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Published in: European Radiology 3/2019

01-03-2019 | Health Economy

Assessment of the safety climate in outpatient diagnostic services: Development and psychometric evaluation of a questionnaire

Authors: Marianne Jossen, Fabio Valeri, Christina Heilmaier, David Schwappach

Published in: European Radiology | Issue 3/2019

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Abstract

Introduction

Safe practice and safety culture are important issues in outpatient diagnostic imaging services. As questionnaires assessing safety culture through the measurement of safety climate in this setting are not yet available, the present study aimed to develop and validate such an instrument.

Materials and methods

After adaptation of an existing questionnaire and qualitative pretesting, the instrument was tested by collaborators from three outpatient imaging services in Switzerland. Results were first assessed using descriptive statistics. Scores of individual services were compared using a Wilcoxon test assessing differences between rank distributions. The final instrument was tested for validity using inter-rater agreement measures, such as reliability within groups (rWG), and an intraclass correlation coefficient measure (ICC(1)). These measures allowed the assessment of validity of aggregation into a total score (rWG(j)) and validated the instrument for its capacity to distinguish various safety climates of different groups by comparing inter-rater agreement in the overall sample to inter-rater agreement of individual services (rWG) and by measuring group effects (ICC(1)). Furthermore, the final instrument was tested for internal consistency and reliability using Cronbach’s Alpha.

Results

Safety climate scores vary significantly between services. Inter-rater agreement measures show that item aggregation is justified and that the instrument distinguishes various patterns of safety climate. The final instrument proves to be valid, consistent and reliable.

Conclusions

The final instrument presents a valid, consistent and reliable option to measure safety climate in outpatient diagnostic imaging services. Results can be used as a basis for quality improvement.

