Psychometric properties and criterion related validity of the Norwegian version of hospital survey on patient safety culture 2.0.

BACKGROUND: Several studies have been conducted with the 1.0 version of the Hospital Survey on Patient Safety Culture (HSOPSC) in Norway and globally. The 2.0 version has not been translated and tested in Norwegian hospital settings. This study aims to 1) assess the psychometrics of the Norwegian version (N-HSOPSC 2.0), and 2) assess the criterion validity of the N-HSOPSC 2.0, adding two more outcomes, namely 'pleasure of work' and 'turnover intention'. METHODS: The HSOPSC 2.0 was translated using a sequential translation process. A convenience sample was used, inviting hospital staff from two hospitals (N = 1002) to participate in a cross-sectional questionnaire study. Data were analyzed using Mplus. The construct validity was tested with confirmatory factor analysis (CFA). Convergent validity was tested using Average Variance Explained (AVE), and internal consistency was tested with composite reliability (CR) and Cronbach's alpha. Criterion related validity was tested with multiple linear regression. RESULTS: The overall statistical results using the N-HSOPSC 2.0 indicate that the model fit based on CFA was acceptable. Five of the N-HSOPSC 2.0 dimensions had AVE scores below the 0.5 criterium. The CR criterium was meet on all dimensions except Teamwork (0.61). However, Teamwork was one of the most important and significant predictors of the outcomes. Regression models explained most variance related to patient safety rating (adjusted R2 = 0.38), followed by 'turnover intention' (adjusted R2 = 0.22), 'pleasure at work' (adjusted R2 = 0.14), and lastly, 'number of reported events' (adjusted R2=0.06). CONCLUSION: The N-HSOPSC 2.0 had acceptable construct validity and internal consistency when translated to Norwegian and tested among Norwegian staff in two hospitals. Hence, the instrument is appropriate for use in Norwegian hospital settings. The ten dimensions predicted most variance related to 'overall patient safety', and less related to 'number of reported events'. In addition, the safety culture dimensions predicted 'pleasure at work' and 'turnover intention', which is not part of the original instrument.

The pros and cons of remote work in relation to bullying, loneliness and work engagement: A representative study among Norwegian workers during COVID-19.

Remote work became the new normal during COVID-19 as a response to restrictions imposed by governments across the globe. Therefore, remote work's impact on employee outcomes, well-being, and psychological health has become a serious concern. However, the knowledge about the mechanisms and outcomes of remote work is still limited. In this study, we expect remote work to be negatively related to bullying and assume that bullying will mediate remote work's impact on work engagement and loneliness. To test our hypothetical model, we applied a cross-sectional design using data from a large representative sample of 1,511 Norwegian workers. The data were collected in September 2021 during a period of COVID-19 restrictions in Norway. The results confirmed our hypotheses: remote work was positively related to loneliness and work engagement but negatively related to bullying. Further, bullying was positively related to loneliness and negatively related to work engagement. Moreover, bullying was also found to play a partial mediating role, supporting our hypothesis. This study suggests that remote work is related to both positive and negative mechanisms in the workplace. Remote work can potentially reduce bullying and have a protective function in preventing bullying. However, since remote work has positive relations with both loneliness and work engagement, this study illustrates that organizations should be cautious and perhaps consider a moderate level of remote work. Hence, the results have several implications for HR policies and management.

The Impact of Business Leaders' Formal Health and Safety Training on the Establishment of Robust Occupational Safety and Health Management Systems: Three Studies Based on Data from Labour Inspections.

The impact of occupational safety and health (OSH) training is a neglected topic in safety research. In Norway, such training is mandatory for all business leaders. Hence, the Norwegian working life forms a particularly interesting case for studying the impact of OSH training. On the basis of data from labour inspections performed by the Norwegian Labour Inspection Authority (NLIA), this article examines the impact of business leaders' mandatory OSH training on the establishment of robust OSH systems. Three separate studies have been conducted. In study 1, cross-sectional data from inspections of 29,224 companies are analysed. In study 2 and 3, longitudinal data from inspections of 1119 and 189 companies, respectively, are analysed. The analyses reveal that mandatory OSH training of business leaders is positively associated with compliance with legal requirements related to the minimum content of OSH systems. This means that mandatory OSH training is important for the establishment of robust occupational safety and health management systems.

Competence Development and Collaborative Climate as Antecedents of Job Performance, Job Commitment and Uncertainty: Validation of a Theoretical Model across Four Hospitals.

