Assessing Patient Safety Practices and Outcomes in the U.S. Health Care System

By Donna O. Farley; M. Susan Ridgely et al. | Go to book overview

CHAPTER 3.
USE OF THE HOSPITAL SURVEY ON PATIENT SAFETY CULTURE

SPECIFIC AIMS
One of the major tools that AHRQ developed to help health care providers improve their patient safety culture and practices is the Survey on Patient Safety Culture (SOPS). The first survey developed was the Hospital Survey on Patient Safety Culture (HSOPS). We gathered and assessed information on hospitals’ experiences to achieve the following aims:
1. To develop information on hospitals’ motivation and experiences in using the HSOPS
2. To understand the extent to which the HSOPS has contributed to hospitals’ patient safety efforts
3. To provide feedback to AHRQ on how it might modify the survey questionnaire or technical support to enhance the usefulness of HSOPS to hospitals and other users.

As described in Chapter 1, this part of our product evaluation work focuses on one of the major patient safety tools developed by AHRQ to furnish resources to providers as they work to achieve safer health care for their patients. We limited this analysis to only one tool—the HSOPS—because of budget limitations. However, we suggest that AHRQ undertake similar inquiries with users of other key tools it develops (e.g., TeamSTEPPS), both to document how the tools are contributing to improving safe practices in the field and to obtain feedback from users for improving the tools.


THE SURVEY QUESTIONNAIRE AND PROTOCOL

Early in the patient safety initiative, Quality Interagency Coordination Task Force sponsored the development of the AHRQ-funded HSOPS to provide hospitals a measurement tool to help them assess how well their cultures emphasize patient safety, as well as to facilitate open discussion of error, encourage error reporting, and create an atmosphere of continuous learning and improvement. The survey contains 51 questions that combine into composites that assess 12 dimensions of patient safety culture: communication openness, feedback and communication about error, frequency of events reported, handoffs and transitions, management support for patient safety, nonpunitive response to error, organizational learning/continuous improvement, overall perceptions of patient safety, staffing, supervisor/manager expectations and actions promoting safety, teamwork across units, and teamwork within units.

AHRQ partnered with the American Hospital Association, Department of Defense, and Premier Health Systems to support initial release of the HSOPS in 2004 to U.S. hospitals and health care systems. A growing number of hospitals are using the culture survey. Feedback from these hospitals suggests that the dimensions measured on the survey are relevant at the operational level, and are being used for quality-improvement work. However, quantified data are not yet available to verify this assessment.

AHRQ contracted with Westat to build and manage a benchmark database, into which hospitals can submit their survey data and obtain information on how they compare with others. Westat produces annual reports summarizing the HSOPS data submitted by hospitals to the benchmarking database. These reports provide information segmented in a variety of ways, including hospital characteristics (e.g., bed size, teaching status, region), as well as by

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