Key Points

• An adapted questionnaire that assesses safety climate in outpatient diagnostic imaging services was developed and tested in Switzerland.
• Psychometric evaluation showed the questionnaire to be a valid, consistent and reliable instrument.
• Results are of interest for imaging services as well as for stakeholders interested more globally in monitoring and quality improvement.
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Literature
2.
go back to reference Bundesamt für Gesundheit BAG (2017) [Change of the Ordinance on the Determination and Adaptation of Structures of the Reimbursement System of the Health Insurance]. Bundesamt für Gesundheit, Bern Bundesamt für Gesundheit BAG (2017) [Change of the Ordinance on the Determination and Adaptation of Structures of the Reimbursement System of the Health Insurance]. Bundesamt für Gesundheit, Bern
3.
go back to reference George R, Lau L, Ng K (2014) Team approach to optimize radiology techniques. In: Lau L, Ng K (eds) Radiological safety and quality. Paradigms in leadership and innovation. Springer, Dordrecht George R, Lau L, Ng K (2014) Team approach to optimize radiology techniques. In: Lau L, Ng K (eds) Radiological safety and quality. Paradigms in leadership and innovation. Springer, Dordrecht
4.
go back to reference Gehring K, Schwappach D, Battaglia M et al (2012) Frequency of harm associated with primary care safety incidents. Am J Manag Care 19:323–337 Gehring K, Schwappach D, Battaglia M et al (2012) Frequency of harm associated with primary care safety incidents. Am J Manag Care 19:323–337
5.
go back to reference Weaver SJ, Lubomksi LH, Wilson RF et al (2013) Promoting a culture of safety as a patient safety strategy. A systematic review. Ann Intern Med 158:369–374CrossRefPubMedPubMedCentral Weaver SJ, Lubomksi LH, Wilson RF et al (2013) Promoting a culture of safety as a patient safety strategy. A systematic review. Ann Intern Med 158:369–374CrossRefPubMedPubMedCentral
6.
go back to reference Zohar D, Livine Y, Tenne-Gazit O, Admi H, Donchin Y (2007) Healthcare climate: A framework for measuring and improving patient safety. Crit Care Med 35:1312–1317CrossRefPubMed Zohar D, Livine Y, Tenne-Gazit O, Admi H, Donchin Y (2007) Healthcare climate: A framework for measuring and improving patient safety. Crit Care Med 35:1312–1317CrossRefPubMed
7.
go back to reference DiCuccio MH (2015) The relationship between patient safety culture and patient outcomes: A systematic review. J Patient Saf 11:135–142CrossRefPubMed DiCuccio MH (2015) The relationship between patient safety culture and patient outcomes: A systematic review. J Patient Saf 11:135–142CrossRefPubMed
8.
go back to reference Azevedo KB, da Silva CA, Abrantes A (2017) Assessing the hospital survey of patient safety culture. A review of the assumptions, methods and data analysis protocol. Desenvolvimento e Sociedade 3:7-31 Azevedo KB, da Silva CA, Abrantes A (2017) Assessing the hospital survey of patient safety culture. A review of the assumptions, methods and data analysis protocol. Desenvolvimento e Sociedade 3:7-31
9.
go back to reference Colla JB, Bracken AC, Kinney LM, Weeks WB (2005) Measuring patient safety climate: A review of surveys. Qual Saf Health Care 14:364–366 Colla JB, Bracken AC, Kinney LM, Weeks WB (2005) Measuring patient safety climate: A review of surveys. Qual Saf Health Care 14:364–366
10.
go back to reference Manser T, Brösterhaus M, Hammer A (2014) You can't improve what you don't measure: Safety climate measures available in the German-speaking countries to support safety culture development in healthcare. Z Evid Fortbild Qual Gesundhwes 114:58–71CrossRef Manser T, Brösterhaus M, Hammer A (2014) You can't improve what you don't measure: Safety climate measures available in the German-speaking countries to support safety culture development in healthcare. Z Evid Fortbild Qual Gesundhwes 114:58–71CrossRef
11.
12.
go back to reference Sexton JB, Helmreich RL, Neilands TB et al (2006) The safety attitudes questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 6:44CrossRefPubMedPubMedCentral Sexton JB, Helmreich RL, Neilands TB et al (2006) The safety attitudes questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 6:44CrossRefPubMedPubMedCentral
13.
go back to reference Weingart SN, Farbstein K, Davis RB, Phillips RS (2004) Using a multihospital survey to examine the safety culture. Jt Comm J Qual Saf 30:125–132 Weingart SN, Farbstein K, Davis RB, Phillips RS (2004) Using a multihospital survey to examine the safety culture. Jt Comm J Qual Saf 30:125–132
14.
go back to reference Pfeiffer Y, Manser T (2010) Development of the german version of the hospital survey on patient safety culture: Dimensionality and psychometric properties. Saf Sci 48:1452–1462CrossRef Pfeiffer Y, Manser T (2010) Development of the german version of the hospital survey on patient safety culture: Dimensionality and psychometric properties. Saf Sci 48:1452–1462CrossRef
15.
go back to reference Zimmermann N, Küng K, Sereika SM, Engberg S, Sexton B, Schwendimann R (2013) Assessing the safety attitudes questionnaire (SAQ), German language version in Swiss university hospitals - a validation study. BMC Health Serv Res 13:347CrossRefPubMedPubMedCentral Zimmermann N, Küng K, Sereika SM, Engberg S, Sexton B, Schwendimann R (2013) Assessing the safety attitudes questionnaire (SAQ), German language version in Swiss university hospitals - a validation study. BMC Health Serv Res 13:347CrossRefPubMedPubMedCentral
16.
go back to reference Gehring K, Mascherek A, Bezzola P, Schwappach D (2015) Safety climate in Swiss hospital units: Swiss version of the safety climate survey. J Eval Clin Pract 21:332–338 Gehring K, Mascherek A, Bezzola P, Schwappach D (2015) Safety climate in Swiss hospital units: Swiss version of the safety climate survey. J Eval Clin Pract 21:332–338
17.