Knowledge is lacking regarding how organizational factors are associated with uncertainty in patient treatment. Thus, the aim of the current study was to investigate how competence development and collaborative climate relates to job performance and job commitment, and further whether job performance and job commitment relate to uncertainty. Additionally, we examined whether these associations differed between four different hospitals. We applied data from 6445 hospital workers who provided care to patients. Basic statistics and structural equation modelling (SEM) were used to test the validity of the theoretical model developed in the study and the hypothesized associations. All hypothesized paths between the latent variables were significant and in accordance with the model across the four hospitals. The current study has implications for practical human resource management and indicates that competence development should be strengthened at the individual level and collaborative climate should be strengthened at the ward level. Strengthening competence development and collaborative climate can increase job performance and job commitment of individual workers and reduce uncertainty during care in hospital settings.

Employees' Work-Related Well-Being during COVID-19 Pandemic: An Integrated Perspective of Technology Acceptance Model and JD-R Theory.

Employees' work-related well-being has become one of the most significant interests of researchers and organizations due to the COVID-19 pandemic. This study examines how job characteristics such as mental load and team support, and technology-related factors such as perceived ease of use, perceived usefulness, and technology acceptance, impact employees' work engagement as a dimension of work well-being. Data were collected through a sample of 610 academic employees from three Norwegian universities after COVID-19 restrictions were implemented. The structural model estimation showed that mental load, perceived team support, and technology acceptance were significantly related to work engagement. It also showed that perceived usefulness, perceived ease of use, and mental load were significantly related to technology acceptance. Furthermore, the analysis showed that technology acceptance partially mediates the relationship between job characteristics and work engagement, and fully mediates the relationship between technology-related perceptions and work engagement. Building on the technology acceptance model (TAM) and job demands-resources (JD-R) theory, this study provides insights into the effects of job-related and technology-related factors on remote workers' well-being. By doing so, we contribute to the existing literature by demonstrating how remote working with the use of newly implemented technologies can be related to employees' well-being during a pandemic.

Use of the Hospital Survey of Patient Safety Culture in Norwegian Hospitals: A Systematic Review.

This review aims to provide an overview of empirical studies using the HSOPSC in Norway and to develop recommendations for further research on patient safety culture. Oria, an online catalogue of scientific databases, was searched for patient safety culture in February 2021. In addition, three articles were identified via Google Scholar searches. Out of 113 retrieved articles, a total of 20 articles were included in our review. These were divided into three categories: seven perception studies, six intervention studies, and seven reliability and validation studies. The first study conducted in Norway indicated a need to improve patient safety culture. Only one intervention study was able to substantially improve patient safety culture. The validity of HSOPSC is supported in most studies. However, one study indicated poor quality in relation to the testing of criteria related to validity. This review is limited to Norwegian healthcare but has several relevant implications across the research field, namely that intervention studies should (1) validate dimensions more carefully, (2) avoid pitfalls related to both factor analysis methods and criteria validity testing, (3) consider integrating structural models into multilevel improvement programs, and (4) benefit from applying different, new versions of HSOPSC developed in Norway.

Validation and Adjustment of the Patient Experience Questionnaire (PEQ): A Regional Hospital Study in Norway.

This paper assesses the psychometric qualities of the Patient Experience Questionnaire (PEQ), thereby validating a patient-oriented measurement model in a hospital environment, and modifies the model based on empirical results. This study employed survey data gathered by the Norwegian Institute of Public Health from adult inpatients at somatic hospitals in the Health South-East RHF in Norway. The survey engaged 4603 patients out of 8381 from five main hospitals in the region. The study found that an eight-factor model of the PEQ generally showed good fitness to the data, but assessment of discriminant validity showed that this was not the optimal factor solution among four of the eight dimensions. After comparing models, the study proposed a model with a second-order factor for four of the factors: "nurse services", "doctor services", "information", and "organization", collectively named "treatment services". The proposed model demonstrated good validity and reliability results. The results present theoretical and practical implications. The study recommends that inferential analyses on the PEQ should be done with the second-order factor. Furthermore, a revision of the PEQ is recommended subject to more confirmatory studies with larger samples in different regions. The study indicates a second-order factor structure for assessing and understanding patient experiences-a finding which has both theoretical and managerial implications.

The association between supervisor support and ethical dilemmas on Nurses' intention to leave: The mediating role of the meaning of work.

