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What are patients’ perceptions of their safety within an acute hospital setting? A study to inform the development of a measurement questionnaire

Student thesis: Doctoral ThesisDoctor of Healthcare

Approaches to safety improvements have been driven by empirical studies focusing on healthcare staff development. Traditionally, tools used to measure safety have focused on understanding safety climate and safety culture from the healthcare professional perspective. However, few studies have concentrated on patients’ experiences and their perceptions of safety and there are few validated tools to measure patient perceptions of safe/unsafe care. Consequently, little is known about how patients decide if they are safe, and how their experiences and voices can influence and drive safety improvements. 

The overall aim of the study was to explore what patients understood by being safe, and how they experienced safety within an acute hospital setting. The findings were then used to inform the development of the King’s Patient Safety Measure (KPSM). 

Setting of study 
The study was carried out within a large acute teaching hospital in London with a diverse socio-demographic and ethnic population. 

A sequential mixed methods design was used, where the results of each objective informed the next objective of the study. There were four objectives, the first of which involved a scoping review of the literature and feedback from patient representatives within the acute trust, to inform the layout and questions to be examined in the pilot questionnaire. The second objective was to development and pilot test the questionnaire using cognitive interviewing. The third objective involved conducting a cross-sectional study to establish the validity and reliability of the tool in a questionnaire to 158 patients within general medical wards. Survey analysis involved descriptive statistics, factor analysis. Objective four explored the relationships between patient demographics (ethnic background, age, gender, social deprivation, family support), mode of admission and patient perceptions of safety, using ANOVA. 

This study demonstrated that a validated tool can be developed with patients to measure how safe they feel during their acute hospital stay. Key items that patients identified in making them feel unsafe included poor communication with health professionals, especially with communication about medications, poor infection control practice and staffing levels. Items that patients identified in making them feel safe included staff showing compassionate care, clear communication and adequate staffing levels. Exploratory factor analysis was used to establish the factor loading for each of the thirteen items of the questionnaire. Factor loadings for all items were between 0.52 and 0.86, demonstrating that all the items made an important contribution to a single factor. The Cronbach alpha score for the thirteen-item score was 0.914 illustrating internal consistency of the overall scale, therefore suggesting all thirteen items should be kept. The Pearson correlation score of .648 with question 12, “How safe you felt during your hospital stay demonstrated strong construct validity, illustrating the thirteen-item scale was a reliable measure of aspects of safety that were important to patients. 
There were no statistically significant differences in the perceptions of feeling safe between ethnic background and mode of admission, age, sex and whether they have family support during their hospital stay. Thus, the measure was found to be appropriate and universally applicable for all patients.

 Healthcare policy makers need to acknowledge that patients experience and describe their world of safety differently from healthcare professionals, and consequently the framework in which to engage them needs to shift to enable their voices to be heard. 
 Further testing of the KPSM should be undertaken as the tool has the potential to be used as an early warning trigger tool and for the findings to be used as learning for health care staff. 

Assessment of patients’ perceptions and experiences of safety remains a challenge. In this study patients reported the King’s Patient Safety Measure was easy to complete and captured items that were important in making them feel safe. The involvement of patients in the development of the King’s Patient Safety Measure demonstrated the important contribution patients can make to the safety agenda and in doing so, provides a patient feedback method which ensures their voices can be heard.
Original languageEnglish
Awarding Institution
  • Jane Sandall (Supervisor)
  • David Foster (External person) (Supervisor)
Award date1 Nov 2019

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