Appendix C. Sample Data Collection Protocol for the Nursing Home Point of Contact: Paper Survey

Survey User's Guide: Nursing Home Survey on Patient Safety Culture

Your Data Collection Tasks and Schedule for the Nursing Home Survey on Patient Safety Culture

Listed below are the schedule and tasks for administering the paper survey. Fill in the dates for your survey. Post this protocol in your office to remind you of the schedule.

Target Date Activity
One week before survey distribution

Date: ________________
Print and post publicity materials. Post survey flyers throughout the nursing home (e.g., in elevators, on bulletin boards, in work areas). Promote survey throughout the data collection period.
Beginning of Week 1
(Start of Survey Data Collection)

Date: ________________
Distribute survey packets to all staff members on the survey distribution list. Consider distributing the packets at staff meetings and encourage survey participation. Caution staff, however, not to discuss their answers if they complete their surveys during the meeting.
Beginning of Week 3



Date: ________________
Remind staff to complete the survey. If you are not using individual identifiers to track respondents, distribute reminder cards to all staff. If you are using identifiers to track respondents, distribute reminder cards only to nonrespondents.

If your nursing home is not very large and you have the time, you may find it more effective to remind staff in person to complete the survey. Thank those who have already done so.
Beginning of Week 5

Date: ________________
Distribute a second survey packet. If you are not using individual identifiers to track respondents, distribute second survey packets to all staff. If you are using identifiers to track respondents, distribute second survey packets only to nonrespondents.
End of Week 6

Date: ________________
Close out data collection.

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Current as of September 2008
Internet Citation: Appendix C. Sample Data Collection Protocol for the Nursing Home Point of Contact: Paper Survey: Survey User's Guide: Nursing Home Survey on Patient Safety Culture. September 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/nursing-home/nhguide/nhguideapc.html