1 1 results from the ahrq hospital survey on patient safety culture joann sorra, ph.d. westat ahrq...
TRANSCRIPT
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Results from the AHRQ Hospital Survey
on Patient Safety Culture
Joann Sorra, Ph.D. Westat
AHRQ Annual Conference 2008:Promoting Quality…Partnering for Change
September 2008Bethesda, MD
Westat1650 Research Blvd. Rockville, MD 20850
[email protected] 301-294-3933
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Objectives
Present results from the AHRQ Hospital Survey on Patient Safety Culture
Discuss future activities and long-term AHRQ support for the Surveys on Patient Safety (SOPS)
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Background Hospital Survey on Patient Safety Culture
(HSOPS)
Developed by Westat, funded by AHRQ
Survey development process: Reviewed literature & existing surveys Interviewed hospital staff Identified key areas of safety culture Developed survey items & pretested Obtained input from researchers & stakeholders Pilot tested in 21 hospitals with 1,437 respondents
Final survey released November 2004 www.ahrq.gov/qual/hospculture
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HSOPS Patient Safety Culture Dimensions 42 items assess 12 dimensions of patient safety culture
1. Communication openness 2. Feedback & communication about error 3. Frequency of event reporting 4. Handoffs & transitions 5. Management support for patient safety 6. Nonpunitive response to error 7. Organizational learning--continuous improvement 8. Overall perceptions of patient safety 9. Staffing 10. Supv/mgr expectations & actions promoting patient safety 11. Teamwork across units12. Teamwork within units
Patient safety “grade” (Excellent to Poor) Number of events reported in past 12 months
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HSOPS Comparative Database AHRQ has funded an HSOPS comparative database
Annual reports (2007 & 2008) http://www.ahrq.gov/qual/hospsurvey08/
Purposes: Comparison—of survey results in efforts to establish, improve and maintain a culture of patient safety
Assessment and Learning—in patient safety improvement process (rather than basis for determining punitive actions or external judgment of hospital performance)
Supplemental Information—to help hospitals identify strengths and areas with potential for patient safety culture improvement
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2008 HSOPS Comparative Database
519 U.S. hospitals, 160,176 respondents Average # respondents per hospital = 309 staff
Survey administration Paper 48% Web 27% Both 25%
Average hospital response rate = 54% Paper 60% Web 44% Both 52%
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Work Areas
Surgery 10% (14,327) Medicine 9% Many areas/no specific area 9% ICU 7% Radiology 6% Emergency 5% Lab 5%
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Staff Positions & Patient Contact
Nursing 36% (55,119)
Technicians (EKG, Lab, Radiology, etc) 11% Management, administration 7% Physicians, PAs, NPs 5% Pharmacists 2%
77% had direct interaction with patients
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Hospital Strengths & Areas for Improvement
1. Teamwork Within Units
2. Supervisor/Mgr Support for Patient Safety
3. Management Support for Patient Safety
4. Org Learning--Continuous Improvement
9. Teamwork Across Units
10. Staffing
11. Handoffs & Transitions
12. Nonpunitive Response to Error 44%
45%
55%
57%
70%
70%
75%
79%
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Patient Safety Grade
24%
48%
23%
4% 1%0%
20%
40%
60%
80%
100%
AExcellent
BVery Good
CAcceptable
DPoor
EFailing
1111
Number of Events Reported
52%
28%
13%5% 2% 1%
0%
20%
40%
60%
80%
100%
None 1 to 2 3 to 5 11 to 20 21 or more
6 to 10
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Results by Hospital Characteristics
Smaller hospitals (49 beds or fewer) scored highest on all dimensions of safety culture
Smallest hospitals (6 – 24 beds) 21% more positive on Handoffs & Transitions than largest hospitals (400+ beds)
56% positive vs. 35%
No differences teaching vs. non-teaching
Government hospitals scored higher than non-govt on Handoffs & Transitions Staffing Teamwork Across Units
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Results by Work Area
Rehabilitation scored highest on 9 of 12 dimensions of safety culture
Largest differences by work area/unit:
- Overall perceptions of patient safety (% positive) Rehab 76% vs. ICU & Medicine 55%
- Patient safety grade (% “Excellent” or “Very good”) Rehab 82% vs. Emergency & Medicine 62%
ICUs had highest % error reporting (68%) vs. Anesthesiology & Rehab (43%)
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Results by Staff Position
Administration/Mgmt scored highest on 11 of 12 dimensions of safety culture
Patient safety grade (% “Excellent” or “Very good”)- Admin/Mgmt 82% vs. Registered Nurse/LVN/LPN 67%
Number of events reported (reported 1 or more events in past 12 months)
- Pharmacists 78% vs. Unit assts/clerks/secretaries 23%
- Direct patient contact 53% vs. No direct contact 32%
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98 Trending Hospitals
Average time between surveys 14 months
Average change on dimensions was +2%
Biggest increase 44% of trending hospitals had increase +5% on Patient Safety Grade
38% of trending hospitals had +5% on: Overall perceptions of patient safety Frequency & number of events reported Nonpunitive response to error
Biggest decrease 27% of trending hospitals had -5% on Staffing
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Actions Taken by Trending Hospitals Shared survey results
79% shared with staff; 62% with board of directors; 54% with physicians
79% had implemented more than 1 action
49% or more hospitals implemented Training Changes in policies or procedures Patient safety walkarounds SBAR communication (situation-background-assessment- recommendation)
Other actions Yearly patient safety fairs Patient safety bulletin boards & newsletters Root cause analyses
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Future Activities New Medical Office and Nursing Home
surveys on patient safety culture
Same development steps as HSOPS Pilot tested in 202 medical offices & 40 nursing
homes Toolkit materials similar to HSOPS:
» Survey Administration User’s Guides» Preliminary Comparative Results from Pilot Tests» Microsoft Excel Data Entry & Reporting Tools» PowerPoint Survey Feedback Templates
Comparative databases in 2010 Voluntary data submission Free comparative report
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Long-term AHRQ Support for SOPS AHRQ will support all 3 surveys for next 4 years
Three, in-person SOPS User Group Meetings Combined with CAHPS User Group Meeting Free registration December 4-5, 2008 in Scottsdale AZ April 2010 in Baltimore MD
Free technical assistance & national conference calls
SOPS user network
Gathering information about interventions being implementing to address areas for improvement
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International HSOPS Users
International Hospital SOPS comparative database
Focus on countries participating in the World Health Organization’s (WHO) High 5s Patient Safety Initiative
http://www.who.int/patientsafety/solutions/high5s/en/index.html
Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the U.S.
2020
International HSOPS Users
24 countries
- Australia - Malta- Bahrain - Netherlands- Belgium - Norway- Brazil - Saudi Arabia - Canada - Scotland- Denmark - Serbia- El Salvador - Spain- France - Sweden- Germany - Switzerland- Greece - Taiwan - Ireland - Turkey- Italy - United Kingdom
