Hospital Survey on Patient Safety Culture: 2014 User Comparative Database Report

Chapter 7. Trending: Comparing Results Over Time

Many hospitals that administer the hospital survey have indicated that they intend to continue to administer the survey on a regular basis and 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 653 participating hospitals, we have data from two administrations of the survey for 359 hospitals, allowing us to examine trends over time for these hospitals. This chapter presents trending results from these 359 hospitals.

Highlights

  • For the 359 hospitals with trending data, the average length of time between the previous and most recent survey administrations was 23 months (range: 7 months to 40 months).
  • Across the 359 trending hospitals, the average percent positive scores across the 12 patient safety culture composites increased by 1 percentage point (ranging across the composites from a change of -1 to a change of 2 percentage points).
  • The average percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" increased 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 359 trending hospitals.

Additional characteristics of trending hospitals follow:

  • The average change in response rate from the previous administration was an increase of 5 percentage points (range: one hospital had an 86 percentage point decrease in response rate and one had a 70 percentage point increase).
  • The average time between the previous and most recent survey administrations was 23 months (range: 7 months to 40 months.)x

Note: Descriptive statistics on the 359 trending hospitals compared with nontrending hospitals by bed size, teaching status, ownership and control, and region are provided in Tables 7-2, 7-3, 7-4, and 7-5.

Description of Trending Statistics

Table 7-6 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 7-7 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 any 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.

Composite and Item-Level Trending Results

Table 7-8 presents trending results for each of the 12 patient safety culture composites. Table 7-9 presents similar trending results for the 42 survey items. Table 7-10 and Table 7-11 present the trending results for patient safety grade and whether at least one event was reported over the past 12 months, respectively.

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.
  • Feedback and Communication About Error had the largest percentage of hospitals that increased 5 percentage points or more; 31 percent of hospitals increased by at least 5 percentage points.
  • Staffing had the largest percentage of hospitals that decreased 5 percentage points or more; 24 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 "Excellent" or "Very Good") and shows that:

  • 25 percent of hospitals increased by 5 percentage points or more.
  • 57 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:

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

Charts 7-4, 7-5, and 7-6 display the overall number of composites for which trending hospitals increased, decreased, or did not change:

  • 46 percent of hospitals decreased by 5 percentage points or more on at least one composite.
  • Most hospitals (65 percent) increased by 5 percentage points or more on at least one composite.
  • Two-thirds of hospitals (67 percent) changed less than 5 percentage points on seven or more composites.

Trending Results by Hospital and Respondent Characteristics

Part III of the report contains Appendixes C and D, which show trends over time for the 359 hospitals that administered the survey and submitted data more than once. Average percent positive scores from the most recent and previous administrations are shown for 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.
  • Tenure in current work area/unit.

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.

Highlights From Appendix C: Trending Results by Hospital Characteristics

Bed Size (Tables C-1, C-3)

  • Hospitals with 100-199 beds increased up to 3 percentage points on 11 patient safety composites.
  • Hospitals with 100-199 and 300-399 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 2 percentage point increase, from 76 percent to 78 percent and from 72 to 74 percent, respectively).

Teaching Status and Ownership and Control (Table C-5)

  • Teaching hospitals increased up to 3 percentage points on nine patient safety composites; nonteaching hospitals showed increases up to 2 percentage points on eight composites and decreased by 1 percentage point on Management Support for Patient Safety and Staffing.
  • Government-owned hospitals increased up to 3 percentage points across 10 composites and non–government-owned hospitals showed increases up to 2 percentage points across 9 composites; both government-owned and non–government-owned hospitals decreased by 1 percentage point on Staffing.

Geographic Region (Table C-9)

  • East North Central hospitals increased up to 3 percentage points on 11 patient safety composites and decreased by 1 percentage point on Staffing.

Highlights From Appendix D: Trending Results by Respondent Characteristics

Work Area/Unit (Table D-1)

  • Pharmacy increased up to 4 percentage points on 11 patient safety composites.

Staff Position (Table D-5)

  • Pharmacists increased up to 4 percentage points on nine patient safety composites.

Interaction With Patients (Table D-9)

  • Respondents with direct interaction with patients increased up to 2 percentage points across 10 patient safety culture composites; respondents without direct interaction increased up to 3 percentage points across 7 composites.

Tenure in Current Work Area/Unit (Table D-13)

  • Respondents with less than 1 year in their work area/unit showed increases up to 3 percentage points across 11 patient safety culture composites; respondents with 16 to 20 years in their work area/unit increased up to 3 percentage points across 9 composites.

x. Ninety-three hospitals previously submitted data but were not included in trending analysis because their data were more than 4 years old.


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Page last reviewed March 2014
Internet Citation: Hospital Survey on Patient Safety Culture: 2014 User Comparative Database Report: Chapter 7. Trending: Comparing Results Over Time. March 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/2014/hosp14ch7.html