Culture survey assessments

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 ... 

Once hospitals use the survey to identify areas for improvement, their next step is to work out what they can do, what actions they can take, to improve patient safety culture. A resource list describing dozens of patient safety initiatives is available to survey users on the AHRQ web site, but hospitals still have to identify what will be effective and which initiatives are likely to be successful in their facilities. For the Hospital SOPS 2011 Comparative Database (Sorra et al. 2008), we asked 456 trending hospitals what types of patient safety initiatives they had implemented between survey assessments. The top five initiatives are shown in Table 12.2. 

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). 

The 20 questions included in Figure 15.11 were selected from the actively caring person scale of our Safety Culture Survey. Each of the five actively caring states discussed in this chapter is assessed. There are only four questions per state, so this should not be considered a reliable nor a valid measure of these factors. In other words, do not read too much into this survey. Just respond to each query according to the instructions and then check the answer key in Figure 15.12 to increase your imderstanding of the five actively caring person states. 

The impact of an intervention can be measured by comparing perception surveys given before and after implementation. At one plant, our baseline Safety Culture Survey indicated that secretaries had below-average levels of perceived empowerment, as assessed by the measures of self-efficacy, personal control, and learned optimism described earlier in Chapter 15. A special recognition intervention was devised and later the survey was administered again to measure changes in the five actively caring person states as well as safety perceptions and attitudes. 

Based on our assessment, we recommended that the culture change initiative build on the strengths identified in the safety climate and culture survey. NASA employees generally worked well as teams, liked and respected each other, and felt comfortable talking to peers. These strengths could be harnessed to create reinforcement mechanisms for behaviors that support the agency s values and desired culture. 

Generation of data on the nutrient content of agricultural products and foods forms the basis for estimating nutrient intakes of populations via dietary surveys, nutritional labelling for consumer protection, nutrition education for consumer food choice, home and institution menu planning and food purchase, and for research in nutrient requirements and metabolism, toxicant chemical composition is used to assess effects of farm management practices, crop culture, and food processing on chemical content and implications for human health. 

Lahanier et al. Cited in Janssens K (2005) A survey of the recent use of X-ray beam methods for non-destructive investigations in the cultural heritage sector, Cultural Heritage Conservation and Environment Impact Assessment by Non-Destructive Testing and Micro-analysis, Van Grieken R, Janssens K (Eds) AA Balkema Publishers, London, pp. 265-308. 

Headwork starts with the online self-assessment tool, the Global Diversity Survey, taken as prework, followed with coverage of the dimensions of diversity and culture as well as of the business case for diversity and inclusion. 

Nearly all tests used for assessing the children s mental level had, at an earlier stage, been adapted to the Spanish population that was the case with, for example, the Bayley Scales of Infant Development, the McCarthy Scales of Children s Abilities, and Cattell s Culture Fair Intelligence Test. Some of the psychomotor tests that were not adapted to Spain were included in the survey anyway because of their expected relevance. 

There was no explicit assessment of safety culture, in combination with a quantitative evaluation of the HSE environment in the accident reports. Such an assessment could be used to get a collective measure or temperarnre of the priority of safety in the organization, related to best practice . In Itho (2004) there is shown a correlation between the level of safety culture and quantitative incidents/acddents thus safety culture could be used as an indicator of the holes in harriers or the level of erosion of barriers, in combination with quantitative HSE data. A more specific measure tan culture is described by Rundmo (1997) i.e. when an employee in the Norwegian oil and gas industry feels at risk he/she is at risk. A proactive indicator could thus be a workplace survey, measuring risk perceptions or performing a more broadly based assessment of safety culture in combination with other local quantitative indicators such as gas emissions, injuries compared with best practice in the industry. 

Mannion, R., Konteh, F.H. and Davies, H.T.O. 2009. Assessing organisational culture for quality and safety improvement A national survey of tools and tool use. Quality and Safety in Health Care, 18, 153-6. 

Safety climate surveys are well embedded as measures of safety culture in industry and have also been translated and applied in healthcare (Abdullah et al. 2009 Cox and Cheyne 2000 Cox and Cox 1991 Coyle et al. 1995 Flin et al. 2006 Helmreich arid Merritt 1998 Meams et al. 1998, 2003 Modak et al. 2007 Nieva and Sorra 2003 Smits et al. 2008 Sorra and Nieva 2004). Safety climate is regarded as the surface features of the underlying safety culture (Flin et al. 2000). Surveys typically assess workforce perceptions of procedures and behaviours in the work environment that indicate the priority given to safety. 

As further baekgroimd for the survey, Westat eondueted telephone and in-person interviews with hospital nurses, staff and physieians to assess whether the survey dimensions eovered all relevant aspects of patient safety culture or whether any new dimensions were needed. Based on these interviews, there was a general eonsensus that the draft dimensions and items appeared to measure key patient safety eoneepts. 

The need for a valid and reliable instrument to assess safety culture is not restricted to the United States. The AHRQ Hospital SOPS instrument has been widely adopted in over 45 countries around the world and the instmment has been translated into more than 20 languages. It has become the de-facto international survey for measuring safety culture in healthcare. While other industries such as aviation, nuclear power and petrochemicals have been interested in assessing safety culture there is neither a standard nor agreement as to what to measure. However, in healthcare, the AHRQ instmment is a standard and it has created a shared mental model of safety culture that has become almost universal in healthcare throughout the world. 

Patient safety researchers have developed several surveys to assess patient safety climate, including the Safety Attitudes Questionnaire (SAQ), AHRQ s Hospital Survey on Patient Safety Culture (SOPS see Chapter 12 for more detailed information), and Patient Safety Climate in Healthcare Organizations. Our chapter provides an in-depth examination of the SAQ in terms of what it measures, key findings and limitations and future areas in need of research. 

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