Improve patient safety in hospitals at unit level

A Dutch questionnaire based on an US counterpart that aims to measure patient safety culture in hospitals does indeed measure the culture in a hospital unit. Each hospital can use it, as is demonstrated in a publication of researchers of NIVEL and the EMGO Institute for Health and Care Research (VUmc) in Quality and Safety in Health Care.

In the USA, a questionnaire (HSOPS) has been developed to measure patient safety culture in hospitals. The Dutch version of the questionnaire, COMPaZ, contains 11 ‘dimensions’ of patient safety culture. The dimensions cover a range of safety related topics, such as teamwork within and between units, willingness to report incidents, support from management, feedback about incidents, communication openness –does a healthcare provider dare to speak up when there is an unsafe situation– and information transfer during shift changes. The questionnaire is to be filled out by individual healthcare professionals in a hospital unit. But does the questionnaire indeed give information about the safety culture in a unit or does it merely measure attitudes of individual staff members?

Unit culture
The questionnaire measures unit culture, as is demonstrated in an analysis of the results using multilevel modeling. NIVEL-researcher Marleen Smits used this statistical method to find ‘clustering’ of responses in units and in hospitals. “If the questionnaire really measures unit culture, the answers of staff of the same unit have to cluster. In other words: the answers of staff members of unit A have to be more similar to each other than to the answers of staff members of other units”. This applied to each of the 11 dimensions: apparently the questionnaire does measure unit culture and not just individual attitudes.

Recommendations and research
The researchers recommended to direct interventions to improve safety culture at unit level. The study is part of the Dutch Patient Safety Research Program that has been initiated by the Dutch Society of Medical Specialists with financial support from the Ministry of health, Welfare and Sport. For this study, the questionnaire was filled out by 1889 healthcare providers of 87 units in 19 hospitals (circa four units per hospital). The Dutch questionnaire COMPaZ can be obtained via The authors have also written a manual with instructions for the use of COMPaZ, which can also be acquired via the website.