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Open Access Highly Accessed Research article

Patient safety culture measurement in general practice. Clinimetric properties of 'SCOPE'

Dorien LM Zwart13*, Maaike Langelaan2, Rosalinde C van de Vooren1, Marijke M Kuyvenhoven1, Cor J Kalkman3, Theo JM Verheij1 and Cordula Wagner24

Author Affiliations

1 Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands

2 Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands

3 Patient Safety Center, University Medical Center Utrecht, The Netherlands

4 EMGO+ Institute, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands

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BMC Family Practice 2011, 12:117  doi:10.1186/1471-2296-12-117

Published: 1 November 2011



A supportive patient safety culture is considered to be an essential condition for improving patient safety. Assessing the current safety culture in general practice may be a first step to target improvements. To that end, we studied internal consistency and construct validity of a safety culture questionnaire for general practice (SCOPE) which was derived from a comparable questionnaire for hospitals (Dutch-HSOPS).


The survey was conducted among caregivers of Dutch general practice as part of an ongoing quality accreditation process using a 46 item questionnaire. We conducted factor analyses and studied validity by calculating correlations between the subscales and testing the hypothesis that respondents' patient safety grade of their practices correlated with their scores on the questionnaire.


Of 72 practices 294 respondents completed the questionnaire. Eight factors were identified concerning handover and teamwork, support and fellowship, communication openness, feedback and learning from error, intention to report events, adequate procedures and staffing, overall perceptions of patient safety and expectations and actions of managers. Cronbach's alpha of the factors rated between 0.64 and 0.85. The subscales intercorrelated moderately, except for the factor about intention to report events. Respondents who graded patient safety highly scored significantly higher on the questionnaire than those who did not.


The SCOPE questionnaire seems an appropriate instrument to assess patient safety culture in general practice. The clinimetric properties of the SCOPE are promising, but future research should confirm the factor structure and construct of the SCOPE and delineate its responsiveness to changes in safety culture over time.