Submit Manuscript | http://medcraveonline.com Introduction The Safety Attitudes Questionnaire (SAQ) has been one of the most popular instruments for gauging safety culture among healthcare workers (HCWs) in hospitals around the world. 1 South Korea is one such country that has benefted from SAQ for years. 2 However, despite its positive impact on improving safety, the SAQ Korean version (SAQ-K) has a couple of weaknesses. First, considering HCWs’ large workload, the SAQ-K included too many items, leading respondents to not care or even drop out in the middle of completing the questionnaire. In addition, several items contained unclear expressions due to the English-to-Korean translation. In this study, we tried to develop a newer version of the SAQ with a string tag of ‘-K2’ by completely resolving these problems with the previous instrument. SAQ-K2 is kinder to respondents by providing a smaller number of items in a more explicit and more natural translation. Many resources have been invested in this reform. To illustrate, since just after the debut of SAQ-K in late 2012, we immediately launched a plan to improve it. We published almost 30 articles on such improvements. 1–28 Many of them provided item-level information using item response theory (IRT). 4,18 Each of the studies added another cobblestone, paving the road to safer healthcare; such microscopic- level explorations of the instrument laid the groundwork for these updates. Furthermore, we found that Taiwanese researchers using the SAQ-Chinese version were experiencing very similar problems, which led us to suspect the issues arose from the similar Asian background of these two countries. 29 Working as a team, researchers from Taiwan and Korea actively collaborated, resolving issues in a shorter time than we expected. As a result, Taiwan currently enjoys a newer version of SAQ-C, known as the Taiwanese Patient Safety Culture survey instrument (TPSC), 1 whereas Korea has its SAQ-K2. All updates were carefully applied and validated using a confrmatory factor analysis (CFA). As the methods and results sections show how all the items and domains achieved the string tag ‘-K2’, we close this introduction here and directly dive into the details. To ensure a better fow, some contents from the discussion section have been dispersed to other sections. Methods I. Modifcation of the previous version of SAQ-K This section describes in a step-by-step way the many tasks that took place simultaneously or in a reiterative way. We have divided the information into steps only to provide a clearer explanation. Removal of a non-functioning domain The original SAQ-K consists of 34 items in 6 domains. First we removed the entire stress recognition (SR) domain (i.e., four items), leaving fve domains. SR was designed to ask respondents to acknowledge that stressors infuenced their performance. However, in some countries, including Korea, HCWs believe they should be Biom Biostat Int J. 2019;8(3):93‒99. 93 ©2019 Jeong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. An effciency-oriented reform of safety attitudes questionnaire–Korean version (Development of SAQ-K2) Volume 8 Issue 3 - 2019 Heon-Jae Jeong, 1 Wui-Chiang Lee, 2 Deog Hyeon Son, 3 Jung Hwa Lee, 3 Su Sang Ryu, 3 Shin Hye Yoo, 4 Eun Jin Bae, 5 Chulho Kim, 6 Su Ha Han 7 1 President & CEO, The Care Quality Research Group; Advisor, Joint Commission Taiwan, Taiwan 2 Department of Medical Affairs and Planning, Taipei Veterans General Hospital & National Yang-Ming University School of Medicine, Taipei, Taiwan 3 Eson Convalescent Hospital, Korea 4 Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Korea 5 Moon’s eye hospital, Korea 6 Department of Neurology, Chuncheon Sacred Hospital, Korea 7 Department of Nursing, SoonChunHyang University, Korea Correspondence: Su Ha Han, Department of Nursing, SoonChunHyang University, 31 SoonChunHyang 6-gil, dongnam- gu, Cheonan-si, Chungcheongnam-do, 31151, South Korea, Tel +82-41-570-2487, Fax +82-41-570-2498, Email Received: April 30, 2019 | Published: May 16, 2019 Abstract The Safety Attitudes Questionnaire has long been used in the healthcare industry to measure healthcare workers’ attitudes toward patient safety culture; as a result, it has been translated into a variety of languages, including Korean. Recently, with the help of item response theory, we realised we do not need the original 41 items of the questionnaire to guarantee accuracy, so we reduced the instrument to a 23-item survey. Except for the stress recognition domain, every domain functioned well. We suspect the stress recognition domain did not fare well due to cultural differences. Stress recognition refers to individuals understanding that signifcant stress can lead to a greater probability to make an error. However, healthcare workers, especially those in Asian countries such as Taiwan and Korea, do not accept such an idea. Rather, we found that such workers believe they should fnish their work, regardless of how tired they are. They believe that admitting to stress makes them appear weak and can lead to them being fred. As the chasm between these two concepts cannot easily be crossed, we ultimately decided to remove the stress recognition domain from this second version of the survey. In sum, the new version of the Safety Attitudes Questionnaire contains 23 items across fve domains. Their psychometric property was tested using confrmatory factor analysis, and information function curves helped us determine which items should be retained in the new instrument by visualising the behaviour of items and domains. Keywords: Patient Safety, Safety Culture, Culture Survey, 환자안전문화, 문화설문, SAQ Biometrics & Biostatistics International Journal Research Article Open Access