Journal of Surgical Simulation 2018; 5: A: 5 - 5

Published: 11 September 2018


Oral presentation

Special Issue: Improving patient safety culture through low cost innovation

Kelsey Flott, Will Gage, Marie Batey, Julian Redhead and Ara Darzi
Corresponding author: Kelsey Flott, Patient Safety Translational Research Centre, Imperial College, London, UK. Email:


Background: International discourse on patient safety has emphasized that while large-scale infrastructure investments are a part of ensuring safety, they are often untenable, and, crucially, not always sufficient to changing practice and instilling safe behaviour.1  Safe culture - characterised by clear communication, freedom from blame and effective mechanisms for learning - is central to ensuring safe care delivery. 2,3 Despite its seemingly inexact definition, safety culture can be broken down, measured and improved using low cost, freely available tools such as the internationally validated Safety Attitudes Questionnaire (SAQ).4

Objective: Implement the SAQ as a low cost intervention to take a baseline measure of safety culture in a complex, multi-site acute hospital trust and use results to design a targeted safety culture action plan.

Methods: The SAQ was conduced at Imperial College Healthcare Trust (ICHT) across six sites. Fieldwork ran for 12 weeks between October 2016 and January 2017. All staff (n=8,353) were sent a link to the online SAQ. Two reminder emails were sent at four weekly intervals.

The adapted version of the SAQ included 33 statements about safety culture to which respondents presented on a Likert scale with options from “strongly agree” to “strongly disagree.” Questions were scored and averages were taken for each statement at the Trust level and then compared by staff group, hospital site, division and directorate. Finally, the 33 statements were themed according to the Manchester Patient Safety Framework (MaPSaF) to identify overall patterns where safety culture needed to be improved.5

Results: The final response rate was 1580/8353 (19%). Organisational level results highlighted communication as a key strategic priority for improving safety culture, scoring (3.85/10). Leadership was also a concern, especially as it related to dealing with problem staff and perceptions around staffing; on average leadership questions scored (4.30/10). Results broken down by staff group, site, division and directorate revealed interesting variation and served as a guide for targeted action planning.

Conclusion: Culture is the crux of safe behaviour, error reduction and public trust in the health service. This low cost tool provides a baseline for assessing interventions, allows nuanced insight into safety culture, and informs an actionable plan for cultivating positive safety attitudes.  


1. Yu A, Flott K, Chainani N, Fontana G, Darzi A. Patient Safety 2030. NIHR Imperial Patient Safety Translational Research Centre, London; 2016. Accessed 23 February 2018.

2. Howell A-M, Burns EM, Hull L, Mayer E, Sevdalis N, Darzi A. International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process. BMJ Qual Saf 2016.

3. Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care.  BMJ Qual Saf 2004; 13: i85-i90.

4.Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 2006; 6: 44.

5. National Patient Safety Agency. Patient safety resources, Manchester Patient Safety Framework. Accessed 23 February 2018.


safety culture; safety attitudes questionnaire; patient safety

Additional Information

This presentation was given at the 7th Annual Homerton Simulation Conference: Novel thinking and new technology in healthcare and education, Homerton University Hospital, London, UK, on 7 December 2017.

Conflicts of interest: none declared.