The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research

Sexton, J. Bryan; Helmreich, Robert L.; Neilands, Torsten B.; Rowan, Kathy; Vella, Keryn; Boyden, James; Roberts, Peter R; Thomas, Eric J.

doi:10.1186/1472-6963-6-44

Cited by 1,437 publications

(1,881 citation statements)

References 29 publications

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“…Furthermore, as evidence from other critical industries19 and clinical settings20, 21, 22, 23 suggests a positive relationship between safety climate and safety outcome, we measured the ICU's safety climate prior to and following the implementation year. Safety climate was determined by the Safety Attitudes Questionnaire (SAQ) using a Likert scale transformed to a 100‐point scale 24. The SAQ is a validated healthcare derivative of the Cockpit Management Attitudes Questionnaire 20, 25.…”

Section: Methodsmentioning

confidence: 99%

Crew Resource Management in the Intensive Care Unit: a prospective 3‐year cohort study

Haerkens

Kox

Lemson

et al. 2015

Acta Anaesthesiol Scand

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BackgroundHuman factors account for the majority of adverse events in both aviation and medicine. Human factors awareness training entitled “Crew Resource Management (CRM)” is associated with improved aviation safety. We determined whether implementation of CRM impacts outcome in critically ill patients.MethodsWe performed a prospective 3‐year cohort study in a 32‐bed ICU, admitting 2500–3000 patients yearly. At the end of the baseline year, all personnel received CRM training, followed by 1 year of implementation. The third year was defined as the clinical effect year. All 7271 patients admitted to the ICU in the study period were included.The primary outcome measure was ICU complication rate. Secondary outcome measures were ICU and hospital length of stay, and standardized mortality ratio.ResultsOccurrence of serious complications was 67.1/1000 patients and 66.4/1000 patients during the baseline and implementation year respectively, decreasing to 50.9/1000 patients in the post‐implementation year (P = 0.03). Adjusted odds ratios for occurrence of complications were 0.92 (95% CI 0.71‐1.19, P = 0.52) and 0.66 (95% CI 0.51‐0.87, P = 0.003) in the implementation and post‐implementation year. The incidence of cardiac arrests was 9.2/1000 patients and 8.3/1000 patients during the baseline and implementation year, decreasing to 3.5/1000 patients (P = 0.04) in the post‐implementation year, while cardiopulmonary resuscitation success rate increased from 19% to 55% and 67% (P = 0.02). Standardized mortality ratio decreased from 0.72 (95% CI 0.63‐0.81) in the baseline year to 0.60 (95% CI 0.53‐0.67) in the post‐implementation year (P = 0.04).ConclusionOur data indicate an association between CRM implementation and reduction in serious complications and lower mortality in critically ill patients.

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Section: Methodsmentioning

confidence: 99%

Crew Resource Management in the Intensive Care Unit: a prospective 3‐year cohort study

Haerkens

Kox

Lemson

et al. 2015

Acta Anaesthesiol Scand

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“…Of the tools shown to correlate with patient outcomes, the Safety Attitudes Questionnaire (SAQ) 113 has the strongest validity evidence, and has been adapted for use across multiple settings and learner levels. The SAQ contains six domains, one of which is teamwork.…”

Section: Teamwork Tools Associated With Patient Outcomesmentioning

confidence: 99%

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

et al. 2013

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OBJECTIVE: Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. DATA SOURCES: We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. STUDY ELIGIBILITY: Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. STUDY APPRAISAL AND SYNTHESIS METHODS:Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. RESULTS: Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. LIMITATIONS: Review is limited to quantitative assessments of teamwork in internal medicine. CONCLUSIONS:There is strong validity evidence for several published tools assessing teamwork in internal medicine. However, few teamwork assessments have been directly linked to patient outcomes. 3,4 Recognizing this, the Institute of Medicine, the Joint Commission, the Agency for Healthcare Research and Quality (AHRQ), and others have made teamwork a top priority in their recommendations for improving healthcare. [5][6][7][8][9] Teamwork is also prominently positioned within the American Board of Internal Medicine (ABIM) requirements for maintenance of certification for internists, 10 as well as the Accreditation Council for Graduate Medical Education's core competencies, 11 milestones, 12 and medical student competencies. 13 As such, every physician at the undergraduate, graduate, and continuing professional level must demonstrate competency in teamwork.While there is broad agreement on the imperative to improve teamwork, there is littl...

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“…6,7 Nurses rated the quality of communication and collaboration they had experienced with hospitalists using a 5-point ordinal scale (1 ¼ very low, 2 ¼ low, 3 ¼ adequate, 4 ¼ high, 5 ¼ very high). The second section assessed teamwork and safety climate using the teamwork and safety domains of the Safety Attitudes Questionnaire (SAQ), 19 which is based on previous research in aviation and medicine and has been validated in clinical settings. 20,21 The final section of the survey assessed nurses' perceptions of whether SIDR improved efficiency of communication, collaboration among team members, and patient care using a 5-point Likert scale (1 ¼ strongly disagree; 2 ¼ disagree; 3 ¼ neutral; 4 ¼ agree; 5 ¼ strongly agree).…”

Section: Provider Surveymentioning

confidence: 99%

Improving teamwork: Impact of structured interdisciplinary rounds on a hospitalist unit

O’Leary

Haviley

Slade

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Effective collaboration and teamwork is essential in providing safe and effective care. Research reveals deficiencies in teamwork on medical units involving hospitalists.OBJECTIVE:The aim of this study was to assess the impact of an intervention, Structured Inter‐Disciplinary Rounds (SIDR), on nurses' ratings of collaboration and teamwork.METHODS:The study was a controlled trial involving an intervention and control hospitalist unit. The intervention, SIDR, combined a structured format for communication with a forum for regular interdisciplinary meetings. We asked nurses to rate the quality of communication and collaboration with hospitalists using a 5‐point ordinal scale. We also assessed teamwork and safety climate using a validated instrument. Multivariable regression analyses were used to assess the impact on length of stay (LOS) and cost using both a concurrent and historic control.RESULTS:A total of 49 of 58 (84%) nurses completed surveys. A larger percentage of nurses rated the quality of communication and collaboration with hospitalists as high or very high on the intervention unit compared to the control unit (80% vs. 54%; P = 0.05). Nurses also rated the teamwork and safety climate significantly higher on the intervention unit (P = 0.008 and P = 0.03 for teamwork and safety climate, respectively). Multivariable analyses demonstrated no difference in the adjusted LOS and an inconsistent effect on cost.CONCLUSIONS:SIDR had a positive effect on nurses' ratings of collaboration and teamwork on a hospitalist unit, yet no impact on LOS and cost. Further study is required to assess the impact of SIDR on patient safety measures. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research

Cited by 1,437 publications

References 29 publications

Crew Resource Management in the Intensive Care Unit: a prospective 3‐year cohort study

Crew Resource Management in the Intensive Care Unit: a prospective 3‐year cohort study

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

Improving teamwork: Impact of structured interdisciplinary rounds on a hospitalist unit

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