No Slide Title

							    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
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                    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)




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                         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



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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
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             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


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        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%


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                 Work Areas

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




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        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




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      Hospital Strengths & Areas for Improvement
 1. Teamwork Within Units                                 79%

 2. Supervisor/Mgr Support for Patient Safety            75%

 3. Management Support for Patient Safety               70%

 4. Org Learning--Continuous Improvement                70%



 9. Teamwork Across Units                         57%

10. Staffing                                      55%

11. Handoffs & Transitions                      45%

12. Nonpunitive Response to Error               44%


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                   Patient Safety Grade

100%


80%


60%
                      48%

40%
          24%                  23%
20%
                                          4%
                                                   1%
 0%
          A            B         C         D        E
       Excellent   Very Good Acceptable   Poor   Failing



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        Number of Events Reported

100%


80%


60%    52%


40%
               28%

20%                    13%
                                 5%
                                            2%       1%
 0%
       None   1 to 2   3 to 5   6 to 10   11 to 20   21 or
                                                     more



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         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




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                 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%)


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               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%




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                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
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     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

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              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
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       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
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               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.



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           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
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             Questions?




DatabasesOnSafetyCulture@ahrq.hhs.gov

  SafetyCultureSurveys@ahrq.hhs.gov




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