Open Access Open Badges Research article

Psychometric properties of the hospital survey on patient safety culture, HSOPSC, applied on a large Swedish health care sample

Mats Hedsköld1*, Karin Pukk-Härenstam12, Elisabeth Berg1, Marion Lindh3, Michael Soop4, John Øvretveit1 and Magna Andreen Sachs1

Author Affiliations

1 Medical Management Centre, Karolinska Institutet, SE 171 77 Stockholm, Sweden

2 Astrid Lindgren´s Childrens´ Hospital, Karolinska University Hospital, SE 171 76 Stockholm, Sweden

3 Public Healthcare Services Committee Administration, Stockholm County Council, Box 6909, SE 102 39 Stockholm, Sweden

4 National Board of Health and Welfare, SE 106 30 Stockholm, Sweden

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BMC Health Services Research 2013, 13:332  doi:10.1186/1472-6963-13-332

Published: 22 August 2013



A Swedish version of the USA Agency for Healthcare Research and Quality “Hospital Survey on Patient Safety Culture” (S-HSOPSC) was developed to be used in both hospitals and primary care. Two new dimensions with two and four questions each were added as well as one outcome measure. This paper describes this Swedish version and an assessment of its psychometric properties which were tested on a large sample of responses from personnel in both hospital and primary care.


The questionnaire was mainly administered in web form and 84215 forms were returned (response rate 60%) between 2009 and 2011. Eleven per cent of the responses came from primary care workers and 46% from hospital care workers. The psychometric properties were analyzed using both the total sample and the hospital and primary care subsamples by assessment of construct validity and internal consistency. Construct validity was assessed by confirmatory (CFA) and exploratory factor (EFA) analyses and internal consistency was established by Cronbachs’s α.


CFA of the total, hospital and primary care samples generally showed a good fit while the EFA pointed towards a 9-factor model in all samples instead of the 14-dimension S-HSOPSC instrument. Internal consistency was acceptable with Cronbach’s α values above 0.7 in a major part of the dimensions.


The S-HSOPSC, consisting of 14 dimensions, 48 items and 3 single-item outcome measures, is used both in hospitals and in primary care settings in Sweden for different purposes. This version of the original American instrument has acceptable construct validity and internal consistency when tested on large datasets of first-time responders from both hospitals and primary care centres. One common instrument for measurements of patient safety culture in both hospitals and primary care settings is an advantage since it enables comparisons between sectors and assessments of national patient safety improvement programs. Future research into this version of the instrument includes comparing results from patient safety culture measurements with other outcomes in relation to safety improvement strategies.

Patient safety culture; Hospital Survey on Patient Safety Culture; S-Hospital Survey on Patient Safety Culture; Primary care; Psychometric properties; Construct validity; Internal consistency