Chapter 1. Introduction
2008 Comparative Database Report
Patient safety is a critical component of healthcare quality. As healthcare organizations continually strive to improve, there is a 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. Funded by the Agency for Healthcare Research and Quality (AHRQ), the Hospital Survey on Patient Safety Culture was developed under contract by Westat, a private research organization. To develop this patient safety culture assessment tool, a review of research pertaining to safety, patient safety, error and accidents, and error reporting was conducted, as well as an examination of existing published and unpublished safety culture assessment tools.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, 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 from the AHRQ Web site (https://archive.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/index.html) and include the survey, a survey administration user's guide, a survey feedback report template, an article about safety culture assessment, and several conference call presentations providing additional information about the survey. 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 2008 Comparative Database and Report
Since its release, the Hospital Survey on Patient Safety Culture has been widely implemented across the U.S. Hospitals administering the survey have expressed interest in comparing their survey results against other hospitals as an additional source of information to help them identify areas of strength and areas for improvement in patient safety culture. 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 against 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 ((https://archive.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/index.html).
The survey results presented in this report represent the largest compilation of data from the Hospital Survey on Patient Safety Culture 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 since 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, 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 if there are mode effects that affect 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, while the data submitted by hospitals 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), as well as some logic checks, we have otherwise presented the data as submitted. We have not made any additional attempts to verify or audit the accuracy of the data submitted by the hospitals.