Patient safety climate strength: a concept that requires more attention.
Measuring safety culture is essential to patient safety improvement activities. Standardized safety culture surveys, including the Safety Attitudes Questionnaire and the AHRQ Surveys on Patient Safety Culture, are typically reported as numerical scores calculated by aggregating individual responses. This study analyzed safety culture surveys from an accreditation program in a novel manner. Investigators summarized the safety culture level (the averaged ratings of patient safety culture from respondents), culture strength (the consistency of safety ratings among all the members of a department), and culture shape (the distribution of numerical responses). Even among units with identical levels of safety culture, they found that the consistency and distribution of responses revealed different safety climates. One department had high degrees of agreement about safety culture while the other showed divergent perceptions. These two results have different implications for understanding safety culture. The authors advocate for examining agreement and distribution of safety culture survey results as well as mean scores in order to achieve a more comprehensive and actionable understanding of patient safety culture. A past PSNet interview discussed how to measure and change safety culture.