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

Executive Summary

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

The 2014 user comparative database report displays results from 653 hospitals and 405,281 hospital staff respondents. This report also includes a chapter on trending that presents results showing change over time for 359 hospitals that administered the survey and submitted data more than once.

From 2007 to 2012, data were collected annually. Data from past databases were retained until more recent data were submitted as long as the data were no more than 4.5 years old. Starting with the current database, data will be collected every 2 years and may be a maximum of only 2 years old. Hospitals must submit their data to consecutive databases in order to trend their results over time. Only hospitals that successively submit survey data will be included in trending analysis.

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.

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.

2014 Survey Administration Statistics

  • For the 2014 report, 653 hospitals submitted data.
  • The average hospital response rate was 54 percent, with an average of 621 completed surveys per hospital.
  • Most hospitals (76 percent) administered Web surveys. Hospitals administering Web surveys had, on average, lower response rates (54 percent) compared with response rates from paper (69 percent), yet slightly higher response rates compared with mixed-mode surveys (52 percent).

Hospital Characteristics

  • Database hospitals represent a range of bed sizes and geographic regions.
  • Most database hospitals are nonteaching (63 percent) and non–government owned (79 percent).
  • Overall, the characteristics of the 653 database hospitals are fairly consistent with the distribution of U.S. hospitals registered with the American Hospital Association (AHA).

Respondent Characteristics

  • There were 405,281 hospital staff respondents.
  • The top three work areas of respondents were:
  • Other (31 percent).ii
  • Medicine (11 percent).
  • Surgery (10 percent).
  • The top three staff positions of respondents were:
  • Registered nurse or licensed vocational nurse/licensed practical nurse (35 percent).
  • Other (22 percent).iii
  • Technician (e.g., EKG, Lab, Radiology) (11 percent).
  • Most respondents (76 percent) indicated that they had direct interaction with patients, and most respondents worked either less than 40 hours a week (45 percent) or 40 to 59 hours per week (48 percent).

Areas of Strength for Most Hospitals

The three areas of strength or composites with the highest average percent positive responses were:iv

  1. Teamwork Within Units (81 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 (76 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 (73 percent positive response)—the extent to which mistakes have led to positive changes and changes are evaluated for effectiveness.

Areas With Potential for Improvement for Most Hospitals

The three areas that showed potential for improvement, or with the lowest average percent positive responses, were:

  1. Nonpunitive Response to Error (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 (47 percent positive response)—the extent to which important patient care information is transferred across hospital units and during shift changes.
  3. Staffing (55 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.

Results by Hospital Characteristics

Bed Size

  • The smallest hospitals (6-24 beds) had the highest percent positive average across all composites (69 percent); larger hospitals (400 beds or more) had the lowest (61 percent positive).
  • Smaller hospitals (6-24 beds) had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (81 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 or more on 6 of the 12 composites.
  • Non–government-owned hospitals had a higher percentage of respondents who reported one or more events in the past year (45 percent) than government-owned hospitals (37 percent).

Geographic Region

  • East South Centralv hospitals had the highest average percent positive response across all composites (68 percent positive); New England hospitals had the lowest (60 percent positive).
  • East South Central and 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" (80 percent); New England hospitals had the lowest (70 percent).
  • West North Central hospitals had the highest percentage of respondents who reported one or more events in the past year (47 percent); the lowest percentage of respondents reporting one or more events was in the West South Central region (40 percent).

Results by Respondent Characteristics

Work Area/Unit

  • Respondents in Rehabilitation had the highest average percent positive response across the composites (70 percent positive); Emergency had the lowest (59 percent positive).
  • Rehabilitation had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (86 percent); Emergency had the lowest (65 percent).
  • ICU (Any Type) had the highest percentage of respondents reporting one or more events in the past year (61 percent); Rehabilitation had the lowest (38 percent).

Staff Position

  • Respondents in Administration/Management had the highest average percent positive response across the composites (75 percent positive); Pharmacists had the lowest (62 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" (87 percent); registered nurse, licensed vocational nurse, or licensed practical nurse and Pharmacists had the lowest (71 percent).
  • Pharmacists had the highest percentage of respondents reporting one or more events in the past year (73 percent); Unit Assistants/Clerks/Secretaries had the lowest (14 percent).

Interaction With Patients

  • Respondents with direct patient interaction were more positive than those without direct interaction on Handoffs and Transitions (49 percent positive compared with 42 percent positive) but less positive on Management Support for Patient Safety (71 percent positive compared with 77 percent positive).
  • 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" (81 percent) than respondents with direct patient interaction (75 percent).
  • More respondents with direct patient interaction reported one or more events in the past year (48 percent) than respondents without direct patient interaction (29 percent).

Tenure in Work Area/Unit

  • Respondents with less than a year in their current work area/unit had the highest average percent positive response across the composites (68 percent positive); respondents with 1 to 10 years had the lowest (63 percent positive).
  • Respondents with less than a year in their current work area/unit had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (82 percent); respondents with 1 to 5 years had the lowest (74 percent).
  • Respondents with 6 to 10 years in their current work area/unit had the highest percentage of respondents reporting one or more events in the past year (47 percent); respondents with less than a year had the lowest (30 percent).

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 359 hospitals (of the 653 total database hospitals) that administered the survey and submitted data more than once are highlighted.

Trending Hospitals

  • For the 359 hospitals with trending data, the average length of time between previous and most recent survey administrations was 23 months (range: 7 months to 40 months).
  • The distribution of the 359 trending hospitals by bed size, teaching status, and ownership and control is similar to the distribution of the 653 database hospitals.

Trending: Overall Summary Statistics

  • 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.

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 the number of composites that increased, decreased, or changed less than 5 percentage points.

Trending Results by Hospital Characteristics

Bed Size
  • 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
  • Teaching hospitals increased up to 3 percentage points on 9 patient safety composites; nonteaching hospitals showed increases up to 2 percentage points on 8 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
  • East North Central hospitals increased up to 3 percentage points on 11 patient safety composites and decreased by 1 percentage point on Staffing.

Trending Results by Respondent Characteristics

Work Area/Unit
  • Pharmacy work area/units increased up to 4 percentage points on 11 patient safety composites.
Staff Position
  • Pharmacists had increases up to 4 percentage points on 9 patient safety composites.
Interaction With Patients
  • 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 Work Area/Unit
  • Respondents with less than 1 year in their work area/unit increased 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.

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. Agency for Healthcare Research and Quality. Hospital Survey on Patient Safety Culture. www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/index.html. Last accessed on January 8, 2014.

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. Many respondents chose "Other," which allowed them to note their staff position. However, this information was not collected from the hospitals.

iv. 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").

v. 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 March 2014
Internet Citation: Hospital Survey on Patient Safety Culture: 2014 User Comparative Database Report: Executive Summary. March 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/2014/hosp14summ.html