The AHRQ Surveys on Patient Safety Culture Setting the Standard for Patient Safety Culture Around the Globe AHRQ Annual

1. The AHRQ Surveys on Patient Safety Culture Setting the Standard for Patient Safety Culture Around the Globe AHRQ Annual Meeting September 19, 2011 Joann Sorra, Ph.D Senior Study Director Westat joannsorra@westat.com

2. Objectives • Define patient safety culture • Discuss reasons to assess patient safety culture • Discuss international use of the AHRQ Surveys on Patient Safety Culture

3. What is Patient Safety Culture? “The way we do things around here” Exists at multiple levels: System Organization Department Unit Shared by staff Beliefs, values & norms What is • Rewarded • Supported • Expected

4. AHRQ SOPS Surveys • Assess provider & staff opinions about patient safety culture in • Hospitals (2004) • Nursing homes (2008) • Medical offices (2009) • Retail pharmacies (Expected Summer 2012)

5. Dimensions Assessed • Teamwork • Staffing • Training • Handoffs • Communication • Organizational learning • Management support for patient safety • Nonpunitive response to mistakes • Overall perceptions of patient safety

6. Why Assess Patient Safety Culture? • Raise staff awareness • Diagnose & assess the status of patient safety culture • Identify strengths & areas for improvement • Evaluate the impact of patient safety initiatives • Examine trends & track change over time • Satisfy directives or regulatory requirements • Compare with other organizations

7. Free Toolkit Materials • User’s guide • Survey feedback report PPT template • Resource list of patient safety initiatives • Reference list (coming soon—includes international publications) • Data entry & analysis tool • Comparative database reports • Research data sets (for de-identifiable data) • Translation guidelines • International users contact the User Network • To connect with other international users • Obtain information about existing translations www.ahrq.gov/qual/patientsafetyculture

8. 41 Countries 41 Countries

9. 41 Countries

10. 22 Languages

11. International Initiatives • The European Network for Patient Safety (EUNetPaS) • World Health Organization (WHO) High 5s Patient Safety Initiative • Other regional collaboratives

12. EUNetPaS • 78% of EU citizens consider medical errors to be an important issue in their country • Officially launched in 2008 in Utrecht, Netherlands • Aims to establish an umbrella network of all 27 EU Member States to encourage collaboration in patient safety

13. EUNetPaS Goals • Establish common principles at the EU level • Integrating knowledge, experiences and expertise from Member States • Facilitate the development of patient safety programs in Member States • Support countries less advanced in patient safety

14. Key Topic Areas • Promoting a culture of patient safety • Structuring education and training in patient safety in Member States • Proposing a core European curricula for patient safety in higher education • Implementing reporting and learning systems • Piloting the implementation of medication safety programs in hospitals

15. AHRQ Survey Endorsement • EUNetPaS published a two-volume report in 2010 reviewing patient safety culture instruments • AHRQ Hospital SOPS—One of only 3 patient safety culture instruments officially recommended after an extensive review of available tools

16. WHO High 5s • Launched in 2006 to reduce the frequency of 5 challenging patient safety problems in 5 countries over 5 years • Focus has been on 3 initiatives • Medication reconciliation at transitions in care • Performing correct site surgery • Managing concentrated injectable medicines • Seven countries • UK, France, Netherlands, Germany, Singapore , Australia & Canada

17. High 5s & HSOPS • Administered the HSOPS in 2009 and 2010 • 23,520 respondents from 59 hospitals in 6 countries • Produced feedback reports • For participating hospitals, countries, and an international comparative report • Hope to examine relationships between patient safety culture and implementation of the High 5s patient safety initiatives

18. Other Regional Collaboratives • Middle East Regional Network For Patient Safety Culture & Human Factors • Egypt, Jordan, Kuwait, Libya, Qatar, Saudi Arabia, United Arab Emirates • Over 20 researchers and representatives from hospitals and health systems • Goals: Obtain WHO & AHRQ support; hold regional meetings; establish a patient safety culture database for comparative purposes; adopt standard Arabic translations of the AHRQ SOPS surveys • PaSCAL—Patient Safety Culture Alliance in Italy • Organized by the European Institute of Oncology (InstitutoEuropeodiOncologia--IEO) • 23 participating hospitals • Held a Quality Week conference in November 2010

19. International Comparisons The general finding: • The U.S. typically scores higher on most dimensions • Notable exceptions where other countries have much higher scores than the U.S.

20. Challenges of International Comparisons • Quality and comparability of translations • Translations have shown variable psychometric properties (factor structure & reliability) • Differences in the structure and delivery of healthcare • Cultural influences on how respondents interpret and answer survey questions

21. AHRQ SOPS: Setting the Standard • 2011 Hospital SOPS Comparative Database Report • 1,032 hospitals and 472,397 staff • Largest non-proprietary, free in the public domain, patient safety culture database in the world • The Nursing Home and Medical Office SOPS surveys are likely to follow • NH SOPS Database report released August 2012 • MO SOPS Database open for data submission through Oct ober15—Report available Spring 2012

22. Email: safetyculturesurveys@ahrq.hhs.gov joannsorra@westat.com