Executive Summary

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

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. Since the first annual user comparative database report, which was released in 2007 and included data from 382 U.S. hospitals, the number of hospitals and respondents included in the database has grown each year.

The 2012 user comparative database report displays results from 1,128 hospitals and 567,703 hospital staff respondents. This report also includes a chapter on trending that presents results showing change over time for 650 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.

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—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 reported over the past 12 months.

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2012 Database Hospitals

The 1,128 hospitals in the 2012 database fall into two categories:

  • 508 hospitals from the previous database report that are still included in the 2012 report.
  • 620 hospitals that submitted data for the 2012 report.

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Survey Administration Statistics

  • The average hospital response rate was 53 percent, with an average of 503 completed surveys per hospital.
  • Most hospitals (66 percent) administered Web surveys. Hospitals administering a Web survey had, on average, lower response rates (51 percent) compared with response rates from paper (61 percent), yet higher response rates compared with mixed-mode surveys (49 percent).
  • Most hospitals (90 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 1,128 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 567,703 hospital staff respondents from 1,128 hospitals.
  • The top three work areas of respondents were:
    • Other (30 percent).i
    • Medicine (12 percent).
    • Surgery (10 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

Four areas of strength emerged. 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, Strongly disagree) to negatively worded items (e.g., "We have safety problems in this unit"). The four areas with the highest percent positive responses were:

  1. Teamwork Within Units (average 80 percent positive response)the extent to which staff support each other, treat each other with respect, and work together as a team.
  2. Supervisor/Manager Expectations and Actions Promoting Patient Safety (average 75 percent positive response)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.
  3. Organizational Learning—Continuous Improvement (average 72 percent positive response)the extent to which mistakes have led to positive changes and changes are evaluated for effectiveness.
  4. Management Support for Patient Safety (average 72 percent positive response)the extent to which hospital management provides a work climate that promotes patient safety and shows that patient safety is a top priority.

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Areas With Potential for Improvement for Most Hospitals

Three areas showed potential for improvement:

  1. Nonpunitive Response to Error (average 44 percent positive response)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.
  2. Handoffs and Transitions (average 45 percent positive response)the extent to which important patient care information is transferred across hospital units and during shift changes.
  3. Staffing (average 56 percent positive response)the extent to which there are enough staff to handle the workload and work hours are appropriate to provide the best care for patients.

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Results by Hospital Characteristics

Bed Size

  • The smallest hospitals (6-24 beds) had the highest percent positive average across all patient safety culture composites (68 percent); larger hospitals (400 beds or more) had the lowest (60 percent).
  • Smaller hospitals (49 beds or less) had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (80 percent); larger hospitals (400 beds or more) had the lowest (71 percent).

Teaching Status and Ownership and Control

  • Nonteaching hospitals on average scored higher than teaching hospitals by 5 percentage points 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 reported more events (47 percent) than government-owned hospitals (41 percent).

Geographic Region

  • East South Central,iii West South Central, and South Atlantic/Associated Territories hospitals had the highest average percent positive response across all composites (65 percent positive); New England hospitals had the lowest (60 percent positive).
  • West North Central hospitals had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (78 percent); New England hospitals had the lowest (69 percent).
  • Pacific/Associated Territories hospitals had the highest percentage of respondents who reported one or more events in the past year (49 percent); the lowest percentage of respondents reporting events was in the West South Central region (41 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" (85 percent); Emergency had the lowest (64 percent).
  • ICU (Any Type) had the highest percentage of respondents reporting one or more events in the past year (64 percent); Rehabilitation hadthe lowest (39 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 (68 percent).
  • Pharmacists had the highest percentage of respondents reporting one or more events in the past year (71 percent); Unit Assistants/Clerks/Secretaries had the lowest (17 percent).

Interaction With Patients

  • Respondents with direct patient interaction were more positive on Handoffs and Transitions compared with those without direct patient interaction (47 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 (77 percent positive compared with 71 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" (80 percent) than respondents with direct patient interaction (75 percent).
  • More respondents with direct patient interaction reported one or more events in the past year (50 percent) than respondents without direct patient interaction (30 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 650 hospitals (of the 1,128 total database hospitals) that administered the survey and submitted data more than once are highlighted.

Trending Hospitals

  • 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.

Trending: Overall Summary Statistics

  • 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.

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 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).

Trending: Teaching Status and Ownership and Control

  • 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 decreases of 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.

Trending: Region

  • 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).

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Trending Results by Respondent Characteristics

Trending: Work Area/Unit

  • 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).

Trending: Staff Position

  • 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).

Trending: Interaction With Patients

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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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 specify their position. However, this information was not collected from the hospitals.
ii Many respondents chose "Other," which allowed them to note their specific work area or unit. However, this information was not collected from the hospitals.
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.Return to Contents
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  • 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 December 2012
Internet Citation: Executive Summary: 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/hosp12summ.html