Cross-cultural adaptation and validation of the Hospital Survey on Patient Safety Culture 2.0 – Brazilian version

(2023) 23:32 Reis et al. BMC Health Services Research https://doi.org/10.1186/s12913-022-08890-7 BMC Health Services Research Open Access RESEARCH Cross‑cultural adaptation and validation of the Hospital Survey on Patient Safety Culture 2.0 – Brazilian version Claudia Tartaglia Reis1* , Josué Laguardia2 , Paola Bruno de Araújo Andreoli3 , Cassimiro Nogueira Júnior4   and Mônica Martins5    Abstract Background Patient safety culture concerns the values, beliefs and standards shared by an organisation’s health staff and other personnel which influence their care provision actions and conduct. Several countries have made a priority of strengthening patient safety culture to improve the quality and safety of health care. In this direction, measuring the patient safety culture through validated instruments is a strategy applied worldwide. The purpose of this study was to adapt transculturally and validate the HSOPSC 2.0 to Brazilian Portuguese and the hospital context in Brazil. Methods Of the various validated scales for measuring safety culture, the instrument most used internationally is the Hospital Survey on Patient Safety Culture (HSOPSC) developed by the United States Agency for Healthcare Research and Quality in 2004 and revised in 2019, when version 2.0 was released. Adaptation was conducted on a universalist approach and the adapted instrument was then applied to a sample of 2,702 respondents (56% response rate) comprising staff of a large general hospital in the city of São Paulo. Construct validity was investigated by Exploratory Structural Equation Modelling-within-Confirmatory Factor Analysis (ESEM-within-CFA) and reliability was measured in each dimension by means of Cronbach alpha coefficients. Results ESEM fit indexes showed good data fit with the proposed model: χ2 = 634.425 df = 221 χ2/df ratio = 2.9 p-value < 0.0000; RMSEA = 0.045 (90% C.I. = 0.041—0.050) and probability RMSEA <  = .05 = 0.963; CFI = 0.986; TLI = 0.968. However, ten items had loads lower than 0.4. Cronbach alpha values were 0.6 or more for all dimensions, except Handoffs and information exchange (α= 0.50) and Staffing and work pace (α = 0.41). Conclusion The psychometric properties of the Brazilian version were found to be satisfactory, demonstrating good internal consistency and construct validity as expressed by estimates of reliability and indexes of model fit. However, given factor loadings smaller than 0.4 observed in ten items and considering that the scale translated and adapted to Portuguese was tested on a single sample during the Covid-19 pandemic, the authors recognize the need for it to be tested on other samples in Brazil to investigate its validity. Keywords Organizational culture, Safety culture measurement, Patient safety, Health care quality, Cross-cultural adaptation, Validity and reliability, Questionnaire, HSOPSC 2.0 *Correspondence: Claudia Tartaglia Reis 1 Ministério da Saúde, Planejamento e Gestão SMS Cataguases (MG), Rua Manoel Ramos Trindade 76/201, Cataguases, MG 36770‑014, Brazil 2 Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil 3 Quality, Patient Safety and Clinical Outcomes Manager – Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil 4 Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil 5 Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Reis et al. BMC Health Services Research (2023) 23:32 Background Over the past twenty years, the patient safety movement has developed in several directions. At first, studies endeavoured to understand the magnitude of the problems related to safety incidents, the factors contributing to such occurrences and their consequences and harm to patients, known as adverse events. The focus later broadened to take in human and organisational considerations that might contribute to preventing the occurrence of these undesirable outcomes for patients by measures to improve the health service context [1–3]. In that regard, several countries made a priority of strengthening patient safety culture with a view to improving the quality and safety of health care. Recently, the subject has gained greater prominence as countries face concerns relating to the Covid-19 pandemic [4, 5]. Increasingly, the discussion has addressed the roles of leadership, communication, teamwork, and other dimensions of the safety culture shared among health organisation staffs [6]. The current agenda directed to improving the quality of patient care includes topics related to building a safety culture that is open and fair to both health personnel and patients, encourages learning and prioritises open communication among work teams. The World Health Organisation also stresses the importance of leadership support for building a robust safety culture and assuring psychological security in the workplace, avoiding overwork of health staffs, and encouraging the reporting and investigation of safety incidents to benefit continued learning [7]. Patient safety culture, an integral part of organisational culture, concerns the values, beliefs and standards that are shared by an organisation’s health personnel and other workers and influence their manner, actions and conduct in relation to safety [8]. In that light, measures directed to strengthening safety culture have become a subject for ample discussion among health organisation managers and researchers all over the world. To assist them in planning investments in improvement, it has been recommended to measure patient safety culture using validated instruments, a strategy applied worldwide [9]. Of the various validated instruments for measuring safety culture, the Hospital Survey on Patient Safety Culture – Version 1.0 (HSOPSC Version 1.0), developed by the United States Agency for Healthcare Research and Quality (AHRQ) i (...truncated)