Update on the Hospital Survey on Patient Safety Culture
- Government approval for data collection: Winter 2015.
- Cognitive testing and input from Technical Expert Panel: Spring/Summer 2016.
- Pilot test and bridge study data collection: Late 2016/Early 2017.
- Data analysis: Spring/Summer 2017.
- Release of Hospital 2.0 survey and Health IT Patient Safety supplemental item set: Early 2018.
Why are you making changes to the Hospital Survey on Patient Safety Culture?
What types of changes are being made?
How will Version 2.0 and the new supplemental items be tested?
Can my hospital participate in the pilot test/bridge study data collection?
How do the changes affect trending on the hospital survey?
How will the Health IT Patient Safety supplemental items be integrated into the hospital survey?
The Hospital Survey on Patient Safety Culture was initially released in 2004. In the past 10 years, hospitals have provided feedback suggesting changes to the survey. To incorporate this feedback, AHRQ is developing a revised survey.
As a result of feedback from hospitals since the release of the hospital survey more than 10 years ago, the development of a revised 2.0 version has the following 8 objectives:
- Shift to a Just Culture framework for understanding responses to errors. Currently, items focus on nonpunitive response to errors but new items will focus on just culture, which emphasizes learning rather than blame and the importance of understanding both system and individual factors that contribute to error.
- Reduce the number of negatively worded items. Negatively worded items can reduce biased responses such as "straight-lining" (providing the same answer for every item) or answering questions in a socially desirable and positive way. However, users report that respondents have difficultly correctly interpreting and responding to negatively worded items and recommended that the number be reduced.
- Add a "Does not apply/Don’t know" response option. When respondents do not have experience in an area or an item does not apply to them, they are not sure how to answer. Adding a "does not apply/don’t know" response option will allow an appropriate response and will make the hospital survey consistent with the other, more recent, AHRQ patient safety culture surveys.
- Reword complex and/or difficult-to-translate items. Items that currently use idiomatic expressions that do not translate well (e.g., "things fall between the cracks") or that use complex phrasing will be simplified to facilitate better understanding of the items and make it easier to translate the survey into other languages.
- Reword items to be more applicable to physicians and nonclinical staff. Users have indicated that the wording of some of the items makes it difficult for physicians to answer and some items are difficult for nonclinical staff to answer. Problematic items will be reworded to make them more applicable to these types of respondents.
- Align the Hospital Survey on Patient Safety Culture with the other AHRQ patient safety culture surveys. Developing patient safety culture surveys for other settings has provided opportunities to test new items and refinements of the original hospital survey. Version 2.0 will incorporate wording from the more recently developed patient safety culture surveys, where relevant, to allow for cross-setting comparisons that are not currently possible.
- Reduce survey length. The revised survey will be shorter than the original instrument. The initial draft of the Version 2.0 survey is slightly longer; however, through cognitive interviewing, pilot testing and analysis, and expert review, AHRQ will identify items that can be deleted from the Version 2.0 draft, resulting in a shorter final instrument.
- Develop a supplemental item set. A set of supplemental items on Health Information Technology (Health IT) Patient Safety will be developed. The supplemental items can be added to the Hospital Survey on Patient Safety Culture Version 2.0.
The draft Version 2.0 survey and the Health IT Patient Safety supplemental item set will be cognitively tested with individual respondents in both English and Spanish to ensure respondents are interpreting the questions as anticipated. Then, a combined pilot test and bridge study data collection effort will be conducted in 40 hospitals with about 500 providers and staff from each hospital. Half of the staff will receive the Version 2.0 survey with the Health IT Patient Safety supplemental items and the other half will receive the original hospital survey.
Results from the pilot test will be analyzed to determine which items to retain for the final instruments. In addition, results from the bridge study component of the data collection, which compares scores on Version 2.0 with the original hospital survey, will enable us to understand the extent to which differences in survey scores are due to changes in the survey version versus actual changes in patient safety culture. The bridge study will provide information that will help hospitals understand how to trend scores from the original hospital survey to the new Version 2.0.
In late 2016, AHRQ will recruit 40 hospitals that differ in type, size, and geographic region for the pilot test and bridge study. If your hospital is interested in participating, please email SafetyCultureSurveys@westat.com.
Results from the bridge study will help hospitals compare their scores on Version 2.0 to the original hospital survey to understand the extent to which changes in scores are due to changes in the survey versus actual changes in patient safety culture.
AHRQ will provide guidance on how to integrate the Health IT Patient Safety supplemental item set into the Hospital Survey on Patient Safety Culture Version 2.0 upon their release.
Page originally created April 2015