Chapter 7. Trending: Comparing Results Over Time

Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report

Many hospitals that administer 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 1,128 participating hospitals, we have data from two administrations of the survey for 650 hospitals, allowing us to examine trends over time for these hospitals. This chapter presents trending results from these 650 hospitals.

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Highlights

  • For the 650 hospitals with trending data, the average length of time between previous and most recent survey administrations was 20 months (range: 6 months to 66 months).
  • The distribution of the 650 trending hospitals by bed size, teaching status, and ownership and control is similar to the distribution of the 1,128 database hospitals.
  • The average percent positive scores on the patient safety culture composites increased by 1 percentage point (ranging from 0 to 2 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 by 1 percentage point.
  • The average number of respondents reporting one or more events decreased by 1 percentage point.

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, or 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 650 trending hospitals.

Additional characteristics of the 650 trending hospitals follow:

  • Most of the 650 trending hospitals (80 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 a 90 percent point decrease in response rate and one had an 85 percent point increase).
  • The average time between the previous and most recent survey administrations was 20 months (range: 6 months to 66 months).

Note: Descriptive statistics on the 650 trending hospitals by bed size, teaching status, ownership and control , and region are provided in Appendix C (Tables C-1, C-2, C-3 and C-4). 

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Description of Trending Statistics

Table 7-2a shows examples of the types of statistics provided 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 types of 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 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 shows the percentages of trending hospitals that increased, decreased, or did not change for each of the 12 patient safety culture composites. The chart shows 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; 29 percent of hospitals increased by at least 5 percentage points.
  • Communication Openness had the largest percentage of hospitals that decreased 5 percentage points or more; 19 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 may not add to 100 due to rounding) and shows that:

  • 29 percent of hospitals increased by 5 percentage points or more.
  • 52 percent of hospitals changed less than 5 percentage points.
  • 18 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 the proportion of respondents reporting one or more events and shows that:

  • 19 percent of hospitals increased by 5 percentage points or more.
  • 51 percent of hospitals changed less than 5 percentage points.
  • 30 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 (64 percent) increased by 5 percentage points or more on at least one composite.
  • 51 percent of hospitals decreased by 5 percentage points or more on at least one composite.
  • More than half the hospitals (62 percent) changed less than 5 percentage points on seven or more composites.

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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, which show trends over time for the 650 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/2012/.

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 all 12 composites (an average increase of 2 percentage points).
  • Hospitals with 50-99 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 3 percentage point increase, from 75 percent to 78 percent).

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

  • Nonteaching hospitals showed increases up to 2 percentage points on all 12 patient safety composites; teaching hospitals showed increases up to 1 percentage point on half of the composites and decreased by 1 percentage point on Supervisor/Manager Expectations.
  • Government-owned hospitals showed increases up to 2 percentage points across 11 composites; non-government-owned hospitals showed increases up to 2 percentage points on 9 composites.

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

  • West North Central hospitals had the greatest increases in percent positive response over time on 6 of the 12 composites (average increase of 2 percentage points).
  • 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 3 percentage point increase, from 75 percent to 78 percent).

Highlights From Appendix D: Trending Results by Respondent Characteristics

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

  • Rehabilitation had the greatest increase in percent positive response on all 12 patient safety culture composites (average increases of 3 percentage points).
  • Emergency, Radiology, and Rehabilitation had the greatest increases over time in the average percentage of respondents giving their work area/unit a patient safety grade of "Excellent" or "Very Good" (3 percentage point increases, from 62 percent to 65 percent, 79 percent to 82 percent, and 82 percent to 85 percent, respectively).
  • Anesthesiology and Lab had the greatest increases in the average percentage of respondents reporting one or more events in the past year (3 percentage point increases). The largest decrease was in Psychiatry/Mental Health (a 4 percentage point decrease).

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

  • Patient Care Asst./Aide/Care Partner had the greatest increase in positive response over time on 4 of the 12 patient safety composites (average increase of 2 percentage points).
  • Pharmacists 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 3 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 (an 11 percentage point decrease).

Interaction With Patients (Table D-9)

  • Respondents with direct interaction with patients showed an increase of 1 percentage point across 11 patient safety culture composites; respondents without direct interaction showed an increase of 1 percentage point across 10 composites.

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Current as of December 2012
Internet Citation: Chapter 7. Trending: Comparing Results Over Time: Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report. December 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/2012/hosp12ch7.html