Development and Validation of a Brief Culture-of-Safety Survey

Area of Science:

• Healthcare Management
• Patient Safety Research
• Psychometrics

Background:

• Culture of Safety (COS) is vital for patient safety but lengthy surveys pose measurement challenges.
• Existing 19-item COS surveys are validated but can be burdensome for healthcare systems.
• Developing a concise yet reliable COS measurement tool is a priority for efficient safety assessment.

Purpose of the Study:

• To develop a shortened Culture of Safety (COS) survey.
• To achieve measurement properties comparable to a validated 19-item instrument.
• To reduce the burden of COS measurement in healthcare settings.

Main Methods:

• Item Response Theory (IRT) was employed to reduce a 19-item COS survey.
• Survey questions were evaluated for discrimination and information content.
• Cognitive interviews validated rewording of key concepts into an abbreviated scale.

Main Results:

• The 19-item survey was reduced to a 4-item scale using IRT, maintaining measurement properties (Cronbach's alpha = 0.80, Pearson correlation > 0.90).
• A fifth item was added to adequately assess error-reporting culture, validated through cognitive interviews.
• The resulting 5-item survey demonstrated comparable measurement properties and interpretation to the original scale.

Conclusions:

• A mixed-methods approach successfully condensed a lengthy COS survey into a brief 5-question instrument.
• The revised 5-item survey retains comparable measurement properties and interpretation.
• Organizations should weigh the benefits of a briefer survey against potential loss of detailed safety culture insights.