Description
Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events.
Hospital Survey on Patient Safety Culture
What Is the HSOPSC? Hospital Survey on Patient Safety Culture (HSOPSC): An Introduction
Suzanne R. Anders, RN, BSBA, CPHQ Health Services Advisory Group
? Survey from hospital staff’s perspective ? It can be completed by all types of staff, from housekeeping and security to nurses and physicians.
Survey Background
The HSOPSC was sponsored by the Medical Errors Workgroup of the QuIC, funded by AHRQ, and developed by Westat. ? QuIC: Quality Interagency Coordination Task Force that consists of representatives from 11 federal agencies ? AHRQ: Agency for Healthcare Research and Quality is the lead federal agency charged with conducting and supporting research to improve patient safety and health care quality for all Americans. ? Westat: A statistical survey research corporation that serves agencies of the U.S. government, as well as businesses, foundations, and state and local governments.
Survey Development
? A review of the literature and existing safety culture tools ? Interviews with hospital staff ? Cognitive testing ? Input/comment from researchers and healthcare stakeholders ? Pilot-tested with over 1,400 respondents from 21 hospitals
Why Survey?
? Raise awareness about patient safety issues ? Diagnose the current status of safety culture ? Evaluate specific patient safety interventions or programs ? Conduct internal and external benchmarking ? Track change over time ? Fulfill Participation Agreement requirement
Why the AHRQ Survey?
? ? ? ? Free Hospital-wide Reliable and valid Promotes benchmarking
Health Services Advisory Group –1–
Hospital Survey on Patient Safety Culture
Modifications
Modifications are possible; however, take care not to affect the reliability or validity of the survey.
How Long Does it Take?
? There are 51 items to be answered ? Approximately 10 minutes to complete ? Most of the items use:
– Agree/Disagree, or – Never/Always responses
? Written comments can be added at the end of the survey.
What Areas Are Covered?
? Unit-level Safety Areas Covered
– Overall perceptions of safety – Frequency of events reported – Supervisor/manager expectations & actions promoting patient safety – Organizational learning—continuous improvement – Teamwork within units – Communication openness – Feedback & communication about error – Nonpunitive response to error – Staffing
What Areas Are Covered?
? Hospital-level Safety Areas Covered
– Hospital Management Support for Patient Safety – Teamwork Across Hospital Units – Hospital Handoffs and Transitions
What Areas Are Covered?
? Outcomes
– – – – Overall Perceptions of Safety Frequency of Event Reporting Patient Safety Grade (of the Hospital Unit) Number of Events Reported
What Areas Are Covered?
? Hospital-wide Safety Areas Covered
– Hospital management support for patient safety – Teamwork across hospital units – Hospital handoffs & transitions
? There are also two other questions that ask about:
– The patient safety “grade” the respondent would assign their work area/unit. – The number of events the respondent has reported in last 12 months.
Health Services Advisory Group –2–
Hospital Survey on Patient Safety Culture
Benchmarking Results
? Hospitals wanting to compare their hospital’s patient safety culture survey results to those of other hospitals can use the comparative results in the Hospital Survey on Patient Safety Culture: 2008 Comparative Database Report as one basis for comparison in their efforts to establish, improve, and maintain a culture of patient safety in their institutions.
Administration Statistics
? The 2008 database consists of data from 160,176 hospital staff respondents across 519 participating hospitals. ? The average hospital response rate was 54 percent, with an average of 309 completed surveys per hospital. ? Most hospitals (48 percent) administered paper surveys, which resulted in higher response rates (60 percent) compared to web (44 percent) or mixed mode surveys (52 percent). ? Most hospitals (70 percent) administered the survey to all staff or a sample of all staff from all hospital departments.
