Fiabilidad y validez de la versión brasileña del HSOPSC: un estudio de revisión

Reis, Cláudia Tartaglia; Laguardia, Josué; Barros, Cláudia Garcia de; Andreoli, Paola Bruno de Araujo; Martins, Mônica

Acessibilidade / Reportar erro

Brasil

Cadernos de Saúde Pública

Español English

Brasil

Español English

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Sumário

METHODOLOGICAL ISSUES • Cad. Saúde Pública 35 (8) • 2019 • https://doi.org/10.1590/0102-311X00246018 copiar

Fiabilidad y validez de la versión brasileña del HSOPSC: un estudio de revisión

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen:

El estudio tuvo como objetivo revisar las propiedades psicométricas de la versión del Hospital Survey on Patient Safety Culture (HSOPSC) adaptado al portugués, para su uso en el contexto brasileño. Se realizó un estudio transversal observacional, en un hospital grande con cuidados intensivos, privado, sin ánimo de lucro, punto de referencia en seguridad del paciente, situado en una de las mayores metrópolis brasileñas. Los participantes se seleccionaron de un muestreo no probabilístico entre todo el personal elegible de los diversos departamentos hospitalarios invitados a participar en el estudio. La fiabilidad del HSOPSC se evaluó estimando el alfa de Cronbach para cada dimensión. Se utilizaron tanto el análisis factorial confirmatorio (AFC), como la matriz de correlaciones entre las dimensiones y los modelos de ecuaciones estructurales exploratorios (ESEM) en el análisis exploratorio y confirmatorio para la validez estructural del constructo. El porcentaje general de respuesta fue de un 18,7% (n = 1,439). Hubo cuatro dimensiones (“percepciones generales de seguridad del paciente”; “dotación de personal”; “trabajo en equipo en las unidades”; y “respuesta al error no-punitiva”), problemas recurrentes de consistencia interna. El AFC mostró un ajuste aceptable con el modelo original de 12-dimensiones. Las correlaciones entre las dimensiones del modelo original de 12-dimensiones indicaron problemas de validez discriminante, mientras que varianza residual era mayor a 0,70 en 13 ítems. Los ESEM del modelo original de 12-dimensiones tuvieron un buen ajuste con los siguientes índices: CFI = 0,985; TLI = 0,968 y RMSEA = 0,026 (90%CI: 0,024-0,029). A pesar de que eran mejores que los de la primera evaluación, los resultados obtenidos en esta revisión de la validez y fiabilidad de la versión del cuestionario, traducido y adaptado al contexto brasileño, es necesario que haya más investigaciones al respecto sobre este asunto.

Palabras-clave:
Seguridad del Paciente; Cultura Organizacional; Encuestas de Atención de Salud; Reproducibilidad de los Resultados

