The hospital survey on patient safety culture in Portuguese hospitals: Instrument validity and reliability

Margarida Eiras, Ana Escoval, Isabel Monteiro Grillo, Carina Silva-Fortes

Research output: Contribution to journalArticlepeer-review

31 Citations (Scopus)


Purpose: Quantitative instruments to assess patient safety culture have been developed recently and a few review articles have been published. Measuring safety culture enables healthcare managers and staff to improve safety behaviours and outcomes for patients and staff. The study aims to determine the AHRQ Hospital Survey on Patient Safety Culture (HSPSC) Portuguese version's validity and reliability. Design/methodology/approach: A missing-value analysis and item analysis was performed to identify problematic items. Reliability analysis, inter-item correlations and inter-scale correlations were done to check internal consistency, composite scores. Inter-correlations were examined to assess construct validity. A confirmatory factor analysis was performed to investigate the observed data's fit to the dimensional structure proposed in the AHRQ HSPSC Portuguese version. To analyse differences between hospitals concerning composites scores, an ANOVA analysis and multiple comparisons were done. Findings: Eight of 12 dimensions had Cronbach's alphas higher than 0.7. The instrument as a whole achieved a high Cronbach's alpha (0.91). Inter-correlations showed that there is no dimension with redundant items, however dimension 10 increased its internal consistency when one item is removed. Originality/value: This study is the first to evaluate an American patient safety culture survey using Portuguese data. The survey has satisfactory reliability and construct validity.

Original languageEnglish
Pages (from-to)111-122
Number of pages12
JournalInternational Journal Of Health Care Quality Assurance
Issue number2
Publication statusPublished - 2014


  • Assessment
  • Decision making
  • Patient safety


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