2014 User Comparative Database Report
Chapter 1. Introduction
Patient safety is a critical component of health care quality. As health care organizations continually strive to improve, there is growing recognition of the importance of establishing a culture of patient safety. Achieving a culture of patient safety requires an understanding of the values, beliefs, and norms about what is important in an organization and what attitudes and behaviors related to patient safety are supported, rewarded, and expected.
The Agency for Healthcare Research and Quality (AHRQ) funded and supervised development of the Hospital Survey on Patient Safety Culture. Developers reviewed research pertaining to safety, patient safety, error and accidents, and error reporting. They also examined existing published and unpublished safety culture assessment tools. In addition, hospital employees and administrators were interviewed to identify key patient safety and error-reporting issues.
The Hospital Survey on Patient Safety Culture, 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. Each of the 12 patient safety culture composites is listed and defined in Table 1-1.
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. In addition, respondents are asked to provide limited background demographic information about themselves (their work area/unit, staff position, whether they have direct interaction with patients, tenure in their work area/unit, etc.).
The survey's toolkit materials are available at the AHRQ Web site (www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/index.html) and include the survey, survey items and dimensions, user's guide, feedback report template, information about the Microsoft Excel™ Data Entry and Analysis Tool, and the Hospital Patient Safety Improvement Resource List. The toolkit provides hospitals with the basic knowledge and tools needed to conduct a patient safety culture assessment and ideas regarding how to use the data.
The Hospital Survey on Patient Safety Culture is available in Spanish on the AHRQ Web site. The Spanish translation is designed for U.S. Spanish-speaking respondents from different countries. A number of translations in other languages have already been developed by international users who have agreed to share their translations. Information for translators and translation guidelines are available for download at the AHRQ Web site (www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/t...).
The survey results presented in this report represent the leading compilation of hospital survey data currently available and therefore provide a useful reference for comparison. However, several limitations to these data should be kept in mind.
First, the hospitals that submitted data to the database are not a statistically selected sample of all U.S. hospitals, since only hospitals that administered the survey on their own and were willing to submit their data for inclusion in the database are represented. However, the characteristics of the database hospitals are fairly consistent with the distribution of hospitals registered with the American Hospital Association (AHA) and are described further in Chapter 3.
Second, hospitals that administered the survey were not required to undergo any training and administered it in different ways. Some hospitals used paper-only surveys, others used Web-only surveys, and others used a combination of these two methods to collect the data. It is possible that these different modes could lead to differences in survey responses; further research is needed to determine whether and how different modes affect the results.
In addition, some hospitals conducted a census, surveying all hospital staff, while others administered the survey to a sample of staff. When a sample was drawn, no data were obtained to determine the methodology used to draw the sample. Survey administration statistics that were obtained about the database hospitals, such as survey administration modes and response rates, are provided in Chapter 2.
Finally, the data hospitals submitted have been cleaned for blank records (where responses to all survey items were missing with the exception of demographic items) and straight-lining (where responses to all items in sections A, B, C, D, and F of the survey were the same). Otherwise, data are presented as submitted. No additional attempts were made to verify or audit the accuracy of the data submitted.