Objective To study the psychometric characteristics of German version of the Hospital Survey on Patient Safety Culture and to compare its dimensionality to other language versions in order to understand the instrument’s potential for cross-national studies. Design Cross-sectional multicentre study to establish psychometric properties of German version of the survey instrument. Setting 73 units from 37 departments of two German university hospitals. Participants Clinical personnel (n=995 responses, response rate 39.6%). Primary and secondary outcome measures Psychometric properties (eg, model fit, internal consistency, construct validity) of the instrument and comparison of dimensionality across different language translations. Results The instrument demonstrated acceptable to good internal consistency (Cronbach’s alpha 0.64–0.88). Confirmatory factor analysis of the original 12-factor model resulted in marginally satisfactory model fit (root mean square error of approximation (RMSEA)=0.05; standardised root mean residual (SRMR)=0.05; comparative fit index (CFI)=0.90; goodness of fit index (GFI)=0.88; Tucker-Lewis Index (TLI)=0.88). Exploratory factor analysis resulted in an alternative eight-factor model with good model fit (RMSEA=0.05; SRMR=0.05; CFI=0.95; GFI=0.91; TLI=0.94) and good internal consistency (Cronbach’s alpha 0.73–0.87) and construct validity. Analysis of the dimensionality compared with models from 10 other language versions revealed eight dimensions with relatively stable composition and appearance across different versions and four dimensions requiring further improvement. Conclusions The German version of Hospital Survey on Patient Safety Culture demonstrated satisfactory psychometric properties for use in German hospitals. However, our comparison of instrument dimensionality across different language versions indicates limitations concerning cross-national studies. Results of this study can be considered in interpreting findings across national contexts, in further refinement of the instrument for cross-national studies and in better understanding the various facets and dimensions of patient safety culture.

Objectives: In recent years, several instruments for measuring patient safety culture (PSC) have been developed and implemented. Correct interpretation of survey findings is crucial for understanding PSC locally, for comparisons across settings or time, as well as for planning effective interventions. We aimed to evaluate the influence of gender, profession, and managerial function on perceptions of PSC and on the interplay between various dimensions and perceptions of PSC. Methods: We used German and Swiss survey data of frontline physicians and nurses (n = 1786). Data analysis was performed for the two samples separately using multivariate analysis of variance, comparisons of adjusted means, and series of multiple regressions. Results: Participants’ profession and managerial function had significant direct effect on perceptions of PSC. Although there was no significant direct effect of gender for most of the PSC dimensions, it had an indirect effect on PSC dimensions through statistically significant direct effects on profession and managerial function. We identified similarities and differences across participant groups concerning the impact of various PSC dimensions on Overall Perception of Patient Safety. Staffing and Organizational Learning had positive influence in most groups without managerial function, whereas Teamwork Within Unit, Feedback & Communication About Error, and Communication Openness had no significant effect. For female participants without managerial functions, Management Support for Patient Safety had a significant positive effect. Conclusions: Participant characteristics have significant effects on perceptions of PSC and thus should be accounted for in reporting, interpreting, and comparing results from different samples.

Objectives To study the psychometric properties of the Georgian version of the Hospital Survey on Patient Safety Culture (HSPSC-GE). Design Cross-sectional study. Setting Three Georgian hospitals. Participants Staff of participating hospitals (n=579 responses, response rate 41.6%). Primary and secondary outcome measures Psychometric properties (Model fit, internal consistency, construct validity) of the instrument, factor structure derived from the data. Results HSPSC-GE demonstrated acceptable construct validity but highly limited internal consistency (Cronbach’s alpha 0.35–0.87). Confirmatory factor analysis with the original 12-factor model resulted in poor model fit (root mean square error of approximation (RMSEA)=0.06; standardised root mean square residuals (SRMR)=0.08; comparative fit index (CFI)=0.74; goodness of fit index (GFI)=0.81; Tucker-Lewis Index (TLI)=0.70). Accounting for reversed item bias resulted in improved fit indices. Exploratory factor analysis resulted in an alternative five-factor model including only 19 items, but with satisfactory model fit (RMSEA=0.07; SRMR=0.07; CFI=0.90; GFI=0.89; TLI=0.88). Conclusions The HSPSC-GE as a whole demonstrated poor psychometric properties. However, a number of dimensions demonstrated acceptable internal consistency and reliability. Our results indicated presence of reversed item bias, which may be inherent to the original instrument design of the HSPSC and should be taken into account while interpreting or comparing results, as well as in analyses of psychometric properties of the instrument. Nevertheless, the HSPSC-GE provides first insights in hospital patient safety culture (PSC) in Georgia and we recommend using it in its full form to facilitate deeper analysis and further development of PSC in Georgian healthcare.