AIM: To examine the association between supervisor support and ethical dilemmas on nurses' intention to leave health care organisations, both directly and through the mediating role of the meaning of work. BACKGROUND: The shortage of nurses makes it vital that organisations retain nurses and so reduce the costs associated with replacing experienced nurses. METHODS: This cross-sectional study samples 2,946 registered nurses from a selected health region in Norway. Structural equation modelling was used to test a hypothesized model. RESULTS: Social support from the supervisor and ethical dilemmas is associated with nurses' intention to leave, both directly and indirectly through the mediating role of the meaning of work. CONCLUSION: Health care organisations should enhance social support from supervisors and the meaning of work, and reduce the level of ethical dilemmas in hospitals. IMPLICATIONS FOR NURSING MANAGEMENT: Health care organisations should continuously develop and offer training in nurse manager skills, such as being empathic, understanding employees' needs and how to communicate and handle ethical dilemmas. Managers should value staff contributions, encourage staff involvement in ethical questions and highlight the impact of nurses' work on improving the welfare of others.

Development and Investigation of a New Model Explaining Job Performance and Uncertainty among Nurses and Physicians.

The purpose of this paper is to develop and investigate a new theoretical model explaining variance in job performance and uncertainty among nurses and physicians. The study adopted a cross-sectional survey. Data was collected from 2946 nurses and 556 physicians employed at four public hospitals in Norway. We analysed data using descriptive statistics, correlations, Cronbach's alpha, confirmatory factor analyses and structural equation modelling. To explain job performance and uncertainty, two sets of explanatory variables were used: first, satisfactions of three psychological needs-namely autonomy, social support and competence development-and second, employee perceptions of hospital management quality (HMQ) and local leadership quality (LLQ). The results supported the theoretical model among nurses and physicians; (1) HMQ was positively associated with LLQ; (2) LLQ was positively associated with psychological needs; (3) the majority of psychological needs were positively associated with job performance and negatively associated with uncertainty, but more of these relations were significant among nurses than physicians. The results suggest that job performance and uncertainty among nurses and physicians can be improved by helping personnel meet their psychological needs. Improving job design and staff involvement will be important to strengthen need satisfaction. Results suggest enhancement of HMQ and LLQ will be positively related to need satisfaction among nurses and physicians and will strengthen job performance and reduce uncertainty.

Changing to improve? Organizational change and change-oriented leadership in hospitals.

PURPOSE: This paper aims to fill gaps in one's knowledge of the impact of organizational change on two outcomes relevant to hospital service quality (performance obstacles and physician job satisfaction) and in one's knowledge of the role of middle manager change-oriented leadership in relation to the same outcomes. Further, the authors aim to identify how physician participation in decision-making is impacted by organizational change and change-oriented leadership, as well as how it mediates the relationships between these two variables, performance obstacles and job satisfaction. DESIGN/METHODOLOGY/APPROACH: The study adopted a cross-sectional survey design including data from Norwegian hospital physicians (N = 556). A hypothetical model was developed based on existing theory, confirmatory factor analysis was carried out in order to ensure the validity of measurement concepts, and the structural model was estimated using structural equation modelling. FINDINGS: The organizational changes in question were positively related to performance obstacles both directly and indirectly through participation in decision-making. Organizational change was also negatively related to job satisfaction, both directly and indirectly. Change-oriented leadership was negatively related to performance obstacles, but only indirectly through participation in decision-making, whereas it was positively related to job satisfaction both directly and indirectly. ORIGINALITY/VALUE: The authors developed a theoretical model based on existing theory, but to their knowledge no other studies have tested these exact relationships within one model. These findings offer insights relevant to current and ongoing developments in the healthcare field and to the question of how hospitals may deal with continuous changes in ways that could contribute positively towards outcomes relevant to service quality.

Assessing safety climate in prehospital settings: testing psychometric properties of a common structural model in a cross-sectional and prospective study.

