Patient safety has become a global concern in modern healthcare systems, particularly as adverse events persist across healthcare settings, from primary care to hospital-based services. A significant proportion of these events are preventable and tied to systemic issues rather than isolated errors. In this context, assessing patient safety accurately is vital. Numerous instruments have been developed to evaluate different aspects of safety culture, behaviours and outcomes. The wide range of tools reflects the multidimensional nature of patient safety, but also presents challenges for standardisation and comparison. A scoping review was conducted to map the existing instruments and their characteristics, offering insight into the current state of patient safety assessment worldwide.
Global Scope and Diversity of Assessment Instruments
The review identified 47 distinct instruments designed to evaluate patient safety across various healthcare contexts. These tools vary widely in their application scope, target populations and geographical distribution. The majority were developed for use in intra-hospital settings, particularly in emergency departments, but several also addressed pre-hospital care, primary care and general healthcare environments. Notable instruments include the Safety Attitudes Questionnaire (SAQ), the Hospital Survey on Patient Safety Culture (HSOPSC) and the Patient Measure of Safety (PMOS). These tools were predominantly applied in countries such as the United States, Canada and European nations, although some were adapted for use in Latin America, the Middle East and Asia. The distribution suggests a growing global commitment to embedding patient safety culture within health services.
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Dimensions of Patient Safety: Common Themes and Specific Focus
The instruments reviewed encompass 71 unique dimensions related to patient safety. Recurring themes included teamwork, communication, job satisfaction, safety climate and working conditions. These core dimensions highlight the emphasis on organisational culture and interpersonal dynamics as critical drivers of safety outcomes. Some instruments, like the Alberta Registered Nurse Survey and PSCHO (Patient Safety Climate in Healthcare Organisations), provided extensive coverage with up to 14 dimensions, allowing for a detailed assessment of both structural and cultural components. Others, such as the WHO Hand Hygiene Self-Assessment Framework, focused on specific safety interventions. Less common dimensions, including burnout, resource access and emotional exhaustion, appeared in only a few tools, indicating emerging areas of interest that may warrant broader inclusion in future assessments.
Applications, Strengths and Limitations in Healthcare Contexts
The review also explored the contexts in which these instruments are used and the populations they target. While many tools were developed for healthcare professionals, others incorporated perspectives from patients or family members, particularly in emergency settings. Instruments like the Person-Centred Climate Questionnaire—Family (PCQ-F) exemplify this shift toward holistic, inclusive assessment. The tools differ in format, typically employing closed-ended questions and Likert-scale responses. Although these instruments offer valuable insights into institutional safety culture and professional perceptions, the lack of consistent validation data limits their utility for benchmarking or outcome correlation. Moreover, the abundance of tools can hinder comparability between institutions, particularly when tools are adapted to local contexts without harmonised standards. Additionally, few studies reviewed provided evidence on the direct impact of tool usage on measurable safety outcomes, such as reduction in adverse events or mortality.
The review has underscored the complexity and richness of the current landscape of patient safety assessment instruments. The diversity of tools reflects a global recognition of the importance of safety culture and a desire to measure and improve it. However, this same diversity presents challenges for cross-institutional benchmarking and evaluation. While many instruments are well-established and widely adopted, others remain context-specific, limiting generalisability. The findings highlight a need for greater harmonisation and validation of patient safety tools, alongside the inclusion of outcome measures that link safety culture to clinical performance. For healthcare managers, policymakers and researchers, selecting appropriate instruments aligned with specific objectives and contexts is essential for driving meaningful improvements in patient safety.
Source: Healthcare
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