Item statements | Mean | SD | Minimum | Maximum | % ‘I don’t know’ answers | |
Control-based safety management | ||||||
Formalisation: A supervisor stresses the importance of compliance with safety rules and regulations. | ||||||
1 | In this department, it is considered extremely important to follow safety rules and procedures (eg, regarding hand hygiene). (1a) | 3.35 | 0.563 | 1 | 4 | 0.2 |
2 | In this department, people can ignore formal safety rules and procedures if it helps to get the job done. (1a*) | 2.91 | 0.712 | 1 | 4 | 3.1 |
3 | In this department, everything has to be done by the book. (1a) | 2.83 | 0.590 | 1 | 4 | 1.1 |
4 | In this department, it is not necessary to follow safety rules and procedures to the letter. (1a*) | 3.26 | 0.705 | 1 | 4 | 1.0 |
5 | In this department, nobody gets too upset if people break safety rules and procedures. (1a*) | 3.26 | 0.618 | 1 | 4 | 2.1 |
Monitor compliance: A supervisor monitors compliance with safety rules and regulations during care delivery and audits, as well as based on registrations in (electronic) patient records. | ||||||
6 | When my supervisor is in the department, he/she monitors whether we comply with safety rules and procedures (eg, regarding hand hygiene). (6b) | 3.22 | 0.966 | 1 | 5 | 4.0 |
7 | Whether we comply with safety rules is monitored based on information registered in (electronic) patient records (eg, information regarding pressure ulcers, pain, frail elderly). (6b) | 3.72 | 0.841 | 1 | 5 | 2.9 |
8 | In this department, it is rarely monitored whether employees comply with safety rules and procedures. (6b*) | 3.57 | 0.858 | 1 | 5 | 1.9 |
9 | In this department, employees’ compliance with safety rules and procedures is monitored on a regular basis, for example during safety audits or walk rounds. (6b) | 3.73 | 0.866 | 1 | 5 | 2.1 |
Provide feedback on (non-)compliance: A supervisor provides employees with either positive or negative feedback on their compliance with safety rules and regulations and uses formal sanction policies in case of recurrent non-compliance. | ||||||
10 | My supervisor says a good word when he/she sees a job done according to established patient safety procedures. (2c) | 3.42 | 1.021 | 1 | 5 | 1.1 |
11 | In my department, anyone who violates safety rules or procedures is swiftly corrected. (6c) | 3.30 | 0.860 | 1 | 5 | 2.7 |
12 | When we repeatedly do not comply with safety rules or procedures, disciplinary actions will be taken. (6c) | 3.21 | 0.882 | 1 | 5 | 9.5 |
13 | Compliance with safety rules and procedures (eg, regarding hand hygiene) does substantially contribute to a positive assessment in our department. (6c) | 3.44 | 0.875 | 1 | 5 | 2.8 |
Commitment-based safety management | ||||||
Prioritise patient safety: A supervisor gives priority to delivering safe care and demonstrates this to employees, both in words and deeds. | ||||||
14 | My supervisor overlooks patient safety problems that happen over and over. (2c*) | 3.90 | 0.858 | 1 | 5 | 2.2 |
15 | Whenever pressure builds up, my supervisor wants us to work faster, even if it means taking shortcuts. (2c*) | 3.60 | 0.977 | 1 | 5 | 1.2 |
16 | The actions of my supervisor show that patient safety is a top priority. (2c) | 3.45 | 0.911 | 1 | 5 | 4.3 |
Show commitment on patient safety: A supervisor shows determination to ensure patient safety by encouraging employees to deliver safe care to patients, coaching workers in safety behaviours and taking improvement initiatives. | ||||||
17 | My supervisor provides continuous encouragement to do our jobs safely. (3b) | 3.85 | 0.942 | 1 | 5 | 1.2 |
