Measuring safety culture

Evidence scan

February 2011


Key points

  • It is not possible to recommend one tool as the most effective or efficient for use by healthcare teams in the UK, but the evidence does tell us that some tools, such as the Safety Attitudes Questionnaire, have been more widely tested than others.
  • The most rigorously tested and well known tools:
    • Safety Attitudes Questionnaire
    • Patient Safety Culture in Healthcare Organisations
    • Hospital Survey on Patient Safety Culture
    • Safety Climate Survey
    • Manchester Patient Safety Assessment Framework.
    • Tools that are short, easily repeatable over time and adaptable to various contexts may be most practical.
    • Tools might not always be transferable from one context to another (eg a tool that works well in an intensive care unit does not necessarily work well for emergency services).
    • Similarly, tools that have been validated in the USA have been found to have issues when applied in the UK. It is important any safety-culture tool used in the UK is tested and validated (and the results of these tests shared), rather than assuming the tools constructed elsewhere will be sensitive and appropriate for the UK.

    This evidence scan provides a brief overview of some of the tools available to measure safety culture and climate in health care.

    Safety culture refers to the way patient safety is thought about and implemented within an organisation and the structures and processes in place to support this. Safety climate is a subset of broader culture and refers to staff attitudes about patient safety within the organisation.

    Measuring safety culture or climate is important because the culture of an organisation and the attitudes of teams have been found to influence patient safety outcomes and these measures can be used to monitor change over time. It may be easier to measure safety climate than safety culture.

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