Executive Summary

2011 User Comparative Database Report: Hospital Survey on Patient Safety Culture

In response to requests from hospitals interested in comparing their results with those of other hospitals on the Hospital Survey on Patient Safety Culture, the Agency for Healthcare Research and Quality (AHRQ) established the Hospital Survey on Patient Safety Culture comparative database. The first annual comparative database report was released in 2007 and included data from 382 U.S. hospitals.

The Hospital Survey on Patient Safety Culture 2011 User Comparative Database Report displays results from 1,032 hospitals and 472,397 hospital staff respondents. The 2011 report also includes a chapter on trending that presents results showing change over time for 512 hospitals that administered the survey and submitted data more than once.

Hospitals do not necessarily administer the hospital patient safety culture survey every year. They may administer it on an 18-month, 24-month, or other cycle. Therefore, the comparative database is a "rolling" indicator. It retains data for up to 3.5 prior years when a hospital does not have new data to submit, replaces older data with more recent data when available, and adds data from hospitals submitting for the first time. The user comparative database report will be produced yearly through at least 2012.

This user comparative database report was developed as a tool for the following purposes:

  • Comparison—To allow hospitals to compare their patient safety culture survey results with those of other hospitals.
  • Assessment and Learning—To provide data to hospitals to facilitate internal assessment and learning in the patient safety improvement process.
  • Supplemental Information—To provide supplemental information to help hospitals identify their strengths and areas with potential for improvement in patient safety culture.
  • Trending—To provide data that describe changes in patient safety culture over time.

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Survey Content

The hospital survey, released in November 2004, was designed to assess hospital staff opinions about patient safety issues, medical errors, and event reporting. The survey includes 42 items that measure 12 areas, or composites, of patient safety culture:

  1. Communication openness.
  2. Feedback and communication about error.
  3. Frequency of events reported.
  4. Handoffs and transitions.
  5. Management support for patient safety.
  6. Nonpunitive response to error.
  7. Organizational learning and continuous improvement.
  8. Overall perceptions of patient safety.
  9. Staffing.
  10. Supervisor/manager expectations and actions promoting safety.
  11. Teamwork across units.
  12. Teamwork within units.

The survey also includes two questions that ask respondents to provide an overall grade on patient safety for their work area/unit and to indicate the number of events they have reported over the past 12 months.

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2011 Database Hospitals

The 1,032 hospitals in the 2011 database fall into two categories:

  • 466 hospitals from the previous database report that are still included in the 2011 report.
  • 566 hospitals that submitted data for the 2011 report.

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Survey Administration Statistics

  • The average hospital response rate was 52 percent, with an average of 458 completed surveys per hospital.
  • Most hospitals (56 percent) administered Web surveys. Hospitals administering a Web survey had, on average, lower response rates (49 percent) compared with response rates from paper (62 percent) or mixed-mode surveys (51 percent).
  • Most hospitals (78 percent) administered the survey to all staff or a sample of all staff.

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Characteristics of Participating Hospitals

  • Database hospitals represent a range of bed sizes and geographic regions.
  • Most database hospitals are nonteaching (66 percent) and non-government owned (80 percent).
  • Overall, the characteristics of the 1,032 database hospitals are fairly consistent with the distribution of U.S. hospitals registered with the American Hospital Association (AHA).

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Characteristics of Respondents

  • There were 472,397 hospital staff respondents from 1,032 hospitals.
  • The top three work areas of respondents were:
    • Other (32 percent).i
    • Medicine (11 percent).
    • Surgery (9 percent).
  • The top three staff positions of respondents were:
    • Registered Nurse or Licensed Vocational Nurse/Licensed Practical Nurse (35 percent).
    • Other (21 percent).ii
    • Technician (e.g., EKG, Lab, Radiology) (11 percent).
  • Most respondents (76 percent) indicated that they had direct interaction with patients.

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Areas of Strength for Most Hospitals

Three areas of strength emerged. Results are expressed in terms of percent positive response. Percent positive is the percentage of positive responses (e.g., Agree, Strongly agree) to positively worded items (e.g., "People support one another in this unit") or negative responses (e.g., Disagree) to negatively worded items (e.g., "We have safety problems in this unit").

Teamwork Within Units (average 80 percent positive response)—This composite is defined as the extent to which staff support each other, treat each other with respect, and work together as a team. This composite had the highest average percent positive response.

Supervisor/Manager Expectations & Actions Promoting Patient Safety (average 75 percent positive response)—This composite is defined as the extent to which supervisors/managers consider staff suggestions for improving patient safety, praise staff for following patient safety procedures, and do not overlook patient safety problems. This composite had the second highest average percent positive response.

Patient Safety Grade—On average, most respondents within hospitals (75 percent) gave their work area or unit a grade of either "A-Excellent" (29 percent) or "B-Very Good" (46 percent) on patient safety.

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Areas With Potential for Improvement for Most Hospitals

Three areas showed potential for improvement.

Nonpunitive Response to Error (average 44 percent positive response)—This composite is defined as the extent to which staff feel that their mistakes and event reports are not held against them and that mistakes are not kept in their personnel file. This composite had the lowest average percent positive response.

Handoffs and Transitions (average 45 percent positive response)—This composite is defined as the extent to which important patient care information is transferred across hospital units and during shift changes. This composite had the second lowest average percent positive response.

Number of Events Reported—On average, most respondents within hospitals (54 percent) reported no events in their hospital over the past 12 months. It is likely that events were underreported. This is an area for improvement for most hospitals because underreporting of events means potential patient safety problems may not be recognized or identified and therefore may not be addressed.

