Journal List > Korean J Adult Nurs > v.30(4) > 1106160

Kim, Lee, and Shin: Development and Validation of the Patient Safety Perception Scale for hospitalized Patients



The purpose of this study was to develop a instrument to evaluate patient safety perception in hospitalized patient and to examine its validity and reliability.


For the development of the initial items, the literature was reviewed along with the existing measuring tools. The items were evaluated by experts for content validity. This study was conducted from September 2017 to January 2018. A total of 294 hospitalized patients participated in the study to verify the validity and reliability of the instrument. Data were analyzed by item analysis, exploratory factor analysis, confirmatory factor analysis, criterion-related validity, and internal consistency.


The final instrument were derived containing 24 items and 3 factors. There were 10 items on “ activities to ensure”, 10 items on “ patient's safety practices”, and 4 items on “ trust of the medical system.” The criterion-related validity was estab-lished using the Patient Measure of Safety (r=.72, p<.001). The Cronbach's ⍺ for this instrument was .93.


The findings of this study indicate that this instrument has satisfactory validity and reliability. It can quantitatively measure the degree of patient safety awareness of hospitalized patients.


1. Lee SG. Development and psychometric evaluation of the Korean patient safety culture survey instrument for hospitals [dissertation]. Seoul: Chung-Ang University;2015.
2. Lee SI. Necessity and enactment of patient safety law. Healthcare Policy Forum. 2013; 11(2):37–42.
3. de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. BMJ Quality & Safety. 2008; 17(3):216–23.
4. Waeschle RM, Bauer M, Schmidt CE. Errors in medicine: caus-es, impact and improvement measures to improve patient safety. Der Anaesthesist. 2015; 64(9):689–704.
5. Wachter RM. Understanding patient safety. 2nd ed.New York: McGraw Hill Medical;2012.
6. World Health Organization. Patient safety [Internet]. Geneva: WHO;2009. [cited 2018 January 29]. Available from:.
7. Baek SW, Lee SJ, Huh JE. Patient safety and accountability, improving medical ethics and patient safety. Seoul: Bomungak;2009.
8. Kim MR. Concept analysis of patient safety. Journal of Korean Academy of Nursing. 2011; 41(1):1–8.
9. Organisation for Economic Cooperation and Development. OECD reviews of health care quality: Korea 2012 raising standards. Paris: OECD Publishing;2012.
10. Yum HK. Management and perspectives of patient safety in healthcare. Journal of the Korean Medical Association. 2013; 56(6):454–8.
11. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington DC: National Acade-mies Press;2001.
12. Ha EH, Hyun KS, Cho JY. Awareness of hospital safety culture and safety activities of workers in a tertiary care hospital. Journal of Academic Social Nursing Education. 2016; 22(2):191–201.
13. Kim JE, Lee NJ, Jang SM, Kim YM. Healthcare service consum-ers' perception of patient safety. Perspectives in Nursing Science. 2013; 10(2):133–40.
14. Davis RE, Sevdalis N, Jacklin R, Vincent CA. An examination of opportunities for the active patient in improving patient safety. Journal of Patient Safety. 2012; 8(1):36–43.
15. Lee JH, Lee SI. Patient safety: the concept and general approach. Journal of Korean Society of Quality Assurance in Health Care. 2009; 15(1):9–18.
16. Halligan M, Zecevic A. Safety culture in healthcare: a review of concepts. dimensions, measures and progress. BMJ Quality & Safety. 2011; 20(4):338–43.
17. Elder NC, Regan SL, Pallerla H, Levin L, Post D, Cegela DJ. Development of an instrument to measure senior's patient safety health beliefs: the Seniors Empowerment and Advocacy in Patient Safety (SEAPS) survey. Patient Education and Coun-seling. 2007; 69(1-3):100–7.
18. Park MJ, Kim IS, Ham YL. Development of a perception of importance on patient safety management scale (PI-PSM) for hospital employee. The Journal of the Korea Contents Association. 2013; 13(5):332–41.
19. Yoon SH, Kim BS, Kim SY. Development and validation of the Korean patient safety culture scale for nursing homes. Journal of Korean Academy Nursing. 2013; 43(3):379–88.
20. Chen I-C, Li H-H. Measuring patient safety culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMC Health Services Research. 2010; 10(1):152–63.
21. Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis: a global perspective. 7th ed.Upper Saddle River, N.J.: London: Pearson Education;2010.
22. DeVellis RF. Scale development: theory and applications. 3rd ed.Thousand Oaks, CA: SAGE Publications;2012. p. 73–114.
23. Cho HA, Shin HS. A systematic review of published studies on patient safety in Korea. Journal of Korea Academy of Dental Administration. 2014; 2(1):61–82.
24. Kim SK, You JS, Park JS, Ko EB, Tchoe HJ. Study on the consumer and healthcare professionals' perceptions of safety in hospital. Seoul: National Evidence-based Healthcare Collaborating Agency;2015. p. 1–161.
25. An JO. The effect of patient safety program on perception of safety in military patients. [master's thesis]. Seoul: Yonsei University;2016.
26. Giles SJ, Lawton RJ, Din I, McEachan RRC. Developing a patient measure of safety (PMOS). Quality and Safety in Health Care. 2013; 22(7):554–62.
27. McEachan RRC, Lawton RJ, O'Hara JK, Armitage G, Giles S, Parveen S, et al. Developing a reliable and valid patient measure of safety in hospitals (PMOS): a validation study. BMJ Quality & Safety. 2014; 23(7):1–9.
28. Hayton JC, Allen DG, Scarpello V. Factor retention decisions in exploratory factor analysis: a tutorial on parallel analysis. Organizational Research Methods. 2004; 7(2):191–205.
29. Mohsin-Shaikh S, Garfield S, Franklin BD. Patient involvement in medication safety in hospital: an exploratory study. International Journal of Clinical Pharmacy. 2014; 36(3):657–66.
30. Ministry of Health and Welfare. Patient Safety Act (Law No. 13113) [Internet]. Seoul: Ministry of Health and Welfare;2015. [cited 2018 May 10]. Available from:.