Characteristics of Participating Hospitals
? ? ? ? Bed Size Teaching Status Ownership Region
Characteristics of Respondents
? There are 160,176 hospital staff respondents from 519 hospitals. ? One-third of respondents (33 percent) selected “Other” as their work area, followed by “Surgery” (10 percent), “Medicine” (9 percent), and “Many different hospital units/No specific unit” (9 percent). ? Over one-third of respondents (36 percent) selected “Registered Nurse” or “Licensed Vocational Nurse/Licensed Practical Nurse (LVN/LPN)” as their staff position, followed by “Other” (22 percent), and “Technician (e.g., EKG, Lab, Radiology)” (11 percent). ? Most respondents (77 percent) indicated they had direct interaction with patients
Results
? Teamwork Within Units—79% indicating this is an area of strength for most hospitals. ? Nonpunitive Response to Error—44% indicating this is an area with potential for improvement for most hospitals. ? The survey item with the lowest average percent positive response (36 percent) was: “Staff worry that mistakes they make are kept in their personnel file” (an average of only 36 percent strongly disagreed or disagreed with this item). ? Adverse Event Reporting—52% had reported no events in their hospital over the past 12 months. It is likely that this represents under-reporting of events and was identified as an area for improvement for most hospitals
Decisions
? ? ? ? Who When How What
Health Services Advisory Group –3–
Hospital Survey on Patient Safety Culture
Who Will You Survey?
? Hospital staff who have direct contact or interaction with patients (clinical staff, such as nurses, or nonclinical staff, such as unit clerks) ? Hospital staff who may not have direct contact or interaction with patients but whose work directly affects patient care (staff in units such as pharmacy, laboratory/pathology) ? Hospital-employed physicians who spend most of their work hours in the hospital (emergency department physicians, hospitalists, pathologists) ? Hospital supervisors, managers, and administrators
Who Will You Survey? (Continued)
? The size of your sample will depend on whom you want to survey and your available resources. ? The more staff you survey, the more likely you are to adequately represent your population. ? Average response rate: 30%–50%
Who Will You Survey? (Continued)
? Simple random versus systematic sample Simple random sampling involves selecting staff randomly, such that each staff member has an equal chance of being selected. Systematic sampling essentially involves selecting every Nth person from a population list
When Will You Administer the Survey?
? In the first half of 2009
– Hospitals already administering the survey need not survey – Plan for at least 10 weeks from the beginning of the project to the end of data collection.
How Will You Survey?
? Distribution and return ? Data collection process ? Web-based survey process ? ? ? ?
Web-based Survey Pros
Inexpensive Fewer human resources needed Easy to administer and complete No copying, data entry, or major data cleanup ? Ease of repeated use for hospitals ? Anonymous
Health Services Advisory Group –4–
Hospital Survey on Patient Safety Culture
What To Do To Ensure Higher Respondent Rates
? ? ? ? ? CEO message, support, and involvement Hospital-wide incentive (goal and reward) Prize drawing Results will be shared with all staff Improvement interventions to be developed and implemented based on survey results ? Provide computer access
Web-based Survey Cons
? Computer access
– Centralized PC kiosks available to employee
? Need to follow up with non-responders
– Print page of completion – HSAG can monitor the number of respondents
? Time to log onto computer and complete the survey
HSAG’s Support of the Survey Process
? ? ? ? Assist with a customized approach Create the Web-based survey tool Meet with implementation team Provide suggestions for best practice
– Aim for a return rate of 80%–100% – Track number of respondents – – – – – –
Next Steps
? Form a project team
Develop an implementation plan Select a sample Establish contact persons Prepare materials Distribute materials Track response rates
? Provide report summary
Users Guide
? http://www.ahrq.gov/qual/hospculture/usergd.htm#Contents
– Getting Started provides information on planning the project, outlines major decisions and tasks in a task timeline, and discusses hiring a vendor and forming a project team. – Selecting a Sample describes the process of selecting a suitable sample group from your staff. – Determining Your Data Collection Methods outlines decisions about how surveys will be sent and returned and discusses the importance of establishing points-of-contact within the hospital. – Establishing Data Collection Procedures suggests techniques for maximizing your response rate, discusses the importance of protecting confidentiality, and outlines survey materials to be assembled. – Conducting a Web-based Survey presents the pros and cons of using a Web-based survey approach to data collection and outlines special considerations that must be taken into account. – Preparing and Analyzing Data, and Producing Reports discusses the steps needed to prepare the data and analyze the responses and provides suggestions for producing feedback reports.
Contact Information
? Suzanne R. Anders
– [email protected] – 1.520.661.9370
Health Services Advisory Group –5–
Hospital Survey on Patient Safety Culture
Over 1 million drug-related injuries occur every year in health care settings. The Institute of Medicine estimates that at least a quarter of these injuries are preventable. To find out how to prevent medication errors, go to http://www.hsag.com/drugsafety/.
This material was prepared by Health Services Advisory Group Inc., the Medicare Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. AZ-9SOW-6.2.3-101508-02
Health Services Advisory Group –6–
doc_815315566.pdf
Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events.