Dimension/Items	Studies
Dimension/Items	Current study	Brazil ¹⁸18. Reis CT, Laguardia J, Vasconcelos AGG, Martins M. Reliability and validity of the Brazilian version of the Hospital Survey on Patient Safety Culture (HSOPSC): a pilot study. Cad Saúde Pública 2016; 32:e00115614.	Brazil e-version ¹⁹19. Andrade LEL, Melo LOM, Silva IG, Souza RM, Lima ALB, Freitas MR, et al. Adaptação e validação do Hospital Survey on Patient Safety Culture em versão brasileira eletrônica. Epidemiol Serv Saúde 2017; 26:455-68.	USA ²⁰20. Sorra J, Nieva V. Hospital Survey on Patient Safety Culture. Rockville: Agency for Healthcare Research and Quality; 2004. (AHRQ Publication, 04-0041).	Netherlands ²¹21. Smits M, Christiaans-Dingelhoff I, Wagner C, Wal Gv, Groenewegen PP. The psychometric properties of the 'Hospital Survey on Patient Safety Culture' in Dutch hospitals. BMC Health Serv Res 2008; 8:230.	Norway ⁸8. Olsen E. Reliability and validity of the Hospital Survey on Patient Safety Culture at a Norwegian hospital. In: Øvretveit J, Sousa PJ, editors. Quality and safety improvement research: methods and research practice from the International Quality Improvement Research Network (QIRN). Lisboa: Escola Nacional de Saúde Pública, Universidade Nova de Lisboa; 2008. p. 173-86.	Switzerland ²²22. Pfeiffer Y, Manser T. Development of the German version of the Hospital Survey on Patient Safety Culture: dimensionality and psychometric properties. Saf Sci 2010; 48:1452-62.	UK ²³23. Waterson P, Griffiths P, Stride C, Murphy J, Hignett S. Psychometric properties of the Hospital Survey on Patient Safety Culture: findings from the UK. Qual Saf Health Care 2010; 19:2e.	Scotland ²⁴24. Sarac C, Flin R, Mearns K, Jackson J. Hospital survey on patient safety culture: psychometrics analysis on a Scottish sample. BMJ Qual Saf 2011; 20:842-8.	Japan ¹⁰10. Ito S, Seto K, Kigawa M, Fujita S, Hasegawa T, Hasegawa T. Development and applicability of Hospital Survey on Patient Safety Culture (HSOPS) in Japan. BMC Health Serv Res 2011; 11:28.	Slovenia ¹²12. Robida A. Hospital Survey on Patiet Safety Culture in Slovenia: a psychometric evaluation. Int J Qual Health Care 2013; 25:469-75.	Portugal ¹³13. Eiras M, Escoval A, Grillo IM, Silva-Fortes C. The hospital survey on patient safety culture in Portuguese hospitals: instrument validity and reliability. Int J Health Care Qual Assur 2014; 27:111-22.	France ²⁵25. Perneger TV, Staines A, Kundig F. Internal consistency, factor structure and construct validity of the French version the Hospital Survey on Patient Safety Culture. BMJ Qual Saf 2014; 23:389-97.
Unit-level safety culture
Supervisor expectations and actions promoting patient safety (B1, B2, B3R, B4R)	0.74	0.76	0.73	0.75	0.70	0.77	0.79	0.68	0.79	0.70	0.74	0.72	0.75
Organizational learning - continuous improvement (A6, A9, A13)	0.62	0.56	0.61	0.68	0.57	0.51	0.68	0.66	0.64	0.65	0.36	0.71	0.57
Teamwork within units (A1, A3, A4, A11)	0.72	0.66	0.70	0.74	0.66	0.77	0.75	0.73	0.80	0.83	0.74	0.73	0.80
Communication openness (C2, C4, C6R)	0.69	0.69	0.59	0.64	0.72	0.68	0.64	0.67	0.73	0.62	0.74	0.67	0.67
Feedback/communication about error (C1, C3, C5)	0.68	0.72	0.74	0.81	0.75	0.70	0.78	0.80	0.78	0.77	0.72	0.76	0.77
Non-punitive response to error (A8R, A12R, A16R)	0.54	0.35	0.53	0.74	0.69	0.64	0.70	0.65	0.77	0.71	0.61	0.57	0.60
Staffing (A2, A5R, A7R, A14R)	0.46	0.20	0.59	0.70	0.49	0.65	0.65	0.58	0.60	0.46	0.65	0.48	0.61
Hospital-level safety culture
Hospital management support for patient safety (F1, F8, F9R)	0.69	0.84	0.74	0.84	0.68	0.79	0.83	0.69	0.79	0.61	0.82	0.77	0.79
Teamwork across units (F2R, F4, F6R, F10)	0.45	0.67	0.67	0.75	0.59	0.65	0.77	0.70	0.70	0.70	0.74	0.73	0.71
Handoffs and transitions (F3R, F5R, F7R, F11R)	0.72	0.70	0.73	0.75	0.68	0.65	0.72	0.77	0.74	0.73	0.66	0.71	0.78
Outcome measures
Overall perceptions of patient safety (A10R, A15, A17R, A18)	0.41	0.52	0.63	0.77	0.79	0.76	0.76	0.67	0.84	0.62	0.65	0.62	0.68
Frequency of event reported (D1, D2, D3)	0.91	0.91	0.87	0.88	0.62	0.82	0.70	0.83	0.71	0.88	0.88	0.90	0.86

