The SCOPE-PC instrument for assessing patient safety culture in primary care: a psychometric evaluation

Primary healthcare differs from hospitals in terms of - inter alia - organisational structure. Therefore, patient safety culture could differ between these settings. Various instruments have been developed to measure collective attitudes of personnel within a primary healthcare organisation. However, the number of valid and reliable instruments is limited.

Psychometric properties of the SCOPE-Primary Care instrument were tested to examine the instrument's applicability in home care services in Belgium.

A cross-sectional study was conducted by administering the SCOPE-PC questionnaire in a single home care organisation with more than 1000 employees, including nurses, midwives, healthcare assistants, diabetes educators and nursing supervisors. First, a confirmatory factor analysis was performed to test whether the observed dataset fitted to the proposed seven-factor model of the SCOPE-PC instrument. Second, Cronbach's alphas were calculated to examine internal consistency reliability. Finally, the instrument's validity was also examined.

In total, 603 questionnaires were retained for further analysis, representing an overall response rate of 43.9%. Most respondents were nursing staff, followed by healthcare assistants and nursing supervisors. The results of the confirmatory factor analyses satisfied the chosen cut-offs, indicating an acceptable to good model fit. With the exception of the dimension 'organizational learning' (0.58), Cronbach's alpha scores of the SCOPE-PC scales indicated a good level of internal consistency: 'open communication and learning from error' (0.86), 'handover and teamwork' (0.78), 'adequate procedures and working conditions' (0.73), 'patient safety management' (0.81), 'support and fellowship' (0.75), and 'intention to report events (0.85). Moreover, inter-correlations between the seven dimensions as well as with the patient safety grade were moderate to good.

The present study indicated that the SCOPE-Primary Care instrument has good psychometric properties for home care services in Belgium. No modifications are required to the original questionnaire in order to allow benchmarking between primary healthcare settings.