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The development and psychometric evaluation of a safety climate measure for primary care
  1. C de Wet1,
  2. W Spence2,
  3. R Mash3,
  4. P Johnson4,
  5. P Bowie1
  1. 1National Health Service Education for Scotland, Glasgow, UK
  2. 2University of Glasgow, Glasgow, UK
  3. 3Family Medicine and Primary Care, University of Stellenbosch, Cape Town, RSA
  4. 4Robertson Centre for Biostatistics, Glasgow, UK
  1. Correspondence to Dr Carl de Wet, Associate Adviser, National Health Service Education for Scotland, 2 Central Quay, Glasgow G3 8BW, UK; carl.dewet{at}


Introduction Building a safety culture is an important part of improving patient care. Measuring perceptions of safety climate among healthcare teams and organisations is a key element of this process. Existing measurement instruments are largely developed for secondary care settings in North America and many lack adequate psychometric testing. Our aim was to develop and test an instrument to measure perceptions of safety climate among primary care teams in National Health Service for Scotland.

Method Questionnaire development was facilitated through a steering group, literature review, semistructured interviews with primary care team members, a modified Delphi and completion of a content validity index by experts. A cross-sectional postal survey utilising the questionnaire was undertaken in a random sample of west of Scotland general practices to facilitate psychometric evaluation. Statistical methods, including exploratory and confirmatory factor analysis, and Cronbach and Raykov reliability coefficients were conducted.

Results Of the 667 primary care team members based in 49 general practices surveyed, 563 returned completed questionnaires (84.4%). Psychometric evaluation resulted in the development of a 30-item questionnaire with five safety climate factors: leadership, teamwork, communication, workload and safety systems. Retained items have strong factor loadings to only one factor. Reliability coefficients was satisfactory (α=0.94 and ρ=0.93).

Discussion This study is the first stage in the development of an appropriately valid and reliable safety climate measure for primary care. Measuring safety climate perceptions has the potential to help primary care organisations and teams focus attention on safety-related issues and target improvement through educational interventions. Further research is required to explore acceptability and feasibility issues for primary care teams and the potential for organisational benchmarking.

  • Patient safety
  • general practice
  • safety culture

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  • Funding NHS Education Scotland.

  • Competing interests None.

  • Ethics approval This research project was considered by the Multi-Research Ethics Committee (A) based in Lothian National Health Service board, but was judged not to require ethical approval.

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