# Presentation: 106104

## Hospital Survey on 

- 			Name
- 			Title
- 			Address
- 			Phone
- 			Email

***Hospital Survey on ***
***Patient Safety Culture***
**Feedback Results**
**{Site}**
**{City, State}**
** ****{Date}      **

## Survey Background

- 	The *Hospital Survey on Patient Safety Culture *was sponsored by the Quality Interagency Coordination Task Force (QuIC), a group established in accordance with a 1998 Presidential directive to ensure that all Federal agencies involved in purchasing, providing, studying, or regulating health care services are working together and toward a common goal of improving quality care.  The survey was funded by the Agency for Healthcare Research and Quality (AHRQ).
- 	The development of this safety culture assessment tool included a review of the scientific literature pertaining to safety, error and accidents, as well as error reporting.  In addition, hospital employees and managers were interviewed to identify key patient safety and error reporting issues.  Other published and unpublished safety culture assessment tools also were examined.

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## Survey Measures

*Four overall patient safety outcomes:*
- 1.	Overall perceptions of safety
- 2.	Frequency of events reported
- 3.	Number of events reported
- 4.	Overall patient safety grade

- The research survey also is intended to measure:

- The Hospital Survey on Patient Safety Culture is designed to measure:

*Ten dimensions of culture pertaining to patient safety:*
- 1.	Supervisor/manager expectations &	   6.   Nonpunitive response to error
- 	actions promoting patient safety	   7.   Staffing
- 2.	Organizational learning – continuous	   8.   Hospital management support
-  	improvement 	 		         for patient safety
- 3.	Teamwork within units 		   9.   Teamwork across hospital units
- 4.	Communication openness		 10.   Hospital handoffs & transitions
- 5.  	Feedback & communications
- 	about error

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## Survey Methodology

**In a short paragraph, describe your hospital’s sample and data collection methodology, for example:**
- 	In _Date(s)_, the *Hospital Survey on Patient Safety Culture * was distributed to a sample of _XX_ (or all)
- 	staff at _Hospital X_.  Overall, _**XX responses to the survey were received, a(n) XX% response **_**	**_**rate**_.
- 	To maximize response rates, standard survey procedures were followed:
- 	   1.  	A prenotification letter from the hospital _X_ was distributed, encouraging participation.
- 	   2.  	One week later, the survey was distributed, including a cover letter from the hospital _X_,
- 		a survey, and a postage-paid return envelope.
- 	   3.  	Two weeks after the survey, a reminder postcard was distributed to nonrespondents.
- 	   4.  	Two weeks after the reminder postcard, a second survey was distributed to
- 		nonrespondents.
- 	   5.  	Two weeks after the second survey, a final reminder postcard was distributed to
- 		nonrespondents.
- 	In this feedback report, the percentages of employee responses to specific survey items are grouped according to the safety culture dimensions being assessed.  Some percentages shown in the graphs may not add to exactly 100 percent, due to rounding.  Since the total number of respondents was _XX_, in each graph _XX_% is approximately equivalent to one person’s answer.

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## Demographic Data about Respondents

**1.  Primary hospital work area, department or clinical area where**
**	**** ****respondents spend most** **of their work time:**
- 	%	Many different hospital units / No specific unit 		%	Psychiatry / mental health
- 	%	Medicine (non-surgical)			%	Rehabilitation
- 	%	Surgery			%	Pharmacy
- 	%	Obstetrics			%	Laboratory
- 	%	Pediatrics			%	Radiology
- 	%	Emergency department			%	Anesthesiology
- 	%	Intensive care unit (any type)		%	Other
- 					%	(Blank/Missing)
**2.  Staff position in the hospital:**
- 	%	Registered nurse			%	Dietician
- 	%	Physician assistant / Nurse practitioner		%	Unit assistant / Clerk / Secretary
- 	%	LVN / LPN			%	Respiratory therapist
- 	%	Patient care assistant / Hospital aide / Care partner	%	Physical, occupational, or speech therapist
- 	%	Attending / Staff physician		%	Technician (e.g., EKG, Lab, Radiology)
- 	%	Resident physician / Physician in training		%	Administration / Management
- 	%	Pharmacist			%	Other
- 					%	(Blank/Missing)

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## Demographic Data (continued)

**3.  Time worked**
- 	**--in the hospital****	**% Less than 20 hours	% 20 to 39 hours	% 40 hours or more
- 	(hours/week)								**	**
- 	**--in the hospital****	**% Less than 1 year	% 1 to 5 years	% 6 to 10 years
- 	(years)
- 			% 11 to 15 years	% 16 to 20 years	% 21 years or more
- 	**--in their current****	**** **
**	****hospital work area****	**% Less than 1 year	% 1 to 5 years	% 6 to 10 years** **
**	**(years)
- 	**	**** ****	**% 11 to 15 years  	% 16 to 20 years	% 21 years or more
- 	**--in their current****	**% Less than 1 year 	% 1 to 5 years 	% 6 to 10 years
**	****specialty** (years)
**	****	****	**% 11 to 15 years 	% 16 to 20 years	% 21 years or more
**	****	****	****	****	****	**
**4.  Percentage of respondents with direct interaction or contact with patients:**       %

