CULTURE OF SAFETY
SURVEYS
TAKING THE PULSE OF
YOUR ORGANIZATION
Tatum O’Sullivan, RN, MHSA, CPHRM
Ambulatory Risk & Patient Safety Manager
North Shore Physicians Group
tkosullivan@partners.org
OBJECTIVES

Purpose of the Survey

Options

Frequency of Surveys

Benefits of Survey

Pitfalls & Challenges

Helpful Hints
PURPOSE OF THE SURVEY





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Raise staff awareness about patient safety
Diagnose and assess the current status of patient
safety culture (patient safety issues, medical
errors, and event reporting)
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
POSITIVE PATIENT SAFETY CULTURE (PSC)


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Guides discretionary behavior of healthcare
professionals towards viewing patient safety as a
highest priority
Defined as individual/group values, attitudes,
perceptions, competencies, & patterns of
behavior, which determine the commitment to
and the style and proficiency of an organization’s
health & safety management
Fujita, et.al, (2013). The characteristics of patient safety culture in Japan, Taiwan, and the United States. BMC Health Services Research, 13:20.
THE BUSINESS CASE

Joint Commission Requirements


Leap Frog Survey


The Joint Commission requires that hospitals
measure the culture of safety within the organization
using valid and reliable tools (LD.03.01.01, EP 1)
A general employee satisfaction survey that has a
small component of the survey addressing
organizational culture does not qualify. A Culture
survey must be undertaken at minimum biannually
with priority to high-risk areas and other targeted
units where the majority of care is provided.
In the Ambulatory Setting it is critical for PCMH
and team-based care and is required as part of
Primed Status
OPTIONS FOR SURVEYS

The AHRQ Offers 4 Surveys
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
Bryan Sexton

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
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Hospital Survey on Patient Safety Culture
Medical Office Survey on Patient Safety Culture
Nursing Home Survey on Patient Safety Culture
Pharmacy Survey on Patient Safety Culture—New!
Safety Attitudes Questionnaire – Short Form
Safety Attitudes Questionnaire – Teamwork and Safety Climate
Safety Attitudes Questionnaire – Ambulatory Version
Safety Attitudes Questionnaire – ICU Version
Safety Attitudes Questionnaire – Labor and Delivery Version
Safety Attitudes Questionnaire – Operating Room Version
Safety Attitudes Questionnaire – Pharmacy Version
Safety Climate Survey
Hybrid Versions
https://med.uth.edu/chqs/surveys/safety-attitudes-and-safety-climatequestionnaire/
http://www.ahrq.gov/professionals/quality-patientsafety/patientsafetyculture/index.html
AHRQ Safety & Culture Survey
Section
# of
Questions
Example
Patient Safety &
Quality Issues
9
A patient was unable to get an appointment within 48 hours for an
acute/serious problem? Daily, Weekly, Monthly, Several times in past 12
months, Once in past 12 months, Not in past 12 months, Don’t know
Information
Exchange with
Other Settings
5
Office has had problems exchanging accurate, complete and timely
information with other medical offices? Daily, Weekly, Monthly, Several
times in past 12 months, Once in past 12 months, Not in past 12 months,
Don’t know
Working in your
Medical Office
15
When someone in this office gets really busy, others help out? SD, D,
Neither agree or disagree, A, SA, Don’t know
Communication
& Followup
12
Providers in this office are open to staff ideas about how to improve office
processes? Never, Rarely, Sometimes, Most of the time, Always, Don’t
know
Leadership
Support
4
They place a high priority on improving patient care processes? SD, D,
Neither agree or disagree, A, SA, Don’t know
Your Medical
Office
7
When there is a problem in our office we see if we need to change the way
we do things? SD, D, Neither agree or disagree, A, SA, Don’t know
Overall Ratings
6
Overall, how would you rate your medical office on being patient-centered?
Poor, Fair, Good, Very good, Excellent
-8-
AHRQ 12 DOMAINS
SAFETY ATTITUDES QUESTIONNAIRE

2 Major Domains
Safety Climate
 Teamwork Climate
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The original extended version consists of 60 items
The short form version includes only 30 core items,
four of which are responded to separately for the
hospital and unit level, yielding a total of 34 items
Measures Provider Attitudes about:

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Job Satisfaction (5 items)
Perceptions of Management (4 items)
Teamwork (6 items)
Safety Climate (7 items)
Working Conditions (4 items)
Stress Recognition (4 items)
WHAT’S THE BEST WAY TO ADMINISTER?