Index	Current study	Brazil ¹⁸18. Reis CT, Laguardia J, Vasconcelos AGG, Martins M. Reliability and validity of the Brazilian version of the Hospital Survey on Patient Safety Culture (HSOPSC): a pilot study. Cad Saúde Pública 2016; 32:e00115614.	Brazil e-version ¹⁹19. Andrade LEL, Melo LOM, Silva IG, Souza RM, Lima ALB, Freitas MR, et al. Adaptação e validação do Hospital Survey on Patient Safety Culture em versão brasileira eletrônica. Epidemiol Serv Saúde 2017; 26:455-68.	USA ²⁰20. Sorra J, Nieva V. Hospital Survey on Patient Safety Culture. Rockville: Agency for Healthcare Research and Quality; 2004. (AHRQ Publication, 04-0041).	Netherlands ²¹21. Smits M, Christiaans-Dingelhoff I, Wagner C, Wal Gv, Groenewegen PP. The psychometric properties of the 'Hospital Survey on Patient Safety Culture' in Dutch hospitals. BMC Health Serv Res 2008; 8:230.	Scotland ²⁴24. Sarac C, Flin R, Mearns K, Jackson J. Hospital survey on patient safety culture: psychometrics analysis on a Scottish sample. BMJ Qual Saf 2011; 20:842-8.	Switzerland ²²22. Pfeiffer Y, Manser T. Development of the German version of the Hospital Survey on Patient Safety Culture: dimensionality and psychometric properties. Saf Sci 2010; 48:1452-62.	UK ²³23. Waterson P, Griffiths P, Stride C, Murphy J, Hignett S. Psychometric properties of the Hospital Survey on Patient Safety Culture: findings from the UK. Qual Saf Health Care 2010; 19:2e.	Japan ¹⁰10. Ito S, Seto K, Kigawa M, Fujita S, Hasegawa T, Hasegawa T. Development and applicability of Hospital Survey on Patient Safety Culture (HSOPS) in Japan. BMC Health Serv Res 2011; 11:28.	Slovenia ¹²12. Robida A. Hospital Survey on Patiet Safety Culture in Slovenia: a psychometric evaluation. Int J Qual Health Care 2013; 25:469-75.	Portugal ¹³13. Eiras M, Escoval A, Grillo IM, Silva-Fortes C. The hospital survey on patient safety culture in Portuguese hospitals: instrument validity and reliability. Int J Health Care Qual Assur 2014; 27:111-22.
TLI	0.91	0.93	0.94	0.88	0.88	0.91	0.85	0.91	0.88	0.87	0.86
CFI	0.92	0.89	0.94	0.90	0.90	0.93	0.87	0.93	0.89	0.89	0.88
RMSEA	0.04	0.10	0.05	0.05	0.05	0.05	0.06	0.05	0.05	0.05	0.05
Sample	1,439	219	863	1,171	974	974	974	974	6,395	976	573

	DIM 1	DIM 2	DIM 3	DIM 4	DIM 5	DIM 6	DIM 7	DIM 8	DIM 9	DIM 10	DIM 11
DIM 2	0.11
DIM 3	0.68	0.22
DIM 4	0.09	0.65	0.16
DIM 5	0.63	0.29	0.71	0.11
DIM 6	0.05	0.68	0.16	0.61	0.19
DIM 7	0.07	0.82	0.18	0.63	0.18	0.94
DIM 8	0.01	0.34	0.05	0.41	0.15	0.63	0.49
DIM 9	0.12	0.63	0.11	0.75	0.20	0.56	0.71	0.331
DIM 10	0.53	0.17	0.59	0.11	0.89	0.14	0.15	0.028	0.11
DIM 11	0.10	0.42	0.08	0.55	0.18	0.38	0.54	0.240	0.89	0.01
DIM 12	0.44	0.09	0.46	0.05	0.57	0.07	0.12	0.020	0.16	0.58	0.17

