Using the AHRQ Surveys on Patient Safety Culture

The Surveys on Patient Safety Culture™ or SOPS™ is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). The trademark signifies that the surveys and items were developed in accordance with principles and standards established by the Agency.


As part of its goal to support a culture of patient safety and quality improvement in the Nation's health care system, AHRQ sponsored the development of patient safety culture assessment tools to enable health care organizations to assess how their providers and staff perceive various aspects of patient safety culture in the following settings:

Health care organizations can use these survey assessment tools to:

  • Raise staff awareness about patient safety.
  • Diagnose and assess the current status of patient safety culture.
  • Identify strengths and areas for patient safety culture improvement.
  • Examine trends in patient safety culture change over time.
  • Evaluate the cultural impact of patient safety initiatives and interventions.
  • Conduct internal and external comparisons.

SOPS surveys feature a set of standardized questions, referred to as core items. Some of the surveys also include optional supplemental items that users may add to assess content areas not included in the core questionnaire:

SOPS surveys are known for their rigorous and scientific development and evaluation process. The development process includes input from providers, managers, and staff in health care organizations, as well as from researchers and patient safety experts. The surveys and administration methodologies undergo extensive testing and are aligned with other SOPS surveys where appropriate. In addition, the SOPS team periodically reviews the surveys and receives input from users and experts to ensure that the questions are consistent with changes in the health care delivery system, existing standards of practice, and survey best practices.

SOPS surveys are typically reported back to leadership, providers, and staff in the health care organizations that complete the survey to support efforts to assess and improve their own patient safety culture. Some of the surveys are used for incentive programs or are required for accreditation or reimbursement.

AHRQ Guidelines Regarding Use of the SOPS Name

Organizations that administer an existing SOPS survey, with or without supplemental items, may use the SOPS name as long as the core items and response options of the survey have not been changed, omitted, or reordered. The SOPS name may not be used if the wording of core items or response options has been modified, if core items are omitted and only a subset of core items are used, or if the survey items are administered out of order.

Users may add supplemental or custom questions toward the end of a SOPS survey before the background questions. In cases where a subset of core items are used and the entire SOPS survey is not administered, AHRQ requests appropriate attribution for the items that are used, by noting that the questionnaire or items have been "adapted from" or "modified from" a specified SOPS survey.

To maintain comparability and consistency across SOPS surveys, AHRQ offers the following guidelines regarding what changes you can make to a SOPS survey and how to give proper attribution to the SOPS program.

Changing the Core Survey

Some organizations use a subset of SOPS survey items as starting points for a modified questionnaire. Changes to the core survey would include any of the following:

  • Changing the wording of the items or response options.
  • Changing the order of the items or response options.
  • Deleting one or more items.
  • Adding supplemental or custom questions among the core items within the survey.

If these kinds of changes are made, the survey is no longer considered a SOPS survey. In addition, the results of your survey are not comparable to other organizations in the SOPS Databases. The successful use of SOPS surveys depends on everyone administering the same items in the same order.

Modifying Work Areas or Staff Positions

Some organizations may choose to modify the units/work areas or staff positions included in the SOPS survey to better match the names and titles used within their organizations. Modification of units/work areas and staff positions is acceptable; however, if the organization plans to submit to any of the SOPS Databases, they must recode the modified units/work areas or staff positions so they crosswalk back to the original survey’s units/work areas or staff positions.

Adding to a SOPS Survey

SOPS surveys can be customized to meet needs unique to your organization or staff by adding supplemental or custom questions to the end of the core survey before the background questions. You are welcome to use:

  • Supplemental items developed under the SOPS program or
  • Items from other surveys or developed for your purposes, including open-ended questions.

As long as all the core items and response options of the SOPS surveys are retained and presented in order, the questionnaire qualifies as a SOPS survey and can be referred to as such. Any supplemental items or additional items from other surveys must be added to the end of the SOPS survey, just before the Background Questions section. When inserting supplemental items, remember to include the appropriate subheadings for each supplemental item set.


Page last reviewed March 2018
Page originally created August 2017
Internet Citation: Using the AHRQ Surveys on Patient Safety Culture. Content last reviewed March 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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