Figure 1.
Proposed model of the patient safety perception scale for confirmatory factor analysis.
Table 1.
Exploratory Factor Analysis and Parallel Analysis
Items Factor loading Commu-nality Initial Eigen -values 95%tile Eigen -values CV (%) Cronbach's ⍺
Factor 1 (activities to ensure safety) 14.67 1.91 38.60 .92
 x44 Medical staff work together to provide safe care. .86 .69
 x43 Medical staff try to take initiative to improve patient safety. .82 .67
 x41 Medical staff correctly share information with other staff about my treatment. .80 .58
 x39 Medical staff use the equipment skillfully. .76 .56
 x46 Medical staff is always checking for side effects of examination/operation/medication. .71 .50
 x37 Medical staff provide accurate information about my treatment. .71 .60
 x48 The equipment needed for my treatment always work properly. .66 .48
 x47 Medical staff often rounds the patient's room at night. .64 .37
 x52 Medical staff consider patient safety issues that arise in the hospital important. .68 .55
 x40 Medical staff always ask for my consent before treatment. .53 .45
Factor 2 (patient's safety practice) 3.50 1.79 48.20 .90
 x21 I am well aware of how to prevent falls. .79 .55
 x23 I know the purpose of various examinations, procedures, and operations I have received. .78 .60
 x24 I know the procedure of patient identification performed at the hospital. .76 .52
 x20 I know the precautions related to my treatment. .74 .60
 x19 I ask questions certainly about my treatment. .75 .51
 x22 I am well aware of the drugs that are administered to me. .71 .48
 x26 I inform my doctor or nurse when I have an abnormality in my body. .64 .49
 x12 I always follow patient safety rules. .55 .36
 x25 I know I need to wash my hands to prevent infection. .56 .46
 x32 I tell the medical staff my health information in detail. .58 .48
Factor 3 (trust of the medical system) 2.22 1.71 53.89 .85
 x7 I trust the system of medical information security in the hospital. .84 .67
 x8 I think the medical equipment of the hospital is safe. .84 .69
 x9 I think the medical practice of the hospital is safe. .76 .56
 x6 I generally trust the medical staff. .60 .51
Total .93

CV=cumulative variance.

Table 2.
Model Fit of Confirmatory Factor Analysis (N=294)
Model x2 df p x2/df TLI CFI RMSEA (90% CI) SRMR
Research model (Correlated 3 factors) 618.14 249 .001 2.48 .90 .91 .07 (.06~.08) .05
Alternative model I (Independent 3 factors) 821.51 252 .001 3.26 .84 .86 .08 (.08~.10) .24
Alternative model II (Single factor) 1570.91 252 .001 6.23 .63 .66 .13 (.12~.14) .11

TLI=Turker-Lewis index; CFI=comparative fit index; RMSEA=root mean square error of approximation; SRMR=standardized root-mean-square residual; CI=confidence interval.

