Frequently Asked Questions

Surveys on Patient Safety Culture

These frequently asked questions address issues related to the Hospital Survey on Patient Safety Culture, the Nursing Home Survey on Patient Safety Culture, and the Medical Office Survey on Patient Safety Culture. The frequently asked questions are organized into general questions that pertain to all settings followed by questions pertaining to specific survey settings.

These frequently asked questions address issues related to the Hospital Survey on Patient Safety Culture, the Nursing Home Survey on Patient Safety Culture, and the Medical Office Survey on Patient Safety Culture. The frequently asked questions are organized into general questions that pertain to all settings followed by questions pertaining to specific survey settings. 

Contents

General Questions

  1. Why should a health care organization conduct a safety culture survey?
  2. There are other organizational culture and safety culture surveys; why should an organization use one of the AHRQ Surveys on Patient Safety Culture?
  3. How often should an organization administer the AHRQ Surveys on Patient Safety Culture?
  4. Can I use the AHRQ Surveys on Patient Safety Culture outside the United States?
  5. Can I translate the AHRQ Surveys on Patient Safety Culture?
  6. Can I modify the AHRQ Surveys on Patient Safety Culture or do I need to use them as is?
  7. Are there Spanish versions of the AHRQ Surveys on Patient Safety Culture available?
  8. Whom can I contact if I have further questions?

Questions Specific to the Hospital Survey on Patient Safety Culture

  1. What areas of patient safety culture do the survey questions cover on the Hospital Survey on Patient Safety Culture?
  2. How long is the Hospital Survey on Patient Safety Culture?
  3. Can hospital systems that include ambulatory/outpatient facilities also use this survey?
  4. Can I compare my hospital's survey results against other hospitals?
  5. Can international hospitals participate in the Hospital Survey on Patient Safety Culture Comparative Database?

Questions Specific to the Nursing Home Survey on Patient Safety Culture

  1. What areas of patient safety culture do the survey questions cover on the Nursing Home Survey on Patient Safety Culture?
  2. How long is the Nursing Home Survey on Patient Safety Culture?
  3. Does the Nursing Home Survey on Patient Safety Culture apply to assisted living facilities, community care facilities, or independent living facilities?
  4. Can I compare my nursing home's survey results against other nursing homes?

Questions Specific to the Medical Office Survey on Patient Safety Culture

  1. What areas of patient safety culture do the survey questions cover on the Medical Office Survey on Patient Safety Culture?
  2. How long is the Medical Office Survey on Patient Safety Culture?
  3. What is considered a medical office?
  4. Can any size medical office conduct the Medical Office Survey on Patient Safety Culture?
  5. Does it matter what specialty or specialties my medical office covers?
  6. Can I compare my medical office's survey results against other medical offices?

General Questions 

Question 1: Why should a health care organization conduct a safety culture survey?

Answer: Safety culture surveys are useful for measuring organizational conditions that can lead to adverse events and patient harm in health care organizations. Organizations that want to assess their existing culture of patient safety should consider conducting a safety culture survey. Safety culture surveys can be used to:

  • Raise staff awareness about patient safety.
  • Diagnose and assess the current status of patient safety culture.
  • Identify strengths and areas for patient safety culture improvement.
  • Examine trends in patient safety culture change over time.
  • Evaluate the cultural impact of patient safety initiatives and interventions.
  • Conduct internal and external comparisons.

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Question 2: There are other organizational culture and safety culture surveys; why should an organization use one of the AHRQ Surveys on Patient Safety Culture?