Background: Healthcare systems worldwide experience shortages of healthcare professionals. Retention of physicians is becoming an increasing problem. The psychological safety among physicians affects not only performance but also their emotional well-being and job satisfaction. This study aims to evaluate early career physicians’ perception of psychological safety and its influence on job satisfaction and intention to leave. Methods: In a cross-sectional study, early career physicians, currently in fellowship programs in Germany were invited to fill in an electronic survey. The instrument consisted of demographic variables and sections from validated and well-established questionnaires. Psychological safety was evaluated on three levels—in relation to the team leader, team as a whole, and peers. Also, job satisfaction was assessed with standardized measures, and participants were asked if they were considering leaving their current employer. Participants were recruited via a nationwide learning platform—an online educational portal for medical students and early career physicians. Data analyses included descriptive, correlation analysis, and regression analyses to determine univariate and multivariate associations with job satisfaction and intention to leave. Results: The study sample consisted of 432 early career physicians. Most were fulltime employed (85.6%), female (78.2%), and in first 3 years of their postgraduate education (77.5%). A total of 47.2% indicated intention to leave their current employment. On a Likert-10 agreement scale, with high scores indicating greater psychological safety, the mean scores for leader-related, team-related, and peer-related psychological safety were 6.01 [95% confidence interval = 5.81–6.21), 7.30 (7.11–7.49), and 7.95 (7.78–8.12), respectively. In correlation analysis, all dimensions of psychological safety showed significant associations with job satisfaction and the intention to leave. In the multiple regression analyses, female gender (B = −0.10; P = .04) and age group (B = −0.08; P < .01) were associated with lower job satisfaction. High leader and team-related psychological safety were significantly associated with higher job satisfaction (B = 0.18, P < .01; B = 0.10, P < .01), and negatively related to intention to leave (OR = 0.53, P < 0.01; OR = 0.77, P < .01). Conclusion: This survey enhances our understanding of the nuances of psychological safety among early career physicians. In Germany, they reported low-to-medium levels of psychological safety related to the leader and low job satisfaction. Almost every second participant indicated intention to leave the organization. Leader-related psychological safety had highest effect on job satisfaction and intention to leave. Our findings corroborate the eminent role of leadership, workplace, and safety culture for job satisfaction and retention of early career physicians, what consequently affects quality and safety of healthcare.

Objective: To study the psychometric properties of the Georgian version of the Safety Attitudes Questionnaire short version.Design: Cross-sectional study.Setting: Three Georgian hospitals.Participants: Personnel of participating hospitals (n=305 responses, estimated response rate 30%).Interventions: None.Primary and secondary outcome measures: Psychometric properties (model fit, internal consistency, construct validity, convergent and discriminant validity) of the instrument, factor structure derived from the data.Results: The Georgian version of Safety Attitudes Questionnaire demonstrated acceptable construct validity and internal consistency (Cronbach’s alpha 0.61–0.91). Three factors, Teamwork Climate, Safety Climate and Working Conditions, had limited convergent and discriminant validity. Confirmatory factor analysis with the original six-factor model resulted in limited model fit (χ²/df=2.14, root mean square error of approximation (RMSEA)=0.06, goodness of fit index (GFI)=0.83, CFI=0.88, TLI=0.86). Exploratory factor analysis resulted in a modified four-factor model with satisfactory model fit (χ²/df=2.09, RMSEA=0.06, GFI=0.88, CFI=0.93, TLI=0.91).Conclusions: The Georgian version of the Safety Attitudes Questionnaire (short version) demonstrated acceptable psychometric properties, with acceptable to good internal consistency and construct validity. While the whole model had limited fit to the data, a modified factor model resulted in good model fit. Our findings suggest the dimension Working Conditions has questionable psychometric properties and should be interpreted with caution. Other two correlated dimensions Teamwork Climate and Safety Climate share considerable variance and may be merged. Overall, the instrument can provide valuable information relevant for advancement of patient safety culture in Georgian hospitals.

Aim: To measure safety performance, situational judgement test, which is a method composed of job‐related situations, can be used. This study aimed to develop and test its psychometric properties by measuring the safety performance of healthcare professionals in German hospitals.Design: An explorative cross‐sectional study.Methods: A team of researchers, nurses and physicians developed seven items, which focus on different safety areas. Descriptive statistics were calculated for each item. Cronbach's alpha was calculated as an indication of internal consistency. Spearman's correlation between the items was evaluated as analysis of construct validity. A cross‐sectional survey with healthcare professionals in three German hospitals was conducted to test the developed instrument.Results: A total of 168 healthcare professionals participated (response rate: 39.1%). 70.2% were women, and 38.7%, 33.9%, 15.5% and 11.3% were registered nurses, nurses in training, physicians and other healthcare professionals respectively. The situational judgement test demonstrated an acceptable psychometric performance.