Advancing the Measurement of Patient Safety Culture: Development and Psychometrics of the AHRQ SOPS Hospital Survey Version 2.0

Background: Establishing a culture of patient safety is essential to delivering safe and high quality care within healthcare organizations. Understanding the importance of measuring patient safety culture using a standardized tool, the Agency for Healthcare Research and Quality (AHRQ) released the Surveys on Patient Safety Culture ^® (SOPS ^® ) Hospital Survey (HSOPS 1.0) in 2004. Based on input from various sources, the goals of this study were to develop and pilot test a shorter, updated version of the survey, the SOPS Hospital Survey 2.0 (HSOPS 2.0), and assess the new survey’s psychometric properties. Methods: Survey development included survey user feedback, a literature review, 56 cognitive interviews, and two multi-site pilot studies using web-based surveys. The first pilot in 2017 resulted in further edits to the HSOPS 2.0 survey and led to a second and final pilot in 2018-2019. Psychometric analysis was conducted on the final pilot test with data from 4,345 provider and staff respondents in 25 hospitals. Results: Overall, the psychometric properties of the HSOPS 2.0 survey were good for the 32 survey items grouped into 10 composite measures and two single-item measures. All but one of the composite measures had acceptable internal consistency reliability, and site-level reliability was also acceptable for all but one composite measure, which was slightly below the criterion. Construct validity was supported by acceptable CFA fit indices and statistically significant, moderate to high hospital-level correlations among most of the measures. Conclusions: The goals of the HSOPS 2.0 survey were to improve upon the original 1.0 survey by developing an updated, shorter, reliable instrument while measuring similar core concepts as the 1.0 version. The HSOPS 2.0 survey demonstrates good psychometric properties and is a reliable and valid instrument for assessing patient safety culture. Health systems, hospitals, and researchers can use the HSOPS 2.0 survey to raise awareness about patient safety among hospital providers and staff, assess patient safety culture to identify areas of strength and opportunities for improvement, and to ultimately improve the overall safety and quality of care.