AHRQ offers tool to gauge hospitals' safety culture

March 21, 2005

Recognizing a need for healthcare systems to be able to evaluate employee attitudes about patient safety and quality improvements, the Medical Errors Workgroup of the Quality Interagency Coordination Task Force (QuIC) sponsored the development of a survey tool. The tool will help hospitals, and their departments, evaluate employees' support-or nonsupport-of safety and quality issues.

Recognizing a need for healthcare systems to be able to evaluate employee attitudes about patient safety and quality improvements, the Medical Errors Workgroup of the Quality Interagency Coordination Task Force (QuIC) sponsored the development of a survey tool. The tool will help hospitals, and their departments, evaluate employees' support-or nonsupport-of safety and quality issues.

Funded by the Agency for Healthcare Research & Quality in partnership with Premier Inc., the Department of Defense, and the American Hospital Association, the Hospital Survey on Patient Safety Culture was developed by Westat of Rockville, Md., and pilot-tested this past year in 21 U.S. hospitals.

In addition, the survey measures three hospital-level aspects of safety culture: hospital management support for patient safety (three items), teamwork across hospital units (four items), and hospital handoffs and transitions (four items).

Finally, four outcome variables are included: overall perceptions of safety (four items), frequency of event reporting (three items), patient safety grade (of the hospital unit) (one item), and number of events reported (one item).

The survey is paper-based, but is adaptable for Web use, can be modified to meet each hospital's specific needs, and may be used systemwide or within targeted departments.

Indian River Memorial Hospital in Vero Beach, Fla., conducted the survey among 1,200 staff-both clinical and nonclinical-via a Web-based version on the hospital intranet. All the directors received the survey results and could then go in and break it down by departments.

In the pharmacy department, nine pharmacists and 10 other pharmacy staff participated on a voluntary basis. Se Choi, Pharm.D., director of pharmacy services, found the survey to be "a very good tool."

Explaining how the survey was beneficial, Choi pointed specifically to the communications section and Question 1: We are given feedback about changes put into place based on event reports. She said four employees responded very negatively on that, so the hospital obtained a score of 3.3 (on a scale of 1 to 5). "That's low; we should be higher." And as regards Question 4: Staff feel free to question the decisions or actions of those with more authority, she said, "We had eight pharmacy staff state they didn't feel they could question the decision-that's not the culture I want. Everybody should be able to question or enter some issues. So although I don't know who gave the low scores, there is definitely a need for improvement. So these are very useful and powerful data that we can actually work at improving."

The survey was completed in the fall, and Choi has already taken steps to put the data to use. Indian River plans to redo the survey after one year, and Choi looks forward to seeing how these new initiatives will affect responses in the follow-up.