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

Marianne Jossen; Fabio Valeri; Christina Heilmaier; David Schwappach

doi:10.1007/s00330-018-5646-1

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

Eur Radiol. 2019 Mar;29(3):1538-1545. doi: 10.1007/s00330-018-5646-1. Epub 2018 Aug 7.

Authors

Marianne Jossen¹, Fabio Valeri², Christina Heilmaier³, David Schwappach^{4

5}

Affiliations

¹ EQUAM Foundation, Effingerstrasse 25, 3008, Bern, Switzerland. marianne.jossen@icloud.com.
² Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
³ Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
⁴ Swiss Patient Safety Foundation, Asylstrasse 77, 8032, Zurich, Switzerland.
⁵ Institute for Social and Preventive Medicine (ISPM), University Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.

PMID: 30088070
DOI: 10.1007/s00330-018-5646-1

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 (r_WG), and an intraclass correlation coefficient measure (ICC(1)). These measures allowed the assessment of validity of aggregation into a total score (r_WG(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 (r_WG) 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.

Keywords: Organisational culture; Outpatient service; Psychometrics; Safety; Surveys and questionnaires.

Publication types

Validation Study

MeSH terms

Ambulatory Care / organization & administration*
Ambulatory Care / standards
Diagnostic Imaging* / adverse effects
Diagnostic Imaging* / standards
Female
Humans
Male
Organizational Culture
Psychometrics
Quality Improvement
Reproducibility of Results
Surveys and Questionnaires*
Switzerland