Chapter 1. Introduction
Hospital Survey on Patient Safety Culture: 2010 User Comparative Database
Patient safety is a critical component of health care quality. As health care organizations continually strive to improve, there is growing recognition of the importance of establishing a culture of patient safety. Achieving a culture of patient safety requires an understanding of the values, beliefs, and norms about what is important in an organization and what attitudes and behaviors related to patient safety are supported, rewarded, and expected.
Development of the Survey
Recognizing the need for a measurement tool to assess the culture of patient safety in health care organizations, the Medical Errors Workgroup of the Quality Interagency Coordination Task Force (QuIC) sponsored the development of a hospital survey focusing on patient safety culture. The Agency for Healthcare Research and Quality (AHRQ) funded and supervised development of the Hospital Survey on Patient Safety Culture (hospital survey). Developers reviewed research pertaining to safety, patient safety, error and accidents, and error reporting. They also examined existing published and unpublished safety culture assessment tools. In addition, hospital employees and administrators were interviewed to identify key patient safety and error-reporting issues.
The survey was pilot tested and revised and then released by AHRQ in November 2004. It was designed to assess hospital staff opinions about patient safety issues, medical error, and event reporting and includes 42 items that measure 12 areas or composites of patient safety culture. Each of the 12 patient safety culture composites is listed and defined in Table 1-1.
The survey also includes two questions that ask respondents to provide an overall grade on patient safety for their work area/unit and to indicate the number of events they have reported over the past 12 months. In addition, respondents are asked to provide limited background demographic information about themselves (their work area/unit, staff position, whether they have direct interaction with patients, etc). The survey's toolkit materials are available at the AHRQ Web site (http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html) and include the survey, survey items and dimensions, user's guide, feedback report template, information about acquiring the Microsoft Excel™ Data Entry and Analysis Tool, an article about safety culture assessment, and a series of three national technical assistance conference calls. The toolkit provides hospitals with the basic knowledge and tools needed to conduct a patient safety culture assessment and ideas regarding how to use the data.
The 2010 Comparative Database and Report
Since its release, the hospital survey has been widely implemented across the United States. Hospitals administering the survey have expressed interest in comparing their results with other hospitals as an additional source of information to help them identify areas of strength and areas for improvement. In response to these requests, AHRQ funded the Hospital Survey on Patient Safety Culture Comparative Database to enable hospitals to compare their most recent survey results with other hospitals and to examine trends in patient safety culture over time. Hospitals interested in submitting to the database should go to the AHRQ Web site for more information (http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/y2dbsubmission.html).
What's New in the 2010 User Comparative Database Report?
The Hospital Survey on Patient Safety Culture 2010 User Comparative Database Report is an update of the 2009 report, presenting the most current survey data and trending data available. The 2010 report includes 321 trending hospitals that submitted data to the comparative database more than once, which provides substantially more data to analyze trends in patient safety culture over time. On average, hospitals show small increases in the patient safety culture composites and survey items over time. The average increase in composite scores across the 321 trending hospitals is 2 percent (ranging from 1 percent to 3 percent). In addition, the 2010 report contains questionnaire data on actions taken by 292 trending hospitals to improve patient safety culture.
In addition, we enacted several new rules regarding a minimum number of responses for calculating the percent positive scores. First, we only calculated percent positive scores for hospitals that had at least 10 completed surveys. Second, item-level results were only calculated when there were at least three responses to the item. If a hospital had fewer than three responses to a survey item, the hospital's score for that item was set to missing. Third, if a hospital had fewer than five respondents in a breakout category (e.g., work area/unit, staff position, direct interaction with patients), no statistics were calculated for that breakout category (i.e., all scores were set to missing). These minimums also apply to the statistics displayed in Appendixes B and D (results by respondent characteristics).
The survey results presented in this report represent the largest compilation of hospital survey data currently available and therefore provide a useful reference for comparison. However, there are several limitations to these data that should be kept in mind.
First, the hospitals that submitted data to the database are not a statistically selected sample of all U.S. hospitals. Only hospitals that administered the survey on their own and were willing to submit their data for inclusion in the database are represented. However, the characteristics of the database hospitals are fairly consistent with the distribution of U.S. hospitals registered with the American Hospital Association (AHA) and are described further in Chapter 3.
Second, hospitals that administered the survey were not required to undergo any training and administered it in different ways. Some hospitals used a paper-only survey, others used Web-only surveys, and others used a combination of these two methods to collect the data. It is possible that these different modes could lead to differences in survey responses; further research is needed to determine whether mode of administration affects the results.
In addition, some hospitals conducted a census, surveying all hospital staff, while others administered the survey to a sample of staff. In cases in which a sample was drawn, no data were obtained to determine the methodology used to draw the sample. Survey administration statistics that were obtained about the database hospitals, such as survey administration modes and response rates, are provided in Chapter 2.
Finally, the data hospitals submitted have been cleaned for out-of-range values (e.g., invalid response values due to data entry errors) and blank records (where responses to all survey items were missing). In addition, some logic checks were made. Otherwise, data are presented as submitted. No additional attempts were made to verify or audit the accuracy of the data submitted.