Open Access Highly Accessed Research article

The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research

John B Sexton1*, Robert L Helmreich1, Torsten B Neilands2, Kathy Rowan3, Keryn Vella3, James Boyden4, Peter R Roberts5 and Eric J Thomas1

Author Affiliations

1 The University of Texas Center of Excellence for Patient Safety Research and Practice, The University of Texas – Houston Medical School, Houston, USA

2 Center for AIDS Prevention Studies, University of California, San Francisco, USA

3 Intensive Care National Audit & Research Centre, London, UK

4 Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ, UK

5 Medical Research Institute of New Zealand, Wellington, NZ; University of Texas – Houston Medical School, Division of General Medicine, Department of Medicine (EJT), USA

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BMC Health Services Research 2006, 6:44  doi:10.1186/1472-6963-6-44

Published: 3 April 2006



There is widespread interest in measuring healthcare provider attitudes about issues relevant to patient safety (often called safety climate or safety culture). Here we report the psychometric properties, establish benchmarking data, and discuss emerging areas of research with the University of Texas Safety Attitudes Questionnaire.


Six cross-sectional surveys of health care providers (n = 10,843) in 203 clinical areas (including critical care units, operating rooms, inpatient settings, and ambulatory clinics) in three countries (USA, UK, New Zealand). Multilevel factor analyses yielded results at the clinical area level and the respondent nested within clinical area level. We report scale reliability, floor/ceiling effects, item factor loadings, inter-factor correlations, and percentage of respondents who agree with each item and scale.


A six factor model of provider attitudes fit to the data at both the clinical area and respondent nested within clinical area levels. The factors were: Teamwork Climate, Safety Climate, Perceptions of Management, Job Satisfaction, Working Conditions, and Stress Recognition. Scale reliability was 0.9. Provider attitudes varied greatly both within and among organizations. Results are presented to allow benchmarking among organizations and emerging research is discussed.


The Safety Attitudes Questionnaire demonstrated good psychometric properties. Healthcare organizations can use the survey to measure caregiver attitudes about six patient safety-related domains, to compare themselves with other organizations, to prompt interventions to improve safety attitudes and to measure the effectiveness of these interventions.