BACKGROUND: Little research exists on patient safety climate in the prehospital context. The purpose of this article is to test and validate a safety climate measurement model for the prehospital environment, and to explore and develop a theoretical model measuring associations between safety climate factors and the outcome variable transitions and handoffs. METHODS: A web-based survey design was utilized. An adjusted short version of the instrument Hospital Survey on Patient Safety Culture (HSOPSC) was developed into a hypothetical structural model. Three samples were obtained. Two from air ambulance workers in 2012 and 2016, with respectively 83 and 55% response rate, and the third from the ground ambulance workers in 2016, with 26% response rate. Confirmatory factor analysis (CFA) was applied to test validity and psychometric properties. Internal consistency was estimated and descriptive data analysis was performed. Structural equation modelling (SEM) was applied to assess the theoretical model developed for the prehospital setting. RESULTS: A post-hoc modified instrument consisting of six dimensions and 17 items provided overall acceptable psychometric properties for all samples, i.e. acceptable Chronbach's alphas (.68-.86) and construct validity (model fit values: SRMR; .026-.056, TLI; .95-.98, RMSEA; .031-.052, CFI; .96-.98). A common structural model could also be established. CONCLUSIONS: The results provided a validated instrument, the Prehospital Survey on Patient Safety Culture short version (PreHSOPSC-S), for measuring patient safety climate in a prehospital context. We also demonstrated a positive relation between safety climate dimensions from leadership to unit level, from unit to individual level, and from individual level on the outcome dimension related to transitions and handoffs. Safe patient transitions and handoffs are considered an important outcome of prehospital deliveries; hence, new theory and a validated model will constitute an important contribution to the prehospital safety climate research.

Evidence for essential unidimensionality of AUDIT and measurement invariance across gender, age and education. Results from the WIRUS study.

INTRODUCTION: Globally, alcohol use is among the most important risk factors related to burden of disease, and commonly emerges among the ten most important factors. Also, alcohol use disorders are major contributors to global burden of disease. Therefore, accurate measurement of alcohol use and alcohol-related problems is important in a public health perspective. The Alcohol Use Identification Test (AUDIT) is a widely used, brief ten-item screening instrument to detect alcohol use disorder. Despite this the factor structure and comparability across different (sub)-populations has yet to be determined. Our aim was to investigate the factor structure of the AUDIT-questionnaire and the viability of specific factors, as well as assessing measurement invariance across gender, age and educational level. METHODS: We employed data (N = 4,318) from the ongoing screening study in the Norwegian national WIRUS project. We used Confirmatory Factor Analysis (CFA) to establish the factor structure of the AUDIT. Next, we investigated the viability of specific factors in a bi-factor model, and assessed measurement invariance of the preferred factor structure. RESULTS: Our findings indicate the AUDIT is essentially unidimensional, and that comparisons can readily be done across gender, age and educational attainment. CONCLUSION: We found support for a one-factor structure of AUDIT. To the best of our knowledge, this is the first study to investigate the viability of specific factors in a bi-factor model as well as evaluating measurement invariance across gender, age and educational attainment for the AUDIT questionnaire. Therefore, further studies are needed to replicate our findings related to essential unidimensionality.

Making a career in hospitals: Determinants of registered nurses' aspirations to become a manager.

AIM: To examine seven determinants of Registered Nurses' aspirations to become a manager in four Norwegian public hospitals. BACKGROUND: Research evidence shows that nurses submit few applications to management positions. Understanding the determinants that influence nurses' aspirations to become managers can provide healthcare organizations with important knowledge on the drivers and barriers in recruitment and on the development of nurse managers. DESIGN: This study adopted a cross-sectional web-based survey design. METHOD: Logistic regression analysis based on 2,630 Registered Nurses' responses to a self-completion survey in a Norwegian regional health authority collected during October 2014. The overall response rate was 40%. RESULTS: Findings indicate that men and younger nurses are most likely to report an aspiration in management. The social support of an immediate supervisor and institutional stress are positively associated with an aspiration to become a manager; however, high experienced workloads have the opposite effect. CONCLUSION: Healthcare organizations should work strategically to develop a human resource management policy that ensures that the organization develops the nurse managers it needs now and in the future. IMPACT: This study addresses the challenge of having enough qualified nurse managers. The main findings indicate that job demands can have both a negative and positive impact on nurses' aspirations to become a manager. Healthcare organizations should, however, reduce demands and consider increasing job resources. The results should have an impact on the human resource department, managers, and other key personnel in healthcare organizations.

The influence of change-oriented leadership on work performance and job satisfaction in hospitals - the mediating roles of learning demands and job involvement.

