Assessing Patient Safety Culture

Context: Interest in the measurement of organizational culture that supports patient safety has grown among health care providers. Objective: To review available quantitative instruments for the assessment of patient safety culture. Methods: Surveys were identified through a systematic review, which included a MEDLINE and internet search, expert input, and review of references from relevant articles. For each instrument, we examined target populations, number of questions, safety dimensions covered, reliability and validity testing, and ease of use. Results: Our review yielded 13 instruments, covering a total of 23 individual dimensions of patient safety grouped into the broad categories of management/supervision, risk, work pressure, competence, rules, and miscellaneous. The instruments varied substantially in content (number of dimensions addressed), emphasis, and length. Although most of the surveys have substantial face validity, limited validation of the instruments by comparison with qualitative measures of patient safety culture, such as in-depth interviews or observation, has been done, and few data exist on their ability to predict other existing patient safety outcomes or indicators. Questions about how best to analyze and interpret the results remain. Conclusions: The desire to address safety culture in the hope of improving patient safety will continue to motivate researchers and managers to make use of safety culture surveys. Choice of instruments will depend on the intended use, the target population, reliability, validity, and other considerations. An awareness of the differences between the instruments and their collective limitations should facilitate this endeavor.