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The ConCom Safety Management Scale: developing and testing a measurement instrument for control-based and commitment-based safety management approaches in hospitals
  1. Carien W Alingh1,2,
  2. Mathilde M H Strating1,
  3. Jeroen D H van Wijngaarden1,
  4. Jaap Paauwe1,2,
  5. Robbert Huijsman1
  1. 1 Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
  2. 2 Department of Human Resource Studies, Tilburg University, Tilburg, The Netherlands
  1. Correspondence to Carien W Alingh, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam 3000 DR, The Netherlands; alingh{at}


Background Nursing management is considered important for patient safety. Prior research has predominantly focused on charismatic leadership styles, although it is questionable whether these best characterise the role of nurse managers. Managerial control is also relevant. Therefore, we aimed to develop and test a measurement instrument for control-based and commitment-based safety management of nurse managers in clinical hospital departments.

Methods A cross-sectional survey design was used to test the newly developed questionnaire in a sample of 2378 nurses working in clinical departments. The nurses were asked about their perceptions of the leadership behaviour and management practices of their direct supervisors. Psychometric properties were evaluated using confirmatory factor analysis and reliability estimates.

Results The final 33-item questionnaire showed acceptable goodness-of-fit indices and internal consistency (Cronbach’s α of the subscales range: 0.59–0.90). The factor structure revealed three subdimensions for control-based safety management: (1) stressing the importance of safety rules and regulations; (2) monitoring compliance; and (3) providing employees with feedback. Commitment-based management consisted of four subdimensions: (1) showing role modelling behaviour; (2) creating safety awareness; (3) showing safety commitment; and (4) encouraging participation. Construct validity of the scale was supported by high factor loadings and provided preliminary evidence that control-based and commitment-based safety management are two distinct yet related constructs. The findings were reconfirmed in a cross-validation procedure.

Conclusion The results provide initial support for the construct validity and reliability of our ConCom Safety Management Scale. Both management approaches were found to be relevant for managing patient safety in clinical hospital departments. The scale can be used to deepen our understanding of the influence of patient safety management on healthcare professionals’ safety behaviour as well as patient safety outcomes.

  • Patient safety
  • management
  • nurses

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  • Contributors CWA, MMHS, JDHvW, JP and RH contributed to the study design. CWA and JDHvW developed the initial set of survey items. MMHS, RH and JP reviewed the draft versions of the questionnaire and commented on the content validity. All authors approved the final set of items used in this study. CWA collected the data and together with MMHS conducted the analyses, in close collaboration with JDHvW, RH and JP. CWA took the lead in drafting the manuscript, while all authors reviewed the paper, commented on various drafts and rewrote parts of it. All authors read and approved the final manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Ethics Review Board of the School of Social and Behavioral Sciences, Tilburg University, confirmed that our study was outside the scope of the Netherlands' Medical Research Involving Human Subjects Act and that the rights and privacy of study participants have been taken into account sufficiently (administration number: EC-2017.62).

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