In addition to the A-HSOPS 2.0, there are two other tools that are used in Australia. They are the:
- Safety Attitudes Questionnaire (SAQ) – short version
- Manchester Patient Safety Framework (MaPSAF).
Both of these tools have been used in Australian hospitals and provide a view of the key elements of patient safety culture. SAQ has been validated in South Australia and Victoria. MaPSAF, while resource intensive, provides an opportunity to measure, and improve on, patient safety culture concurrently. While the A-HSOPS 2.0 is recommended, hospitals may continue using these other tools to meet their needs or understand trends in patient safety culture over time. Information on each of these tools is provided below.
The literature review and environmental scan provides a comprehensive list of alternative tools available. Other surveys may be appropriate where the focus of the measurement is on a particular speciality or setting or if the aim of the project is to focus on a specific element of patient safety culture in more detail.
The SAQ was developed in 2004 by researchers at the University of Texas in the US and continues to be widely used to measure patient safety culture.
The full version of the questionnaire includes 60 items, of which 30 items are standard and identical across all settings. The generic SAQ Short-form version, includes the 30 standard items from the full SAQ, plus an additional six items, and three demographic items, providing a total of 39 items.
The survey is comprised of six factors:
- Teamwork Climate
- Safety Climate
- Job Satisfaction
- Perceptions of Management
- Working Conditions
- Stress Recognition.
Validation and use in Australia
The Staff Survey on Patient Safety was developed by South Australia Health who worked with researchers to adapt the SAQ. This survey was used in a state-wide study in 2009[i] and repeated in some SA Local Health Networks in 2013.
The Safety Climate Survey was developed by the Victorian Managed Insurance Authority and the Victorian Quality Council who worked with an consultants to adapt the SAQ. This survey was piloted in six hospitals in 2010. They also developed a guide for use and a range of templates to support implementation.
The modifications of the SAQ continue to be used in Australia to monitor patient safety culture and measure the impact of improvement projects.
The MaPSaF was designed specifically for use in the UK’s National Health Service in 2009.[ii] The MaPSaF provides a different approach to assessing patient safety culture. Rather than collecting information from a survey, the MaPSaf uses a card sorting activity and facilitated discussion to support units to understand their culture.
The implementation is ideally facilitated by a person within the healthcare organisation and teams who have a lead role in the patient safety agenda, rather than by a professional facilitator. The framework includes an improvement process that is designed to involve frontline staff in seven steps to assess and improve safety culture within their work unit. The seven steps are:
- Safety culture
- Lead and support staff
- Integrated risk management
- Promote incident reporting
- Involve patients and the public
- Learn and share lessons
- Implement solutions.
The framework is presented as a grid for organisations to assess themselves against five levels of maturity in nine or ten dimensions of safety culture. This allows the generation of a profile of the patient safety culture in terms of areas of relative strength and challenge, which can be used to identify issues for change and improvement.
The ten dimensions are:
- Overall commitment to continuous improvement
- Priority given to patient safety
- System errors and individual responsibility /perception of causes of incidents
- Recording incidents and best practice
- Evaluating incidents and best practice
- Learning and effecting change
- Communication about safety issues
- Personnel management and safety issues
- Staff education and training about safety
- Team working around safety issues.
The five levels of maturity are (E=most mature):
- Pathological: why waste time on patient safety?
- Reactive: we take it seriously and do something after an incident
- Bureaucratic or Calculative: we have systems in place to manage patient safety
- Proactive: we are always on the alert thinking about safety issues that might emerge
- Generative: managing patient safety is an integral part of everything we do.
Validation and use in Australia
The MaPSaF has been evaluated in a hospital setting overseas[iii]. While MaPSaF has not been validated in Australia, it is widely used and well regarded in Australia as an integrated measurement and improvement strategy.
[i] Öhrn A, Rutberg H, Nilsen P. Patient safety dialogue: evaluation of an intervention aimed at achieving an improved patient safety culture. Journal of patient safety. 2011 Dec 1;7(4):185-92.
[ii] Parker D. Managing risk in healthcare: understanding your safety culture using the Manchester Patient Safety Framework (MaPSaF). Journal of nursing management. 2009 Mar;17(2):218-22.
[iii] Braithwaite J, Westbrook MT, Pirone C, Robinson P, Robinson M, Michael S. Staff Survey on Patient Safety. Adelaide, SA: Communio and Centre for Healthcare Resilience and Implementation Science, UNSW for the South Australian Council for Safety and Quality in Health Care and South Australian Department of Health; 2009.