1. 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

2. Objectives Purpose of the Survey Options Frequency of Surveys
Benefits of Survey
Pitfalls & Challenges
Helpful Hints

3. Purpose of the Survey 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

4. Positive Patient Safety Culture (PSC)
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.

5. 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 , EP 1)
Leap Frog Survey
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

6. Options for Surveys The AHRQ Offers 4 Surveys Bryan Sexton
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!
Bryan Sexton
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
questionnaire/
safety/patientsafetyculture/index.html

8. 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
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9. AHRQ 12 Domains

11. Safety Attitudes Questionnaire
2 Major Domains
Safety Climate
Teamwork Climate
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:
Job Satisfaction (5 items)
Perceptions of Management (4 items)
Teamwork (6 items)
Safety Climate (7 items)
Working Conditions (4 items)
Stress Recognition (4 items)

12. 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 s/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

13. Timeline

14. 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 ed 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
Please take a few moments and share your perceptions and thank you for your help - our patient safety depends on it.
Sincerely,
President

15. At a minimum every 2 years
Frequency of Surveys
At a minimum every 2 years
Items to Consider:
Assess operations and leadership changes

16. Benefits of Survey 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

17. Pitfalls & Challenges Too Many Surveys – Survey Fatigue
Employee Satisfaction, Focus Groups, Etc.
Failure to Recognize the Value
Make results available ASAP
Newsletters, Meetings,
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

18. 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

19. 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

20. Useful Links
AHRQ
patient-safety/patientsafetyculture/index.html
SAQ
attitudes-and-safety-climate-questionnaire/
Pascal Metrics
The Patient Safety Group cfm

21. https://nnepatientsafety.org/

22. Questions…Comments…Ideas