Psychometric properties of the second version of the hospital survey on patient safety culture across a regional hospital system of Brazil.
Article
Muñoz, Richard, Oliveira, Danilo, Arrieta, Alejandro. (2026). Psychometric properties of the second version of the hospital survey on patient safety culture across a regional hospital system of Brazil.
. 10.1186/s12913-026-14709-6
Muñoz, Richard, Oliveira, Danilo, Arrieta, Alejandro. (2026). Psychometric properties of the second version of the hospital survey on patient safety culture across a regional hospital system of Brazil.
. 10.1186/s12913-026-14709-6
The World Health Organization emphasizes regular patient safety culture (PSC) measurement for safer healthcare. While global interest grows, PSC awareness and measurement lags in Latin America. This study tackles the need for a validated PSC tool in Brazil. It aims to evaluate the psychometric properties of the Brazilian Portuguese version of the Hospital Survey on Patient Safety Culture v2 (HSOPSC v2) within a regional Brazilian hospital system.
Methods
The survey was distributed to 4,152 clinical and non-clinical staff across eight private non-profit hospitals in Brazil between April and May 2023. Construct validity was assessed using confirmatory factor analyses (CFA) and exploratory structural equation modeling (ESEM). Reliability was evaluated through Cronbach's alphas for CFA models and McDonald's Omega for ESEM models. Convergent validity was tested by regressing HSOPSC v2 patient safety outcomes on factor scores of the best-fitting model. Ethical considerations were addressed through anonymous survey administration to ensure respondent privacy and encourage truthful responses.
Results
Out of 2,434 respondents (59% response rate), nurses (39%), females (72%), and those with multiple jobs (75%) were most represented. A bifactor ESEM model best fit the data, with all HSOPSC v2 items significantly linked to the general PSC factor. "Communication about Error," "Response to Error," and "Staffing and Work Pace" showed the most influence on overall PSC. While reliability was generally strong, "Staffing and Work Pace" and "Organizational Learning" showed very weak reliability. Convergent validity was supported by significant links between model factors and patient safety outcomes, with the general factor explaining the most variance in patient safety grade (28.3%).
Conclusion
The HMA survey, adapted from the HSOPSC v2, demonstrates strong psychometric properties, making it a valid and reliable instrument for measuring PSC in the Brazilian healthcare context. The bifactor ESEM model's superior fit suggests the presence of a general PSC factor alongside 10 dimensions of PSC. The significant associations between model factors and patient safety outcomes highlight the survey's practical relevance. These findings support the use of the HSOPSC v2 survey for PSC measurement in Brazil, which can inform targeted interventions to improve patient safety across various hospitals and staff roles.
