Safer Culture Measures

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Measures of Safer Culture

Following is a list of safety measure tools available for healthcare teams to use. More information, background, references, and caveats about each of these measures is available in the full Safer Culture Roadmap whitepaper.

• California Patient Safer Culture Scale (Cal-PSCS)
  Based on organizational change research, this measure assesses key areas of employee sensemaking that contribute to climate and culture, including employee perceptions about having the support of co-workers in difficult situations (team cohesion), leadership messages of safety support (leader commitment/prioritization), resources and environment conducive to improving patient safety, and error reporting behavior. This is a good option to use in combination with another comprehensive scale.
• High-Value Care Culture Survey
  Used to investigate strategies for improving care quality outcomes at a low cost and the impact of salary and productivity bonuses. Assesses leadership and health system messaging (leader commitment/prioritization), data transparency and access (communication), comfort with cost conversations (psychological safety), and blame-free environment (fair rewarding/ punishing)
• Hospital Survey on Patient Safer Culture (HSOPSC)
  Assesses perceptions of management support and expectations for safety (leader commitment), teamwork, communication openness (psychological safety), communication about errors, non-punitive responses to errors (fair rewarding/punishing), staffing practices (policies and resources for safety), and incident reporting
• Latino Student Patient Safety Questionnaire
  Spanish-language questionnaire designed to assess attitudes and knowledge about patient safety. The questionnaire contains 5 factors: openness in communication, understanding of human factor, proactive attitude to avoid risks in security, awareness of error, and system complexity and interrelationship. The five factors represent the different types of information health science students receive about patient safety in their programs.
• Manchester Patient Safety Assessment Framework (MaPSAF)
  Integrates Safer Culture maturity framework with dimensions of commitment and prioritization of safety, incident reporting and response, communication, staff knowledge and training about safety, and teamwork. Intended to use as an educational exercise or to build engagement by demonstrating how much the organization has progressed towards developing Safer Culture, not as an assessment tool.
• Medical Office Survey on Patient Safer Culture (MOSOPS)
  AHRQ sponsored the development of this measure in response to requests for a survey in this setting. This survey is designed specifically for outpatient medical office providers and other staff and asks for their opinions about the culture of patient safety and health care quality in their medical office. Items on communication about error, communication openness, office processes and standardization, organizational learning, overall perceptions of patient safety and quality, leadership support for patient safety, patient care tracking/follow-up, staff training, teamwork, and work pressure/pace. See second link for further information.
• Medical Student Safety Attitudes and Professional Survey (MSSAPS)
  Focuses on promoting curricular and cultural change for residents during their hospital rotations. Includes 28 items measuring 5 dimensions: Safer Culture, teamwork culture, experiences with professionalism, error disclosure culture, and comfort expressing professional concerns.
• Nordic Patient Safer Culture Questionnaire (TUKU)
  Measures the psychological factors and employees perceptions of the organizational functions. Contains a total of 65 Likert-type questions on psychological dimensions and organizational functions including: safety motivation, sense of control, sense of personal responsibility, mindfulness, work conditions management, work process management, safety management and leadership, supervisory support for safety, proactive safety development, hazard control, competence management, change management, and management of third parties.
• Nursing Home Survey on Patient Safer Culture (NHSPSC)
  Designed to measure the culture of resident safety from a nursing home staff perspective. It contains 42 items that measure 12 composites of organizational culture pertaining to patient Safer Culture. Includes questions on: teamwork, staffing, compliance with procedures, training & skills, nonpunitve response to mistakes, handoffs, feedback & communication about incidents, communication openness, supervisor expectations & actions promoting resident safety, overall perceptions of resident safety, management support for resident safety, and organizational learning.
• Patient Safety Climate in Healthcare Organizations (PSCHO) Scale
  Assesses aspects of leader commitment/prioritization, policies/resources, psychological safety, and fair rewarding/punishing
• Pharmacy Survey on Patient Safer Culture (PSOPSC)
  Measures Safer Culture in a pharmacy setting by AHRQ. Assesses 11 dimensions of pharmacy with 36 items of patient Safer Culture in Likert-type format. Dimensions include: physical space and environment, teamwork, staff training & skills, communication openness, patient counseling, staffing work pressure and pace, communication about prescriptions across shifts, communication about mistakes, response to mistakes, organizational learning – continuous improvement, and overall perceptions of patients safety.
• Safety Attitudes Questionnaire
  Assesses perceptions of: management support/approval, teamwork climate, safety climate, quality of the working environment (resources), and impact of stress on performance; and feelings of job satisfaction
• Safety Organizing Scale (SOS)
  Captures behaviors theorized to underlie a Safer Culture. It is a 9-item unidimensional measure of self-reported behaviors enabling a Safer Culture. Questions touch on topics such as: mapping team skills, talking about mistakes, discussing alternative solutions, discussing risks, utilizing skills, discussing error prevention, and pooling expertise in a crisis (Vogus & Sutcliffe, 2007).
• Safety, Communication, Operational Reliability, and Engagement (SCORE) Survey
  Updated the Safety Attitudes Questionnaire based on job demands-resources theory. Assesses teamwork climate, safety climate, improvement readiness, local leadership, personal burnout, and burnout climate
• SCOPE
  Evaluates the state of patient Safer Culture in Dutch general practice. This measure was called SCOPE, which is an acronym in Dutch for systematic culture inquiry on patient safety in primary care. SCOPE includes 8 dimensions: handover and teamwork, support and fellowship, communication openness, feedback about and learning from error, intention to report events, adequate procedures and adequate staffing, overall perceptions of safety, and supervisor/manager expectations/actions.
• TRAnsitional Patient Safety Climate Evaluation (TRACE)
  Measures transitional patient safety climate from the perspective of general practitioners and hospital physicians. Transitional patient culture is considered by van Melle et al. (2018) as a meeting of the Safer Cultures that exist within two individual organizations. TRACE questionnaire consists of 20 items on transitional patient safety climate with three overarching themes: transitional collaboration, communication, and transitional patient safety. It also contains a section with 7 items on incident reporting and three questions on subjective assessment of patient safety in their own practice.
• TWINS Patient Safety
  Consists of 8 dimensions with a total of 10 items (most dimensions are only represented with one item). Questions include topics such as: supervisor support, open communication, patient safety focus, and patient safety priority. Survey is a 5-point Likert scale of agreement and frequency.
• Victorian Safety Climate Survey (SCS)
  Designed to measure safety climate in organizations and to identify opportunities for improvement. The SCS includes 74 items, 42 items that form the six factor analysis-derived domains in the original SAQ and 32 items that are separate from those domains. Includes questions with the following domains: teamwork climate safety climate, stress recognition, job satisfaction, perceptions of management, and work conditions. Originally called the Victorian Pilot Patient Safety Climate Survey and then was later changed to just the Safety Climate Survey.