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## Main Findings: Strengths

- 		We identify as strengths, those positively worded items which about 75% of respondents endorse by answering “Agree / Strongly agree,” or “Most of the time / Always” (or when about 75% of respondents *disagreed* with negatively worded items).
- 		A number of strengths emerged from the results:
- Most respondents...
- Respondents...

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## Main Findings: Areas for Improvement

- 		Areas with the potential for improvement were identified as items which about 50% of respondents answered negatively using “Disagree / Strongly disagree” or “Never / Rarely” (or when 50% of respondents *disagreed* with positively worded items).
- 		A number of areas for improvement emerged from the results:
- Most respondents....
- Respondents.....

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## Overall Perceptions of Safety

***Overall Perceptions of Safety***

**R**  Indicates reversed-worded items.
- 	NOTE:  The item letter and number in parentheses indicate the item’s survey location.

**Survey Items**_** **_

-  % Strongly Disagree/    % Neither      % Strongly Agree/
-           Disagree		                     Agree

-   1.	Patient safety is never sacrificed to get more
-       work done.  (A15)
-   2.	Our procedures and systems are good at
- 	preventing errors from happening.  (A18)
- R3.	It is just by chance that more serious
- 	mistakes don’t happen around here.  (A10)
- R4.	We have patient safety problems in this
- 	unit.  (A17)

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## Frequency of Events Reported

***Frequency of Events Reported***

- 1. When a mistake is made, but is _*caught and corrected before affecting the patient*__,_ how often is this reported?  (D1)
- 2. When a mistake is made, but has _*no potential to harm the patient*__,_ how often is this reported?  (D2)
- 3. When a mistake is made that _*could harm the patient*_, but does not, how often is this reported?  (D3)

- NOTE: The item letter and number in parentheses indicate the item’s survey location.

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## Number of Events Reported 

- Respondents were asked to indicate the number of events they had reported in the past 12 months.
**1. In the past 12 months, how many event reports have you filled out and submitted? **(Survey item G1)

**100%**

**  ****80%**

**  ****60%**

**  ****40%**

**  ****20%**

**1 to 2**

**3 to 5**

**6 to 10**

**Zero or**
**No response**

**11 to 20**

** ****21 or **
**more**

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## Overall Patient Safety Grade

- Respondents were asked to give their work unit an overall grade on patient safety.
**2.  Please give your work area/unit in this hospital an overall grade on patient safety.** 	(Survey item E1)

**100%**

**  ****60%**

**  ****40%**

**  ****20%**

**  ****80%**

**A **
**Excellent**

**B **
**Very Good**

**C **
**Acceptable**

**D **
**Poor**

**E **
**Failing**

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## Supervisor/Manager Expectations & Actions Promoting Patient Safety

***Supervisor/Manager Expectations & ******Actions Promoting Patient Safety***

- R Indicates reversed-worded items.
- NOTE: The item letter and number in parentheses indicate the item’s survey location.

**Survey Items**_** **_

-  **% Strongly Disagree/    % Neither      % Strongly Agree/**
**          ****Disagree****	****	****                     Agree**

-  1. 	My supervisor/manager says a good word
- 	when he/she sees a job done according
- 	to established patient safety procedures. (B1)
-  2. 	My supervisor/manager seriously
- 	considers staff suggestions for improving
- 	patient safety. (B2)
- R3.	Whenever pressure builds up, my
- 	supervisor/manager wants us to work
- 	faster, even if it means taking shortcuts. (B3)
- R4.	My supervisor/manager overlooks patient
- 	safety problems that happen over and over.
- 	(B4)

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## Organizational Learning—Continuous Improvement

- NOTE: The item letter and number in parentheses indicate the item’s survey location.

**Survey Items**_** **_

-  **% Strongly Disagree/    % Neither      % Strongly Agree/**
**          ****Disagree****	****	****                     Agree**

-  1.	We are actively doing things to improve	patient safety.  (A6)
-  2.	Mistakes have led to positive changes	here.  (A9)
-  3.	After we make changes to improve	patient safety, we evaluate their	effectiveness.  (A13)

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## Teamwork Within Units

***Teamwork Within Units***

- NOTE: The item letter and number in parentheses indicate the item’s survey location.