Answer: The AHRQ Surveys on Patient Safety Culture have several advantages. They are:

  1. Free—available to the public. The surveys were developed by AHRQ and are available free of charge.
  2. An organizationwide instrument. The surveys were designed to be administered to all types of staff, including clinical and nonclinical staff in hospitals, nursing homes, and medical offices. They can be used to assess individual units or departments or can be administered organizationwide.
  3. Reliable and valid. The survey development process was careful and rigorous, based on a review of the existing research and other culture surveys. More important, the survey items have demonstrated reliability and validity (for more details, refer to the survey Toolkit materials available on the AHRQ Web site at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html).
  4. Comprehensive and specific. The surveys cover several areas of patient safety culture, providing a level of detail that helps organizations identify specific areas of strength and areas for improvement.
  5. Easy to use. Each survey has an accompanying Toolkit that contains the following materials:
    • Survey Forms
    • Survey Items and Dimensions
    • A Survey User's Guide: Gives step-by-step instructions on how to select a sample, administer the survey and obtain high response rates, and how to analyze and report results.
    • Survey feedback report PowerPoint® template: Can be customized to display survey results to administrators and staff throughout the organization and for presentation purposes.
    • Data Entry and Analysis Tool: A data entry and analysis tool that works with Microsoft® Excel and makes it easy to input your individual-level data from the survey. The tool then automatically creates tables and graphs to display your survey results. To request the tool for the hospital, medical office, or nursing home survey, send an E-mail to: DatabasesOnSafetyCulture@ahrq.hhs.gov.

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Question 3: How often should an organization administer the AHRQ Surveys on Patient Safety Culture? 

Answer: On average, hospitals that have submitted to the Hospital Survey on Patient Safety Culture Comparative Database more than once readminister the survey every 16 months. Although we do not provide any set recommendations regarding when to readminister the survey, we do caution against administering the survey less than 6 months apart. This would apply as well to the medical office and nursing home settings.

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Question 4: Can I use the AHRQ Surveys on Patient Safety Culture outside the United States? 

Answer: The AHRQ Surveys on Patient Safety Culture are free to the public and can be administered outside the United States. If you plan to translate and administer one of the surveys outside the United States, please contact SafetyCultureSurveys@ahrq.hhs.gov to share information about your administration of the survey. For more information about international use of the Surveys on Patient Safety Culture, go to http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/pscintusers.html.

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Question 5: Can I translate the AHRQ Surveys on Patient Safety Culture? 

Answer: The Hospital Survey on Patient Safety Culture and the Nursing Home Survey on Patient Safety Culture are both available in Spanish. The Spanish translations are 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 http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/transguide.html. If you plan to translate one of the surveys, please contact SafetyCultureSurveys@ahrq.hhs.gov.

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Question 6: Can I modify the AHRQ Surveys on Patient Safety Culture or do I need to use them as is?

Answer: To compare your facility's results against other facilities, you should not modify the surveys. In general, we recommend making only those changes or additions to a survey that are absolutely necessary. Any changes may affect the reliability and overall validity of the survey and may make comparisons with other facilities difficult.

  • Modifying background items—Your facility may wish to modify the responses to these background questions so that they reflect the names of work units, staff position titles, and the like.
  • Adding items—If your facility would like to add items to the survey, we recommend adding these items toward the end of the survey.
  • Making the survey shorter or removing items—Although the surveys take only about 10 to 15 minutes to complete, your facility may want to administer a shorter survey with fewer items. The Survey User's Guides provide information on the safety culture dimensions assessed in the survey and the reliability figures for each dimension. Delete the dimensions that your facility is not interested in assessing (be sure to delete all of the items associated with those dimensions). In this way, your facility's results on the remaining safety culture dimensions still can be compared to other facilities that use the survey.
  • Adapting the survey for Web-based data collection—We recommend using a paper-based survey data collection methodology to make sure you obtain the highest possible response rates. Despite the probability of lower response rates, your facility may decide that it is more feasible and logistically advantageous to collect data with a Web-based survey. Web-based surveys have a wide range of design features and can involve different data collection procedures. Be sure to read "Conducting a Web-based Survey" in the Survey User's Guide for guidelines on how to adapt the safety culture survey for this type of data collection.

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Question 7: Are Spanish versions of the AHRQ Surveys on Patient Safety Culture available? 

