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Hospital Survey on Patient Safety Culture: 2011 User Comparative Report Database

When it comes to patient safety culture,  most hospitals report their strongest areas relate to teamwork within work units and supervisor/manager expectations and actions promoting safety. Areas identified with the  most potential for improvement are non-punitive response to error, hand-offs and transition, and the number of reported events. These are the findings from an analysis of  hospitals using  the Agency for Healthcare Research and Quality’s assessment tool,  Hospital Survey on Patient Safety Culture.

The responses  from over 1000 hospitals that have used the survey are available in an online comparative database report. The report allows hospitals to compare their survey results with other hospitals and provides data to identify their strengths and areas for improvement. Since AHRQ has been collecting the survey data since 2007, time trending data is also available. The data is analyzed by hospital characteristics [bed size, teaching status, ownership type, geographic region] and by respondent characteristics [work area/unit, staff position, and patient interaction level].

The survey database report includes data on 42 measure in 12 key areas of patient safety culture:

  1. Communication openness
  2. Feedback and communication about error
  3. Frequency of events reported
  4. Hand-offs and transitions
  5. Management support for patient safety
  6. Non-punitive response to error
  7. Organizational learning and continuous learning
  8. Overall perceptions of patient safety
  9. Staffing
  10. Supervisor/manager expectations and actions promoting safety
  11. Teamwork across units
  12. Teamwork within units

Source:  Sorra J and others. Hospital survey on patient safety culture: 2011 user comparative database report. Agency for Healthcare Research and Quality, 2011. http://www.ahrq.gov/qual/hospsurvey11/

Also available:

Sorra J and others. Nursing home  survey on patient safety culture: 2011 user comparative database report. Agency for Healthcare Research and Quality, 2011. http://www.ahrq.gov/qual/nhsurvey11/

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Why does change fail? What helps a project succeed?

The factors that either helped or hindered the success of an operations improvement project were identified based on the experience of 6 hospitals that participated in the Robert Wood Johnson Foundation Urgent Matters program.  This program was intended to assist hospitals with information to improve patient flow and decrease crowding in the emergency department.

What facilitated implementation of change

  • Being part of the Urgent Matters learning network
  • Putting together an inclusive planning team with representatives from various areas of the hospital
  • Executive leadership support
  • Homegrown implementation strategies
  • Aligned reporting structure
  • Trying things that were not radically different

What got in the way of change

  • Staff resistance
  • Organizational culture
  • Inadequate staffing
  • Cynicism leftover from past failed efforts
  • Lack of information monitoring progress

What I like about this article: That there was an effort to methodically study why a performance improvement effort in a small group of hospitals succeeded or failed; and, that these results can be generalized and applied to other types of situations.

Source: Van Dyke, K.J., and others.  Facilitators and barriers to the implementation of patient flow improvement strategiesQuality Management in Health Care;20(3):223-233, July-Sept. 2011.  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Striving for Top Box: Hospitals Increasing Quality and Efficiency

This latest release in the Hospitals in Pursuit of Excellence Signature Leadership Series shares insights and best practices based on visits and interviews with three innovative health systems focused on improving both efficiency and quality of care.

  • Novant Health in North Carolina shares its experience in two areas: creating a remarkable patient experience and moving toward a payer neutral revenue system and away from cost-shifting.
  • The top box strategy of Piedmont Health in Georgia focused on physician alignment/clinical integration and on robust use of clinical data and information systems for performance measurement of cost management/efficiency and of infection control and preventable mortality.
  • The performance improvement strategy for Banner Health in Arizona centered on creating a culture of accountability, consistently communicating and measuring performance initiatives, sharing best practices across the system, and recognizing employees for performance improvement.

Recommended key elements for top box improvement include:

  • Start by addressing supplies and staffing for cost reduction.
  • Focus on incremental improvements that will snowball into big gains.
  • Address areas that will have substantial cost and quality impact.
  • Develop action plans stating crisp aims for improvement.
  • Share data transparently throughout the organization.
  • Manage with a payer neutral revenue strategy.
  • Reduce unnecessary clinical variation for quality improvement.
  • Invest in data infrastructure for frequent and detailed reporting.

Source: Health Research and Educational Trust/Hospitals in Pursuit of Excellence. Striving for top box: hospitals increasing quality and efficiency. Chicago: American Hospital Association, May 2011. http://www.hret.org/topbox/index.shtml

Progress Report on 4 Early Leaders in Patient Safety Improvement

In a new report and series of case studies, The Commonwealth Fund assesses the progress made by four health systems in their leading efforts to improve patient safety over the past five years. The Department of Veterans Affairs, Sentara Healthcare, OSF HealthCare, and Johns Hopkins Medicine  — all large and complex organizations — are featured, sharing valuable insights on their strategies, lessons learned, and progress. All have required a sustained focus on making patient safety a core value, a readiness to innovate and change, and perseverance. 


McCarthy D and Klein S. Keeping the commitment: a progress report on four early leaders in patient safety improvement. Synthesis report. New York: Commonwealth Fund, Mar. 2011. http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2011/Mar/1478_McCarthy_keeping_commitment_patient_safety_case_study_synthesis.pdf

McCarthy D and Chase D. Advancing patient safety in the U.S. Department of Veterans Affairs. Case study – keeping the commitment: progress in patient safety. New York: Commonwealth Fund, Mar. 2011. http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2011/Mar/1477_McCarthy_VA_case_study_FINAL_March_v2.pdf

McCarthy D and Chase D. Sentara Healthcare: making patient safety an enduring organizational value. Case study – keeping the commitment: progress in patient safety. New York: Commonwealth Fund, Mar. 2011. http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2011/Mar/1476_McCarthy_Sentara_case_study_FINAL_March.pdf

Klein S and McCarthy D.  OSF HealthCare: promoting patient safety through education and staff engagement. Case study – keeping the commitment: progress in patient safety. New York: Commonwealth Fund, Mar. 2011. http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2011/Feb/1475_McCarthy_OSF_case_study_FINAL_v3.pdf

Klein S and McCarthy D.  Johns Hopkins Medicine: embedding patient safety in a university-affiliated integrated health care delivery system. Case study – keeping the commitment: progress in patient safety. New York: Commonwealth Fund, Mar. 2011. http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2011/Mar/1474_McCarthy_Johns_Hopkins_case_study_FINAL_March.pdf