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Results by Hospital Characteristics

Bed Size

  • Very small hospitals (6-24 beds) had the highest overall average percent positive response on the patient safety culture composites.
  • Small hospitals (25-49 beds) had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (81 percent positive for 25-49 beds vs. 70 percent for 400 beds or more).

Teaching Status and Ownership and Control

  • Nonteaching hospitals had a higher average percent positive response than teaching hospitals on Teamwork Across Units (60 percent positive compared with 55 percent positive) and Handoffs and Transitions (47 percent positive compared with 42 percent).
  • Non-government-owned hospitals had a higher percentage of respondents who reported one or more events in the past year (47 percent) than government-owned hospitals (42 percent).

Geographic Region

  • East South Centraliii and West South Central hospitals had the highest average percent positive response across the composites (66 percent positive); New England hospitals had the lowest (59 percent positive).
  • Mid-Atlantic, East South Central, and West South Central hospitals scored highest on the percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (78 percent).
  • Pacific hospitals had the highest percentage of respondents who reported one or more events in the past year (51 percent); the lowest percentage of respondents reporting events was in the West South Central region (43 percent).
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Results by Respondent Characteristics

Work Area/Unit

  • Respondents in Rehabilitation had the highest average percent positive response across the composites (69 percent positive); Emergency had the lowest (57 percent positive).
  • Rehabilitation had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (84 percent); Emergency had the lowest (63 percent).
  • ICU (any type) had the highest percentage of respondents reporting one or more events in the past year (63 percent); Rehabilitation had the lowest (42 percent).

Staff Position

  • Respondents in Administration/Management had the highest average percent positive response across the composites (74 percent positive); Pharmacists had the lowest (60 percent positive).
  • Administration/Management had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good"(86 percent); Pharmacists had the lowest (67 percent).
  • Pharmacists had the highest percentage of respondents reporting one or more events in the past year (72 percent); Unit Assistants/Clerks/Secretaries had the lowest (18 percent).

Interaction with Patients

  • Respondents with direct patient interaction were more positive on Handoffs and Transitions compared with those without direct patient interaction (46 percent positive compared with 39 percent).
  • Respondents without direct patient interaction were more positive than those with direct patient interaction on Management Support for Patient Safety (78 percent positive compared with 71 percent) and Feedback & Communication About Error (68 percent positive compared with 63 percent).
  • Respondents without direct patient interaction had a higher percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (79 percent) than respondents with direct patient interaction (74 percent).
  • More respondents with direct patient interaction reported one or more events in the past year (50 percent) than respondents without direct patient interaction (31 percent).

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Trending: Comparing Results Over Time

Results regarding changes over time on the patient safety culture composites, patient safety grade, and number of events reported for the 512 hospitals (of the 1,032 total database hospitals) that administered the survey and submitted data more than once are highlighted.

Trending Hospitals

  • For the 512 hospitals with trending data, the average length of time between previous and most recent survey administrations was 20 months (range: 6 months to 61 months).
  • The distribution of the 512 trending hospitals by bed size, teaching status, and ownership and control is similar to the distribution of the 1,032 database hospitals.

Trending: Overall Summary Statistics

  • 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).

Additional Trending Statistics

The charts in Chapter 7 provide results for two additional ways of summarizing changes in patient safety composite scores over time. The first series of charts displays the number of hospitals that increased, decreased, or did not change by 5 percentage points or more for each composite, patient safety grade, and number of events reported. The second set of charts displays the distribution of trending hospitals by number of composites that increased, decreased, or changed less than 5 percentage points.

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Trending Results by Hospital Characteristics

Trending: Bed Size

  • 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).
  • Very small 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).

Trending: Teaching Status and Ownership and Control

  • 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.

Trending: Region

  • 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 increase 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).

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Trending Results by Respondent Characteristics

Trending: Work Area/Unit

  • 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).

Trending: Staff Position

  • Administration/Management had the greatest increase in positive response over time on 4 of the 12 patient safety culture composites (average increase of 3 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).

Trending: Interaction with Patients

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

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Action Planning for Improvement

The delivery of survey results is not the end point in the survey process; it is just the beginning. Often, the perceived failure of surveys to create lasting change is actually due to faulty or nonexistent action planning or survey followup.

Seven steps of action planning are provided to give hospitals guidance on next steps to take to turn their survey results into actual patient safety culture improvement:

  1. Understand your survey results.
  2. Communicate and discuss the survey results.
  3. Develop focused action plans.
  4. Communicate action plans and deliverables.
  5. Implement action plans.
  6. Track progress and evaluate impact.
  7. Share what works.

i Many respondents chose "Other," which allowed them to note their specific work area or unit.
ii Many respondents chose "Other," which allowed them to specify their position.
iii States and territories are categorized into AHA-defined regions as follows:

  • New England: CT, MA, ME, NH, RI, VT
  • Mid-Atlantic: NJ, NY, PA
  • South Atlantic/Associated Territories: DC, DE, FL, GA, MD, NC, SC, VA, WV, Puerto Rico, Virgin Islands
  • East North Central: IL, IN, MI, OH, WI
  • East South Central: AL, KY, MS, TN
  • West North Central: IA, KS, MN, MO, ND, NE, SD
  • West South Central: AR, LA, OK, TX
  • Mountain: AZ, CO, ID, MT, NM, NV, UT, WY
  • Pacific/Associated Territories: AK, CA, HI, OR, WA, American Samoa, Guam, Marshall Islands, Northern Mariana Islands

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Page last reviewed April 2011
Internet Citation: Executive Summary: 2011 User Comparative Database Report: Hospital Survey on Patient Safety Culture. April 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/2011/hosp11summ.html