AHRQ's Patient Safety Culture Survey Yields Meaningful Results at Palo Alto Medical Foundation

Patient Safety
November 2005

The Palo Alto Medical Foundation, a multi-specialty medical group located near San Francisco, is now using AHRQ's Hospital Survey on Patient Safety Culture. The first survey was administered in September 2005 to 1,180 staff members in nine locations.

Employees surveyed are either directly involved with patient care or support such care. Departments such as facilities, information technology, medical records, electronic health systems, and the IT help desk were included in the survey. Departments that did not have patient care functions, such as human resources, finance, accounting, and purchasing, were not surveyed. Physicians were also excluded, in part because the majority of questions don't directly pertain to physicians' roles; many are more appropriate for staff members who support physicians.

"Our goal was to establish a baseline measurement of employee perceptions, to see how our combined efforts for improvement are working," explains Theresa Manley, RN, Patient Safety Officer. The response rate was nearly 73 percent, with 855 employees completing the survey.

Initially, Manley was concerned about the number of questions the survey contained. However, after attending the Orlando National Patient Safety Congress in May 2005, she felt more confident about using the survey. She even altered it slightly to add more questions about physician leaders. "We took the section about coordinators/supervisors/managers and adapted it for the physicians who lead the staff in many departments," Manley says.

While the survey questions were distributed on paper, participants anonymously submitted their answers via a Web link. The staff had eight days to register their responses. To encourage participation, posters with a baseball theme were used to generate competition among departments for the highest percentage of completed surveys. In addition, colorful wristbands and badge holders imprinted with "Patient Safety: Our Top Priority" were given out upon survey completion as visible incentives to encourage the remaining staff to take part.

"People responded quickly and enthusiastically," Manley reports. "They loved the badge holders and wrist bands." Registered nurses responded in high numbers: 80 percent of RNs completed a survey. Furthermore, one satellite office and a few departments achieved 100 percent participation.

Some conclusions were immediately evident. The survey revealed that 76 percent of employees have never completed an incident report. This is one priority Manley plans to focus on right away. In addition, while the questions distributed on paper seemed overwhelming to many employees, they soon discovered that the survey was easy and fast to complete online. The next time, there will be no paper tool.

With meaningful results and a baseline perception established, the survey will be re-administered on a regular basis, probably every two years. "Fortunately, we don't have a lot of employee turnover, so every other year seems to be a good plan for us," Manley says. The next time the survey is used, there may be some changes about who gets the survey, as well as adjustments of the questions for staff members who don't have direct patient contact.

The Palo Alto Medical Foundation holds semiannual employee forums, and the Fall 2005 forums were used to share results of the patient safety culture survey with all staff. "These forums are typically well-attended, because employees get face time with our president," Manley says. Such quick turn-around on reporting results may reinforce the value of the survey among employees.

"Overall, this survey is a really good way to measure how your processes are. The level of detail in the questions is good, and I like the way this tool is worded," she reports.

Manley has used many other AHRQ products and research. "I use the AHRQ Web site all the time," she says. "The proven but inexpensive safety practices and literature reviews are always really helpful."

The Hospital Survey on Patient Safety Culture can be accessed online at www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/index.html.

Impact Case Study Identifier: 
AHRQ Product(s): Hospital Survey on Patient Safety Culture
Topics(s): Patient Safety
Geographic Location: California
Implementer: Palo Alto Medical Foundation
Date: 11/01/2005
Page last reviewed October 2014
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