Measuring the safety culture in a hospital setting: a concept whose time has come?

Getting the right 'patient safety culture' is thought to be an important component in improving patient safety in hospitals, however there is a lack of clarity in how best to measure and improve it, and whether such improvement actually translates to better patient outcomes. This paper reflects on the Counties Manukau District Health Board (CMDHB) experience with a patient safety survey and attempts to answer questions other organisations may ask when deciding whether to invest in such survey.

A literature search was undertaken to identify valid and reliable patient safety culture survey tools. These were reviewed with respect to how best to interpret and use the results.

If hospitals decide to undertake a patient safety culture survey, the recommended survey tools are the Safety Attitudes Questionnaire (SAQ) and the Hospital Survey on Patient Safety (HSOPS). Both have been widely used and have sound and comprehensive psychometrics. Only the SAQ has established links with patient safety outcomes such as reduced healthcare associated infections.

Surveys can provide some insights into the patient safety culture within an organisation, but the opportunity costs of undertaking a survey should be carefully considered. Much of their value lies in raising the profile of patient safety and promoting conversations; making patient safety 'the way we do business around here'.