Development and Validation of a Brief Culture-of-Safety Survey.
Journal
Joint Commission journal on quality and patient safety
ISSN: 1938-131X
Titre abrégé: Jt Comm J Qual Patient Saf
Pays: Netherlands
ID NLM: 101238023
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
received:
30
09
2021
revised:
17
04
2022
accepted:
19
04
2022
pubmed:
28
5
2022
medline:
30
8
2022
entrez:
27
5
2022
Statut:
ppublish
Résumé
Culture of safety (COS) is recognized as a critical component of patient safety but can be burdensome to measure due to survey length. This project aimed to develop a shortened COS survey with comparable measurement properties to a validated 19-item instrument. Item response theory (IRT) was used to reduce items from a 19-item COS survey at a 10-hospital health system. Using a 50% random sample, IRT was applied to evaluate survey question discrimination and information. Concepts from the key questions in each subdomain were reworded into a new abbreviated scale. Cognitive interviews with clinicians were conducted to validate reworded questions for adequacy, clarity, and consistency of interpretation. The 19-item survey was reduced with IRT to 4 items. Cronbach's alpha for the 4-item IRT-derived scale was 0.80 (average inter-item covariance = 0.36) and was comparable to the original scale despite ∼75% reduction in items. Pearson correlation between the 4-item scale and the original scale was > 0.90. The 4-item scale demonstrated convergent validity. Results were replicated in a 50% random validation sample. Cognitive interviews revealed inadequacy of the shortened scale in assessing error-reporting culture. A fifth item was developed and qualitatively validated for this construct. Using a mixed methods approach, a lengthy COS survey was condensed and revised to a brief 5-question survey with comparable measurement properties and respondent interpretation. A shorter instrument necessarily loses detailed insight into multiple aspects of safety culture, and organizations should consider trade-offs in choosing to develop a briefer survey.
Sections du résumé
BACKGROUND
Culture of safety (COS) is recognized as a critical component of patient safety but can be burdensome to measure due to survey length. This project aimed to develop a shortened COS survey with comparable measurement properties to a validated 19-item instrument.
METHODS
Item response theory (IRT) was used to reduce items from a 19-item COS survey at a 10-hospital health system. Using a 50% random sample, IRT was applied to evaluate survey question discrimination and information. Concepts from the key questions in each subdomain were reworded into a new abbreviated scale. Cognitive interviews with clinicians were conducted to validate reworded questions for adequacy, clarity, and consistency of interpretation.
RESULTS
The 19-item survey was reduced with IRT to 4 items. Cronbach's alpha for the 4-item IRT-derived scale was 0.80 (average inter-item covariance = 0.36) and was comparable to the original scale despite ∼75% reduction in items. Pearson correlation between the 4-item scale and the original scale was > 0.90. The 4-item scale demonstrated convergent validity. Results were replicated in a 50% random validation sample. Cognitive interviews revealed inadequacy of the shortened scale in assessing error-reporting culture. A fifth item was developed and qualitatively validated for this construct.
CONCLUSION
Using a mixed methods approach, a lengthy COS survey was condensed and revised to a brief 5-question survey with comparable measurement properties and respondent interpretation. A shorter instrument necessarily loses detailed insight into multiple aspects of safety culture, and organizations should consider trade-offs in choosing to develop a briefer survey.
Identifiants
pubmed: 35623965
pii: S1553-7250(22)00084-8
doi: 10.1016/j.jcjq.2022.04.006
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
430-438Informations de copyright
Copyright © 2022 The Joint Commission. Published by Elsevier Inc. All rights reserved.