Dimension/Items	DIM 1	DIM 2	DIM 3	DIM 4	DIM 5	DIM 6	DIM 7	DIM 8	DIM 9	DIM 10	DIM 11	DIM 12
Teamwork within units
People support one another in this unit (A1)	0.849	-0.011	-0.003	-0.056	0.057	0.026	-0.004	0.011	0.008	-0.011	0.000	-0.011
When a lot of work needs to be done quickly, we work together as a team to get the work done (A3)	0.684	0.058	0.119	-0.014	-0.001	-0.03	0.006	0.006	0.013	-0.006	0.019	-0.05
In this unit, people treat each other with respect (A4)	0.673	-0.006	0.073	0.110	-0.034	-0.067	0.040	0.042	0.033	0.052	-0.034	0.035
When one area in this unit gets really busy, others help out (A11) *	0.378	0.260	-0.007	0.018	0.052	-0.005	-0.019	-0.008	-0.006	-0.027	-0.007	-0.001
Supervisor expectations and actions promoting patient safety
My supervisor/manager pays a compliment when he/she sees a job done according to established patient safety procedures (B1)	0.024	0.027	-0.004	0.015	-0.001	0.023	0.062	0.788	0.008	-0.037	0.023	0.029
My supervisor/manager gives serious consideration to staff suggestions for improving patient safety (B2)	0.040	-0.015	-0.003	-0.005	-0.009	0.147	-0.012	0.682	-0.007	0.036	0.138	0.008
Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts (B3R)	-0.046	0.155	-0.138	-0.011	0.407	0.000	-0.056	0.096	0.051	0.175	-0.085	-0.025
My supervisor/manager overlooks patient safety problems that happen repeatedly (B4R)	-0.043	0.381	0.095	0.052	0.075	-0.106	0.065	0.109	0.050	0.219	-0.003	0.062
Organizational learning - continuous improvement
We are actively doing things to improve patient safety (A6)	0.241	0.145	0.482	0.061	0.024	0.069	-0.054	-0.017	-0.020	0.043	0.012	-0.032
A9 Mistakes have led to positive changes here	0.227	-0.019	0.493	0.065	0.160	0.035	-0.042	0.022	-0.065	-0.102	0.016	-0.012
After we make changes to improve patient safety, we evaluate their effectiveness (A13)	0.060	0.088	0.585	0.011	-0.068	0.061	0.018	-0.019	0.053	-0.038	-0.079	0.024
Hospital management support for patient safety
Hospital management provides a work climate that promotes patient safety (F1)	0.019	-0.012	-0.047	0.013	0.010	0.016	-0.109	0.003	-0.050	0.604	-0.397	-0.008
The actions of hospital management show that patient safety is a top priority (F8)	0.074	0.069	-0.035	0.041	-0.108	0.034	0.017	0.028	0.447	0.294	0.224	0.014
Hospital management seems interested in patient safety only after an adverse event happens (F9R)	0.007	0.015	-0.045	0.115	-0.084	0.035	-0.084	0.017	0.506	0.006	0.128	0.174
Overall perceptions of patient safety
It is just by chance that more serious mistakes do not happen here (A10R) *	-0.002	-0.019	0.014	0.506	-0.072	0.007	-0.043	0.069	-0.032	-0.038	0.064	-0.054
Patient safety is never sacrificed to get more work done (A15)	0.069	0.609	0.016	-0.131	0.035	-0.004	0.015	-0.051	-0.019	0.006	0.063	-0.015
We have patient safety problems in this unit (A17R)	-0.055	0.414	-0.102	0.316	0.072	0.102	-0.021	0.042	-0.012	-0.022	-0.103	-0.040
Our procedures and systems are good at preventing errors from happening (A18)	0.102	0.375	0.303	-0.014	-0.111	-0.087	0.047	0.074	0.015	0.010	-0.014	0.030
Feedback & communication about error
We are given feedback about changes put into place based on event reports (C1)	-0.035	0.019	-0.004	0.056	-0.035	0.512	0.087	0.026	0.027	0.150	-0.001	-0.067
We are informed about errors that happen in this unit (C3)	0.000	0.017	0.006	0.067	-0.027	0.643	0.148	-0.037	-0.061	-0.029	0.018	0.041
In this unit, we discuss ways to prevent errors from happening again (C5)	-0.002	0.014	-0.011	-0.054	-0.011	0.514	0.189	0.110	0.013	-0.009	0.161	-0.009
