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Pharmacy Survey on Patient Safety Culture

Survey Development

Patient safety culture can be defined as the set of values, beliefs, and norms about what is important, how to behave, and what attitudes are appropriate when it comes to patient safety in a workgroup or organization. The Pharmacy Survey on Patient Safety Culture is intended to help a pharmacy assess the extent to which its culture emphasizes the importance of patient safety. It is the fourth survey AHRQ has produced on patient safety culture. Previously developed surveys address patient safety culture in hospitals, nursing homes, and medical offices. The surveys are available online at

The survey design team conducted a review of the literature on patient and medication safety in pharmacies, interviewed more than two dozen pharmacy experts and researchers, identified appropriate survey topics, and drafted survey items for review by a technical expert panel. The draft survey was cognitively tested with pharmacy staff to ensure that the questions were easy to understand and answer, and that the items were relevant.

In 2012, a pilot administration was conducted with 60 pharmacies and 496 staff throughout the United States. Of the 60 pharmacies, only 55 included responses from at least five staff and therefore were included in the results in this report. The pilot data were analyzed to examine the survey’s psychometric properties (reliability and factor structure), with the end goal of shortening the pilot survey, including only the best items.

The final survey includes 36 survey items that measure the 11 areas of organizational culture pertaining to patient safety described in Table 1. The survey uses either 5-point agreement scales (“Strongly disagree” to “Strongly agree”) or frequency scales (“Never” to “Always”). Items include a “Does not apply or Don’t know” option.

The survey also includes three questions that ask respondents to rate the frequency with which mistakes are documented and one question that provides an overall rating on patient safety. 

Table 1. Patient Safety Culture Composites and Definitions

Patient Safety Culture Composite Definition: The extent to which…
Communication About Mistakes Staff discuss mistakes that happen and talk about ways to prevent mistakes
Communication About Prescriptions Across Shifts Information about prescriptions is communicated well across shifts, and there are clear expectations and procedures for doing so
Communication Openness Staff freely speak up about patient safety concerns and feel comfortable asking questions, and staff suggestions are valued
Organizational Learning—Continuous Improvement The pharmacy tries to figure out what problems in the work process lead to mistakes and makes changes to keep mistakes from happening again
Overall Perceptions of Patient Safety There is a strong focus and emphasis on patient safety, and the pharmacy is good at preventing mistakes
Patient Counseling Patients are encouraged to talk to the pharmacist; pharmacists spend enough time talking to patients and tell them important information about new prescriptions
Physical Space and Environment The pharmacy is well organized and free of clutter, and the pharmacy layout supports good workflow
Response to Mistakes The pharmacy examines why mistakes happen and helps staff learn from mistakes, and staff are treated fairly when they make mistakes
Staff Training and Skills Staff get the training they need, new staff receive orientation, and staff have the skills they need to do their jobs well
Staffing, Work Pressure, & Pace There are enough staff to handle the workload, staff do not feel rushed, staff can take breaks, and work can be completed accurately despite distractions
Teamwork Staff treat each other with respect, work together as an effective team, and understand their roles and responsibilities

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Page last reviewed September 2012
Page originally created September 2012
Internet Citation: Survey Development. Content last reviewed September 2012. Agency for Healthcare Research and Quality, Rockville, MD.


The information on this page is archived and provided for reference purposes only.


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