Military Hospitals Employ AHRQ Hospital Survey on Patient Safety Culture

Patient Safety
May 2007

The Department of Defense Patient Safety Program chose AHRQ's Hospital Survey on Patient Safety Culture as an anonymous, Web-based initiative to assess staff attitudes and beliefs about patient safety, medical errors, and event reporting in Military Health System (MHS) facilities.

David Tornberg, MD, MPH, former Chief Medical Officer, TRICARE Management Activity says, "This survey helped the DoD's Military Health System realize our mission of improving patient safety by enabling open discussion regarding the identification of safety issues specific to each unique environment in our system."

The Tri-Service Survey on Patient Safety was conducted in late 2005 and early 2006. Data were collected from all MHS fixed facilities worldwide, comprising 68 hospitals, 340 outpatient clinic/ambulatory care centers, and 76 dental clinics. Among the three Services' respondents (e.g., clinical staff, house staff, nonclinical staff, active duty and reservist military, civilian employees, and contractors), there was an overall response rate of 53 percent, with 62,548 individuals completing the survey.

Staff were provided with a hyperlink to the survey Web site and received multiple reminders to complete the survey. The majority of respondents were active duty military providing direct patient care, working 50-59 hours per week. Half of all respondents worked in the MHS facility from one to five years, with 49 percent assigned to their current work areas for the same amount of time.

The survey was conducted throughout the MHS with four specific goals in mind:

  • To improve the quality of health care services and provide a safer care environment in all MHS settings
  • To understand the status of patient safety culture in MHS facilities
  • To raise staff awareness about patient safety issues
  • To see the results as a tool for forward action planning and program evaluation

Twelve general areas of patient safety culture were assessed in the survey. Each area was explored with three or four survey items. Two questions asked staff to "grade" their work area as it related to patient safety and the number of event reports that had been submitted within the past 12 months. The majority of respondents gave their overall work area a grade of "A-Excellent" or "B-Very Good." Nine of the 12 survey areas received a 50 percent or better positive response, with only three areas falling below 50 percent.

Survey areas with the highest positive scores were categorized as Patient Safety Strengths and included Teamwork within Work Areas, Supervisor/Manager Expectations and Actions Promoting Patient Safety, and Management and Support for Patient Safety. Lowest positive scores were designated Areas for Improvement and included Staffing, Nonpunitive Response to Error, Handoffs and Transitions, and Number of Events Reported.

Information derived from the survey will be used throughout the MHS in developing strategies for improving patient safety. Following MHS-wide communication and discussion of survey data, the long-term value of the survey will come from Action Planning for Improvement, transforming insights derived from the survey data into action plans, and converting action plans into measurable improvements in patient safety throughout the MHS environment.

Two other significant patient safety initiatives are also underway. The first, TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) is an evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and other teamwork skills among health care professionals. Secondly, the Patient Safety Reporting System will provide standardized event and near-miss capturing and reporting of patient safety events at MHS facilities throughout the DoD.

The mission of the DoD Patient Safety Program is to lead the Military Health System to a culture of safety and quality through collaboration among the Services and across entities via a systems approach to change, engaged leadership, fostering trust, and transparency with improved teamwork, communication, and collaboration.

The Hospital Survey on Patient Safety Culture can be accessed online at

Impact Case Study Identifier: 
AHRQ Product(s): Hospital Survey on Patient Safety Culture
Topics(s): Patient Safety
Geographic Location: National
Implementer: Department of Defense
Date: 05/01/2007

Hospital Survey on Patient Safety Culture, Agency for Healthcare Research and Quality, Rockville, MD. (Contract No. 290-96-0004)

Page last reviewed October 2014