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Hospital Survey on Patient Safety Culture: psychometric evaluation in Kuwaiti public healthcare settings
  1. Gheed Al Salem1,2,
  2. Paul Bowie3,
  3. Jill Morrison4
  1. 1 Institute of Health and Well-being, University of Glasgow, Glasgow, UK
  2. 2 Quality and Accreditation Directorate, Ministry of health, Kuwait City, Kuwait
  3. 3 Safety & Improvement, NHS Education for Scotland, Glasgow, Scotland, UK
  4. 4 General Practice and Primary Care, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Gheed Al Salem; drgheed{at}


Objective As healthcare organisations endeavour to improve the quality and safety of their services, there is increasing recognition of the importance of building a culture of safety to promote patient safety and improve the outcomes of patient care. Surveys of safety culture/climate have not knowingly been conducted in Kuwait public hospitals, nor are valid or reliable survey instruments available for this context. This study aims to investigate the psychometric properties of the HSOPSC (Hospital Survey on Patient Safety Culture) tool in Kuwaiti public hospitals in addition to constructing an optimal model to assess the level of safety climate in this setting.

Design Cross-sectional study.

Setting Three public hospitals in Kuwait.

Participants About 1317 healthcare professionals.

Main outcome measure An adapted and contextualised version of HSOPSC was used to conduct psychometric evaluation including exploratory factor analysis, confirmatory factor analysis reliability and correlation analysis.

Results 1317 questionnaires (87%) were returned. Psychometric evaluation, showed an optimal model of eight factors and 22 safety climate items. All items have strong factor loadings (0.42–0.86) and are theoretically related. Reliability analysis showed satisfactory results (α >0.60).

Conclusions This is the first validation study of a standardised safety climate measure in a Kuwaiti healthcare setting. An optimal model for assessing patient safety climate was produced that mirrors other international studies and which can be used for measuring the prevailing safety climate. More importance should be attached to the psychometric fidelity of safety climate questionnaires before extending their use in other healthcare culture and contexts internationally.

  • patient safety
  • safety culture
  • psychometrics
  • surveys
  • quality improvement

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  • Contributors GA, PB and JM made considerable contributions to conception and design of the psychometric evaluation. GA completed the psychometric assessment and development of the final eight-factor model. GA was involved in drafting the manuscript while JM and PB have done revising of the drafts. All authors have given final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Ethical approval was sought from the Medical, Veterinary and Life Sciences College ethics committee of the University of Glasgow in Scotland and the Medical and Health Sciences Research Committee of the Ministry of Health in Kuwait.

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

  • Data sharing statement Data are available. Please contact the corresponding author.

  • Patient consent for publication Not required.

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