BMJ Qual Saf doi:10.1136/bmjqs-2011-000601
  • Original research

The H-PEPSS: an instrument to measure health professionals' perceptions of patient safety competence at entry into practice

Open Access
  1. Peter G Norton4
  1. 1School of Health Policy & Management, York University, Toronto, Canada
  2. 2Department of Geography, University of Toronto, Toronto, Canada
  3. 3School of Nursing, York University, Toronto, Canada
  4. 4Department of Family Medicine (Emeritus) University of Calgary, Calgary, Canada
  1. Correspondence to Dr Liane R Ginsburg, School of Health Policy & Management, HNES Bldg. Rm. 413, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; lgins{at}
  1. Contributors LG designed the study (including data collection tools and methods), monitored data collection, cleaned and analysed the data, and drafted and revised the paper. She is the guarantor. EC contributed to the study design and helped to draft and revise the manuscript. DT and PGN contributed to overall study design as well as revising and approving the manuscript.

  • Accepted 3 April 2012
  • Published Online First 5 May 2012


Background Enhancing competency in patient safety at entry to practice requires introduction and integration of patient safety into health professional education. As efforts to include patient safety in health professional education increase, it is important to capture new health professionals' perspectives of their own patient safety competence at entry to practice. Existing instruments to measure patient safety knowledge, skills and attitudes have been developed largely to examine the impact of specific patient safety curricular initiatives and the psychometric analyses of the instruments used thus far have been exploratory in nature.

Methods Confirmatory factor analytic approaches are used to extensively test the Health Professional Education in Patient Safety Survey (H-PEPSS), a newly designed survey rooted in a patient safety competency framework and designed to measure health professionals' self-reported patient safety competence around the time of entry to practice. The H-PEPSS focuses primarily on the socio-cultural aspects of patient safety including culture, teamwork, communication, managing risk and understanding human factors.

Results Results support a parsimonious six-factor measurement model of health professionals' perceptions of patient safety competency. These results support the validity of a reduced version of the H-PEPSS and suggest it can be appropriately used at or near training completion with a variety of health professional groups.

Conclusions Given increased demands for patient safety competency among health professionals at entry to practice and slow, but emerging changes in health professional education, ongoing research to understand the extent of patient safety competency among health professionals around the time of entry to practice will be important.


  • Funding This study was funded by a research grant from the Canadian Patient Safety Institute, RFA09-1181-ON.

  • Competing interests None.

  • Ethics approval The study received approval from the Human Participants Review Committee in the Office of Research Ethics at York University in Toronto and at Queen's University (Health Sciences Research Ethics Board).

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

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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