Chapter 7. Trending: Comparing Results Over Time

2011 User Comparative Database Report

Many hospitals that have administered the hospital survey have indicated that they intend to readminister the survey on a regular basis to track changes in patient safety culture over time. While the overall results presented earlier in this report reflect only the most recent survey data from all 1,032 participating hospitals, we have data from two administrations of the survey for 512 hospitals, allowing us to examine trends over time for these hospitals. This chapter presents trending results from these 512 hospitals.

Highlights

  • For the 512 hospitals with trending data, the average time between previous and most recent survey administrations was 20 months (range: 6 months to 61 months).
  • The average percent positive scores on the patient safety culture composites increased slightly by 2 percentage points (ranging from 1 to 3 percentage points).
  • The average percentage of respondents who gave their work area/unit a patient safety grade of "A-Excellent" or "B-Very Good" increased slightly by 3 percentage points.
  • The average number of respondents reporting one or more events increased by only 1 percentage point.
  • The top three patient safety actions implemented by hospitals between the previous and most recent survey administration were:
    • Improved fall prevention program (56 percent).
    • Conducted root cause analysis (52 percent).
    • Implemented SBAR (situation-background-assessment-recommendation) communication (51 percent).

When reviewing the results in this chapter, keep in mind that survey scores might change, or not change, over time for a number of complex reasons. Important factors to consider are whether the hospital implemented patient safety initiatives or took actions between survey administrations and the length of time between administrations.

Survey methodology issues can also play a big role in score changes. Low survey response rates for the previous or most recent administration, changes in the number of staff asked to complete the survey, and changes in the types of staff asked to complete the survey will make it difficult to interpret changes in scores over time.

Table 7-1 displays summary statistics from the previous and most recent survey administrations for the 512 trending hospitals.

Additional characteristics of the 512 trending hospitals follow:

  • Most of the 512 trending hospitals (79 percent) administered the survey to the same types of staff in their previous and most recent administrations.
  • The average change in response rate from the previous administration was a decrease of 1 percentage point (range: one hospital had an 85 percent decrease in response rate and one had an 85 percent increase).
  • The average time between the previous and most recent survey administrations was 20 months (range: 6 months to 61 months).

Note: Descriptive statistics of the 512 trending hospitals by bed size, teaching status, and ownership and control are provided in Appendix C (Tables C-1, C-2, and C-3).

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Description of Trending Statistics

Table 7-2a shows examples of the statistics shown in this chapter. The tables show the average percentage of respondents who answered positively in the most recent survey administration (left column) and the previous administration (middle column) for the trending hospitals only. The change over time (Most Recent Score minus Previous Score) is shown in the right column. The change is a negative number if the most recent administration showed a decline and a positive number if the most recent administration showed an increase.

Table 7-2b shows additional trending statistics that are provided. The maximum increase shows the score from the hospital or hospitals with the largest percent positive score increase on a particular composite or item. Similarly, the maximum decrease shows the score from the hospital or hospitals with the largest percent positive score decrease.

The average increase was calculated by including only hospitals that had an increase in their most recent score; hospitals that showed no change or decreased were not included when calculating the average increase. Similarly, the average decrease was calculated by including only hospitals that had a decrease in their most recent score; hospitals that showed no change or increased were not included when calculating the average decrease.

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Composite and Item-Level Trending Results

Table 7-3 presents trending results on each of the 12 patient safety culture composites. The table shows average percent positive scores for the most recent and previous administrations, average change over time, maximum increase and maximum decrease, and average increase and decrease over time.

 Table 7-4 presents similar trending results for the 42 survey items. Table 7-5 and Table 7-6 present the trending results for patient safety grade and number of events reported over the past 12 months, respectively.

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 Bar Charts of Trending Results

Chart 7-1 show the percentage of trending hospitals that increased, decreased, or did not change for each of the 12 patient safety culture composites. These charts show that:

  • Most hospitals changed less than 5 percentage points on the 12 composites.
  • Staffing had the largest percentage of hospitals that increased 5 percentage points or more; 37 percent of hospitals increased by at least 5 percentage points.
  • Frequency of Events Reported had the largest percentage of hospitals that decreased 5 percentage points or more; 15 percent of hospitals decreased by at least 5 percentage points.

Chart 7-2 displays results for the percentages of trending hospitals that increased, decreased, or did not change on patient safety grades (percent providing grades of "A-Excellent" or "B-Very Good"; percentages do not add to 100 due to rounding) and shows that:

  • 38 percent of hospitals increased by 5 percentage points or more.
  • 47 percent of hospitals changed less than 5 percentage points.
  • 16 percent of hospitals decreased by 5 percentage points or more.

