- The Hospital
Survey on Patient Safety Culture (HSOPS) was administered at baseline and at
follow-up in all units.
- Among adult ICUs,
a statistically significant improvement was found in two dimensions: "feedback and communication about
error" and "teamwork within unit." No statistically significant differences
were found among the remaining HSOPS dimensions.
Survey on Patient Safety Culture (HSOPS) is a reliable and valid survey13 designed to assess clinician and
staff perceptions of the culture of safety within their unit and overall
hospital. The instrument contains seven unit-level safety culture dimensions,
four hospital-level dimensions, and four outcome variables.
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were collected during two time periods: at the start of project participation
and during a follow-up period near project completion. Participating units were
invited to collect fresh HSOPS data from unit staff members or to upload
previously collected survey data collected during annual safety culture surveys
conducted by their organizations. To be included in analyses, units had to be
an adult ICU and have a baseline and follow-up survey response rate between
zero and 100 percent. Analyses
were carried out to test the change in perceptions of safety culture and to mirror
as closely as possible the methods used reported in the original Michigan Study
and reported by Sexton et al. (2011).14 It should be noted that the study
published by Sexton et al. examined the Safety Attitude Questionnaire, an
instrument containing a single "safety climate" dimension while the HSOPS
measures 10 dimensions of the safety culture construct as well as 4 outcome
variables. Analyses of baseline/follow-up changes in HSOPS dimension scores
were assessed using a two-tailed, paired samples t-test with Bonferonni
correction for multiple tests. Dimensions with a statistically significant
change were further examined to assess the changes in the number of units
classified as "needing improvement" (defined as a score of less than 50 percent,
a threshold suggested within the HSOPS user's manual). Changes in
classification were assessed using McNemar's test.
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among adult ICUs with baseline and follow-up response rates between zero and
100 percent (n=302) can be found in Table 18 and Figure 18.
A statistically significant improvement was found for two dimensions: "feedback
and communication about error" (38.9 percent at baseline versus 44.8 percent at
follow-up; p<0.01) and "teamwork within unit" (75.1 percent baseline
versus 77.7 percent at follow-up; p<0.01). The number of units
classified as "needing improvement" within the "feedback and communication
about error" dimension was statistically significantly reduced by 22 percent (77.8
percent of units at baseline versus 63.9 percent of units at follow-up; p<.001).
However, the number of units classified as "needing improvement" within the
"teamwork within units" dimension did have a statistically significant change
(4.3 percent of units at baseline versus 5.3 percent of units at follow-up).
There were no statistically significant changes in other dimensions of the
Table 18. Baseline and follow-up HSOPS scores
by dimension in adult ICUs (n=302)
Percent Positive Dimension Scores
of Patient Safety
|Frequency of event
|Pt. Safety Grade (Excellent
or Very Good)
Support for Patient Safety
|Teamwork Across Units
Expectations & Actions Promoting Patient Safety
Communication About Error
|Teamwork Within Unit
Figure 18. Baseline and follow-up HSOPS scores by dimension among adult ICUs (n=302)
13. Agency for Healthcare Research and Quality,
HSOPS Safety Culture Dimensions and Reliabilities at: http://www.ahrq.gov/qual/patientsafetyculture/hospdim.htm.
14. Sexton JB, Berenholtz SM, Goeschel SR, et
al. Assessing and improving safety climate in a large cohort of intensive care
units. Critical Care Medicine 2011;39(5):934-999.
significant different, p<0.01.
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