Feedback Results

Hospital Survey on Patient Safety Culture

This survey tool can be used to assess the safety culture of a hospital or specific units within hospitals and to track changes in patient safety over time and evaluate the impact of patient safety interventions.

Text Version of a Slide Presentation

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For further information about this feedback report, contact:

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Slide 1

Survey Background

The Hospital Survey on Patient Safety Culture was sponsored by the Quality Interagency Coordination Task Force (QuIC), a group established in accordance with a 1998 Presidential directive to ensure that all Federal agencies involved in purchasing, providing, studying, or regulating health care services are working together and toward a common goal of improving quality care. The survey was funded by the Agency for Healthcare Research and Quality (AHRQ).

The development of this safety culture assessment tool included a review of the scientific literature pertaining to safety, error and accidents, as well as error reporting. In addition, hospital employees and managers were interviewed to identify key patient safety and error reporting issues. Other published and unpublished safety culture assessment tools also were examined.

Slide 2

Survey Measures

The Hospital Survey on Patient Safety Culture is designed to measure:

Four overall patient safety outcomes:

  1. Overall perceptions of safety.
  2. Frequency of events reported.
  3. Number of events reported.
  4. Overall patient safety grade.

The research survey also is intended to measure:

Ten dimensions of culture pertaining to patient safety:

  1. Supervisor/manager expectations & actions promoting patient safety.
  2. Organizational learning—continuous improvement.
  3. Teamwork within units.
  4. Communications openness.
  5. Feedback & communications about error
  6. Nonpunitive response to error.
  7. Staffing.
  8. Hospital management support for patient safety.
  9. Teamwork across hospital units.
  10. Hospital handoffs & transitions.

Slide 3

Survey Methodology

{In a short paragraph, describe your hospital's sample and data collection methodology}

In Date(s), the Hospital Survey on Patient Safety Culture was distributed to a sample of XX staff at Hospital X. Overall, XX responses to the survey were received, a(n) XX% response rate.

To maximize response rates, standard survey procedures were followed:

  1. A prenotification letter from the hospital X was distributed, encouraging participation.
  2. One week later, the survey was distributed, including a cover letter from the hospital X, a survey, and a postage-paid return envelope.
  3. Two weeks after the survey, a reminder postcard was distributed to nonrespondents.
  4. Two weeks after the reminder postcard, a second survey was distributed to nonrespondents.
  5. Two weeks after the second survey, a final reminder postcard was distributed to nonrespondents.

In this feedback report, the percentages of employee responses to specific survey items are grouped according to the safety culture dimensions being assessed. Some percentages shown in the graphs may not add to 100% due to rounding. Since the total number of respondents was XX, in each graph XX% is approximately equivalent to one person's answer.

Slide 4

Demographic Data about Respondents

1. Primary hospital work area, department or clinical area where respondents spend most of their work time:

____ % Many different hospital units / No specific unit
____ % Medicine (non-surgical)
____ % Surgery
____ % Obstetrics
____ % Pediatrics
____ % Emergency department
____ % Intensive care unit (any type)
____ % Psychiatry / mental health
____ % Rehabilitation
____ % Pharmacy
____ % Laboratory
____ % Radiology
____ % Anesthesiology
____ % Other
____ % (Blank/Missing)

2. Staff position in the hospital:

____ % Registered nurse
____ % Physician assistant / Nurse practitioner
____ % LVN / LPN
____ % Patient care assistant / Hospital aide / Care partner
____ % Attending / Staff physician
____ % Resident physician / Physician in training
____ % Pharmacist
____ % Dietician
____ % Unit assistant / Clerk / Secretary
____ % Respiratory therapist
____ % Physical, occupational, or speech therapist
____ % Technician (e.g., EKG, Lab, Radiology)
____ % Administration / Management
____ % Other
____ % (Blank/Missing)

Slide 5

Demographic Data (continued)

3. Time worked

—in the hospital (hours/week)____ % Less than 20 hours____ % 20 to 39 hours____ % 40 hours or more
—in the hospital (years)____ % Less than 1 year____ % 1 to 5 years____ % 6 to 10 years
____ % 11 to 15 years____ % 16 to 20 years____ % 21 years or more
—in their current hospital work area (years)____ % Less than 1 year____ % 1 to 5 years____ % 6 to 10 years
____ % 11 to 15 years____ % 16 to 20 years____ % 21 years or more
—in their current specialty (years)____ % Less than 1 year____ % 1 to 5 years____ % 6 to 10 years
____ % 11 to 15 years____ % 16 to 20 years____ % 21 years or more

4. Percentage of respondents with direct interaction or contact with patients: ____ %

Slide 6

Main Findings: Strengths

We identify as strengths, those positively worded items which about 75% of respondents endorse by answering "Agree / Strongly agree," or "Most of the time / Always" (or when about 75% of respondents disagreed with negatively worded items).

A number of strengths emerged from the results:

  • Most respondents...
  • Respondents...

Slide 7

Main Findings: Areas for Improvement

Areas with the potential for improvement were identified as items which about 50% of respondents answered negatively using "Disagree / Strongly disagree" or "Never / Rarely" (or when 50% of respondents disagreed with positively worded items).

A number of areas for improvement emerged from the results:

  • Most respondents...
  • Respondents...

Slide 8

Overall Perceptions of Safety

Survey Items% Strongly Disagree/
Disagree
% Neither% Strongly Agree/
Agree
1. Patient safety is never sacrificed to get more work done. (A15)555
2. Our procedures and systems are good at preventing errors from happening. (A18)555
R3. It is just by chance that more serious mistakes don't happen around here. (A10)555
R4. We have patient safety problems in this unit. (A17)555

R Indicates reversed-worded items.