Answer: Spanish versions of the Hospital and Nursing Home Surveys for use in the United States are available at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/index.html and http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/nursing-home/index.html.

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Question 8: Whom can I contact if I have further questions?

Answer: If you have questions about the Surveys on Patient Safety Culture or need technical assistance, E-mail SafetyCultureSurveys@ahrq.hhs.gov or DatabasesOnSafetyCulture@ahrq.hhs.gov.

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Questions Specific to the Hospital Survey on Patient Safety Culture 

Question 9: What areas of patient safety culture do the survey questions cover on the Hospital Survey on Patient Safety Culture?

Answer: The survey measures staff perceptions of patient safety culture in their work area/unit, as well as perceptions about patient safety culture in the hospital as a whole. The following 12 dimensions of patient safety culture are included, with each dimension measured by 3 or 4 survey questions:

  1. Communication openness.
  2. Feedback & communication about error.
  3. Frequency of events reported.
  4. Hospital handoffs & transitions.
  5. Hospital management support for patient safety.
  6. Nonpunitive response to error.
  7. Organizational learning-continuous improvement.
  8. Overall perceptions of safety.
  9. Staffing.
  10. Supervisor/manager expectations & actions promoting patient safety.
  11. Teamwork across hospital units.
  12. Teamwork within units.

There are also two other questions that ask about: 

  1. The patient safety "grade" the respondent would assign their work area/unit.
  2. The number of events the respondent has reported in the last 12 months.

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Question 10: How long is the Hospital Survey on Patient Safety Culture? 

Answer: There are a total of 51 items in the survey and it takes approximately 10 minutes to complete. Most of the items use Agree/Disagree or Never/Always response categories, so they are easy to answer. There is room for written comments at the end of the survey.

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Question 11: Can hospital systems that include ambulatory/outpatient facilities also use the Hospital Survey on Patient Safety Culture?

Answer: Ambulatory facilities that are adjacent to or part of a hospital can use the "facility version" of the Hospital Survey on Patient Safety Culture, which is downloadable at: http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/index.html. In this version, the term "hospital" is replaced with the term "facility" throughout the survey (along with accompanying word context changes), but the items are the same.

However, AHRQ has developed the Medical Office Survey on Patient Safety Culture for use in outpatient medical offices. The survey and toolkit materials are available on the AHRQ Web site at: http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/index.html. Because the survey was designed specifically for medical offices, it does not crosswalk or compare directly to the hospital survey. 

If you use the "facility version," you must exclude the ambulatory hospital data when submitting to the Hospital Survey on Patient Safety Culture Comparative Database because the database is only for hospital data.

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Question 12: Can I compare my hospital's survey results against other hospitals?

Answer: In response to requests from hospitals interested in comparing their results with other hospitals on the Hospital Survey on Patient Safety Culture, the Agency for Healthcare Research and Quality (AHRQ) established the Hospital Survey on Patient Safety Culture Comparative Database. AHRQ has produced Comparative Database Reports for 2007, 2008, 2009, and 2010. The AHRQ Hospital Survey on Patient Safety Culture 2010 Comparative Database Report was based on data from 885 hospitals and 338,607 hospital staff respondents. Hospitals can use the comparative results as one basis for comparison in their efforts to establish, improve, and maintain a culture of patient safety in their institutions.

The Hospital Survey on Patient Safety Culture 2010 Comparative Database Report is available at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/2010/index.html. 

Information about eligibility requirements, registration procedures, and benefits of participating in the database is available at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/y2dbsubmission.html.

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Question 13: Can international hospitals participate in the Hospital Survey on Patient Safety Culture Comparative Database? 

Answer: Unfortunately, while any hospital is free to use the survey, the AHRQ Hospital Survey on Patient Safety Culture Comparative Database is currently accepting data only from U.S. hospitals. However, we would like to know more about what your plans are or what you have done with the survey in your country. Please contact SafetyCultureSurveys@ahrq.hhs.gov to share information about your use of the Hospital Survey on Patient Safety Culture.

