Patient safety culture survey

Patient safety culture surveyWhat is Patient Safety Culture?

Put simply, patient safety culture is a term which describes “how we do things around here to keep our patients safe”. It describes our commitment, attitudes and behaviours toward safeguarding patients.


What are we trying to achieve?

A positive patient safety culture is associated with better patient outcomes such as decreased hospital morbidity (deaths), adverse events, readmission rates and injury rates among staff[1].

In an effort to make our hospitals safer, we want to measure how good our patient safety culture is and identify areas in need for further improvement.

What did we find?

Overseas, patient safety culture has been reliably and validly measured using a tool called the Safety Attitudes Questionnaire (SAQ)[2-5]. The questionnaire assesses safety culture based on the following domains:

  1. Good teamwork
  2. A positive safety climate
  3. High job satisfaction
  4. Recognition of stress and understanding how it impacts their work
  5. Good perceptions of management
  6. Optimal working conditions
  7. Good collaboration and communication among staff

Safety Attitude Questionnaire (SAQ) domains

Using the SAQ, staff are asked to rate on a five point scale (“Disagree strongly” to “Agree Strongly”) their level of agreement across the previously mentioned seven domains. For example:

  • "I would feel safe being treated here as a patient"
  • "My suggestions about safety would be acted upon if I expressed them to management"

Survey results can be analysed and used to guide improvement activity and enable a systematic approach towards evaluating service progress.

What have we done?

Even though the SAQ has been used widely overseas, it was not known whether it would be appropriate for New Zealand. We want to test the SAQ and determine whether it is fit for purpose for our hospital services.

SAQ pilot

  1. We have trialled an electronic version of the SAQ in four wards every six months as part of a Patient and Whānau Centred Care Standards and ward accreditation programme [view more about our Care Standards]. The purpose of the pilot survey was to test the survey to:
    1. ensure it was suitable and relevant for local use
    2. establish if the survey process was feasible on a large scale
    3. identify the resources are needed to conduct the survey
    4. assess factors influencing participation
    5. understand how the survey results could be used by wards
  2. Encouraged all staff, including managers, nursing, medical, allied health and support staff such as cleaners and ward clerks to voluntarily and anonymously participate
  3. Analysed and used the results to support service improvement in targeted areas
  4. Refined our SAQ as a result of the trial and feedback from Charge Nurse Managers and a focus group of senior nursing, medical and allied health staff

Lessons learnt from pilot

In total, 96 of an expected 291 staff (33%) responded to the SAQ survey.

Staff participation rates for SAQ pilot
Breakdown of staff occupational groups for SAQ pilot participants

The response rate is similar to other surveys of this nature but is lower than those reported in the literature. Exploring the reasons for the relatively low response rates, our staff told us there was:

  • survey fatigue
  • confusion over survey questions (potential changes to questions required)
  • difficulty accessing the survey online (improve access by having paper copies and QR codes)
  • more publicity required (suggested using posters and other means of communication)

Below is an illustrative result of SAQ results to help us identify areas for improvement:

SAQ pilot results

Where to from here?

  • All inpatient wards will be required to participate in the Patient Safety Culture Survey in order to achieve full ward accreditation [view more about our Care Standards]. The survey will enable all wards to understand their own safety culture, and provide information to continuously monitor and improve patient safety.
  • The measurement of patient safety culture is also being tested using other tools such as the Harvard Surgical Safety Culture Survey [view more about surgical safety culture].

  1. The Health Foundation. Research scan: Does improving safety culture affect patient outcomes? The Health Foundation, 2011.
  2. Health Foundation. Evidence Scan: Measuring safety culture. The Health Foundation, 2011.
  3. The Health Foundation. Safety culture: What is it and how do we monitor and measure it? A summary of learning from a Health Foundation roundtable. The Health Foundation, 2013.
  4. Halligan M, Zecevic A. Safety culture in healthcare: a review of concepts, dimensions, measures and progress. BMJ Quality & Safety. 2011;20(4):338-43.
  5. Sexton J, Helmreich R, Neilands T, al e. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res. 2006;6:44.