PURPOSE: The purpose of this paper is to examine the mechanisms through which change-oriented leadership in hospitals influences job performance and employee job satisfaction. The authors examine the direct and the mediating effects of perceived learning demands and job involvement. DESIGN/METHODOLOGY/APPROACH: This cross-sectional study is based on a survey of four public hospitals in a regional health authority in Norway. FINDINGS: The findings illustrate how change-oriented leadership directly and indirectly influences work performance and job satisfaction. Learning demands and job involvement play mediating roles. Higher levels of change-oriented leadership decrease learning demands and increase job involvement, work performance and job satisfaction. Learning demands have a negative influence on work performance and job satisfaction. Job involvement has a positive influence on work performance and job satisfaction. The strongest relationship in the structural modelling is between change-oriented leadership and job involvement. RESEARCH LIMITATIONS/IMPLICATIONS: This study is based on cross-sectional data. Future studies should therefore explore this further using a longitudinal design. PRACTICAL IMPLICATIONS: The practical implication of the study is to show how leaders by change-oriented behaviour can influence work performance and job satisfaction by reducing learning demands and increasing job involvement. SOCIAL IMPLICATIONS: This study illustrates different paths towards influencing job performance and job satisfaction from change-oriented leadership. It is important to use the potential of reducing learning demands and increasing job involvement, to improve job performance and job satisfaction. ORIGINALITY/VALUE: The authors have developed and validated a new theoretical mediational model explaining variance in job performance and job satisfaction, and how this is related to change-oriented leadership, job involvement and learning demands. This knowledge can be used to increase the probability of successful change initiatives.

Psychometric properties of the Norwegian version of the hospital survey on patient safety culture in a prehospital environment.

BACKGROUND: To develop a culture of patient safety in a regime that strongly focuses on saving patients from emergencies may seem counter-intuitive and challenging. Little research exists on patient safety culture in the context of Emergency Medical Services (EMS), and the use of survey tools represents an appropriate approach to improve patient safety. Research indicates that safety climate studies may predict safety behavior and safety-related outcomes. In this study we apply the Norwegian versions of Hospital Survey on Patient Safety Culture (HSOPSC) and assess the psychometric properties when tested on a national sample from the EMS. METHODS: This study adopted a web based survey design. The Norwegian HSOPSC has 13 dimensions, consisting of 46 items, in addition to two single-item outcome variables. SPSS (version 21) was used for descriptive data analysis, estimating internal consistency, and performing exploratory factor analysis. Confirmatory factor analysis (CFA) was applied to test the dimensional structure of the instruments using Amos (version 21). RESULTS: N = 1387 (27%) EMS employees participated in the survey. Overall, acceptable psychometric properties were observed, i.e. acceptable internal consistencies and construct validity. The patient safety climate dimensions with highest scores (number of positive answers) were "teamwork within units" and "manager expectations & actions promoting patient safety". The dimension "hospital management support for patient safety" had the lowest score. CONCLUSIONS: The results provided a validated instrument, the Prehospital Survey on Patient Safety Culture (PreHSOPSC), for measuring patient safety climate in an EMS setting. In addition, the explanatory power was strong for several of the outcome dimensions; i.e., several of the safety climate dimensions have a strong predictive effect on outcome variables related to employees' perceptions on patient safety and safety-related attitude.

Work climate and the mediating role of workplace bullying related to job performance, job satisfaction, and work ability: A study among hospital nurses.

AIM: To increase understanding of workplace bullying and its relation to work climate and different outcomes among nurses. Examine a proposed bullying model including both job resource and job demands, as well as nurse outcomes reflected in job performance, job satisfaction, and work ability. BACKGROUND: Workplace bullying has been identified as some of the most damaging mechanisms in workplace settings. It is important to increase understanding of workplace bullying in relation to work climate and different outcomes among nurses. DESIGN: This study adopted a cross-sectional web based survey design. METHOD: A sample of 2946 Registered Nurses from four public Norwegian hospitals were collected during October 2014. We analysed data using descriptive statistics, correlations, Cronbach's alpa, confirmatory factor analyses, and structural equation modelling. RESULTS: The majority of work climate characteristics confirmed to influence workplace bullying, and additionally had direct influence on nurse outcomes; job performance, job satisfaction, and work ability. Bullying had a mediational role between most of the work climate dimensions and nurse outcomes. CONCLUSION: This study increases our understanding of organizational antecedent of bullying among nurses. Workplace bullying among nurses functions as a mediator between the majority of work climate dimensions and outcomes related to job satisfaction and work ability. Strategies to reduce bullying should look at the study finding and specifically job resources and job demands that influence bullying and nurse outcomes.

A comparative study of safety climate differences in healthcare and the petroleum industry.

