Surveys safety culture assessment

For these reasons, the EUROCONTROL Safety Cnlture Programme aims to survey all EUROCONTROL member states by the end of 2014, prior to significant SESAR or FAB impact. This was endorsed at a workshop held in Luxembonrg in November 2012 with 20 ANSPs, where it was concluded by the member states that they needed to understand their own safety cultures first before moving to FABs and FAB-based safety culture assessments. 

As an alternative to studying accident cases, OSHA has come up with a method to analyze weakness in what they call the Safety and Health Program. I believe that what OSHA refers to as a Safety and Health Program Assessment could also be considered a safety culture assessment. I have found much of this information to be useful, but I must warn readers in advance that OSHA has set the bar for excellence quite high. Be advised that in some cases reaching the top level may be nearly impossible. So, do not be too disappointed if you find a variety of sections where the survey indicates a need for improvement. 

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. 

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. 

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 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. 

Velji et al. (2008) Situation- Background- Assessment- Recommendation Six to twelve months Clinical unit in a rehabilitation hospital Hospital Survey on Patient Safety Culture Eight of the survey dimensions improved by at least 5%... 

Barry Kirwan works for Eurocontrol in France. His principal responsibility is miming the European Air Traffic Management Safety Culture Programme, which involves surveys for around 30 European States, helping them evaluate and improve their safety culture. He also chairs a Eurocontrol-FAA group on safety research and periodically works on human factors and human reliability assessment issues with the nuclear power indrrstry in the USA and UK. 

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 Medical Office Survey on Patient Safety Culture measures issues relevant to patient safety in the ambulatory medical office setting. Pilot tested in approximately 100 medical offices, the survey lets providers, and staff members to assess their safety culture, identify areas where improvement is needed, track changes in patient safety, and evaluate the effect of interventions. Researchers can also use the survey to assess patient safety culture improvement initiatives (AHRQ Publication No. 08(09)-0059). 

For additional details about this five-step assessment process (such as recommended survey questions and an outline for your assessment report), refer to McSween s book The Values-Based Safety Process Improving Your Safety Culture with a Behavioral Approach (1995). 

The process to assess the safety culture is to determine the collective attitudes (perception) about safety. (Safety perception surveys are discussed in Chapter 17.) Confidential interviews are conducted with all levels of employees and management (see the discussion of independent reviews in Chapter 17). A strategic action plan model is developed where a new course is charted for instilling safety into the organization. The point is to design a new culture that is consistent with management and employees perception of the safety objectives [3]. 

Assess. Survey the culture to determine prevailing attitudes, beliefs, and behaviors related to safety and the environment by way of confidential questionnaires (perception survey), interviews (independent review process), focus group meetings, and visits to assess workplace conditions and possible contributions to incidents [4]. We will cover this in more detail in Chapter 17. 

Assess the current safety culture with a survey of leadership and employees. 

The general consensus within the literatnre is that assessing employee attitudes alone is not satisfactory when wishing to measnre an organization s safety culture, as they can only elicit safety perceptions and attitndes (HSE, 2005a). Other methods that can be used in addition to safety culture questionnaires include observational studies, focus groups, interviews, case studies, surveys, and qnestionnaires. 

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. 

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