**Survey Items**_** **_

-  **% Strongly Disagree/    % Neither      % Strongly Agree/**
**          ****Disagree****	****	****                     Agree**

- 1.	People support one another in this unit.
- 	(A1)
- 2.	When a lot of work needs to be done
- 	quickly, we work together as a team to
- 	get the work done.  (A3)
- 3.	In this unit, people treat each other with
- 	respect. (A4)
- 4.	When one area in this unit gets really
- 	busy, others help out.  (A11)

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## Communication Openness

- 1.	 Staff will freely speak up if they see
- 	 something that may negatively affect
- 	 patient care.  (C2)
- 2.	 Staff feel free to question the decisions
- 	 or actions of those with more authority.  (C4)
- R3.  Staff are afraid to ask questions when
- 	 something does not seem right.  (C6)

- R Indicates reversed-worded items.
- NOTE: The item letter and number in parentheses indicate the item’s survey location.

-             **% Never/           % Sometimes         % Most of the   **
**                ****Rarely                                              time/Always**

**Survey Items**_** **_

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## Feedback and Communication About Error

***Feedback and Communication About Error***

- 1.	We are given feedback about changes put
- 	into place based on event reports.  (C1)
- 2.    We are informed about errors that happen
-        in this unit.  (C3)
- 3.	In this unit, we discuss ways to prevent
- 	errors from happening again.  (C5)

- NOTE: The item letter and number in parentheses indicate the item’s survey location.

-             **% Never/           % Sometimes         % Most of the   **
**                ****Rarely                                              time/Always**

**Survey Items**_** **_

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## Nonpunitive Response to Error

- R1.	Staff feel like their mistakes are held
- 	against them. (A8)
- R2.   When an event is reported, it feels like
- 	the person is being written up, not the
- 	problem.  (A12)
- R3.	Staff worry that mistakes they make are
- 	kept in their personnel file.  (A16)

- R Indicates reversed-worded items.
- NOTE: The item letter and number in parentheses indicate the item’s survey location.

**Survey Items**_** **_

-  **% Strongly Disagree/    % Neither      % Strongly Agree/**
**          ****Disagree****	****	****                     Agree**

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## Staffing

**Survey Items**_** **_

-  **% Strongly Disagree/    % Neither      % Strongly Agree/**
**          ****Disagree****	****	****                     Agree**

- R Indicates reversed-worded items.
- NOTE: The item letter and number in parentheses indicate the item’s survey location.

- 1.	We have enough staff to handle the 	workload.  (A2)
- R2.	Staff in this unit work longer hours than 	 	is best for patient care.  (A5)
- R3.	We use more agency/temporary staff 	 	than is best for patient care.  (A7)
- R4.	We work in “crisis mode” trying to do 	 	too much, too quickly.  (A14)

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## Hospital Management Support for Patient Safety

- R Indicates reversed-worded items.
- NOTE: The item letter and number in parentheses indicate the item’s survey location.

**Survey Items**_** **_

-  **% Strongly Disagree/    % Neither      % Strongly Agree/**
**          ****Disagree****	****	****                     Agree**

-  1.	Hospital management provides a work climate that promotes patient safety. (F1)
-  2.	The actions of hospital management show that patient safety is a top priority. (F8)
- R3. 	Hospital management seems interested in patient safety only after an adverse event happens. (F9)

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## Teamwork Across Hospital Units

***Teamwork Across Hospital Units***

- R Indicates reversed-worded items.
- NOTE: The item letter and number in parentheses indicate the item’s survey location.

**Survey Items**_** **_

-   1.	There is good cooperation among hospital units that need to work together. (F4)
-   2.	Hospital units work well together to provide the best care for patients. (F10)
- R3.	Hospital units do not coordinate well with each other. (F2)
- R4.	It is often unpleasant to work with staff from other hospital units. (F6)

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## Hospital Handoffs & Transitions

- R Indicates reversed-worded items.
- NOTE: The item letter and number in parentheses indicate the item’s survey location.

**Survey Items**_** **_

- R1.	Things “fall between the cracks” when
- 	transferring patients from one unit to 	another.  (F3)
- R2.	Important patient care information is
- 	often lost during shift changes.  (F5)
- R3.	Problems often occur in the exchange
- 	of information across hospital units.  (F7)
- R4.	Shift changes are problematic for
- 	patients in this hospital.  (F11)

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## (verbatim with spelling and grammar edits)

X% of respondents wrote comments (N = X)

“Section I: Your Comments—Please feel free to write any comments 
about patient safety, error, or event reporting in your hospital.”

**X% of respondents wrote comments (N = X)**
**“****Section I: Your Comments—Please feel free to write any comments **
**about patient safety, error, or event reporting in your hospital.”**

***Staff Comments***

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## Staff Comments  Page 1

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