This study aims to suggest a method to choose what items can be removed from a survey instrument, thereby lessening survey participants' burden. We used the Taiwanese Patient Safety Culture (TPSC) survey as an example-in particular, the emotional exhaustion (EE) and work-life balance (WLB) domains. A traditional factor analysis approach, whereby a Likert scale is treated as a linear variable, was applied, and an item response theory (IRT) graded response model (GRM), where a response is treated as an ordinal scale, was used. From both methods, five out of nine EE items and three of seven WLB items were filtered out for removal; these items provided significantly smaller information for domain score estimation than other items. To check whether the downsized versions showed sufficient validity, we tested the factor structure of the remaining items and compared fit indices between the models with all original items and the new models with the remaining items. The new models in both EE and WLB domains showed better model fit than the models with all original items. In this study, we showed how to select more important items while ensuring that the selected items as a whole can provide a better fit compared to the original instrument. This interesting phenomenon may be due to the translation step and different cultural soils where surveys are administered. We strongly recommend checking the possibility that items can be removed when adopting and validating a survey instrument-not only to shorten the overall length, but also to increase validity. IntroductionHealthcare professionals tend to work within extremely tight schedules. Yet those in the field of improving the quality and safety of care almost always want to administer survey questionnaires to these professionals to collect information on various aspects of healthcare. Such information is certainly crucial, but it is also certain that the surveys would put much burden on healthcare professionals. In this regard, it is our obligation to control the burden expected when administering a survey. From a more practical standpoint, fatigue from frequent surveys may result in a low response rate that endangers the representativeness of the survey itself [1], which could lead to less useful survey results.In addition to being frequently asked to participate in surveys, the burden of completing a survey also resides in the characteristics of each questionnaire, such as how many questions are asked, how long each item is, and even what measurement scale is used. Indeed, Jeong and Lee (2016) showed that the number of response options causes significant differences in the time to complete surveys; for example, a 3-point Likert scale is much faster to complete than a 5-point Likert scale [2]. In addition to reducing the time required, they also showed that a 3-point and a 5-point Likert scale yielded very similar results in a population level [3]. Although their studies used a specific instrument, the Safety Attitudes Questionnaire-Korean version (SAQ-K), the resu...