this dimension—Cronbach's alpha (3 items) = .78
  6. Nonpunitive Response To Error
    A8r. Staff feel like their mistakes are held against them (reverse worded).
    A12r. When an event is reported, it feels like the person is being written up, not the problem (reverse worded).
    A16r. Staff worry that mistakes they make are kept in their personnel file (reverse worded).

    Reliability of this dimension—Cronbach's alpha (3 items) = .79
  7. Staffing
    A2. We have enough staff to handle the workload.
    A5r. Staff in this unit work longer hours than is best for patient care (reverse worded).
    A7r. We use more agency/temporary staff than is best for patient care (reverse worded).
    A14r. We work in "crisis mode," trying to do too much, too quickly (reverse worded).

    Reliability of this dimension—Cronbach's alpha (4 items) = .63
  8. Hospital Management Support for Patient Safety
    F1. Hospital management provides a work climate that promotes patient safety.
    F8. The actions of hospital management show that patient safety is a top priority.
    F9r. Hospital management seems interested in patient safety only after an adverse event happens (reverse worded).

    Reliability of this dimension—Cronbach's alpha (3 items) = .83

IV. Safety Culture Dimensions (Hospital-wide)

  1. Teamwork Across Hospital Units
    F4. There is good cooperation among hospital units that need to work together.
    F10. Hospital units work well together to provide the best care for patients.
    F2r. Hospital units do not coordinate well with each other (reverse worded).
    F6r. It is often unpleasant to work with staff from other hospital units (reverse worded).

    Reliability of this dimension—Cronbach's alpha (4 items) = .80
  2. Hospital Handoffs & Transitions
    F3r. Things "fall between the cracks" when transferring patients from one unit to another (reverse worded).
    F5r. Important patient care information is often lost during shift changes (reverse worded).
    F7r. Problems often occur in the exchange of information across hospital units (reverse worded).
    F11r. Shift changes are problematic for patients in this hospital (reverse worded).

    Reliability of this dimension—Cronbach's alpha (4 items) = .80
  1. Adapted from Zohar (2000). A group-level model of safety climate: Testing the effect of group climate on microaccidents in manufacturing jobs. Journal of Applied Psychology 4(85):587-96.

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Current as of September 2004
Internet Citation: Safety Culture Dimensions and Reliabilities: User's Guide: Hospital Survey on Patient Safety Culture. September 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/userguide/hospdim.html