An evaluation of a patient safety culture tool in Saudi Arabia.

Background
Safety culture is considered to be an essential element of patient safety. Several tools are
available to assess patient safety culture in hospitals. One of the most common methods of
assessing safety culture is the use of safety climate questionnaires.
Research question
Is there an existing patient safety culture measure that can be demonstrated to be a valid and
reliable tool for use with the workforce in hospitals in Saudi Arabia?
Aim and objectives
This study aims to identify whether there is an existing English language tool that would be
suitable for assessing patient safety culture in Saudi context. The objectives of the study are:
1. To select an appropriate questionnaire to assess hospital patient safety culture.
2. To evaluate the face validity of the selected patient safety climate questionnaire.
3. To assess the psychometric properties of the selected patient safety climate
questionnaire in hospitals in Saudi Arabia.
4. To develop the most appropriate measure for assessing patient safety culture for use
in hospitals in Saudi Arabia.
Methods
Qualitative methods were used to evaluate face validity (n=12 hospital staft). Quantitative
methods were used to assess psychometric properties (n=862 doctors and nurses in three
hospitals in Saudi Arabia).
Findings
Evaluation of face validity identified a need for minor changes to the Hospital Survey on
Patient Safety Culture (HSOPSC) questionnaire wording before it was used to collect data for
psychometric assessment. The results of Confirmatory Factor Analysis (CF A) and reliability
analysis showed an unsatisfactory fit for the factor structure of the original HSOPSC
questionnaire to the Saudi data. Exploratory Factor Analysis (EF A) was used on one half of
the Saudi dataset to produce an optimal model(s). This was followed by CFA of the resulting
measurement model on the second (validation) half of the data to test the fit of the resulting
optimal factor structure. The result of EF A showed that eight factors (23 safety climate
items) is the optimal model to the Saudi data.
I
All factors consisted of two to four items. The items loading were between 0.43 and 0.97.
The result of CF A confirmed the eight factors solution (CF A=O.94, RMSEA=0.045,
SRMR=O.040, TLI=O.97). The results of EFA, CFA, correlation and reliability analysis
(Cronbach's alpha) showed that the optimal model for the Saudi data consists of eight patient
safety culture dimensions (23 safety climate items).
Conclusion
This is one of very few studies to provide an assessment of an American patient safety culture
tool using data from Saudi Arabia. The results indicate the importance of appropriate
validation of patient safety climate questionnaires prior to applying them to populations
outside contexts in which they were developed. The validated Saudi English language
version of the HSOPSC questionnaire is an appropriate patient safety climate questionnaire to
assess patient safety culture in Saudi hospitals.