Evaluation of psychometric properties of the German Hospital Survey on Patient Safety Culture and its potential for cross-cultural comparisons: a cross-sectional study

Abstract

ObjectiveTo study the psychometric characteristics of German version of the Hospital Survey on Patient Safety Culture and to compare its dimensionality to other language versions in order to understand the instrument’s potential for cross-national studies.DesignCross-sectional multicentre study to establish psychometric properties of German version of the survey instrument.Setting73 units from 37 departments of two German university hospitals.ParticipantsClinical personnel (n=995 responses, response rate 39.6%).Primary and secondary outcome measuresPsychometric properties (eg, model fit, internal consistency, construct validity) of the instrument and comparison of dimensionality across different language translations.ResultsThe instrument demonstrated acceptable to good internal consistency (Cronbach’s alpha 0.64–0.88). Confirmatory factor analysis of the original 12-factor model resulted in marginally satisfactory model fit (root mean square error of approximation (RMSEA)=0.05; standardised root mean residual (SRMR)=0.05; comparative fit index (CFI)=0.90; goodness of fit index (GFI)=0.88; Tucker-Lewis Index (TLI)=0.88). Exploratory factor analysis resulted in an alternative eight-factor model with good model fit (RMSEA=0.05; SRMR=0.05; CFI=0.95; GFI=0.91; TLI=0.94) and good internal consistency (Cronbach’s alpha 0.73–0.87) and construct validity. Analysis of the dimensionality compared with models from 10 other language versions revealed eight dimensions with relatively stable composition and appearance across different versions and four dimensions requiring further improvement.ConclusionsThe German version of Hospital Survey on Patient Safety Culture demonstrated satisfactory psychometric properties for use in German hospitals. However, our comparison of instrument dimensionality across different language versions indicates limitations concerning cross-national studies. Results of this study can be considered in interpreting findings across national contexts, in further refinement of the instrument for cross-national studies and in better understanding the various facets and dimensions of patient safety culture.

Cultura de segurança e comunicação sobre erros cirúrgicos na perspectiva da equipe de saúde

“…The positive safety culture is favorable to the incidents reports, however, in this research it was considered as a fragile area, with positive responses of 45.3% (n=72) in the dimension "Event report frequency". The incident notifications and AE were also considered areas susceptible for improvements in the Chinese research, whose results were similar, with 43% of positive responses (16) , similarly as in the German study, with 38% of positive responses (17) . The results showed the need to increase basic actions for notification and, in this research, with highlight to the medical team, whose index of positive responses were lower than those of the nursing team.…”

“…A multicentric research in Germany university hospitals has shown that, as in this research, the health team pointed relatively lower rates of positive responses regarding the feedback of reported events, which was observed by the percentage of negative/neutral responses regarding it (48%; n=468) (17) . In Brazil, a cross-sectional study carried out at three public hospital units in the state of Paraná sup-ported by 71 safety culture surveys, revealed feedback as a failure issue at the units surveyed (18) .…”

“…These results demonstrated the mutual communication gap among the healthcare, administration and management staff, and they were similar to those reported by the German study participants. This indicated neutrality (53.9%; n=525) for the statement "At this unit, we discuss means of avoiding errors by preventing them from happening again" and 45.4% (n=442) for the statement "Professionals feel free to question the decisions or actions of their superiors" (17) .…”

Patient safety culture in a university hospital emergency department in Switzerland – a survey study

“…With the aim to enable a better interpretation of the results, we made a comparison with previous reports from Sweden, Germany and the United States (US), which used the identical questionnaire to assess patient safety culture in hospitals [ 15 ], [ 22 ], [ 23 ]. Overall, the responses we obtained appear to be similar to those from a Swedish ED, but more positive than those from Germany, and in most cases less positive than those from the US (see figure 1 (Fig.…”

“…Our findings are descriptively compared to the U.S. American Database of 2016 [ 15 ], and two studies from Germany and Sweden, respectively [ 22 ], [ 23 ]. These were selected as they contained enough detailed information for descriptive comparisons to our data.…”