Globally, tens of millions of patients suffer disabling injuries or death every year due to unsafe medical care . A landmark paper from the Institute of Medicine (IOM) concluded that healthcare in the United States is not as safe as it should and could be. At least 44 000, and probably as many as 98 000, people die in hospitals in the US because of medical errors . The Swedish Ministry of Health and Social Affairs estimates that almost 100 000 patients are affected every year by preventable injuries. Half of all preventable injuries occur in connection with surgery or other invasive procedures . According to IOM and the World Health Organization (WHO), medical errors have an important economic burden as they may result in prolonged hospitalization and loss of income [1, 2]. Medical errors may also result in detrimental loss of trust in the healthcare system .
Error is defined as “an act of commission (doing something wrong) or omission (failing to do the right thing) that leads to an undesirable outcome or with significant potential for such an outcome” . However, some errors do not result in adverse events, and these are often characterized as “near misses”. A health care injury is often a consequence of an adverse event, which is preventable in most cases . An adverse event is defined as an injury resulting from a medical intervention (i.e., not due to the underlying medical condition) . The basis of all patient safety work is knowledge of the organization’s risks and awareness of the system’s shortcomings . Patient safety is characterized as a nationwide problem and, to improve patient safety, the focus should be on the processes of care instead of blaming individuals [2, 6].
The concept of safety culture was launched in connection with the Chernobyl nuclear accident in 1986 . Safety culture exists in all health care organizations, and a high level of patient safety is dependent on whether the organization has a positive safety culture . The definition of safety culture and climate has been debated [9, 10]. Safety climate has been described as employees’ perceptions, attitudes, and beliefs about risk and safety. Safety culture is a more complex concept that reflects fundamental values, norms, and expectations . Therefore, the term “climate” is used in this report.
Safety climate surveys are increasingly being used within health care organizations . Twelve tools for measuring patient safety were designated for health care, including the widely used Safety Attitudes Questionnaire (SAQ) and Hospital Survey on Patient Safety (HSOPS) based on their validity, reliability, and the links established between the survey and positive patient outcomes . The SAQ is the only survey tool that demonstrates a link between good survey results and reduced health care-associated infections [13, 14], and it is the most thoroughly validated instrument for assessing the safety climate .
Several risk factors that can influence clinical practice were described by Vincent’s theoretical framework in 1998, including the organization (i.e. safety climate); work environment (i.e. staffing levels and workload); team-; and individual staff (i.e. overconfidence) . Factors that may constitute a threat to patient safety among registered nurses (RNs) working in the operating room (OR) setting include a perceived imbalance in staffing  and increased speed of work [17–19]. Patient safety itself accounts for the greatest stress among RNs working in the OR . The OR environment has been described as a high-risk environment for patients and one of the most complex work places within health care due to its sophisticated technology and the involvement of multidisciplinary team members [7, 21]. In addition, surgical procedures are often performed in high-risk situations and under time pressure .
In summary, patient safety is a central principle of quality in health care and has high priority on the research agenda in most countries. The OR setting has been described as a complex high-risk environment, and some existing safety problem areas exist within the OR. Perceived imbalance in staffing and increased work pace is factors that may threaten patient safety. Measuring the safety climate in a workplace is an important step in understanding and improving patient safety [2, 7]. Previous research has assessed the psychometric properties of the SAQ across countries and in different contexts and settings [22–25]. The internal consistency and Cronbach’s alpha values are acceptable [22–24], and the construct validity measured by CFA generally exhibits satisfactory model fit [22–25]. However, a lack of research exists on safety climate in Swedish OR settings. Therefore, an instrument that measures health care professionals’ attitudes regarding safety climate in the OR would be helpful in understanding and identifying areas that need improvement and for evaluating improvements in interventions. The purpose of the present study was to establish the reliability and validity of the translated version of the SAQ (OR version) by evaluating its psychometric properties.