The Psychological Safety Scale of the Safety, Communication, Operational, Reliability, and Engagement (SCORE) Survey: A Brief, Diagnostic, and Actionable Metric for the Ability to Speak Up in Healthcare Settings.
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2022-09
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Abstract
Objectives
The current study aimed to guide the assessment and improvement of psychological safety (PS) by (1) examining the psychometric properties of a brief novel PS scale, (2) assessing relationships between PS and other safety culture domains, (3) exploring whether PS differs by healthcare worker demographic factors, and (4) exploring whether PS differs by participation in 2 institutional programs, which encourage PS and speaking-up with patient safety concerns (i.e., Safety WalkRounds and Positive Leadership WalkRounds).Methods
Of 13,040 eligible healthcare workers across a large academic health system, 10,627 (response rate, 81%) completed the 6-item PS scale, demographics, safety culture scales, and questions on exposure to institutional initiatives. Psychometric analyses, correlations, analyses of variance, and t tests were used to test the properties of the PS scale and how it differs by demographic factors and exposure to PS-enhancing initiatives.Results
The PS scale exhibited strong psychometric properties, and a 1-factor model fit the data well (Cronbach α = 0.80; root mean square error approximation = 0.08; Confirmatory Fit Index = 0.97; Tucker-Lewis Fit Index = 0.95). Psychological Safety scores differed significantly by role, shift, shift length, and years in specialty. The PS scale correlated significantly and in expected directions with safety culture scales. The PS score was significantly higher in work settings with higher rates of exposure to Safety WalkRounds or Positive Leadership WalkRounds.Conclusions
The PS scale is brief, diagnostic, and actionable. It exhibits strong psychometric properties; is associated with better safety, teamwork climate, and well-being; differs by demographic factors; and is significantly higher for those who have been exposed to PS-enhancing initiatives.Type
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Adair, Kathryn C, Annemarie Heath, Maureen A Frye, Allan Frankel, Joshua Proulx, Kyle J Rehder, Erin Eckert, Caitlin Penny, et al. (2022). The Psychological Safety Scale of the Safety, Communication, Operational, Reliability, and Engagement (SCORE) Survey: A Brief, Diagnostic, and Actionable Metric for the Ability to Speak Up in Healthcare Settings. Journal of patient safety, 18(6). pp. 513–520. 10.1097/pts.0000000000001048 Retrieved from https://hdl.handle.net/10161/26017.
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Scholars@Duke
Kyle Jason Rehder
Mechanical Ventilation, ECMO, Patient Safety and Quality, Communication, Education
Erin Eckert
Erin Eckert, MPA, CPPS is the Program Director for Duke AHEAD and is responsible for administering the Academy’s programs and supporting its community of educators.
She previously served as the Strategic Services Associate for Duke Palliative Care, coordinating the health system’s Goals of Care initiative to improve the frequency, timing, and quality of serious illness conversations with patients and their loved ones. She also supported the Duke Center for Healthcare Safety and Quality as Education Coordinator, leading Duke’s TeamSTEPPS Training Program, Evidence-Based Medicine Workshop, and the Annual Duke Health Quality and Safety Conference.
Before joining Duke, she served as TeamSTEPPS Coordinator for UNC’s Institute for Healthcare Quality Improvement, supporting teamwork training, quality improvement, and simulation programs. She transitioned to health care after more than ten years in emergency management, helping organizations improve disaster teamwork, communication, and leadership through interprofessional planning, training, and simulation exercises.
She attended Kenyon College (BA, Political Science and Economics, cum laude) and received her Masters in Public Administration (MPA) from UNC-Chapel Hill’s School of Government.
John Bryan Sexton
Bryan is the Director of the Duke Center for the Advancement of Well-being Science. He leads the efforts around research, training and coaching, guiding quality improvement and well-being activities.
A psychologist member of the Department of Psychiatry, Bryan is a psychometrician and spends time developing methods of assessing and improving safety culture, teamwork, leadership and especially work-force well-being. Currently, he is disseminating the results from a successful NIH R01 grant that used RCTs to show that we can cause enduring improvements in healthcare worker well-being.
A perpetually recovering father of four, he enjoys running, using hand tools on wood, books on Audible, and hearing particularly good explanations of extremely complicated topics.
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