18 | My supervisor shows determination to maintain a work environment where we deliver safe care to our patients. (3b) | 4.05 | 0.858 | 1 | 5 | 1.4 |
19 | My supervisor behaves in a way that displays a commitment to patient safety. (3b) | 3.98 | 0.870 | 1 | 5 | 1.4 |
20 | My supervisor suggests new ways of doing our jobs more safely. (3b) | 3.28 | 1.033 | 1 | 5 | 2.4 |
21 | My supervisor spends time showing me the safest way to do things at work. (3b) | 2.95 | 1.210 | 1 | 5 | 3.4 |
Show role modelling behaviour: A supervisor is a role model for employees in regard to patient safety and practises what he/she preaches. | ||||||
22 | Regarding safety, my supervisor delivers the consequences he/she describes. (4c) | 3.75 | 0.830 | 1 | 5 | 2.8 |
23 | When my supervisor lays out safety protocols, he/she makes sure people follow it. (4c) | 3.67 | 0.788 | 1 | 5 | 2.9 |
24 | My supervisor enforces the safety protocols he/she describes. (4c) | 3.53 | 0.806 | 1 | 5 | 3.8 |
25 | My supervisor always practises the safety protocols he/she preaches. (4c) | 3.58 | 0.791 | 1 | 5 | 13.2 |
26 | My supervisor does not actually prioritise safety issues as highly as he/she says he/she does. (4c*) | 3.99 | 0.860 | 1 | 5 | 2.7 |
27 | Regarding safety, my supervisor’s words do not match his/her deeds. (4c*) | 3.73 | 0.925 | 1 | 5 | 2.6 |
Encourage participation: A supervisor encourages employees to take initiative on improving patient safety and to participate in decision-making processes on safety issues. | ||||||
28 | My supervisor seriously considers staff suggestions for improving patient safety. (2c) | 3.87 | 0.851 | 1 | 5 | 1.1 |
29 | In this department, staff is involved in decision-making processes. (5c) | 3.20 | 0.950 | 1 | 5 | 0.5 |
30 | My supervisor encourages me to express my ideas and suggestions regarding patient safety improvement. (6c) | 3.93 | 0.836 | 1 | 5 | 0.8 |
31 | My supervisor encourages us to take initiative on improving patient safety whenever it is possible. (6c) | 3.89 | 0.806 | 1 | 5 | 1.4 |
Create safety awareness: A supervisor attempts to increase consciousness of safety issues by making employees aware of the potential safety risks and deficiencies in their own performance. | ||||||
32 | We are informed about errors that happen in this department. (2b) | 3.86 | 0.878 | 1 | 5 | 0.5 |
33 | We are given feedback about changes put into place based on event reports. (2b) | 3.97 | 0.964 | 1 | 5 | 0.4 |
34 | In this department, we discuss ways to prevent errors from happening again. (2b) | 3.94 | 0.883 | 1 | 5 | 0.3 |
35 | We are generally informed about the patient outcomes available for our department. (6b) | 3.85 | 1.003 | 1 | 5 | 4.0 |
36 | In this department, performance indicators for patient safety (eg, pressure ulcers, hospital-acquired infections) are discussed. (6b) | 3.85 | 1.074 | 1 | 5 | 4.4 |
37 | We compare our patient outcomes with results of other departments, and results of this benchmark are discussed. (6b) | 3.40 | 1.186 | 1 | 5 | 15.4 |
1: climate for formalisation scale; 2: items from the Dutch Hospital Survey on Patient Safety Culture; 3: items adapted from Multifactor Leadership Questionnaire-5; 4: Behavioural Integrity Scale; 5: items derived from Safety Attitudes Questionnaire; 6: items formulated by the research team.6 23–26
a: 4-point Likert scale ranging from ‘definitely false’ to ‘definitely true’; b: 5-point Likert scale ranging from ‘never’ to ‘always’; c: 5-point Likert scale ranging from ‘completely disagree’ to ‘completely agree’.
*Reverse-scored items.