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Safety culture in a major accredited Irish university teaching hospital: a mixed methods study using the safety attitudes questionnaire



The measurement of safety culture, the way in which members of an organisation think about and prioritise safety, in a hospital can provide valuable insight and inform quality improvement strategies.


The aim of this study is to describe the safety culture of a university teaching hospital in the Republic of Ireland.


This is a mixed methods survey study using the Safety Attitudes Questionnaire (SAQ). The SAQ was distributed to all staff in the study hospital. Staff attitudes towards six domains of patient safety culture were assessed over 32 Likert-scaled items. Thematic analysis was performed on qualitative data.


A total of 768 staff members completed and returned a copy of the SAQ. The hospital scored above the international benchmark in five out of six domains, indicating a positive safety culture, but scored below the international benchmark in the domain ‘Working Conditions’. This positive safety culture was not mirrored in the qualitative data, from which five themes emerged; three major—Staffing Issues, Patient-Focused Care and Hospital Environment—and two minor—Safe Reporting Culture and Training and Education.


In this study, a mixed methods approach was successfully used to investigate the safety culture in a large Irish hospital. Although the SAQ results indicated a positive safety culture, the qualitative data revealed a number of issues that the hospital staff felt impacted negatively on patient safety. The results of this study will inform future work on the design of an intervention to improve patient safety in the hospital.

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The authors would like to acknowledge the staff of the study hospital who gave their time to complete the survey.

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Correspondence to Laura L. Gleeson.

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Competing interests

The authors A Delaney and D O’Mahony are employed by the study hospital; however, they were not involved in data analysis or writing the manuscript.

Ethical approval

Ethical approval for this study was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals.

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Gleeson, L.L., Tobin, L., O’Brien, G.L. et al. Safety culture in a major accredited Irish university teaching hospital: a mixed methods study using the safety attitudes questionnaire. Ir J Med Sci 189, 1171–1178 (2020).

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  • Safety culture
  • Patient safety
  • Quality improvement
  • Medication safety
  • Irish healthcare