Results from the AHRQ Hospital Survey on Patient Safety Culture Joann Sorra, Ph.D. Westat

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. 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) Objectives

3. 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 Background

4. 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 HSOPS Patient Safety Culture Dimensions

5. 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 HSOPS Comparative Database

6. 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% 2008 HSOPS Comparative Database

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

8. 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 Staff Positions & Patient Contact

9. Hospital Strengths & Areas for Improvement

10. Patient Safety Grade

11. Number of Events Reported

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. 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. 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. 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 98 Trending Hospitals

16. 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 Actions Taken by Trending Hospitals

17. 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 Future Activities

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. 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. International HSOPS Users

20. 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 International HSOPS Users

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