Safety Attitudes Questionnaire
Safety Attitudes Questionnaire (SAQ) · Also known as: SAQ
The Safety Attitudes Questionnaire (SAQ) is a 60-item self-report instrument developed by Sexton and colleagues in the early 2000s to measure organizational safety culture in healthcare settings. Adapted from crew resource management research in aviation, the SAQ assesses clinician and non-clinician perceptions of safety attitudes across six key dimensions. It is widely used in hospital quality improvement and research to identify gaps in safety culture and benchmark institutional performance.
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When to use it
The SAQ is appropriate for any acute-care hospital, surgical center, intensive care unit, or ambulatory surgical center seeking to assess staff perceptions of organizational safety. It is particularly valuable in departments with high error rates, after serious adverse events (root cause analysis), during quality improvement initiatives, or when implementing new protocols or teamwork training. It can be administered hospital-wide or targeted to specific units (operating room, intensive care unit, obstetrics) to identify variation.
Strengths & limitations
- Extensively validated across multiple countries, languages, and healthcare settings (operating rooms, intensive care units, labor and delivery units, general wards). Over 300 published studies.
- Measures six distinct, clinically relevant dimensions of safety culture rather than a single global score, providing actionable feedback on specific strengths and gaps.
- Strong psychometric properties: internal consistency (Cronbach's α = 0.70–0.80 per subscale), good test–retest reliability, and demonstrated association with objective safety outcomes (surgical site infections, medication errors, mortality).
- Brief administration time (10–15 minutes for full form, 5–7 for short form) and simple scoring facilitate widespread implementation.
- Links directly to aviation-derived crew resource management training, enabling hospitals to use results to justify and target team communication interventions.
- Self-report bias: respondents may answer in socially desirable ways, especially if confidentiality concerns are high or leadership climate is perceived as punitive.
- Snapshot measurement: a single administration captures a moment; sustained improvement requires serial measurement and intervention.
- Does not measure technical competence, knowledge, or actual compliance with safety protocols—only perceptions and attitudes.
- Requires adequate response rate (typically ≥60%) to generate valid unit-level or hospital-level scores; low response rates can produce biased estimates of true culture.
Frequently asked
Is the SAQ appropriate for non-hospital settings (primary care, ambulatory clinics, skilled nursing facilities)?
Yes. While originally developed in hospitals, the SAQ has been validated in diverse settings including emergency departments, labor and delivery units, outpatient surgical centers, and primary care clinics. Domain-specific versions and instructions for these contexts are available in the literature.
What is a clinically meaningful change in SAQ scores?
Published studies suggest that a change of 10 or more points on the 0–100 scale per dimension indicates a substantial shift in safety culture. Improvements of this magnitude have been associated with reductions in adverse events and near misses in follow-up cohorts.
Can SAQ results be compared across hospitals?
Broad comparison is limited by variation in sample composition, response rates, and local context. However, published benchmarking studies provide reference ranges for specific departments (e.g., operating rooms, ICUs). Direct comparison with similar units within your hospital system is more meaningful than comparing to national medians.
How can we ensure confidentiality and honest responses?
Administer via anonymous online survey platform or paper questionnaire with neutral third-party collection. Explicitly communicate that results will be presented at the aggregate unit level only (no individual identification). Senior leadership should publicly endorse the survey and commit to non-punitive use of data for improvement. These steps significantly increase response rate and honest reporting.
Sources
- Sexton, J. B., Helmreich, R. L., Neilands, T. B., Rowan, K., Vella, K., Boyden, J., Roberts, P. R., & Thomas, E. J. (2006). The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Services Research, 6, 44. DOI: 10.1186/1472-6963-6-44 ↗
- Thomas, E. J., Sexton, J. B., Neilands, T. B., Helmreich, R. L., & Williamson, J. W. (2005). The effect of executive coaching on communication and teamwork among senior medical residents. Academic Medicine, 80(10), 957-963. link ↗
How to cite this page
ScholarGate. (2026, June 3). Safety Attitudes Questionnaire (SAQ). ScholarGate. https://scholargate.app/en/healthcare-management/safety-attitudes-questionnaire
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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