go back to reference Schutz A, Counte MA, Meurer S (2007) Development of a patient safety culture measurement tool for ambulatory health care settings: Analysis of content validity. Health Care Manag Sci 10:139–149CrossRefPubMed Schutz A, Counte MA, Meurer S (2007) Development of a patient safety culture measurement tool for ambulatory health care settings: Analysis of content validity. Health Care Manag Sci 10:139–149CrossRefPubMed
18.
go back to reference Hoffmann B, Domanska OM, Müller V, Gerlach FM (2009) Development of a questionnaire on the safety climate in family doctor’s services (FraSiK): Transcultural adaptation – report on methods. Z Evid Fortbild Qual Gesundhwes 103:521–529CrossRefPubMed Hoffmann B, Domanska OM, Müller V, Gerlach FM (2009) Development of a questionnaire on the safety climate in family doctor’s services (FraSiK): Transcultural adaptation – report on methods. Z Evid Fortbild Qual Gesundhwes 103:521–529CrossRefPubMed
19.
go back to reference Modak I, Helmreich RL, Thomas EJ, Sexton BJ, Lux TR (2007) Measuring safety culture in the ambulatory setting: The safety attitudes questionnaire - ambulatory version. J Gen Intern Med 22:1–5CrossRefPubMedPubMedCentral Modak I, Helmreich RL, Thomas EJ, Sexton BJ, Lux TR (2007) Measuring safety culture in the ambulatory setting: The safety attitudes questionnaire - ambulatory version. J Gen Intern Med 22:1–5CrossRefPubMedPubMedCentral
20.
go back to reference Ferris N, Kavnoudias H, Thiel C, Stuckey S (2007) The 2005 Australian MRI safety survey. AJR Am J Roentgenol 188:1388–1394CrossRef Ferris N, Kavnoudias H, Thiel C, Stuckey S (2007) The 2005 Australian MRI safety survey. AJR Am J Roentgenol 188:1388–1394CrossRef
21.
go back to reference De Wet C, Spence W, Mash R, Johnson P, Bowie P (2010) The development and psychometric evaluation of a safety climate measure for primary care. Qual Saf Health Care 19:578–854PubMed De Wet C, Spence W, Mash R, Johnson P, Bowie P (2010) The development and psychometric evaluation of a safety climate measure for primary care. Qual Saf Health Care 19:578–854PubMed
22.
go back to reference Häder M (2006) Empiric social research – An introduction. Verlag für Sozialforschung, Wiesbaden Häder M (2006) Empiric social research – An introduction. Verlag für Sozialforschung, Wiesbaden
23.
go back to reference Giai J, Boussat B, Occelli P et al (2017) Hospital survey on patient safety culture (HSOPS): variability of scoring strategies. Int J Qual Healthcare 29:685–692CrossRef Giai J, Boussat B, Occelli P et al (2017) Hospital survey on patient safety culture (HSOPS): variability of scoring strategies. Int J Qual Healthcare 29:685–692CrossRef
24.
go back to reference Sorra J, Gray L, Streagle S et al (2016) AHRQ Hospital Survey on Patient Safety Culture: User’s Guide. AHRQ Publication No. 15-0049-EF. Rockville, MD: Agency for Healthcare Research and Quality Sorra J, Gray L, Streagle S et al (2016) AHRQ Hospital Survey on Patient Safety Culture: User’s Guide. AHRQ Publication No. 15-0049-EF. Rockville, MD: Agency for Healthcare Research and Quality
25.
go back to reference Bauer DF (1972) Constructing confidence sets using rank statistics. J Am Stat Assoc 67:687–690CrossRef Bauer DF (1972) Constructing confidence sets using rank statistics. J Am Stat Assoc 67:687–690CrossRef
26.
go back to reference Hollander M, Douglas AW (1973) Nonparametric statistical methods. Wiley, New York Hollander M, Douglas AW (1973) Nonparametric statistical methods. Wiley, New York
27.
go back to reference LeBreton JM, Senter JL (2008) Answers to 20 questions about inter-rater reliability and inter-rater agreement. Organizational Research Methods 11:815–852 LeBreton JM, Senter JL (2008) Answers to 20 questions about inter-rater reliability and inter-rater agreement. Organizational Research Methods 11:815–852
28.
go back to reference James LR, Demaree RG, Wolf G (1984) Estimating within-group inter-rater reliability with and without response bias. J Appl Psychol 69:85–98CrossRef James LR, Demaree RG, Wolf G (1984) Estimating within-group inter-rater reliability with and without response bias. J Appl Psychol 69:85–98CrossRef
29.
go back to reference James LR, Demaree RG, Wolf G (1993) rwg: An assessment of within-group inter-rater agreement. J Appl Psychol 78:306–309CrossRef James LR, Demaree RG, Wolf G (1993) rwg: An assessment of within-group inter-rater agreement. J Appl Psychol 78:306–309CrossRef
30.
go back to reference Ginsburg L, Oore GD (2016) Patient safety climate strength: a concept that requires more attention. BMJ Qual Saf. 25:680–687CrossRefPubMed Ginsburg L, Oore GD (2016) Patient safety climate strength: a concept that requires more attention. BMJ Qual Saf. 25:680–687CrossRefPubMed
31.
go back to reference Smith-Crowe K, Burke MJ, Cohen A, Doveh E (2014) Statistical significance criteria for the rWG and average deviation inter-rater agreement indices. J Appl Psychol 99:239–261CrossRefPubMed Smith-Crowe K, Burke MJ, Cohen A, Doveh E (2014) Statistical significance criteria for the rWG and average deviation inter-rater agreement indices. J Appl Psychol 99:239–261CrossRefPubMed
33.
go back to reference Cronbach LJ (1951) Coefficient alpha and the internal strucutre of tests. Psychometrika 16:297–334CrossRef Cronbach LJ (1951) Coefficient alpha and the internal strucutre of tests. Psychometrika 16:297–334CrossRef
34.
go back to reference R DevelopmentCore Team (2008) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna R DevelopmentCore Team (2008) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna
Metadata
Title
Assessment of the safety climate in outpatient diagnostic services: Development and psychometric evaluation of a questionnaire
Authors
Marianne Jossen
Fabio Valeri
Christina Heilmaier
David Schwappach
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5646-1

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