AHRQ Hospital Survey On Patient Safety Culture Shows Improved Patient Safety Scores

Some interesting information pulled from the Executive Summary of the new AHRQ Hospital Survey:

The Agency for Healthcare Research and Quality (AHRQ) established the Hospital Survey on Patient Safety Culture comparative database. The first annual comparative database report was released in 2007 and included data from 382 U.S. hospitals. The Hospital Survey on Patient Safety Culture 2011 User Comparative Database Report displays results from 1,032 hospitals and 472,397 hospital staff respondents

Areas of Strength for Most Hospitals

Three areas of strength emerged. Results are expressed in terms of percent positive response. Percent positive is the percentage of positive responses (e.g., Agree, Strongly agree) to positively worded items (e.g., "People support one another in this unit") or negative responses (e.g., Disagree) to negatively worded items (e.g., "We have safety problems in this unit").

Teamwork Within Units (average 80 percent positive response)—This composite is defined as the extent to which staff support each other, treat each other with respect, and work together as a team. This composite had the highest average percent positive response.

Supervisor/Manager Expectations & Actions Promoting Patient Safety (average 75 percent positive response)—This composite is defined as the extent to which supervisors/managers consider staff suggestions for improving patient safety, praise staff for following patient safety procedures, and do not overlook patient safety problems. This composite had the second highest average percent positive response.

Patient Safety Grade—On average, most respondents within hospitals (75 percent) gave their work area or unit a grade of either "A-Excellent" (29 percent) or "B-Very Good" (46 percent) on patient safety.

Areas With Potential for Improvement for Most Hospitals

Three areas showed potential for improvement.

Nonpunitive Response to Error (average 44 percent positive response)—This composite is defined as the extent to which staff feel that their mistakes and event reports are not held against them and that mistakes are not kept in their personnel file. This composite had the lowest average percent positive response.

Handoffs and Transitions (average 45 percent positive response)—This composite is defined as the extent to which important patient care information is transferred across hospital units and during shift changes. This composite had the second lowest average percent positive response.

Number of Events Reported—On average, most respondents within hospitals (54 percent) reported no events in their hospital over the past 12 months. It is likely that events were underreported. This is an area for improvement for most hospitals because underreporting of events means potential patient safety problems may not be recognized or identified and therefore may not be addressed.

Results by Hospital Characteristics

Bed Size

    * Very small hospitals (6-24 beds) had the highest overall average percent positive response on the patient safety culture composites.

    * Small hospitals (25-49 beds) had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (81 percent positive for 25-49 beds vs. 70 percent for 400 beds or more).

Results by Respondent Characteristics

Work Area/Unit

    * Respondents in Rehabilitation had the highest average percent positive response across the composites (69 percent positive); Emergency had the lowest (57 percent positive).

    * Rehabilitation had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (84 percent); Emergency had the lowest (63 percent).

    * ICU (any type) had the highest percentage of respondents reporting one or more events in the past year (63 percent); Rehabilitation had the lowest (42 percent).

Staff Position

    * Respondents in Administration/Management had the highest average percent positive response across the composites (74 percent positive); Pharmacists had the lowest (60 percent positive).

    * Administration/Management had the highest percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good"(86 percent); Pharmacists had the lowest (67 percent).

    * Pharmacists had the highest percentage of respondents reporting one or more events in the past year (72 percent); Unit Assistants/Clerks/Secretaries had the lowest (18 percent).

Trending: Comparing Results Over Time

Results regarding changes over time on the patient safety culture composites, patient safety grade, and number of events reported for the 512 hospitals (of the 1,032 total database hospitals) that administered the survey and submitted data more than once are highlighted.

Trending: Overall Summary Statistics

    * The average percent positive scores on the patient safety culture composites increased slightly by 2 percentage points (ranging from 1 to 3 percentage points).

    * The average percentage of respondents who gave their work area/unit a patient safety grade of "A-Excellent" or "B-Very Good" increased slightly by 3 percentage points.

    * The average number of respondents reporting one or more events increased by only 1 percentage point.

    * The top three patient safety actions implemented by hospitals between the previous and most recent survey administration were:

          o Improved fall prevention program (56 percent).

          o Conducted root cause analysis (52 percent).

          o Implemented SBAR (situation-background-assessment-recommendation) communication (51 percent).

Trending: Bed Size

    * Hospitals with 50-99 beds had the greatest increases in percent positive response over time on 8 of the 12 composites (average increase of 3 percentage points).

    * Very small hospitals (6-24 beds) had the greatest increase in the percentage of respondents who gave their work area/unit a patient safety grade of "Excellent" or "Very Good" (a 4 percentage point increase, from 77 percent to 81 percent).

Trending: Work Area/Unit

    * ICU and Pediatrics had the greatest increases in percent positive response on 5 of the 12 patient safety culture composites (average increases of 4 and 3 percentage points, respectively).

    * Emergency had the greatest increase over time in the average percentage of respondents giving their work area/unit a patient safety grade of "Excellent" or "Very Good" (a 4 percentage point increase, from 60 percent to 64 percent).

    * Lab and Pharmacy had the greatest increases in the average percentage of respondents reporting one or more events in the past year (5 percentage point increases). The largest decrease was in Psychiatry/Mental Health (a 5 percentage point decrease).