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Results from the AHRQ Hospital Survey on Patient Safety Culture (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 10, 2008, Joann Sorra, Ph.D., made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (250 KB).

Slide 1

Results from the AHRQ Hospital Survey on Patient Safety Culture

Joann Sorra, Ph.D.
Westat

AHRQ Annual Conference 2008:
Promoting Quality...Partnering for Change
September 2008
Bethesda, MD

Westat
1650 Research Blvd.
Rockville, MD 20850
joannsorra@westat.com
301-294-3933

Slide 2

Objectives

Present results from the AHRQ Hospital Survey on Patient Safety Culture.
Discuss future activities and long-term AHRQ support for the Surveys on Patient Safety (SOPS).

Slide 3

Background

Hospital Survey on Patient Safety Culture (HSOPS).
Developed by Westat, funded by AHRQ.
Survey development process:
- Reviewed literature & existing surveys.
- Interviewed hospital staff.
- Identified key areas of safety culture.
- Developed survey items & pretested.
- Obtained input from researchers & stakeholders.
- Pilot tested in 21 hospitals with 1,437 respondents.
Final survey released November 2004.
http://www.ahrq.gov/qual/hospculture

Slide 4

HSOPS Patient Safety Culture Dimensions

42 items assess 12 dimensions of patient safety culture:
1. Communication openness.
2. Feedback & communication about error.
3. Frequency of event reporting.
4. Handoffs & transitions.
5. Management support for patient safety.
6. Nonpunitive response to error.
7. Organizational learning—continuous improvement.
8. Overall perceptions of patient safety.
9. Staffing.
10. Supv/mgr expectations & actions promoting patient safety.
11. Teamwork across units.
12. Teamwork within units.
Patient safety "grade" (Excellent to Poor).
Number of events reported in past 12 months.

Slide 5

HSOPS Comparative Database

AHRQ has funded an HSOPS comparative database:
- Annual reports (2007 & 2008)
  http://www.ahrq.gov/qual/hospsurvey08/.
Purposes:
- Comparison—of survey results in efforts to establish, improve and maintain a culture of patient safety.
- Assessment and Learning—in patient safety improvement process (rather than basis for determining punitive actions or external judgment of hospital performance).
- Supplemental Information—to help hospitals identify strengths and areas with potential for patient safety culture improvement.

Slide 6

2008 HSOPS Comparative Database

519 U.S. hospitals, 160,176 respondents:
- Average # respondents per hospital = 309 staff.
Survey administration:
- Paper: 48%.
- Web: 27%.
- Both: 25%.
Average hospital response rate = 54%:
- Paper: 60%.
- Web: 44%.
- Both: 52%.

Slide 7

Work Areas

Surgery: 10% (14,327).
Medicine: 9%.
Many areas/no specific area: 9%.
ICU: 7%.
Radiology: 6%.
Emergency: 5%.
Lab: 5%.

Slide 8

Staff Positions & Patient Contact

Nursing: 36% (55,119).
Technicians (EKG, Lab, Radiology, etc.): 11%.
Management, administration: 7%.
Physicians, PAs, NPs: 5%.
Pharmacists: 2%.
77% had direct interaction with patients.

Slide 9

Hospital Strength and Areas for Improvement

Screen shot of a bar graph with the following data:

Teamwork Within Units: 79%.
Supervisor/Mgr Support for Patient Safety: 75%.
Management Support for Patient Safety: 70%.
Org Learning—Continuous Improvement: 70%.
Teamwork Across Units: 57%.
Staffing: 55%.
Handoffs & Transitions: 45%.
Nonpunitive Response to Error: 44%.

Slide 10

Patient Safety Grade

Bar Graph showing grade scale of 0% to 100%

A–Excellent: 24%.
B–Very Good: 48%.
C–Acceptable: 23%.
D–Poor: 4%.
E–Failing: 1%.

Slide 11

Number of Events Reported

Bar Graph showing grade scale of 0% to 100%

None: 52%.
1–2: 28%.
3–5: 13%.
6–10: 5%.
11–20: 2%.
21 or more: 1%.

