HealthSouth Rehabilitation Facilities Use AHRQ Survey to Identify Top Performers

HealthSouth, one of the nation's largest health care providers, implemented AHRQ's Hospital Survey on Patient Safety Culture in June 2005. Over 11,000 questionnaires were mailed to employees at 104 HealthSouth rehabilitation facilities.

Rebecca Bradley, HealthSouth's Director for Quality Standards, explains that to better meet its needs, the survey was modified by dropping two question items, and adding one custom query. Then the survey was sent to employees in HealthSouth's Inpatient Division, which is comprised of 95 inpatient rehabilitation facilities and 10 long-term acute care hospitals in 28 states and Puerto Rico.

Employees surveyed included both clinical and nonclinical personnel. Each received a letter announcing the survey, followed by the mailing of the actual survey. A second survey and reminder letter were sent a week later.

A total of 4,003 respondents completed the survey—an overall response rate of 37.4 percent. "We were pleasantly surprised at the level of participation of our staff and particularly pleased with the results," Bradley says.

Survey findings, which were grouped by job categories according to job titles, showed that the majority of HealthSouth's processes and policies met or exceeded the national benchmarks in the Hospital Survey on Patient Safety Culture Survey. However, one dimension of care—open communication—was identified as being below the AHRQ benchmark. As a result, HealthSouth will focus efforts on ways to improve communication and coordination of care, particularly for those facilities that fell below the threshold score, by working to develop more purposeful methods for transitioning inpatients to external care providers.

"As the nation's largest provider of inpatient rehabilitative healthcare services, HealthSouth aims to set the standard for excellence throughout the industry, and patient safety is no exception," said Mark Tarr, HealthSouth's Inpatient Division President. "As a large system, it's not often that we are provided with a tool such as the AHRQ survey that will allow us to capture an accurate snapshot of the culture of patient safety in our facilities."

With the belief that managers are responsible for setting the expectations and promoting the culture of a facility, "HealthSouth has developed a plan of action that is a 'top-down' approach," Bradley explains. To help implement this plan, HealthSouth recently partnered with an outside agency to develop Web-based training for CEOs and administrators across all operating divisions. These training sessions will delineate ways to promote a culture of patient safety and the importance of managers' communicating that focus to their staff. Regional nursing leadership seminars have also been planned to incorporate a focus on patient safety.

Using the survey results, HealthSouth developed a patient safety culture ranking report of their facilities. This tool will be used for planning site visits to study the environment of top performers. Subsequently, the plan is to work with other facilities to duplicate those positive processes and management components.

"The AHRQ survey helped us to strengthen our existing patient safety initiatives and identify more resources to enhance communication," Tarr said. "This is a tool we plan to incorporate into the total culture of our organization."

HealthSouth administrators are also currently evaluating the possibility of a follow-up survey and a time frame that will be appropriate to assess the impact of their action plans. "Going forward, we believe there may be an opportunity to expand this study into our other operating divisions," says Bradley.