Psychometric Evaluation of the Japanese Version of the Hospital Survey on Patient Safety Culture 2.0 (J-HSOPS 2.0): A Nationwide Cross-sectional Study

OBJECTIVES: Patient safety culture is a key determinant of health care quality and safety outcomes. The Hospital Survey on Patient Safety Culture (HSOPS) is one of the most widely used instruments for assessing safety culture in healthcare organizations. Although the revised HSOPS 2.0 has been adopted internationally, the Japanese version (J-HSOPS 2.0) has not yet been comprehensively evaluated using large-scale empirical data. METHODS: We conducted a cross-sectional survey of health care professionals in hospitals participating in a nationwide patient safety culture benchmarking program in Japan. The J-HSOPS 2.0 was developed through a structured translation and adaptation process. Construct validity was assessed using confirmatory factor analysis based on the original 10-dimensional HSOPS 2.0 model. Model fit was evaluated using standard goodness-of-fit indices. Convergent validity and reliability were assessed using average variance extracted, composite reliability, and Cronbach alpha, while discriminant validity was examined using factor correlations and the Fornell-Larcker criterion. RESULTS: Data from 76,966 hospital staff members were analyzed. The hypothesized 10-factor structure was broadly supported. Model fit indices indicated acceptable but suboptimal fit (RMSEA=0.067; CFI=0.836). Measurement invariance across professional groups was largely supported. Communication-related dimensions showed relatively strong psychometric performance and were strongly associated with overall patient safety ratings. CONCLUSIONS: The J-HSOPS 2.0 demonstrated acceptable psychometric properties and can be used for benchmarking and quality improvement in Japanese hospitals. These findings support the use of J-HSOPS 2.0 as a practical tool for identifying patient safety risks and guiding safety improvement initiatives in hospital settings.