Slide 12

Results by Hospital Characteristics

Smaller hospitals (49 beds or fewer) scored highest on all dimensions of safety culture.
Smallest hospitals (6–24 beds) 21% more positive on Handoffs & Transitions than largest hospitals (400+ beds):
- 56% positive vs. 35%.
No differences teaching vs. non-teaching.
Government hospitals scored higher than non-govt on:
- Handoffs & Transitions.
- Staffing.
- Teamwork Across Units.

Slide 13

Results by Work Area

Rehabilitation scored highest on 9 of 12 dimensions of safety culture.
Largest differences by work area/unit:
- Overall perceptions of patient safety (% positive):
  Rehab 76% vs. intensive care unit (ICU) & Medicine 55%.
- Patient safety grade (% "Excellent" or "Very good"):
  Rehab 82% vs. Emergency & Medicine 62%.
ICUs had highest % error reporting (68%) vs. Anesthesiology & Rehab (43%).

Slide 14

Results by Staff Position

Administration/Mgmt scored highest on 11 of 12 dimensions of safety culture.
Patient safety grade (% "Excellent" or "Very good"):
- Admin/Mgmt 82% vs. Registered Nurse/Licensed Vocational Nurse/Licensed Practical Nurse (LVN/LPN) 67%.
Number of events reported (reported 1 or more events in past 12 months):
- Pharmacists 78% vs. Unit assts/clerks/secretaries 23%.
- Direct patient contact 53% vs. No direct contact 32%.

Slide 15

98 Trending Hospitals

Average time between surveys 14 months.
Average change on dimensions was +2%.
Biggest increase:
- 44% of trending hospitals had increase +5% on Patient Safety Grade.
38% of trending hospitals had +5% on:
- Overall perceptions of patient safety.
- Frequency & number of events reported.
- Nonpunitive response to error.
Biggest decrease:
- 27% of trending hospitals had -5% on Staffing.

Slide 16

Actions Taken By Trending Hospitals

Shared survey results:
- 79% shared with staff; 62% with board of directors; 54% with physicians.
79% had implemented more than 1 action.
49% or more hospitals implemented:
- Training.
- Changes in policies or procedures.
- Patient safety walkarounds.
- SBAR communication (situation-background-assessment-recommendation).
Other actions:
- Yearly patient safety fairs.
- Patient safety bulletin boards & newsletters.
- Root cause analyses.

Slide 17

Future Activities

New Medical Office and Nursing Home surveys on patient safety culture:
- Same development steps as HSOPS.
- Pilot tested in 202 medical offices & 40 nursing homes.
- Toolkit materials similar to HSOPS:
  - Survey Administration User's Guides.
  - Preliminary Comparative Results from Pilot Tests.
  - Microsoft Excel Data Entry & Reporting Tools.
  - PowerPoint Survey Feedback Templates.
Comparative databases in 2010:
- Voluntary data submission.
- Free comparative report.

Slide 18

Long-term AHRQ Support for SOPS

AHRQ will support all 3 surveys for next 4 years.
Three, in-person SOPS User Group Meetings:
- Combined with Consumer Assessment of Healthcare Providers and Systems (CAHPS®) User Group Meeting.
- Free registration.
- December 4-5, 2008 in Scottsdale AZ.
- April 2010 in Baltimore MD.
Free technical assistance & national conference calls.
SOPS user network.
Gathering information about interventions being implementing to address areas for improvement.

Slide 19

International HSOPS Users

International Hospital SOPS comparative database.
Focus on countries participating in the World Health Organization's (WHO) High 5s Patient Safety Initiative: http://www.who.int/patientsafety/solutions/high5s/en/index.html:
- Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the U.S.

Slide 20

International HSOPS Users

24 countries

Australia.
Bahrain.
Belgium.
Brazil.
Canada.
Denmark.
El Salvador.
France.
Germany.
Greece.
Ireland.
Italy.
Malta.
Netherlands.
Norway.
Saudi Arabia.
Scotland.
Serbia.
Spain.
Sweden.
Switzerland.
Taiwan
Turkey.
United Kingdom.

Slide 21

Questions?

DatabasesOnSafetyCulture@ahrq.hhs.gov
SafetyCultureSurveys@ahrq.hhs.gov

Current as of February 2009

Internet Citation:

Results from the AHRQ Hospital Survey on Patient Safety Culture. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). February 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualmtg08/091008slides/Sorra.htm