1. 1 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

2. 2 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)

3. 3 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  www.ahrq.gov/qual/hospculture

4. 4 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

5. 5 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

6. 6 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%

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

8. 8 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

9. 9 Hospital Strengths & Areas for Improvement

10. 10 Patient Safety Grade

11. 11 Number of Events Reported

12. 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

13. 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. 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%)

14. 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/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%

15. 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

16. 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

17. 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

18. 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 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

19. 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.

20. 20 International HSOPS Users 24 countries - Australia - Malta - Bahrain - Netherlands - Belgium - Norway - Brazil - Saudi Arabia - Canada - Scotland - Denmark - Serbia - El Salvador - Spain - France - Sweden - Germany - Switzerland - Greece - Taiwan - Ireland - Turkey - Italy - United Kingdom

21. 21 Questions? DatabasesOnSafetyCulture@ahrq.hhs.gov SafetyCultureSurveys@ahrq.hhs.gov