Table 3.
Path Coefficient, CR and AVE of Confirmatory Factor Analysis (N=294)
Items B SE β t p CR AVE
Factor 1 x44 1.00 .83 .96 .69
x43 1.03 .06 .80 16.16 .001
x41 1.00 .07 .75 14.58 .001
x39 0.92 .06 .74 14.45 .001
x46 0.99 .07 .70 13.42 .001
x37 1.06 .07 .77 15.21 .001
x48 0.82 .06 .69 13.04 .001
x47 0.80 .07 .60 10.95 .001
x52 1.02 .07 .74 14.34 .001
x40 0.88 .07 .68 12.45 .001
Factor 2 x21 1.00 .72 .94 .61
x23 0.92 .07 .76 12.56 .001
x24 0.98 .09 .70 11.56 .001
x20 0.90 .07 .78 12.76 .001
x19 0.85 .07 .71 11.62 .001
x22 1.02 .09 .69 11.27 .001
x26 0.74 .06 .70 11.53 .001
x12 0.64 .06 .60 9.90 .001
x25 0.72 .07 .67 11.01 .001
x32 0.72 .06 .68 11.21 .001
Factor 3 x7 1.00 .81 .92 .73
x8 0.99 .07 .83 14.77 .001
x9 0.85 .06 .75 13.35 .001
x6 0.81 .07 .69 12.09 .001

SE=standard error; CR=construct reliability; AVE=average variance extract.

Table 4.
Correlation between Relevant Constructs of the PSPS and PMOS (N=294)
Variables PSPS Factor 1 Factor 2 Factor 3 M± SD
r (p) r (p) r (p) r (p)
PSPS 98.07±11.79
 Factor 1 (activities to ensure safety) .86 (<.001) 39.93±5.42
 Factor 2 (patient's safety practice) .86 (<.001) .53 (<.001) 38.71±5.82
 Factor 3 (trust of the medical system) .68 (<.001) .54 (<.001) .42 (<.001) 15.48±2.48
PMOS .72 (<.001) .76 (<.001) .49 (<.001) .52 (<.001) 150.24±17.22

PSPS=patient safety perception scale; PMOS=patient measure of safety.

Appendix 1.
환자안전인식 측정도구
환자안전인식 (patient safety perception)은 입원 환자가 의료현장에서 안전에 위협을 받지 않는다고 인식하는 수준을 의미합니다.
문 항 매우그렇지 않다 그렇지 않다 보통이다 그렇다 매우그렇다
1. 의료진은 안전한 치료 제공을 위해 서로 협력한다.
2. 의료진은 환자안전을 향상시키기 위해 솔선수범하여 노력한다.
3. 의료진은 나의 치료에 대하여 다른 의료진과 정보를 정확하게 공유한다.
4. 의료진은 장비를 능숙하게 사용한다.
5. 의료진은 검사/수술/투약의 부작용 여부를 항상 확인한다.
6. 의료진은 나의 치료에 대하여 정확한 정보를 제공한다.
7. 나의 치료에 필요한 장비는 항상 제대로 작동한다.
8. 의료진은 밤에 수시로 병실 순회를 수행한다.
9. 의료진은 병원에서 발생하는 환자안전문제를 중요하게 여긴다.
10. 의료진은 치료 전에 항상 나의 동의를 구한다.
11. 나는 낙상을 예방하는 방법에 대해 잘 알고 있다.
12. 나는 내가 받은 각종 검사나 시술, 수술의 목적에 대해 알고 있다.
13. 나는 병원에서 수행되는 환자확인 절차에 대해 알고 있다.
14. 나는 나의 치료와 관련된 주의 사항을 알고 있다.
15. 나는 나의 치료에 관한 궁금한 사항을 반드시 질문한다.
16. 나는 나에게 투여되는 약물에 대해 잘 알고 있다.
17. 나는 몸에 이상이 있으면 반드시 의사나 간호사에게 알린다.
18. 나는 언제나 환자안전 수칙을 지킨다.
19. 나는 감염예방을 위해 손씻기를 해야 한다는 것을 알고 있다.
20. 나는 나의 건강에 대한 정보를 의료진에게 충분히 말한다.
21. 나는 병원의 의료정보 보안시스템을 신뢰한다.
22. 나는 병원의 의료 장비가 안전하다고 생각한다.
23. 나는 병원의 의료 기술이 안전하다고 생각한다.
24. 나는 의료진을 일반적으로 신뢰한다.

안전보장 활동=1~10; 환자의 안전 실천=11~20; 의료시스템 신뢰=21~24.

Similar articles