Communication openness
Staff will freely speak up if they see something that may negatively affect patient care (C2)	0.041	-0.067	0.056	0.026	-0.001	0.583	0.059	0.021	0.025	0.007	0.142	0.077
Staff feel free to question the decisions or actions of those with more authority (C4)	-0.018	0.005	0.021	-0.059	0.048	0.544	-0.019	0.277	0.104	0.17	-0.084	0.004
Staff are afraid to ask questions when something does not seem right (C6R)	-0.105	-0.009	0.125	-0.121	0.15	0.001	0.023	0.072	-0.017	0.133	0.443	0.413
Frequency of event reported
When a mistake is made, but is identified and corrected before affecting the patient, how often is this reported? (D1)	0.014	0.051	-0.022	-0.031	-0.028	0.047	0.826	0.006	0.005	-0.002	0.017	-0.015
When a mistake is made, but has no potential to harm the patient, how often is this reported? (D2)	−0.019	−0.015	0.024	−0.011	−0.002	0.042	0.875	−0.038	0.019	0.018	0.027	0.029
When a mistake is made that could harm the patient, but does not, how often is this reported? (D3)	0.003	-0.020	-0.018	0.043	0.032	-0.006	0.742	0.051	-0.015	-0.517	-0.016	-0.012
Teamwork across units
Hospital units do not coordinate well with each other (F2)	-0.030	0.018	0.012	0.075	-0.049	0.022	-0.022	0.152	-0.007	-0.070	0.378	0.469
There is good cooperation among hospital units that need to work together (F4)	0.043	0.004	-0.045	0.023	-0.015	0.159	-0.002	0.045	0.129	-0.108	0.541	-0.060
It is often unpleasant to work with staff from other hospital units (F6)	0.070	0.043	-0.070	-0.028	-0.026	0.01	-0.001	-0.068	0.397	0.016	-0.041	0.402
Hospital units work well together to provide the best care for patients (F10)	0.037	-0.023	-0.090	0.024	0.032	0.048	0.027	-0.058	0.022	0.001	0.610	0.000
Staffing
We have enough staff to handle the workload (A2)	0.182	0.506	0.082	0.009	-0.004	0.030	-0.024	-0.041	-0.052	0.004	0.057	0.031
Staff in this unit work longer hours than is best for patient care (A5R) *	0.005	0.072	-0.004	0.091	-0.155	0.040	-0.018	0.009	-0.024	-0.455	-0.036	0.042
We use more agency/temporary staff than is best for patient care (A7R) ^,*	0.081	-0.003	-0.117	-0.026	0.206	0.130	0.004	0.037	-0.072	0.358	-0.158	0.014
We work in “crisis mode,” trying to do too much too quickly (A14R)	0.063	-0.155	0.126	0.541	0.059	-0.035	0.031	-0.032	-0.017	0.024	0.045	0.066
Handoffs & transitions
Things “fall between the cracks” when transferring patients from one unit to another (F3R) **	-0.047	0.001	0.083	-0.032	0.052	0.343	-0.044	0.027	0.221	-0.073	0.079	0.144
Important patient care information is often lost during shift changes (F5R)	0.045	-0.046	-0.074	0.035	0.021	0.013	0.034	-0.02	0.529	-0.038	-0.070	0.363
Problems often occur in the exchange of information across hospital units (F7R)	-0.040	-0.004	0.142	-0.020	0.039	-0.011	0.007	0.046	0.684	-0.069	0.042	-0.029
Shift changes are problematic for patients in this hospital (F11R)	-0.039	-0.046	0.143	-0.070	0.096	-0.001	0.023	-0.005	0.756	0.100	0.009	-0.049
Non-punitive response to error
Staff feel like their mistakes are held against them (A8R) ^,*	-0.142	0.117	0.056	0.304	0.017	-0.018	0.041	-0.022	0.053	0.276	-0.019	-0.060
When an event is reported, it feels like the person is being written up, not the problem (A12R)	0.082	0.033	0.003	0.069	0.606	-0.014	0.034	-0.016	0.021	0.053	0.037	-0.013
Staff worry that mistakes they make are kept in their personnel file (A16R)	0.094	0.097	0.047	0.338	0.442	0.007	0.003	-0.051	0.017	-0.111	0.002	0.071

