Self-report instruments are commonly used, although the weaknesses of self-reporting are widely recognized. Self-report inventories are often a good solution when researchers need to administer a large number of tests in a relatively short period of time. Scoring of the tests is standardized and based on previously established norms. However, self-report inventories have their weaknesses: Some tests are long and tedious. In some cases, a respondent may simply lose interest and not answer questions accurately. Additionally, people are sometimes not the best judges of their own behavior. Some individuals may try to hide their true feelings, thoughts, and attitudes.
The safety culture environment is considered the most important barrier to improving patient care safety [20
]. The starting point for developing a safety culture should be the evaluation of the current culture by using an appropriate instrument [21
]. This is a starting point for several areas: (1) diagnosis of safety culture and raising awareness, (2) evaluation of patient safety interventions and tracking change over time, (3) internal and external benchmarking, and (4) fulfillment of regulatory or other requirements [6
In the 10-factor model, the reliability (internal consistency) of the factors and construct validity are acceptable. This indicates that the dimensions measure different constructs. However, high factor loading in all the items and a moderately high correlation among them indicate that each item could be used independently to determine patient safety; the number of items measuring the same factors could be limited to shorten the instrument. Internal consistency (α) coefficients, which are based on the original factor structure of the survey, are shown in Table . As expected, all factors were correlated with the outcome variable (i.e., patient safety score). The correlation of the patient safety score with "overall perception of safety" is an indication that the latter scale is accurate.
Overall, we generally found low patient safety culture scores in Turkey. The patient safety culture perception levels of physicians and nurses were similar. The number of participation of nurses in the study was higher than that reported in several other studies [13
]. Improvements may be realized through the following: (1) reporting of adverse events, (2) non-punitive policies with respect to error reporting, (3) open communication, (4)management support for safety culture, and (5) staffing improvements (Table ).
Personnel appeared unwilling to work with those in other units but reported good teamwork within their own units (Table ). Other studies found similar results [22
]. Teamwork is an important part for the development of patient safety, and personnel should be encouraged and supported in their efforts to establish good relationships with people working in other units [1
Frequency of events reported, feedback about error, and organizational learning levels were all quite low (Table ). In various types of hospitals and in rest homes, personnel surveyed by other researchers expressed concerns about application of punitive approaches [13
]. In a study by Kim and colleagues, nurses were found to be inattentive to the "possible occurrence" of medical error, and a lack of open communication was reported [25
]. If there is no system in place to report events and personnel have an intensive workload, reporting of events will be difficult [27
]. Some studies reveal higher percentages of positive opinions about organizational learning, event reporting and open communication [23
Management can show its support for patient safety by maintaining open communication, educating personnel, delegating the workers to identify and correct risks, stating that patient safety is a shared responsibility, and providing adequate resources [7
]. This study shows that physicians and nurses consider management support to be inadequate for patient safety (Table ). While there are studies that report similar results [23
], there are other studies in which personnel report that management support was adequate [28
]. Scarcity in number of personnel and inexperience will weaken the ability of a healthcare facility to provide patient safety.
If healthcare personnel's perception of patient safety culture is generally lower than the benchmark score [14
] in hospitals with 400 or more beds, they will also have higher scores in dimensions such as "overall perception of patient safety" and "handoffs and transitions" (Table ). While this can be due to cultural differences, it can also be due to the reluctance of healthcare personnel to express negative opinions about their workplaces. In other studies that report a low patient safety culture level, "overall perception of patient safety" and "handoffs and transitions" dimensions were also problematic [13
]. Alterations in communication mechanisms during handoffs and a lack of standards in doing so cause patient safety problems [30