AIM: The aim of this article is to compare safety climate in healthcare and the petroleum industry by collecting empirical evidence of differences between the two sectors. METHODS: The Hospital Survey on Patient Safety Culture (HSOPSC) is used to measure the safety climate in two organisations operating in the two different sectors: (1) a large Norwegian university hospital offering a wide range of hospital services and (2) a large Norwegian petroleum company producing oil and gas worldwide. RESULTS AND DISCUSSION: Statistical analyses supported the expected hypotheses that safety climate is positively related to outcome measures and that the level on safety climate and outcome measures are generally higher in the petroleum sector. Empirical findings indicate that healthcare should learn from the petroleum industry regarding safety improvement efforts, and the implication of this is discussed in the paper.

Exploring the possibility of a common structural model measuring associations between safety climate factors and safety behaviour in health care and the petroleum sectors.

The aim of the present study was to explore the possibility of identifying general safety climate concepts in health care and petroleum sectors, as well as develop and test the possibility of a common cross-industrial structural model. Self-completion questionnaire surveys were administered in two organisations and sectors: (1) a large regional hospital in Norway that offers a wide range of hospital services, and (2) a large petroleum company that produces oil and gas worldwide. In total, 1919 and 1806 questionnaires were returned from the hospital and petroleum organisation, with response rates of 55 percent and 52 percent, respectively. Using a split sample procedure principal factor analysis and confirmatory factor analysis revealed six identical cross-industrial measurement concepts in independent samples-five measures of safety climate and one of safety behaviour. The factors' psychometric properties were explored with satisfactory internal consistency and concept validity. Thus, a common cross-industrial structural model was developed and tested using structural equation modelling (SEM). SEM revealed that a cross-industrial structural model could be identified among health care workers and offshore workers in the North Sea. The most significant contributing variables in the model testing stemmed from organisational management support for safety and supervisor/manager expectations and actions promoting safety. These variables indirectly enhanced safety behaviour (stop working in dangerous situations) through transitions and teamwork across units, and teamwork within units as well as learning, feedback, and improvement. Two new safety climate instruments were validated as part of the study: (1) Short Safety Climate Survey (SSCS) and (2) Hospital Survey on Patient Safety Culture-short (HSOPSC-short). Based on development of measurements and structural model assessment, this study supports the possibility of a common safety climate structural model across health care and the offshore petroleum industry.

Patient safety challenges in a case study hospital--of relevance for transfusion processes?

The paper reports results from a research project with the objective of studying patient safety, and relates the finding to safety issues within transfusion medicine. The background is an increased focus on undesired events related to diagnosis, medication, and patient treatment in general in the healthcare sector. The study is designed as a case study within a regional Norwegian hospital conducting specialised health care services. The study includes multiple methods such as interviews, document analysis, analysis of error reports, and a questionnaire survey. Results show that the challenges for improved patient safety, based on employees' perceptions, are hospital management support, reporting of accidents/incidents, and collaboration across hospital units. Several of these generic safety challenges are also found to be of relevance for a hospital's transfusion service. Positive patient safety factors are identified as teamwork within hospital units, a non-punitive response to errors, and unit manager's actions promoting safety.

[Workers' perceptions of safety culture at a hospital]. / Ansattes oppfatninger av sykehusets sikkerhetskultur.

BACKGROUND: Little is known about the quality of work practices regarding patient safety and the safety culture as such in the Norwegian health care services. MATERIAL AND METHOD: A questionnaire survey was performed at Stavanger University Hospital, with health workers as the main target group. The "Hospital Survey On Patient Safety Culture" (HSOPSC) instrument was translated into Norwegian and used to measure safety culture. 1919 workers answered the survey (55%). RESULTS: The different disciplines varied with respect to the culture of reporting (large variation) and the general judgement of patient safety (less variation). 50% of the health workers regarded patient safety to be very good or excellent. Social educators, nurses and specialist nurses regarded patient safety to be lower than that reported by other professional groups. Generally all the safety culture dimensions were significantly correlated and should therefore be considered together. Feedback and communication about error were e.g. the factors, which were most highly correlated with reporting of near events. Norwegian health workers perceive the safety culture to be less adequate than that reported by American health care workers for similar assessments, with the exception of three dimensions (communication openness, non-punitive response to error, supervisor/manager expectations & actions promoting patient safety) dimensions. INTERPRETATION: The results indicate a need to improve safety culture and patient safety in Norwegian health care.