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Questions Specific to the Nursing Home Survey on Patient Safety Culture

Question 14: What areas of patient safety culture do the survey questions cover on the Nursing Home Survey on Patient Safety Culture?

Answer: The Nursing Home Survey on Patient Safety Culture emphasizes resident safety issues. It includes 42 survey items measuring 12 dimensions. Nine of the 12 survey dimensions are similar to those appearing in the Hospital Survey on Patient Safety Culture (HSOPS), although the items included in the dimensions are different. Three HSOPS dimensions were dropped from the nursing home survey: Frequency of event reporting, Teamwork across units, and Teamwork within units. Three new dimensions were added: Compliance with procedures, Training and skills, and Teamwork.

The dimensions in the nursing home survey are:

  1. Communication openness.
  2. Compliance with procedures.
  3. Feedback and communication about incidents.
  4. Handoffs.
  5. Management support for resident safety.
  6. Nonpunitive response to mistakes.
  7. Organizational learning.
  8. Overall perceptions of resident safety.
  9. Staffing.
  10. Supervisor expectations and actions promoting resident safety.
  11. Teamwork.
  12. Training and skills.

In addition, the nursing home survey includes seven background demographic questions and two overall rating questions: 

  1. Would they tell friends that this is a safe nursing home for their family?
  2. How would they rate this nursing home on resident safety?

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Question 15: How long is the Nursing Home Survey on Patient Safety Culture? 

Answer: There are a total of 42 items in the survey and it takes approximately 10 to 15 minutes to complete. Most of the items use Agree/Disagree or Never/Always response categories, so they are easy to answer. There is room for written comments at the end of the survey.

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Question 16: Does the Nursing Home Survey on Patient Safety Culture apply to assisted living facilities, community care facilities, or independent living facilities?

Answer: The survey was designed to measure resident safety culture in a nursing home facility or in a special contained area of a facility (e.g., a hospital) that includes only licensed nursing home beds, so it is important to understand the type of nursing home facility that the survey was designed for.

  • It was not designed for use in assisted living facilities, community care facilities, or independent living facilities.
  • If a nursing home is located on a large campus or facility that has a mix of nursing home and other long-term care programs (such as independent living, assisted living, and rehabilitation services), survey only the facilities or areas with nursing home beds. Exclude staff who work only in areas with independent living, assisted living, or rehabilitation beds.

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Question 17: Can I compare my nursing home's survey results against other nursing homes?

Answer: AHRQ is developing a comparative database for the Nursing Home Survey on Patient Safety Culture that will be modeled after the Hospital Survey on Patient Safety Culture Comparative Database. The purpose of the new database will be to enable nursing homes to compare their survey results with other nursing homes. Nursing homes in the United States that have administered the AHRQ survey will be asked to voluntarily submit data to the new database. Specific dates for data submission will be forthcoming. AHRQ will use the data to produce annual comparative database reports similar to the annual Hospital Survey on Patient Safety Culture Comparative Database Report.

For now, nursing homes can refer to the comparative results in the Nursing Home Survey on Patient Safety Culture Preliminary Comparative Results, which are based on data from almost 3,700 nursing home staff in 40 nursing homes. This report can be found on the AHRQ Web site at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/nursing-home/index.html. 

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Questions Specific to the Medical Office Survey on Patient Safety Culture

Question 18: What areas of patient safety culture do the survey questions cover on the Medical Office Survey on Patient Safety Culture?

Answer: The Medical Office Survey on Patient Safety Culture emphasizes patient safety and health care quality issues. The survey includes 51 items measuring 12 dimensions. Six of the survey dimensions (Communication Openness, Communication About Error, Organizational Learning, Overall Perceptions of Patient Safety and Quality, Owner/Managing Partner/Leadership Support for Patient Safety, and Teamwork) are similar to dimensions in the Hospital Survey on Patient Safety Culture, although the items are different in the two surveys. The remaining six survey dimensions are unique to the medical office survey with items that focus specifically on issues related to patient safety or quality of care in medical offices.

