BMJ Qual Saf 20:797-805 doi:10.1136/bmjqs.2010.049411
  • Original research

The Frankfurt Patient Safety Climate Questionnaire for General Practices (FraSiK): analysis of psychometric properties

  1. Ferdinand M Gerlach1
  1. 1Institute for General Practice, Goethe University Frankfurt, Germany
  2. 2University of Texas Houston Medical School and UT Houston-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA
  1. Correspondence to Barbara Hoffmann, Institute for General Practice, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany; hoffmann{at}
  • Accepted 1 April 2011
  • Published Online First 13 May 2011


Background Safety culture has been identified as having a major impact on how safety is managed in healthcare. However, it has not received much attention in general practices. Hence, no instrument yet exists to assess safety climate—the measurable artefact of safety culture—in this setting. This study aims to evaluate psychometric properties of a newly developed safety climate questionnaire for use in German general practices.

Methods The existing Safety Attitudes Questionnaire, Ambulatory Version, was considerably modified and enhanced in order to be applicable in general practice. After pilot tests and its application in a random sample of 400 German practices, a first psychometric analysis led to modifications in several items. A further psychometric analysis was conducted with an additional sample of 60 practices and a response rate of 97.08%. Exploratory factor analysis with orthogonal varimax rotation was carried out and the internal consistency of the identified factors was calculated.

Results Nine factors emerged, representing a wide range of dimensions associated with safety culture: teamwork climate, error management, safety of clinical processes, perception of causes of errors, job satisfaction, safety of office structure, receptiveness to healthcare assistants and patients, staff perception of management, and quality and safety of medical care. Internal consistency of factors is moderate to good.

Conclusions This study demonstrates the development of a patient safety climate instrument. The questionnaire displays established features of safety climate and additionally contains features that might be specific to small-scale general practices.


  • Funding A grant provided by the Federal Ministry of Education and Research (project no. 01GK0702) has enabled this project.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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