Hospital Survey on Patient Safety Culture
What Is the HSOPSC? Hospital Survey on Patient Safety Culture (HSOPSC): An Introduction
Suzanne R. Anders, RN, BSBA, CPHQ Health Services Advisory Group
? Survey from hospital staff’s perspective ? It can be completed by all types of staff, from housekeeping and security to nurses and physicians.
Survey Background
The HSOPSC was sponsored by the Medical Errors Workgroup of the QuIC, funded by AHRQ, and developed by Westat. ? QuIC: Quality Interagency Coordination Task Force that consists of representatives from 11 federal agencies ? AHRQ: Agency for Healthcare Research and Quality is the lead federal agency charged with conducting and supporting research to improve patient safety and health care quality for all Americans. ? Westat: A statistical survey research corporation that serves agencies of the U.S. government, as well as businesses, foundations, and state and local governments.
Survey Development
? A review of the literature and existing safety culture tools ? Interviews with hospital staff ? Cognitive testing ? Input/comment from researchers and healthcare stakeholders ? Pilot-tested with over 1,400 respondents from 21 hospitals
Why Survey?
? Raise awareness about patient safety issues ? Diagnose the current status of safety culture ? Evaluate specific patient safety interventions or programs ? Conduct internal and external benchmarking ? Track change over time ? Fulfill Participation Agreement requirement
Why the AHRQ Survey?
? ? ? ? Free Hospital-wide Reliable and valid Promotes benchmarking
Health Services Advisory Group –1–
Hospital Survey on Patient Safety Culture
Modifications
Modifications are possible; however, take care not to affect the reliability or validity of the survey.
How Long Does it Take?
? There are 51 items to be answered ? Approximately 10 minutes to complete ? Most of the items use:
– Agree/Disagree, or – Never/Always responses
? Written comments can be added at the end of the survey.
What Areas Are Covered?
? Unit-level Safety Areas Covered
– Overall perceptions of safety – Frequency of events reported – Supervisor/manager expectations & actions promoting patient safety – Organizational learning—continuous improvement – Teamwork within units – Communication openness – Feedback & communication about error – Nonpunitive response to error – Staffing
What Areas Are Covered?
? Hospital-level Safety Areas Covered
– Hospital Management Support for Patient Safety – Teamwork Across Hospital Units – Hospital Handoffs and Transitions
What Areas Are Covered?
? Outcomes
– – – – Overall Perceptions of Safety Frequency of Event Reporting Patient Safety Grade (of the Hospital Unit) Number of Events Reported
What Areas Are Covered?
? Hospital-wide Safety Areas Covered
– Hospital management support for patient safety – Teamwork across hospital units – Hospital handoffs & transitions
? There are also two other questions that ask about:
– The patient safety “grade” the respondent would assign their work area/unit. – The number of events the respondent has reported in last 12 months.
Health Services Advisory Group –2–
Hospital Survey on Patient Safety Culture
Benchmarking Results
? Hospitals wanting to compare their hospital’s patient safety culture survey results to those of other hospitals can use the comparative results in the Hospital Survey on Patient Safety Culture: 2008 Comparative Database Report as one basis for comparison in their efforts to establish, improve, and maintain a culture of patient safety in their institutions.
Administration Statistics
? The 2008 database consists of data from 160,176 hospital staff respondents across 519 participating hospitals. ? The average hospital response rate was 54 percent, with an average of 309 completed surveys per hospital. ? Most hospitals (48 percent) administered paper surveys, which resulted in higher response rates (60 percent) compared to web (44 percent) or mixed mode surveys (52 percent). ? Most hospitals (70 percent) administered the survey to all staff or a sample of all staff from all hospital departments.