Paper Form
Requires more manpower and a trusted person
for data entry
 May not appear as “confidential”
to employees
 Some believe offers more participation


Electronic Format
Organizing emails/user name and passwords
by unit may be cumbersome
 Can be done at employee’s leisure
 Ability to track response rates (not who completed) in
real time

TIMELINE
PRENOTIFICATION LETTER
Dear Team Member,
As part of our commitment to patient safety and quality, Organization X has
partnered with Pascal Metrics Inc. to measure patient safety culture and help us
identify and prioritize opportunities to improve our culture of safety. We will
conduct the Agency for Healthcare Quality and Research (AHRQ) Medical Office
Survey on Patient Safety Culture over the next several weeks. The survey will
help us understand beliefs and attitudes about safety within our organization.
This survey is of great importance, because an organization's beliefs about safety
in the workplace have been shown to prevent errors and injuries. I strongly urge
you to complete the short survey.
Your input is important and honesty is critical. The survey will be emailed to you
from Pascal Metrics in the upcoming days through the beginning of August. This
survey takes approximately eight minutes to complete - and result in reducing
patient harm.
Your responses to the questionnaire are completely anonymous and will be
processed by Pascal Metrics, an independent, external research
company. We will not be provided individual-level results. Pascal will provide a
report summarizing overall patterns of responses, which then can be used to assist
our organization in strengthening further our patient safety program and
processes.
If you should have any questions please don't hesitate to contact our point person:
XXXX XXX at 603-442-2244.
Please take a few moments and share your perceptions and thank you for your
help - our patient safety depends on it.
Sincerely,
President
FREQUENCY OF SURVEYS
 At
a minimum every 2 years
 Items

to Consider:
Assess operations and leadership changes
BENEFITS OF SURVEY


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Provides objective data to something “subjective”
Can be used as a tool to measure improvement
over time
Conveys what the organization’s priorities are to
employees
Allows RM the opportunity to interface with staff
PITFALLS & CHALLENGES

Too Many Surveys – Survey Fatigue


Employee Satisfaction, Focus Groups, Etc.
Failure to Recognize the Value

Make results available ASAP

Newsletters, Meetings, Email
Develop Action Plans with Leaders/Staff
 Compare Results to Previous Years


Selecting the Correct Time Frame
Generally a 4 week window
 Avoid Peak Vacation Times


Summer & Holidays
LIMITATIONS

N/A for all staff

Some questions may not apply to all staff,
particularly support staff
Small sample sizes make it difficult to interpret
results
 Goal is to achieve a minimum of 60% for validity
 Challenging when sharing with staff D/T
positively and negatively worded questions used
 Comments are permitted but can make provide
challenges when additional information is needed

USING A VENDOR
 Robust
survey analysis and reporting
 Reports instantly available
 Compare your results vs. benchmarks
 Web-based survey and analysis
 User-generated reports to dissect data
how you want
 Hospital Survey is available in Spanish
 Easy to setup, take and administer
 Monitor response rates in real-time
 Quick turnaround for starting up
 Export results or import previous results
 Little to no IT/IS required by hospitals
 Hospital defined units/departments
 Simplicity - saves time, money and effort
USEFUL LINKS
AHRQ
 http://www.ahrq.gov/professionals/qualitypatient-safety/patientsafetyculture/index.html

SAQ
 https://med.uth.edu/chqs/surveys/safetyattitudes-and-safety-climate-questionnaire/

Pascal Metrics
 http://www.pascalmetrics.com/products_services/

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The Patient Safety Group
https://www.patientsafetygroup.org/survey/home.
cfm
HTTPS://NNEPATIENTSAFETY.ORG/
QUESTIONS…COMMENTS…IDEAS