Item	DIM 1	DIM 2	DIM 3	DIM 4	DIM 5	DIM 6	DIM 7	DIM 8	DIM 9	DIM 10	DIM 11	DIM 12
People support one another in this unit (A1)	0.849	-0.011	-0.003	-0.056	0.057	0.026	-0.004	0.011	0.008	-0.011	0.000	-0.011
When a lot of work needs to be done quickly, we work together as a team to get the work done (A3)	0.684	0.058	0.119	-0.014	-0.001	-0.030	0.006	0.006	0.013	-0.006	0.019	-0.05
In this unit, people treat each other with respect (A4)	0.673	-0.006	0.073	0.110	-0.034	-0.067	0.040	0.042	0.033	0.052	-0.034	0.035
When one area in this unit gets really busy, others help out (A11)	0.378	0.260	-0.007	0.018	0.052	-0.005	-0.019	-0.008	-0.006	-0.027	-0.007	-0.001
Patient safety is never sacrificed to get more work done (A15)	0.069	0.609	0.016	-0.131	0.035	-0.004	0.015	-0.051	-0.019	0.006	0.063	-0.015
We have patient safety problems in this unit (A17R)	-0.055	0.414	-0.102	0.316	0.072	0.102	-0.021	0.042	-0.012	-0.022	-0.103	-0.040
Our procedures and systems are good at preventing errors from happening (A18)	0.102	0.375	0.303	-0.014	-0.111	-0.087	0.047	0.074	0.015	0.010	-0.014	0.030
My supervisor/manager overlooks patient safety problems that happen repeatedly (B4R) *	-0.043	0.381	0.095	0.052	0.075	-0.106	0.065	0.109	0.050	0.219	-0.003	0.062
We have enough staff to handle the workload (A2)	0.182	0.506	0.082	0.009	-0.004	0.030	-0.024	-0.041	-0.052	0.004	0.057	0.031
We are actively doing things to improve patient safety (A6)	0.241	0.145	0.482	0.061	0.024	0.069	-0.054	-0.017	-0.020	0.043	0.012	-0.032
Mistakes have led to positive changes here (A9)	0.227	-0.019	0.493	0.065	0.160	0.035	-0.042	0.022	-0.065	-0.102	0.016	-0.012
After we make changes to improve patient safety, we evaluate their effectiveness (A13)	0.060	0.088	0.585	0.011	-0.068	0.061	0.018	-0.019	0.053	-0.038	-0.079	0.024
It is just by chance that more serious mistakes do not happen here (A10R)	-0.002	-0.019	0.014	0.506	-0.072	0.007	-0.043	0.069	-−0.032	-0.038	0.064	-0.054
We work in “crisis mode”, trying to do too much too quickly (A14R)	0.063	-0.155	0.126	0.541	0.059	-0.035	0.031	-0.032	-0.017	0.024	0.045	0.066
Staff feel like their mistakes are held against them (A8R) *	-0.142	0.117	0.056	0.304	0.017	-−0.018	0.041	-0.022	0.053	0.276	-0.019	-0.060
Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts (B3R)	-0.046	0.155	-0.138	-0.011	0.407	0.000	-0.056	0.096	0.051	0.175	-0.085	-0.025
When an event is reported, it feels like the person is being written up, not the problem (A12R)	0.082	0.033	0.003	0.069	0.606	-0.014	0.034	-0.016	0.021	0.053	0.037	-0.013
Staff worry that mistakes they make are kept in their personnel file (A16R)	0.094	0.097	0.047	0.338	0.442	0.007	0.003	-0.051	0.017	-0.111	0.002	0.071
We are given feedback about changes put into place based on event reports (C1)	-0.035	0.019	-0.004	0.056	-0.035	0.512	0.087	0.026	0.027	0.150	-0.001	-0.067
