Table 1 Questionnaire scale items

Hospital management support

Hospital management provides a work climate that promotes patient safety.

for patient safety

The actions of hospital management show that patient safety is a top priority.

Hospital management seem to be interested in patient safety only after an adverse event happens.

Supervisor/manager expectations/actions

Supervisors/managers say a good word when they see that a job has been done according to established procedures (standards and guidelines).*

Supervisors/managers seriously consider staff suggestions for improving patient safety.

Whenever pressure builds up, supervisors/managers want staff to work faster, even if it means taking shortcuts or skipping steps.

Supervisors/managers overlook patient safety problems that happen over and over.

Teamwork across hospital

Hospital units do not coordinate well with each other.

units

There is good cooperation among hospital units that need to work together.

It is often unpleasant for staff from one hospital unit to work with staff from other hospital units.

Hospital units work well together to provide the best care for patients.

Teamwork within units

Staff support one another within the units.

When a lot of work needs to be done quickly, staff within the units work together as a team to get the work done.

Staff within the units treat each other with respect.

When one area within a unit gets really busy, others help out.

Communication openness

Staff within units will freely speak up if they see something that may negatively affect patient care.

Staff within units feel free to question the decisions or actions of those with more authority.

Staff within units are afraid to ask questions when something does not seem right.

Hospital handoffs and

Things "fall between the cracks" when transferring patients from one unit to another.

transitions

Important patient care information is often lost during shift changes within the hospital units.

Problems often occur during the exchange of information across hospital units.

Shift changes are problematic for patients within the hospital units.

Nonpunitive response to error

Staff within the individual units feel like their mistakes are held against them.

When an event (e.g., mistake) is reported, it feels like the person is being written up, not the problem.*

Staff worry that mistakes they make are kept in their personnel file.

Feedback and communication about errors

Staff within units are given feedback about changes put into place based on events reported (e.g., mistakes).*

Staff within units are informed about events (e.g., errors) that happen in their units.*

Staff within units discuss ways to prevent an event (e.g., error) from happening again.*

Staffing

Units within this hospital have enough staff to handle the workload.

Unit staff work longer hours than is best for patient care.

The units use more agency/temporary staff than is best for patient care.

Staff within units work in "crisis mode" trying to do too much, too quickly.

Organizational learning

Staff within the units are actively doing things to improve patient safety.

Mistakes have led to positive changes within the hospital units.

After changes have been made to improve patient safety within the units, their effectiveness is evaluated by the staff.

Outcome Dimensions

Overall perceptions of safety

It is just by chance that more serious mistakes don't happen within the units.

Patient safety is never sacrificed to get more work done.

We have patient safety problems within the units.

Unit procedures and systems are good at preventing errors from happening.

Frequency of event reporting

When an event (e.g., error) occurs that is caught and corrected before affecting the patient, how often is this reported?*

When an event (e.g., error) occurs that poses no potential harm to the patient, how often is this reported?*

When an event (e.g., error) occurs that could harm the patient, but does not, how often is this reported?*