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

TLDR

Healthcare provider attitudes toward patient safety, often termed safety climate or culture, are widely studied. The study aims to report the psychometric properties of the University of Texas Safety Attitudes Questionnaire, establish benchmarking data, and explore emerging research areas. The authors conducted six cross‑sectional surveys of 10,843 providers in 203 clinical areas across the USA, UK, and New Zealand, applying multilevel factor analyses to assess scale reliability, factor loadings, and inter‑factor correlations. The questionnaire yielded a reliable six‑factor model (Teamwork Climate, Safety Climate, Perceptions of Management, Job Satisfaction, Working Conditions, Stress Recognition) with 0.9 reliability, substantial variation across organizations, and strong psychometric properties, enabling benchmarking and intervention assessment.

Abstract

There is widespread interest in measuring healthcare provider attitudes about issues relevant to patient safety (often called safety climate or safety culture). Here we report the psychometric properties, establish benchmarking data, and discuss emerging areas of research with the University of Texas Safety Attitudes Questionnaire.Six cross-sectional surveys of health care providers (n = 10,843) in 203 clinical areas (including critical care units, operating rooms, inpatient settings, and ambulatory clinics) in three countries (USA, UK, New Zealand). Multilevel factor analyses yielded results at the clinical area level and the respondent nested within clinical area level. We report scale reliability, floor/ceiling effects, item factor loadings, inter-factor correlations, and percentage of respondents who agree with each item and scale.A six factor model of provider attitudes fit to the data at both the clinical area and respondent nested within clinical area levels. The factors were: Teamwork Climate, Safety Climate, Perceptions of Management, Job Satisfaction, Working Conditions, and Stress Recognition. Scale reliability was 0.9. Provider attitudes varied greatly both within and among organizations. Results are presented to allow benchmarking among organizations and emerging research is discussed.The Safety Attitudes Questionnaire demonstrated good psychometric properties. Healthcare organizations can use the survey to measure caregiver attitudes about six patient safety-related domains, to compare themselves with other organizations, to prompt interventions to improve safety attitudes and to measure the effectiveness of these interventions.