A safety culture survey

Figure 11.1 is a basic example of a safety culture survey. More sophisticated and elaborate models are available. 

FIGURE 11.1 A baseline audit and a safety culture survey help in formulating safety goals. 

In order to identify areas of organisational culture that could be targeted to improve patient safety in Scottish hospitals, a safety culture survey was conducted. The aims of the study were first, to obtain a measure of safety culture from a sample of NHS acute hospitals in Scotland and then to test whether these culture scores were associated with clinical workers safety behaviours and patient and worker injuries. This would also provide a measure of safety culture within the Scottish acute hospital sector and contribute an organisational cultural perspective to the... 

The first is a horizontal review. This review is comprised of a safety culture survey that is sent out to staff with a set of top level questions that determines how they view safety and how they think the company views safety (in words and in deeds). This can be thought of as a 60,000 foot view of the safety of an organization. It will give overall attitudes toward safety illustrating a topological map of safety culture, a lot of general views but not sufficiently detailed for further action. That is done in the next step. 

The principle of safety definition states that the basic or root causes must be identified before a remedy is prescribed. Safety culture and climate surveys can assist in determining the strengths and weaknesses of a safety culture and help identify the basic causes of a less than acceptable culture. Once the problems have been identified, actions can then be effectively taken. 

A total of 987 questioimaires were distributed to 44 randomly selected vessels, of which 41 vessels returned atotal of768 completed questionnaires. This gives a vessel response rate of 93% and an individual response rate of 78%. AU vessels were flying a flag listed on the Paris MOU white or grey Ust. This survey forms part of a major safety culture survey carried out in 2006, performed with a vaUdated instrument (Oltedal, Engen, 2008). 

In this section, results obtained in a case study (Itoh and Andersen 2008, 2010) will be reviewed to illustrate the contribution of safety culture to safety outcome. In a case study, a questioimaire-based survey concerning staff reactions after the adverse event introduced in the last section, was conducted in addition to the safety culture survey. At the same time, incident reports for three years (2004-06) submitted by nurses were obtained from one of the hospitals (Hospital M) that participated in the safety culture survey. Hospital M was a private, acute-type general hospital, located in Tokyo. This hospital covered almost all clinical specialties and, at the time of the survey in 2006, it had about 500 inpatient beds, 160 full-time doctors and 360 full-time nurses. Nurses belonged to any one of 18 clinical work units 14 inpatient wards, an outpatient clinic, operating room, kidney centre, and medical examination unit. 

Research has been carried out to test the psychometric properties of the Safety Attitudes Questionnaire and AHRQ Hospital Safety Culture Survey (Nieva and Sorra 2003 Sexton et al. 2006 Sorra and Nieva 2004). However, there have been important misapplications of survey tools in healthcare. A proliferation of climate surveys now exist, including many where the factor stmcture and construct validity have not been tested. Many hospitals have developed their own bespoke survey tools and these are poorly designed because basic survey design rules have not been followed. One common issue is surveys that do not counter-balance positive and negative statements, thus increasing the risk of response set bias where the... 

Safety as a shared value -Employee perceptions of management safety commitment -Management perceptions of employee safety commitment -Persoimel s reported safety attitudes in safety culture surveys -Management raising safety issues in their t s... 

Hellings, J., Schrooten, W., Klazinga, N. and Vleugels, A. 2007. Challenging patient safety culture Survey resrrlts. International Journal of Health Care Quality Assurance, 20(7), 620-32. 

Kundig, F., Staines, A., Kinge, T. and Pemeger, T.V. 2011. Numbering questionnaites had no impact on the response rate and only a slight influence on the response content of a patient safety culture survey A randomized trial. Journal of Clinical Epidemiology, 64(11), 1262-5. 

Despite the great data and information that are now available as a result of the Hospital SOPS database, one big deficit has been in our understanding of what hospitals are doing between their patient safety culture survey assessments. What initiatives are hospitals implementing How successful are those initiatives in improving patient safety culture and, ultimately, patient safety ... 

An early criticism of patient safety culture survey data was that there was not sufficient evidence that culture was related to medical error, patient safety or quality or patient outcomes. There are still very few empirical studies linking the Hospital SOPS to these important outcomes and many more studies are needed. However, there have been a few key studies showing positive relationships between Hospital SOPS scores and outcomes. 

Experience has shown that a long list of detailed prescriptive recommendations is less effective than a shorter list of goal-oriented recommendations with suggested means of implementation. Typically, some are short term (months) and others are longer term (years). These means of implementation usually arise in the woikshops and from good practice noted in comparable enviromnents, either within the ANSP or in other ANSPs. The recommendations are not mandatory, since the safety culture surveys are not a mandatory or regulatory exercise. 

The Hospital Survey on Patient Safety Culture examines patient safety culture from a hospital staff perspective and allows hospitals to assess their safety culture and track changes over time. Hospitals that administer the patient safety culture survey can voluntarily submit their data to the Comparative Database, a resource for hospitals wishing to compare their survey results to similar types of hospitals (AHRQ Publication No. 04-0041). 

Safety culture surveys were mentioned earher and can be used to gauge perceptions, attitudes and values. Introducing change may need methods of facilitation where people s existing perceptions, attitudes and values can be opened up and examined in a supportive envirorunent. The new or altered paradigm (set of values, attitudes and beliefs) can then be introduced. The third step is to gain adoption and ownership of the new paradigm and lock it in. 

The authors would like to offer one caution here. This survey does not constitute a safety culture. You cannot implement inspections into a culture. These inspections are only to identify issues/hazards that you must fix to enhance your culture. 

Safety percephon surveys are an important tool used to ask queshons that employees can answer anonymously and in conhdence. They provide the ability to measure the answers to questions and summarize responses. They can provide a stahshcal validation of the perceptions of employees about the safety culture. Surveys must be carefully selected and structured to prevent personal bias and a skewing of the responses. 

---