Psychometric Properties and Dimension Analysis of the Hospital Survey On Patient Safety Culture Questionnaire (HSOPSC)

Abstract

Objectives: Medical errors are known as one of the five main causes of mortality. In response to this mortality rate, over two decades, global efforts have been made to increase patient safety and reduce unwanted accidents in health centers. One of the priorities is the development of research to measure the attitudes and beliefs of patient safety from the perspective of health care workers. So, the main goal of this study is to investigate the possible alternative factorial structure of the patient safety culture model in Iran. Methods: The HSOPSC "Hospital Survey on Patient Safety Culture" questionnaire was translated into Persian during the forward-backward translation technique and with the necessary corrections on the items. The validity of the questionnaire was assessed using face and content validity methods. Content validity ratio (CVR) and content validity index (CVI) were calculated. In order to evaluate the internal consistency of the questionnaire, Cronbach's alpha was calculated and to evaluate test-retest reliability, Intraclass Correlation Coefficient (ICC) was calculated. Data were collected from 420 staff members in 4 educational hospitals of Ardabil University of Medical Sciences by HSOPSC questionnaire. Exploratory factor analysis was used to investigate the possible alternative factorial structure. Confirmatory factor analysis and structural equation modeling was used to examine and confirm obtained structure. To perform exploratory and confirmatory factor analysis, the data were divided into two halves (210 items per analysis). SPSS 24 and Amos 24 softwares were used for the analysis. Results: The content validity index (CVI) was 0.92 and the content validity ratio (CVR) was higher than the standard value (0.51) in all items. Internal consistency (∝=0.8) and good test-retest reliability (ICC=0.791) were obtained for HSOPSC questionnaire items. Exploratory factor analysis identified 12 dimensions with Cronbach's alpha range of 0.57 to 0.86, which included “sense of altruism”, “teamwork to maintain and enhance patient safety”, “teamwork, handoffs and transitions across units”, “frequency of events reported”, “non-punitive response to errors”, “effective and fair care and monitoring to improve patient safety”, “management support for patient safety”, “freedom of expression and communication openness”, “requesting to do things irresponsibly and against the patient safety”, “threats to patient safety”, “preventing errors” and “Identification of the errors before patient injury”. The distribution of items in all dimensions differed from the original HSOPSC questionnaire except the two dimensions “management support for patient safety”, “frequency of events reported”. Based on the CFA and SEM, the structure obtained in this study was a proportional model. The best fitness in CFA analysis indicated an acceptable fit for the Persian version of HSOPSC (χ2/df =1.063 < 3 , RMSEA = 0.009 < 0.08 , GFI = 0.94 > 0.90, AGFI = 0.902 > 0.90, NFI = 0.901 > 0.91, CFI = 0.993 > 0.90, RFI= 0.91 > 0.90, IFI=0.99 > 0.90). The critical ratios in all items were acceptable, so it can be said that all factors affect the patient safety culture. Conclusion: Based on CFA and SEM, the model obtained in this study is a proportional model and the composition of the items in the dimensions had a relative stability.The structure of the dimensions obtained in this study was not consistent with the structure of the original HSOPSC model. Considering the importance of the patient safety, it is suggested that future researches in Iran be carried out in several provinces and cities at a national level. Keywords: Patient safety culture, Hospital Survey on Patient Safety Culture (HSOPSC), Psychometric properties, Dimensions Analysis, Structural Equation Modeling