Chart 7-3 displays results for the percentages of trending hospitals that increased, decreased, or did not change in reporting one or more events and shows that:

  • 25 percent of hospitals increased by 5 percentage points or more.
  • 53 percent of hospitals changed less than 5 percentage points.
  • 22 percent of hospitals decreased by 5 percentage points or more.

Chart 7-4 displays the overall number of composites for which trending hospitals increased, decreased, or did not change:

  • Most hospitals (74 percent) increased by 5 percentage points or more on at least one composite.
  • Forty-four percent of hospitals decreased by 5 percentage points or more on at least one composite.
  • More than half the hospitals (56 percent) changed less than 5 percentage points on seven or more composites.

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Patient Safety Actions Implemented

Trending hospitals were asked to provide basic information about the types of patient safety actions they had implemented to improve patient safety culture between their previous and most recent survey administration. Most of the 512 trending hospitals (456, or 89 percent) provided information about the patient safety actions they had implemented.

Table 7-7 shows the percentages of trending hospitals that shared their previous survey results with various groups of people.

Table 7-8 shows the percentages of trending hospitals that reported they had implemented various types of actions.

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Appendixes C and D: Trending Results by Hospital and Respondent Characteristics

Part III of the report contains Appendixes C and D that show trends over time for the 512 hospitals that administered the survey and submitted data more than once. Average percent positive scores from the most recent and previous administrations are shown on the survey composites and items, broken down by the following hospital and respondent characteristics:

Appendix C: Trending Results by Hospital Characteristics

  • Bed size.
  • Teaching status.
  • Ownership and control.
  • Geographic region.

Appendix D: Trending Results by Respondent Characteristics

  • Work area/unit.
  • Staff position.
  • Interaction with patients.

Because there are many breakout tables, they are included in Appendixes C and D. Highlights of the findings from the breakout tables in these appendixes are provided on the following pages. The appendixes are available on the Web at: http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/2011/.

Highlights From Appendix C: Trending Results by Hospital Characteristics

Bed Size (Tables C-5, C-7)

  • Hospitals with 50-99 beds had the greatest increases in percent positive response over time on 8 of the 12 composites (average increase of 3 percentage points)
  • The smallest hospitals (6-24 beds) had the greatest increase in the percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (a 4 percentage point increase, from 77 percent to 81 percent).

Teaching Status and Ownership and Control (Table C-9)

  • Both teaching and nonteaching hospitals, as well as government-owned and non-government-owned hospitals, showed slight increases of 3 percentage points or less across the 12 patient safety composites.

Geographic Region (Tables C-13, C-15)

  • South Atlantic/Associated Area hospitals had the greatest increases in percent positive response over time on 6 of the 12 composites (average increase of 3 percentage points).
  • East North Central and West North Central hospitals had the greatest increases in the percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (a 5 percentage point increase).

Highlights From Appendix D: Trending Results by Respondent Characteristics

Work Area/Unit (Tables D-1, D-3, D-4)

  • ICU and Pediatrics had the greatest increases in percent positive response on 5 of the 12 patient safety culture composites (average increases of 4 and 3 percentage points, respectively).
  • Emergency had the greatest increase over time in the average percentage of respondents giving their work area/unit a patient safety grade of "Excellent" or "Very Good" (a 4 percentage point increase, from 60 percent to 64 percent).
  • Lab and Pharmacy had the greatest increases in the average percentage of respondents reporting one or more events in the past year (5 percentage point increases). The largest decrease was in Psychiatry/Mental Health (a 5 percentage point decrease).

Staff Position (Tables D-5, D-7, D-8)

  • Administration/Management had the greatest increase in positive response over time on 4 of the 12 patient safety culture composites (average increase of 7 percentage points).
  • Administration/Management had the greatest increase over time in the average percentage of respondents giving their work area/unit a patient safety grade of "Excellent" or "Very Good" (a 4 percentage point increase).
  • Dietitians had the greatest decrease over time in the average percentage of respondents reporting one or more events in the past year (a 12 percentage point decrease).

Interaction with Patients (Table D-9)

  • Respondents with and without direct interaction with patients showed a slight increase of 3 percentage points or less across the 12 patient safety culture composites. Respondents without direction interaction with patients showed no change in communication openness.

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Current as of April 2011
Internet Citation: Chapter 7. Trending: Comparing Results Over Time: 2011 User Comparative Database Report. April 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/2011/hosp11ch7.html