Development And Psychometric Evaluation Of Patient Safety Culture Scale Of Community-level Healthcare Institutions In China

[Purpose]Developing an appropriate instrument with good reliability and validity for assessing patient safety culture in Chinese community-level healthcare institutions,so that providing a normative and scientific measurement to make stratigies for improving patient safety culture in Chinese community-level healthcare institutions.[Methods]The project included four phases.In the first phase,based on the Manchester Patient Safety Assessment Framework,we developed the item pool of patient safety culture for Chinese community-level healthcare institutions through literature-review and focus group discussion.In the second phase,conducting two-round Delphi expert consultation,we revised our description,deleted some irrelevant items,and ranked the dimensions.In the third phase,we conducted a pre-survey.On the result of pre-investigation,we calculated the response rate of each option,critical ratio,coefficient of variation,correlation coefficient,Cronbach's?coefficient,and factor loading to select and revise the scale.In the last phase,carrying out a questionnaire survey to test the reliability and validity of the scale through content validity index,structural validity index,internal consistency reliability,and split-half reliability.[Results]The results are listed as follows:1.The item pool of our scale included nine dimensions and fifty-dive items based on the Manchester Patient Safety Assessment Framework through literature review and focus group discussion.The specific dimensions are listed as below:overall commitment to quality(9 items),priority given to patient safety(7 items),perceptions of the causes of patient safety incidents and their identification(9 items),investigating patient safety incidents(5 items),organizational learning following a patient safety incident(4 items),communication about safety issues(6 items),personnel management and safety issues(5 items),staff education and training about safety issues(4 items),and team working around safety issues(6 items).2.Through the first-round expert consultation,the positive coefficient of expert(response rate of questionnaire)was 85.71%,authoritative coefficient was 0.75,and Kendall coefficient was 0.31.According to suggestions from experts,we deleted 14 items and combined dimension“investigating patient safety incidents”with“organizational learning following a patient safety incident”to produce a new dimension“patient safety improvement”.Meanwhile,dimension“personnel management and safety issues”and“staff education and training about safety issues”was incorporated into a new dimension“patient safety training”.In the second-round expert consultation,the positive coefficient of expert was 83.33%,authoritative coefficient was 0.74,and Kendall coefficient was up to 0.45,which was acceptable.In the second expert consultation,we deleted 3 items,then the pre-investigation scale contained 7 dimensions and 38 items.3.In the last phase,we firstly deleted 6 items according to the result of pre-investigation.Then,we conducted formative investigation using the scale with 7 dimensions and 32 items to test the validity and reliability.For reliability,the scale has favorable internal consistency reliability with Cronbach's?coefficient was up to 0.940,meanwhile,the internal consistency reliability was between 0.754 and 0.926 among 7 dimensions and the split-half reliability was up to 0.970.For content validity,the adjusted item content validity index was between 0.64and 0.92,the scale-level content validity index was 0.93,beyond 0.9,and the unanimity content validity index was 0.625.For structural validity,the goodness of fit indices was listed as below:?~2/df=2.993,RMSEA=0.078,CFI=0.925,GFI=0.904,NNFI=0.709,RMR=0.068,the indicator of NNFI were acceptable in general,other indicators were of good fit.Meanwhile,the relevant coefficient among dimension A,B and C was beyond 0.6,but the correlation coefficient was below 0.8,which indicated that the result is acceptable.According to the factor analysis,the adjusted scale was priority given to patient safety(5items),patient safety training(5 items),perceptions of patient safety incidents and their reporting(3 items),punitive feeling(2 items),patient safety improvement(5 items),open communication(3 items),and commitment to quality(9 items).[Conclusions]The patient safety culture scale of Chinese community-level healthcare institutions,which contained 7 dimensions and 32 items,was developed through four phases including methods about literature review,expert consultation,and questionnaire investigation.The scale was confirmed that it was with good reliability and acceptable validity.