Characteristics of Participating Hospitals
? ? ? ? Bed Size Teaching Status Ownership Region
Characteristics of Respondents
? There are 160,176 hospital staff respondents from 519 hospitals. ? One-third of respondents (33 percent) selected “Other” as their work area, followed by “Surgery” (10 percent), “Medicine” (9 percent), and “Many different hospital units/No specific unit” (9 percent). ? Over one-third of respondents (36 percent) selected “Registered Nurse” or “Licensed Vocational Nurse/Licensed Practical Nurse (LVN/LPN)” as their staff position, followed by “Other” (22 percent), and “Technician (e.g., EKG, Lab, Radiology)” (11 percent). ? Most respondents (77 percent) indicated they had direct interaction with patients
Results
? Teamwork Within Units—79% indicating this is an area of strength for most hospitals. ? Nonpunitive Response to Error—44% indicating this is an area with potential for improvement for most hospitals. ? The survey item with the lowest average percent positive response (36 percent) was: “Staff worry that mistakes they make are kept in their personnel file” (an average of only 36 percent strongly disagreed or disagreed with this item). ? Adverse Event Reporting—52% had reported no events in their hospital over the past 12 months. It is likely that this represents under-reporting of events and was identified as an area for improvement for most hospitals
Decisions
? ? ? ? Who When How What
Health Services Advisory Group –3–
Hospital Survey on Patient Safety Culture
Who Will You Survey?
? Hospital staff who have direct contact or interaction with patients (clinical staff, such as nurses, or nonclinical staff, such as unit clerks) ? Hospital staff who may not have direct contact or interaction with patients but whose work directly affects patient care (staff in units such as pharmacy, laboratory/pathology) ? Hospital-employed physicians who spend most of their work hours in the hospital (emergency department physicians, hospitalists, pathologists) ? Hospital supervisors, managers, and administrators
Who Will You Survey? (Continued)
? The size of your sample will depend on whom you want to survey and your available resources. ? The more staff you survey, the more likely you are to adequately represent your population. ? Average response rate: 30%–50%
Who Will You Survey? (Continued)
? Simple random versus systematic sample Simple random sampling involves selecting staff randomly, such that each staff member has an equal chance of being selected. Systematic sampling essentially involves selecting every Nth person from a population list
When Will You Administer the Survey?
? In the first half of 2009
– Hospitals already administering the survey need not survey – Plan for at least 10 weeks from the beginning of the project to the end of data collection.
How Will You Survey?
? Distribution and return ? Data collection process ? Web-based survey process ? ? ? ?
Web-based Survey Pros
Inexpensive Fewer human resources needed Easy to administer and complete No copying, data entry, or major data cleanup ? Ease of repeated use for hospitals ? Anonymous
Health Services Advisory Group –4–
Hospital Survey on Patient Safety Culture
What To Do To Ensure Higher Respondent Rates
? ? ? ? ? CEO message, support, and involvement Hospital-wide incentive (goal and reward) Prize drawing Results will be shared with all staff Improvement interventions to be developed and implemented based on survey results ? Provide computer access
Web-based Survey Cons
? Computer access
– Centralized PC kiosks available to employee
? Need to follow up with non-responders
– Print page of completion – HSAG can monitor the number of respondents
? Time to log onto computer and complete the survey
HSAG’s Support of the Survey Process
? ? ? ? Assist with a customized approach Create the Web-based survey tool Meet with implementation team Provide suggestions for best practice
– Aim for a return rate of 80%–100% – Track number of respondents – – – – – –
Next Steps
? Form a project team
Develop an implementation plan Select a sample Establish contact persons Prepare materials Distribute materials Track response rates
? Provide report summary
Users Guide
? http://www.ahrq.gov/qual/hospculture/usergd.htm#Contents
– Getting Started provides information on planning the project, outlines major decisions and tasks in a task timeline, and discusses hiring a vendor and forming a project team. – Selecting a Sample describes the process of selecting a suitable sample group from your staff. – Determining Your Data Collection Methods outlines decisions about how surveys will be sent and returned and discusses the importance of establishing points-of-contact within the hospital. – Establishing Data Collection Procedures suggests techniques for maximizing your response rate, discusses the importance of protecting confidentiality, and outlines survey materials to be assembled. – Conducting a Web-based Survey presents the pros and cons of using a Web-based survey approach to data collection and outlines special considerations that must be taken into account. – Preparing and Analyzing Data, and Producing Reports discusses the steps needed to prepare the data and analyze the responses and provides suggestions for producing feedback reports.
Contact Information
? Suzanne R. Anders
– [email protected] – 1.520.661.9370
Health Services Advisory Group –5–
Hospital Survey on Patient Safety Culture
Over 1 million drug-related injuries occur every year in health care settings. The Institute of Medicine estimates that at least a quarter of these injuries are preventable. To find out how to prevent medication errors, go to http://www.hsag.com/drugsafety/.
This material was prepared by Health Services Advisory Group Inc., the Medicare Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. AZ-9SOW-6.2.3-101508-02
Health Services Advisory Group –6–
doc_815315566.pdf