Development of the AHRQ Nursing Home Survey on Patient Safety Culture
Slide Presentation
A national technical assistance conference call conducted on March 31, 2010, provides users with an overview of the development of the survey. In addition, two professionals share their success and challenges in survey administration from both a regional perspective and an individual nursing home, and discuss how to maximize survey response and use survey results to develop action plans to target safety culture improvement initiatives. This is one of the sets of speaker slides from the call.
Select to access the slide presentation (PDF File, 530 KB; Plugin Software Help).
- Welcome & Introductions.
- Development of the AHRQ Nursing Home Survey on Patient Safety Culture.
- Objectives.
- Background.
- Hospital SOPS Dimensions.
- Nursing Home SOPS Development.
- NH SOPS Patient Safety Culture Dimensions.
- Nursing Home Pilot Test.
- Nursing Home Pilot Test (continued).
- Patient Safety Culture Composites Average % Positive Response.
- Comments.
- NH SOPS Toolkit.
- SOPS Nursing Home Data Entry and Analysis Tool.
- SOPS Nursing Home Data Entry and Analysis Tool (continued).
- Item Level Results.
- Item-Level Comparative Results.
- Long-term AHRQ Support.
- Questions?.
Slide 1. Welcome & Introductions
- National Technical Assistance Conference Call on the AHRQ Nursing Home Survey on Patient Safety Culture.
- Speakers:
- Deborah Carpenter RN, MSN, CPHQ, PMP
Senior Study Director, Westat. - Tara Brown MPH, CQIA, CQA
Evaluation Specialist, Georgia Medical Care Foundation. - BettyLou Barron RN, MSN
Director of Nursing, Bear Creek Nursing & Rehab Center.
- Deborah Carpenter RN, MSN, CPHQ, PMP
Slide 2. Development of the AHRQ Nursing Home Survey on Patient Safety Culture
Deborah Carpenter, RN MSN CPHQ PMP
National Technical Assistance Conference Call on the AHRQ Nursing Home Survey on Patient Safety Culture
March 31, 2010
Slide 3. Objectives
- Describe survey domains and development process.
- Provide information from pilot study survey administration.
- Present information about the SOPS Nursing Home Data Entry and Analysis Tool.
Slide 4. Background
- AHRQ Nursing Home Survey on Patient Safety Culture released in fall 2008.
- Survey and support tools available at: http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html
Slide 5. Hospital SOPS Dimensions
- 42 items assess 12 dimensions of patient safety culture:
- Communication openness.
- Feedback & communication about error.
- Frequency of event reporting.
- Handoffs & transitions.
- Management support for patient safety.
- Nonpunitive response to error.
- Organizational learning—continuous improvement.
- Overall perceptions of patient safety.
- Staffing.
- Supervisor/manager expectations & actions promoting patient safety.
- Teamwork across units.
- Teamwork within units.
- Patient safety "grade" (Excellent to Poor).
- Number of events reported in past 12 months.
Slide 6. Nursing Home SOPS Development
Many nursing-home (NH) staff have lower education/reading levels; language issues:
- Used simple language in survey items (final survey has Flesch-Kincaid score 5.3 grade reading level).
- Kept survey item wording relatively short.
- Focused on entire NH rather than on "units" or "departments."
Slide 7. NH SOPS Patient Safety Culture Dimensions
- 42 items assess 12 dimensions of patient safety culture:
- Communication openness.
- Compliance with procedures.
- Feedback & communication about incidents.
- Handoffs.
- Management support for resident safety.
- Nonpunitive response to mistakes.
- Organizational learning.
- Overall perceptions of resident safety.
- Staffing.
- Supervisor/manager expectations & actions promoting resident safety.
- Teamwork.
- Training and skills.
- Resident safety "grade" (Excellent to Poor).
- Overall recommendation of nursing home to friends.
Slide 8. Nursing Home Pilot Test
- Identified a site point-of-contact (POC):
- Typically a NH administrator.
- Conducted paper survey administration:
- Conduct a census of all staff unless NH has 300 or more staff & then draw a sample.
- Conduct a census of staff positions with few individuals & draw a sample from nursing assistants/support staff.
- Survey staff, including agency and contract staff, who can read and understand English.
- Survey physicians or other providers who see patients in the NH.
- Conduct a census of all staff unless NH has 300 or more staff & then draw a sample.
Slide 9. Nursing Home Pilot Test
- Overall response rate = 73% (3,698/5,065):
- 80% overall with individual incentives.
- 59% overall without individual incentives.
Without a POC incentive, your response rate is likely to be lower.
Slide 10. Patient Safety Culture Composites Average % Positive Response
Image: Bar charts of the average percent positive response on the patient safety culture composites for the nursing home SOPS pilot study. For the composite Overall Perceptions of Resident Safety, the average percent positive response was 87%; 85% for Feedback & Communication About Incidents; 81% for Supervisor Expectations & Actions Promoting Resident Safety; 76% for Organizational Learning; 72% for Management Support for Resident Safety; 72% for Training & Skills; 67% for Compliance with Procedures; 67% for Teamwork; 63% for Handoffs; 58% for Communication Openness; 55% for Nonpunitive Response to Mistakes; 48% for Staffing.
Slide 11. Comments
- 24% of respondents provided comments.
- Most comments were negative—focused on perceived issues or problems.
- Recurring themes:
- Training.
- Staffing.
- Nonpunitive response to mistakes.
- Teamwork.
Slide 12. NH SOPS Toolkit
- Final formatted survey.
- Survey User's Guide providing instruction on data collection and analysis.
- Preliminary comparative results on survey items & composites based on 40 pilot nursing homes.
- Modifiable PowerPoint® survey feedback template.
- Data entry and analysis tool that works with Microsoft Excel® available by emailing: DatabasesOnSafetyCulture@westat.com
Slide 13. SOPS Nursing Home Data Entry and Analysis Tool
Westat designed a data entry and analysis tool to display results from the new Nursing Home Survey
- Input individual survey data.
- Create graphs and tables to display your survey results overall and by various demographics.
- Analyze which patient safety culture dimensions may need additional attention.
- Compare your results against pilot study NHs.
- Share the results with others in your organization. All results are printable.
Slide 14. SOPS Nursing Home Data Entry and Analysis Tool
- Tool is for a single Nursing Home with a minimum of 5 respondents.
- Each tool will handle data entry of up to 2,500 individual survey responses.
- Requires Microsoft Excel 2003 or higher to use the tool.
- This tool uses Excel macros. Before opening the file, set Excel's macro security level to medium.
Slide 15. Item Level Results
Item results are displayed only when there are 3 or more respondents for an item.
Image: Bar chart showing Overall Perceptions of Resident Safety. Screenshot of item results are displayed as a 3-point bar chart for each item, which shows the percentage of positive, neutral, and negative responses for 3 questions.
Slide 16. Item-Level Comparative Results
Based on 40 Pilot Nursing Homes
Image: Screen shot showing how the item-level comparative results are displayed. The survey item percent positive response is shown as bar chart with one bar representing your nursing home and the other bar chart alongside it representing the comparative results. The minimum and maximum average percent positive scores are also shown.
Slide 17. Long-term AHRQ Support
- AHRQ will support a comparative database on the NH survey in the next year or two:
- NHs will be asked to submit data to the database.
- A comparative report will be produced & released on the AHRQ Web site.
- We are interested in information about interventions NHs have implemented to address areas for improvement.
Slide 18. Questions?
- DatabasesOnSafetyCulture@westat.com
- SafetyCultureSurveys@westat.com
