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Hospital Safety Culture in Taiwan: A Nationwide Survey Using Chinese Version Safety Attitude Questionnaire

Wui-Chiang Lee1*, Hwei-Ying Wung2, Hsun-Hsiang Liao3, Chien-Ming Lo3, Fei-Ling Chang3, Pa-Chun Wang4, Angela Fan5, Hsin-Hsin Chen6, Han-Chuan Yang7 and Sheng-Mou Hou8

Author Affiliations

1 Department of Medical Affairs and Planning, Taipei Veterans General Hospital, and Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, Taipei, Taiwan

2 Taiwan Joint Commission on Hospital Accreditation, Taipei, Taiwan

3 Department of Quality Improvement, Taiwan Joint Commission on Hospital Accreditation, Taipei, Taiwan

4 Fu Jen Catholic University School of Medicine, Taipei County, Taiwan, Quality Management Center, Cathay General Hospital, Taipei, Taiwan

5 National Yang-Ming University School of Medicine, Taipei, Taiwan

6 National Health Research Institutes, Miaoli, Taiwan

7 Department of Healthcare Administration, Asia University, Taichung, Taiwan

8 Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

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BMC Health Services Research 2010, 10:234  doi:10.1186/1472-6963-10-234

Published: 10 August 2010



Safety activities have been initiated at many hospitals in Taiwan, but little is known about the safety culture at these hospitals. The aims of this study were to verify a safety culture survey instrument in Chinese and to assess hospital safety culture in Taiwan.


The Taiwan Patient Safety Culture Survey was conducted in 2008, using the adapted Safety Attitude Questionnaire in Chinese (SAQ-C). Hospitals and their healthcare workers participated in the survey on a voluntary basis. The psychometric properties of the five SAQ-C dimensions were examined, including teamwork climate, safety climate, job satisfaction, perception of management, and working conditions. Additional safety measures were asked to assess healthcare workers' attitudes toward their collaboration with nurses, physicians, and pharmacists, respectively, and perceptions of hospitals' encouragement of safety reporting, safety training, and delivery delays due to communication breakdowns in clinical areas. The associations between the respondents' attitudes to each SAQ-C dimension and safety measures were analyzed by generalized estimating equations, adjusting for the clustering effects at hospital levels.


A total of 45,242 valid questionnaires were returned from 200 hospitals with a mean response rate of 69.4%. The Cronbach's alpha was 0.792 for teamwork climate, 0.816 for safety climate, 0.912 for job satisfaction, 0.874 for perception of management, and 0.785 for working conditions. Confirmatory factor analyses demonstrated a good model fit for each dimension and the entire construct. The percentage of hospital healthcare workers holding positive attitude was 48.9% for teamwork climate, 45.2% for perception of management, 42.1% for job satisfaction, 37.2% for safety climate, and 31.8% for working conditions. There were wide variations in the range of SAQ-C scores in each dimension among hospitals. Compared to those without positive attitudes, healthcare workers with positive attitudes to each SAQ dimension were more likely to perceive good collaboration with coworkers, and their hospitals were more likely to encourage safety reporting and to prioritize safety training programs (Wald chi-square test, p < 0.001 for all).


Analytical results verified the psychometric properties of the SAQ-C at Taiwanese hospitals. The safety culture at most hospitals has not fully developed and there is considerable room for improvement.