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Development and Validation of a Brief Culture-of-Safety Survey

Published:April 27, 2022DOI:https://doi.org/10.1016/j.jcjq.2022.04.006

      Abstract

      Background

      Culture of safety (COS) is recognized as a critical component of patient safety but can be burdensome to measure due to survey length. This project aimed to develop a shortened COS survey with comparable measurement properties to a validated 19-item instrument.

      Methods

      Item response theory (IRT) was used to reduce items from a 19-item COS survey at a 10-hospital health system. Using a 50% random sample, IRT was applied to evaluate survey question discrimination and information. Concepts from the key questions in each subdomain were reworded into a new abbreviated scale. Cognitive interviews with clinicians were conducted to validate reworded questions for adequacy, clarity, and consistency of interpretation.

      Results

      The 19-item survey was reduced with IRT to 4 items. Cronbach's alpha for the 4-item IRT–derived scale was 0.80 (average inter-item covariance = 0.36) and was comparable to the original scale despite ∼75% reduction in items. Pearson correlation between the 4-item scale and the original scale was > 0.90. The 4-item scale demonstrated convergent validity. Results were replicated in a 50% random validation sample. Cognitive interviews revealed inadequacy of the shortened scale in assessing error-reporting culture. A fifth item was developed and qualitatively validated for this construct.

      Conclusion

      Using a mixed methods approach, a lengthy COS survey was condensed and revised to a brief 5-question survey with comparable measurement properties and respondent interpretation. A shorter instrument necessarily loses detailed insight into multiple aspects of safety culture, and organizations should consider trade-offs in choosing to develop a briefer survey.
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      References

      1. The Joint Commission. Patient Safety Systems (PS): Culture of Safety. In: Comprehensive Accreditation Manual for Hospitals (E-dition). Oak Brook, IL: Joint Commission Resources, 2022, PS-1–PS-22.

        • Singla AK
        • et al.
        Assessing patient safety culture: a review and synthesis of the measurement tools.
        J Patient Saf. 2006; 2: 105-115
        • Rao SK
        • et al.
        The impact of administrative burden on academic physicians: results of a hospital-wide physician survey.
        Acad Med. 2017; 92: 237-243
        • Woolhandler S
        • Himmelstein DU.
        Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction.
        Int J Health Serv. 2014; 44: 635-642
        • Erickson SM
        • et al.
        Putting patients first by reducing administrative tasks in health care: a position paper of the American College of Physicians.
        Ann Intern Med. 2017 May 2; 166: 659-661
        • Willis GB
        • Artino Jr, AR
        What do our respondents think we're asking? Using cognitive interviewing to improve medical education surveys.
        J Grad Med Educ. 2013; 5: 353-356
        • Adesoye T
        • et al.
        Perceived discrimination experienced by physician mothers and desired workplace changes: a cross-sectional survey.
        JAMA Intern Med. 2017 Jul 1; 177: 1033-1036
        • Willis GB.
        Cognitive Interviewing: A Tool for Improving Questionnaire Design.
        Sage, Thousand Oaks, CA2005
        • Drolet BC
        • et al.
        Surgical residents’ perceptions of 2011 Accreditation Council for Graduate Medical Education duty hour regulations.
        JAMA Surg. 2013; 148: 427-433
      2. Leapfrog Group. Guidelines for a Culture of Safety Survey. (Updated: Apr 1, 2022.) Accessed May 1, 2022. www.leapfroggroup.org/files/guidelines-culture-safety-survey.

        • Cassel CK
        • et al.
        Getting more performance from performance measurement.
        N Engl J Med. 2014 Dec 4; 371: 2145-2147
        • Panzer RJ
        • et al.
        Increasing demands for quality measurement.
        JAMA. 2013 Nov 13; 310: 1971-1980
        • MacLean CH
        • Kerr EA
        • Qaseem A.
        Time out—charting a path for improving performance measurement.
        N Engl J Med. 2018 May 10; 378: 1757-1761
        • Schuster MA
        • Onorato SE
        • Meltzer DO.
        Measuring the cost of quality measurement: a missing link in quality strategy.
        JAMA. 2017 Oct 3; 318: 1219-1220
        • Gartner, Inc.
        Human Resources Research Team. 3 Innovations to Improve Measuring the Employee Experience.
        Gartner, Stamford, CT2021
        • Casalino LP
        • et al.
        US physician practices spend more than $15.4 billion annually to report quality measures.
        Health Aff (Millwood). 2016; 35: 401-406
        • Meyer GS
        • et al.
        More quality measures versus measuring what matters: a call for balance and parsimony.
        BMJ Qual Saf. 2012; 21: 964-968
        • Lai JS
        • Crane PK
        • Cella D.
        Factor analysis techniques for assessing sufficient unidimensionality of cancer related fatigue.
        Qual Life Res. 2006; 15: 1179-1190
        • Reise SP
        • et al.
        Multidimensionality and structural coefficient bias in structural equation modeling: a bifactor perspective.
        Educ Psychol Meas. 2013; 73: 5-26