Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care

Figures & data

Table 1. Applicability ratings of potential measures of patient safety culture from the EuNetPaS inventory.

Measures of patient safety culture identified from the EuNetPaS inventory (numbers of papers published)	Total applicability rating (maximum possible = 90)
Manchester patient safety framework: primary care (6)	65
AHRQ hospital survey on patient safety culture (7)	61
Patient safety culture in healthcare organizations (8)	57
Teamwork and patient safety attitudes questionnaire (13)	56
Safety attitudes questionnaire (14)	51
Culture of safety questionnaire (9)	50
Checklist for assessing institutional resilience (10)	47
Safety climate assessment tool (12)	44
Hospital culture questionnaire (11)	37

EuNetPaS, European Union network for patient safety; AHRQ, Agency for healthcare research and quality.

Table 2. Ratings of appropriateness of indicators for patient safety culture (first and second rounds) and usefulness (second round).

Appropriateness indicators for patient safety culture	First round Appropriateness Mean	Second round Appropriateness Mean	Usefulness Mean
The practice collects data on patient adverse events	1.87	1.36	1.44
The practice uses a formal root cause analysis tool to investigate adverse events	2.77	NA	NA
The practice looks at trends in its adverse events	2.42	1.88	1.88
The practice gives feedback to patients experiencing adverse events	1.97	1.88	2
The purpose of their medication is explained to patients	1.71	1.36	1.68
Patients are given time in the consultation to ask questions	1.77	1.52	1.52
The practice has a system that allows patients to make improvement suggestions (e.g. a suggestions box)	2.48	1.84	2.04
The practice has formal arrangements in place to safely manage the transition of patients to other care settings (hospital) and back	2.13	1.68	1.92
The practice has a system allowing staff to report risks to patients and/or staff	2.32	1.68	1.72
The practice uses a formal risk assessment process	2.84	NA	NA
The practice uses an electronic trigger tool for the surveillance of adverse drug events	2.55	NA	NA
The practice has a system for collecting data on medication error	2.71	NA	NA
The practice has a guideline for hand hygiene	2.16	1.28	2.32
The practice assesses hand hygiene, e.g. by measuring consumption of alcohol gel	3.35	NA	NA
The practice measures compliance with guidelines on the wearing of jewellery by staff	3.45	NA	NA
The topic of patient safety is regularly discussed at staff meetings	1.97	1.56	1.76
There is a person in the practice who has formal responsibility for patient safety/clinical risk management/quality	2.32	2.16	2.28
The most senior person in the practice discusses patient safety and quality with the staff	3.25	NA	NA
The practice assesses its patient safety culture on a regular basis	2.35	1.8	2
The practice measures the development of its patient safety culture	2.58	NA	NA
The practice has a formal process to ensure that all equipment is well maintained	1.68	1.08	1.64
The practice has a policy on recognizing and handling stress in staff	2.55	NA	NA
The practice regularly measures staff satisfaction	2.87	NA	NA
The practice is compliant with national regulations on the sterilizing of equipment	1.71	1.32	1.72
The practice had a formal system for handling patient complaints	2.03	1.76	1.8
The practice has a process for ensuring that its staff get regular training and updates in order to remain professionally competent	2.03	1.72	1.56

NA, candidate indicators not included in the second round have no ratings corresponding to that round.

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