Assessment of the safety climate in outpatient diagnostic services: Development and psychometric evaluation of a questionnaire
- 133 Downloads
Safe practice and safety culture are important issues in outpatient diagnostic imaging services. As questionnaires assessing safety culture through the measurement of safety climate in this setting are not yet available, the present study aimed to develop and validate such an instrument.
Materials and methods
After adaptation of an existing questionnaire and qualitative pretesting, the instrument was tested by collaborators from three outpatient imaging services in Switzerland. Results were first assessed using descriptive statistics. Scores of individual services were compared using a Wilcoxon test assessing differences between rank distributions. The final instrument was tested for validity using inter-rater agreement measures, such as reliability within groups (rWG), and an intraclass correlation coefficient measure (ICC(1)). These measures allowed the assessment of validity of aggregation into a total score (rWG(j)) and validated the instrument for its capacity to distinguish various safety climates of different groups by comparing inter-rater agreement in the overall sample to inter-rater agreement of individual services (rWG) and by measuring group effects (ICC(1)). Furthermore, the final instrument was tested for internal consistency and reliability using Cronbach’s Alpha.
Safety climate scores vary significantly between services. Inter-rater agreement measures show that item aggregation is justified and that the instrument distinguishes various patterns of safety climate. The final instrument proves to be valid, consistent and reliable.
The final instrument presents a valid, consistent and reliable option to measure safety climate in outpatient diagnostic imaging services. Results can be used as a basis for quality improvement.
• An adapted questionnaire that assesses safety climate in outpatient diagnostic imaging services was developed and tested in Switzerland.
• Psychometric evaluation showed the questionnaire to be a valid, consistent and reliable instrument.
• Results are of interest for imaging services as well as for stakeholders interested more globally in monitoring and quality improvement.
KeywordsOutpatient service Safety Psychometrics Organisational culture Surveys and questionnaires
Institut Institut für angewandte Qualitätsförderung
Culture of Safety Survey
Externe Qualitätssicherungin der ambulanten Medizin
Hospital Survey on Patient Safety
Intraclass correlation coefficient
Reliability within groups
Reliability within groups for multiple judgments
Safety Attitude Questionnaire
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Marianne Jossen
Conflict of interest
The authors of this manuscript declare relationships with the following companies:
Marianne Jossen works for the EQUAM foundation, which uses the developed questionnaires as products.
Statistics and biometry
One of the authors, Fabio Valeri, has significant statistical expertise.
Written informed consent was not required for this study because data collection was anonymous, and participation was voluntary and did not include medical data.
Institutional Review Board approval was not required because data collection was anonymous, and participation was voluntary and did not include medical data.
• Cross-sectional study
• Multicentre study
- 1.Foederatio Medicorum Helveticorum FMH (2017) Ärztestatistik 2016. Foederatio Medicorum Helveticorum, Bern. Available at http://aerztestatistik.myfmh2.fmh.ch. Accessed 13 march 2018
- 2.Bundesamt für Gesundheit BAG (2017) [Change of the Ordinance on the Determination and Adaptation of Structures of the Reimbursement System of the Health Insurance]. Bundesamt für Gesundheit, BernGoogle Scholar
- 3.George R, Lau L, Ng K (2014) Team approach to optimize radiology techniques. In: Lau L, Ng K (eds) Radiological safety and quality. Paradigms in leadership and innovation. Springer, DordrechtGoogle Scholar
- 4.Gehring K, Schwappach D, Battaglia M et al (2012) Frequency of harm associated with primary care safety incidents. Am J Manag Care 19:323–337Google Scholar
- 8.Azevedo KB, da Silva CA, Abrantes A (2017) Assessing the hospital survey of patient safety culture. A review of the assumptions, methods and data analysis protocol. Desenvolvimento e Sociedade 3:7-31Google Scholar
- 9.Colla JB, Bracken AC, Kinney LM, Weeks WB (2005) Measuring patient safety climate: A review of surveys. Qual Saf Health Care 14:364–366Google Scholar
- 13.Weingart SN, Farbstein K, Davis RB, Phillips RS (2004) Using a multihospital survey to examine the safety culture. Jt Comm J Qual Saf 30:125–132Google Scholar
- 16.Gehring K, Mascherek A, Bezzola P, Schwappach D (2015) Safety climate in Swiss hospital units: Swiss version of the safety climate survey. J Eval Clin Pract 21:332–338Google Scholar
- 21.De Wet C, Spence W, Mash R, Johnson P, Bowie P (2010) The development and psychometric evaluation of a safety climate measure for primary care. Qual Saf Health Care 19:578–854Google Scholar
- 22.Häder M (2006) Empiric social research – An introduction. Verlag für Sozialforschung, WiesbadenGoogle Scholar
- 24.Sorra J, Gray L, Streagle S et al (2016) AHRQ Hospital Survey on Patient Safety Culture: User’s Guide. AHRQ Publication No. 15-0049-EF. Rockville, MD: Agency for Healthcare Research and QualityGoogle Scholar
- 26.Hollander M, Douglas AW (1973) Nonparametric statistical methods. Wiley, New YorkGoogle Scholar
- 27.LeBreton JM, Senter JL (2008) Answers to 20 questions about inter-rater reliability and inter-rater agreement. Organizational Research Methods 11:815–852Google Scholar
- 32.Mascherek AC, Schwappach DLB (2017) Patient safety climate profiles across time: Strength and level of safety climate associated with a quality improvement program in Switzerland - A cross-sectional survey study. PLoS One 12:e0181410. https://doi.org/10.1371/journal.pone.0181410 CrossRefGoogle Scholar
- 34.R DevelopmentCore Team (2008) R: A language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar