Hospital SOPS surveys

Hospital work areas and staff asked to complete the survey When the Hospital SOPS was developed, it was not specifically designed and tested for use with non-clinical staff like those in honsekeeping, facilities, or human resources. Yet once the snrvey was released, it became very clear that hospitals wanted to survey all staff from all units and departments, with the understanding that every staff member plays an important role in ensuring patient safety. By being attentive and aware of patient safety risks, in an environment that encourages open communication and learning, even non-clinical staff can help prevent medication errors, patient identification errors and many other types of errors. Since one of the uses of the survey is as an education and awareness tool, it makes sense for hospitals to conduct the survey in a broad way across units and staff positions. 

Mode of survey administration When the first comparative database report was released in 2007, most hospitals administered paper surveys (56 percent), followed by web (25 percent) and mixed mode (both paper and web -19 percent). By 2012, with rapidly advancing technology, web surveys became the predominant mode (66 percent), followed by paper (21 percent) and mixed mode (13 percent). The one caveat in this trend is that paper surveys still seem to get the highest response rates in US hospitals - on average at least 10 percentage points hi er than other modes. So if response rates are a concern and a hospital has the capabihty and resources to conduct a paper survey, it is still best to administer it by paper. But if costs are an issue, it can often be very eost-effective to administer a web snrvey. User s Guides, available for eaeh of the SOPS surveys on the AHRQ web site (www.ahrq.gov), contain tips and guidance on how best to administer the survey and present results. 

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. 

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. 

In another study, Sorra et al. (2012) examined relationships between Hospital SOPS and patients assessments of hospital cate, as measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey. 

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. 

Abbreviations CA, carotid atherosclerosis CPIHD, Caerphilly Prospective Ischemic Heart Disease EVCS, Elderly Vitamin C Status IWHS-D, Lowa Women s Health Study MGH, Mortality in a Geriatric Hospital MRCT Medical Research Council Trial NAHNES I, National Health and Nutrition Examination Survey PSCHD, Prospective Study of vitamin C in Coronary Heart Disease SOP Supplementation... 

In literature several abbreviations are used for the Hospital Survey on Patient Safety Culture (e.g. HSPSC, HSOPSC, HSOPS or SOPS). In the following we will use HSPSC as abbreviation. 

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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