Measuring Patient Safety Culture in Iran Using the Hospital Survey on Patient Safety Culture (HSOPS): an Exploration of Survey Reliability and Validity

Background and Objectives: Patient Safety Culture is increasingly recognized as an essential driver of patient safety. To establish patient safety culture, firstly the current status of the construct should be assessed. Valid assessment of patient safety culture is contingent on the availability of appropriate measurement tools. Hospital Survey on Patient Safety Culture (HSOPS) developed by the Agency for Healthcare Research and Quality (AHRQ) is frequently used for patient safety culture assessment. Dimensions of patient safety culture may vary between different cultures and this affects the utility of popular measurement models in different countries. This study aimed to examine the extent to which the dimensions of patient safety culture in Iran can be explained by the factor structure of HSOPS. Methods: Healthcare workers in all university hospitals of Qazvin, the center of Qazvin province in Iran, were asked to complete the HSOPS survey (n = 231). Descriptive statistics were used for data summarization. Reliability of the questionnaire was evaluated by calculating Cronbach’s alpha. Validity of the construct was assessed by correlation analysis among the factors. Exploratory factor analysis was used to investigate the extent to which HSOPS factor structure underlies our dataset. ANOVA and t-test were used to compare the score means between professions. Findings: HSOPS’s factor structure was not replicated by factor analysis. Reliability analysis yielded generally unacceptable internal consistency. By contrast, correlation analysis provided evidence for validity of construct by reproducing meaningful patterns of interrelations observed in precedent studies. The relative magnitude of factor scores generally followed the pattern in the benchmark study by AHRQ. Conclusions: Based on our results, the reliability of HSOPS for use in Iran seems questionable. Our results, therefore, point to the necessity of large-scale studies to understand the dimensions of patient safety culture in Iran, and to develop a reliable and valid tool for its measurement.