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The Safety Attitudes Questionnaire as a tool for benchmarking safety culture in the NICU
  1. Jochen Profit1,2,3,
  2. Jason Etchegaray4,
  3. Laura A Petersen2,3,
  4. J Bryan Sexton5,
  5. Sylvia J Hysong3,
  6. Minghua Mei2,3,
  7. Eric J Thomas4
  1. 1Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
  2. 2Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
  3. 3Houston Veterans Affairs (VA) Health Services Research and Development Center of Excellence, Health Policy and Quality Program, Michael E DeBakey VA Medical Center, Houston, Texas, USA
  4. 4University of Texas – Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, Texas, USA
  5. 5Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, North Carolina, USA
  1. Correspondence to Jochen Profit, Section of Neonatology, Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, VA HSR&D (152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; profit{at}


Background Neonatal intensive care unit (NICU) safety culture, as measured by the Safety Attitudes Questionnaire (SAQ), varies widely. Associations with clinical outcomes in the adult intensive care unit setting make the SAQ an attractive tool for comparing clinical performance between hospitals. Little information is available on the use of the SAQ for this purpose in the NICU setting.

Objectives To determine whether the dimensions of safety culture measured by the SAQ give consistent results when used as a NICU performance measure.

Methods Cross-sectional survey of caregivers in 12 NICUs, using the six scales of the SAQ: teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management and working conditions. NICUs were ranked by quantifying their contribution to overall risk-adjusted variation across the scales. Spearman rank correlation coefficients were used to test for consistency in scale performance. The authors then examined whether performance in the top four NICUs in one scale predicted top four performance in others.

Results There were 547 respondents in 12 NICUs. Of 15 NICU-level correlations in performance ranking, two were >0.7, seven were between 0.4 and 0.69, and the six remaining were <0.4. The authors found a trend towards significance in comparing the distribution of performance in the top four NICUs across domains with a binomial distribution p=0.051, indicating generally consistent performance across dimensions of safety culture.

Conclusion A culture of safety permeates many aspects of patient care and organisational functioning. The SAQ may be a useful tool for comparative performance assessments among NICUs.

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  • Funding JP's contribution is supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (#1 K23 HD056298-01, PI: Profit). LAP was a recipient of the American Heart Association Established Investigator Award (#0540043N) at the time that this work was carried out. LAP, SJH and MM also receive support from a Veterans Administration Center Grant (VA HSR&D CoE HFP90-20). SJH's contribution is supported in part by the Department of Veterans Affairs Health Services Research and Development Program (#CD 2-07-0818). EJT's effort is supported in part by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (#1 K24 HD053771-01, PI: Thomas and #1 PO1 HS1154401, PI: Thomas). JBS received support from the Agency for Healthcare Research and Quality (AHRQ) (grant # 1UC1HS014246). JE's effort is supported by a K02 award from AHRQ (#1 K02 HS017145-02) and the University of Texas at Houston – Memorial Hermann Center for Quality and Safety.

  • Competing interest None.

  • Ethics approval The original study was approved by the Johns Hopkins University Institutional Review Board, and the analysis of a de-identified data set was approved by the Institutional Review Board at Baylor College of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.