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 9

Frequency of Events Reported

Survey Items% Never/
Rarely
% Sometimes% Most of the time/
Always
1. When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported? (D1)555
2. When a mistake is made, but has no potential to harm the patient, how often is this reported? (D2)555
3. When a mistake is made that could harm the patient, but does not, how often is this reported? (D3)555

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 10

Number of Events Reported

Respondents were asked to indicate the number of events they had reported in the past 12 months.

1. In the past 12 months, how many event reports have you filled out and submitted? (Survey item G1)

Text description is below figure.

Bar chart shows sample percentage of respondents reporting number of events: Zero events or no response, 5%; 1 to 2 events, 5%; 3 to 5 events, 5%; 6 to 10 events, 5%; 11 to 20 events, 5%; 21 or more events, 5%.

Slide 11

Overall Patient Safety Grade

Respondents were asked to give their work unit an overall grade on patient safety.

2. Please give your work area/unit in this hospital an overall grade on patient safety. (Survey item E1)

Text description is below figure.

Bar chart displays sample percentage of respondents providing an overall grade on patient safety: A = Excellent, 5%; B = Very Good, 5%; C = Acceptable, 5%; D = Poor, 5%; E = Failing, 5%.

Slide 12

Supervisor/Manager Expectations & Actions Promoting Patient Safety

Survey Items% Strongly Disagree/
Disagree
% Neither% Strongly Agree/
Agree
1. My supervisor / manager says a good word when he/she sees a job done according to established patient safety procedures. (B1)555
2. My supervisor / manager seriously considers staff suggestions for improving patient safety. (B2)555
R3. Whenever pressure builds up, my supervisor / manager wants us to work faster, even if it means taking shortcuts. (B3)555
R4. My supervisor/manager overlooks patient safety problems that happen over and over. (B4)555

R Indicates reversed-worded items.

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 13

Organizational Learning—Continuous Improvement

Survey Items% Strongly Disagree/
Disagree
% Neither% Strongly Agree/
Agree
1. We are actively doing things to improve patient safety. (A6)555
2. Mistakes have led to positive changes here. (A9)555
3. After we make changes to improve patient safety, we evaluate their effectiveness. (A13)555

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 14

Teamwork Within Units

Survey Items% Strongly Disagree/
Disagree
% Neither% Strongly Agree/
Agree
1. People support one another in this unit. (A1)555
2. When a lot of work needs to be done quickly, we work together as a team to get the work done. (A3)555
3. In this unit, people treat each other with respect. (A4)555
4. When one area in this unit gets really busy, others help out. (A11)555

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 15

Communication Openness

Survey Items% Never/
Rarely
% Sometimes% Most of the time/
Always
1. Staff will freely speak up if they see something that may negatively affect patient care. (C2)555
2. Staff feel free to question the decisions or actions of those with more authority. (C4)555
R3. Staff are afraid to ask questions when something does not seem right. (C6)555

R Indicates reversed-worded items.

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 16

Feedback and Communication About Error

Survey Items% Never/
Rarely
% Sometimes% Most of the time/
Always
1. We are given feedback about changes put into place based on event reports. (C1)555
2. We are informed about errors that happen in this unit. (C3)555
3. In this unit, we discuss ways to prevent errors from happening again. (C5)555

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 17

Nonpunitive Response to Error

Survey Items% Strongly Disagree/
Disagree
% Neither% Strongly Agree/
Agree
R1. Staff feel like their mistakes are held against them. (A8)555
R2. When an event is reported, it feels like the person is being written up, not the problem. (A12)555
R3. Staff worry that mistakes they make are kept in their personnel file. (A16)555

R Indicates reversed-worded items.

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 18

Staffing

Survey Items% Strongly Disagree/
Disagree
% Neither% Strongly Agree/
Agree
1. We have enough staff to handle the workload. (A2)555
R2. Staff in this unit work longer hours than is best for patient care. (A5)555
R3. We use more agency/temporary staff than is best for patient care. (A7)555
R4. We work in "crisis mode" trying to do too much, too quickly. (A14)555

R Indicates reversed-worded items.

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 19

Hospital Management Support for Patient Safety

Survey Items% Strongly Disagree/
Disagree
% Neither% Strongly Agree/
Agree
1. Hospital management provides a work climate that promotes patient safety. (F1)555
2. The actions of hospital management show that patient safety is a top priority. (F8)555
R3. Hospital management seems interested in patient safety only after an adverse event happens. (F9)555

R Indicates reversed-worded items.

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 20

Teamwork Across Hospital Units

Survey Items% Strongly Disagree/
Disagree
% Neither% Strongly Agree/
Agree
1. There is good cooperation among hospital units that need to work together. (F4)555
2. Hospital units work well together to provide the best care for patients. (F10)555
R3. Hospital units do not coordinate well with each other. (F2)555
R4. It is often unpleasant to work with staff from other hospital units. (F6)555

R Indicates reversed-worded items.

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 21

Hospital Handoffs & Transitions

Survey Items% Strongly Disagree/
Disagree
% Neither% Strongly Agree/
Agree
R1. Things "fall between the cracks" when transferring patients from one unit to another. (F3)555
R2. Important patient care information is often lost during shift changes. (F5)555
R3. Problems often occur in the exchange of information across hospital units. (F7)555
R4. Shift changes are problematic for patients in this hospital. (F11)555

R Indicates reversed-worded items.

Note: The item letter and number in parentheses indicate the item's survey location.

Slide 22

Staff Comments

(verbatim with spelling and grammar edits)

X% of respondents wrote comments (N = X)

"Section I: Your Comments—Please feel free to write any comments about patient safety, error, or event reporting in your hospital."

Slide 23

Staff Comments—Page 1

Current as of October 2004
Internet Citation: Feedback Results: Hospital Survey on Patient Safety Culture. October 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/hospculttxt.html