Cross-Cultural Adaptation and Psychometric Validation of the Hospital Survey on Patient Safety Culture Version 2 (HSOPSv2) in Spanish Hospitals

Abstract

INTRODUCTION: Patient safety culture is a key component of healthcare quality. The Hospital Survey on Patient Safety Culture (HSOPS), developed by AHRQ in 2004, has been widely used internationally to assess healthcare professionals' perceptions of safety. In 2019, version 2 (HSOPSv2) was released, with improvements in structure and item clarity. Although a Spanish version for North America exists, it has not yet been validated in the Spanish hospital context. OBJECTIVES: To adapt and validate HSOPSv2 for the Spanish hospital context, ensuring its cultural, linguistic, and psychometric equivalence with the original version, and to assess its suitability for use in Spanish hospitals. METHODS: A cross-cultural adaptation process was conducted, including translation, back-translation, and expert consensus, followed by a cognitive pretest with 20 healthcare professionals. A pilot study was then carried out in four hospitals in Murcia and Alicante, with 369 participants. Internal consistency (Cronbach's ? and composite reliability), convergent validity (AVE, factor loadings), and discriminant validity (Fornell-Larcker criterion and HTMT) were assessed through confirmatory factor analysis using the WLSMV estimator. RESULTS: The 10-factor model showed satisfactory fit indices (CFI and TLI > 0.90; RMSEA < 0.06; SRMR < 0.08). Most dimensions presented acceptable reliability (? and CR > 0.70), except for "Staffing and Work Pace" and "Handoffs and Information Exchange." Convergent validity was adequate in seven of the ten dimensions (AVE ? 0.50), with some weaker loadings in negatively worded items. The Fornell-Larcker criterion indicated overlap in some communication-related constructs, although HTMT results supported overall discriminant validity. CONCLUSIONS: The Spanish version of HSOPSv2 shows satisfactory psychometric properties, comparable to other international adaptations. Its availability provides Spanish hospitals with a robust tool to assess patient safety culture, identify areas for improvement, and design interventions aimed at reducing adverse events and strengthening patient safety.