The dimensions in the medical office survey are:

  1. Communication about error.
  2. Communication openness.
  3. Information exchange with other settings.
  4. Office processes and standardization.
  5. Organizational learning.
  6. Overall perceptions of patient safety and quality.
  7. Owner/managing partner/leadership support for patient safety.
  8. Patient care tracking/followup.
  9. Patient safety and quality issues.
  10. Staff training.
  11. Teamwork
  12. Work pressure and pace.

In addition, the medical office survey includes three items about respondent background characteristics and two overall rating questions: 

  1. How they would rate this medical office on five different areas of health care quality (patient centered, effective, timely, efficient, and equitable)?
  2. How they would rate this medical office on patient safety?

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Question 19: How long is the Medical Office Survey on Patient Safety Culture? 

Answer: There are a total of 51 items in the survey and it takes approximately 10 to 15 minutes to complete. Most of the items use response categories such as Daily/Not in the Past 12 Months, Agree/Disagree, or Never/Always, so they are easy to answer. There is room for written comments at the end of the survey.

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Question 20: What is considered a "medical office"?

Answer: The survey was designed to measure the culture of patient safety in medical offices with the following characteristics:

  • A medical office should be an outpatient facility in a specific location. A medical practice or health care system may have multiple medical offices in different locations, but each unique location would be considered a separate medical office for survey administration and feedback.
  • A medical office could be located in a building containing multiple medical offices, but each office in the building would be considered a separate medical office for the purposes of the survey.
  • Providers in a single medical office should share some or all administrative staff, such as receptionists and schedulers, and share some or all clinical support staff.

These characteristics are essential because the survey asks respondents about patient safety and quality issues for a specific medical office location. The survey can be administered to multiple medical offices within a practice, health care system, or building, but each medical office would have to be identified as a separate office rather than being surveyed as one entity.

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Question 21: Can any size medical office conduct the Medical Office Survey on Patient Safety Culture?

Answer: We recommend restricting administration of the medical office survey to offices with at least three providers. We define providers as:

Physicians (M.D. or D.O.), physician assistants, nurse practitioners, and other providers who are licensed to diagnose medical problems, treat patients, and prescribe medications.

Solo practitioners or offices with only two providers are so small that conducting a survey is probably not an effective way to obtain staff opinions about patient safety culture. Staff in small offices will not feel that their answers are anonymous and may not be willing to complete the survey or answer survey questions honestly. In small offices, rather than administering the survey, it can be used as a tool to initiate open dialogue or discussion about patient safety and quality issues among providers and staff. The office owners or leaders will be the best judge, however, of whether their office is large enough for staff to be willing respondents to the survey.

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Question 22: Does it matter what specialty or specialties my medical office covers? 

Answer: The survey was designed to be appropriate for any specialty. Your office may provide primary care services only, other specialty care services only, or a mix of primary and specialty care services.

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Question 23: Can I compare my medical office's survey results against other medical offices?

Answer: AHRQ is developing a comparative database for the Medical Office Survey on Patient Safety Culture that will be modeled after the Hospital Survey on Patient Safety Culture Comparative Database. The purpose of the new database will be to enable medical offices to compare their survey results with other medical offices. Medical Offices in the United States that have administered the AHRQ survey will be asked to voluntarily submit data to the new database. Specific dates for data submission will be forthcoming. AHRQ will use the data to produce annual comparative database reports similar to the annual Hospital Survey on Patient Safety Culture Comparative Database Report.

For now, medical offices can refer to the comparative results in the Medical Office Survey on Patient Safety Culture Preliminary Comparative Results, which are based on data from more than 4,000 staff in 182 outpatient medical offices. This report can be found on the AHRQ Web site at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/index.html.

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Current as of April 2010
Internet Citation: Frequently Asked Questions: Surveys on Patient Safety Culture. April 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/pscfaq.html