We are informed about errors that happen in this unit (C3)	0.000	0.017	0.006	0.067	-0.027	0.643	0.148	-0.037	-0.061	-0.029	0.018	0.041
In this unit, we discuss ways to prevent errors from happening again (C5)	-0.002	0.014	-0.011	-0.054	-0.011	0.514	0.189	0.110	0.013	-0.009	0.161	-0.009
Staff will freely speak up if they see something that may negatively affect patient care (C2)	0.041	-0.067	0.056	0.026	-0.001	0.583	0.059	0.021	0.025	0.007	0.142	0.077
Staff feel free to question the decisions or actions of those with more authority (C4)	-0.018	0.005	0.021	-0.059	0.048	0.544	-0.019	0.277	0.104	0.170	-0.084	0.004
Things “fall between the cracks” when transferring patients from one unit to another (F3R) *	-0.047	0.001	0.083	-0.032	0.052	0.343	-0.044	0.027	0.221	-0.073	0.079	0.144
When a mistake is made, but is identified and corrected before affecting the patient, how often is this reported? (D1)	0.014	0.051	-0.022	-0.031	-0.028	0.047	0.826	0.006	0.005	-0.002	0.017	-0.015
When a mistake is made, but has no potential to harm the patient, how often is this reported? (D2)	-0.019	-0.015	0.024	-0.011	-0.002	0.042	0.875	-0.038	0.019	0.018	0.027	0.029
When a mistake is made that could harm the patient, but does not, how often is this reported? (D3)	0.003	-0.020	-0.018	0.043	0.032	-0.006	0.742	0.051	-0.015	-0.517	-0.016	-0.012
My supervisor/manager pays a compliment when he/she sees a job done according to established patient safety procedures (B1)	0.024	0.027	-0.004	0.015	-0.001	0.023	0.062	0.788	0.008	-0.037	0.023	0.029
My supervisor/manager gives serious consideration to staff suggestions for improving patient safety (B2)	0.040	-0.015	-0.003	-0.005	-0.009	0.147	-0.012	0.682	-0.007	0.036	0.138	0.008
The actions of hospital management show that patient safety is a top priority (F8)	0.074	0.069	-0.035	0.041	-0.108	0.034	0.017	0.028	0.447	0.294	0.224	0.014
Hospital management seems interested in patient safety only after an adverse event happens (F9R)	0.007	0.015	−0.045	0.115	-0.084	0.035	-0.084	0.017	0.506	0.006	0.128	0.174
Important patient care information is often lost during shift changes (F5R)	0.045	-0.046	-0.074	0.035	0.021	0.013	0.034	-0.020	0.529	-0.038	-0.070	0.363
Problems often occur in the exchange of information across hospital units (F7R)	-0.040	-0.004	0.142	-0.020	0.039	-0.011	0.007	0.046	0.684	-0.069	0.042	-0.029
Shift changes are problematic for patients in this hospital (F11R)	-0.039	-0.046	0.143	-0.070	0.096	-0.001	0.023	-0.005	0.756	0.100	0.009	-0.049

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

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[1] Correspondence J. Laguardia Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, Pavilhão Haity Moussatché, sala 214, Rio de Janeiro, RJ 21045-900, Brasil. josue.laguardia@icict.fiocruz.br