Table 1, Average percent-positive scores for 21 critical access hospitals in 2005 and 2007 - Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 2: Culture and Redesign)

Dimension and item	2005	2007
Overall perceptions of safety	69	57	87	7	72	52	84	9

1.^b Patient safety is never sacrificed to get more work done.	70	52	91	11	72	47	93	12
2.^b Our procedures and systems are good at preventing errors from happening.	69	49	91	10	73	41	86	10
3.^c It is just by chance that more serious mistakes don’t happen around here.	69	55	81	7	71	47	84	11
4.^c We have patient safety problems in this department.	68	50	90	9	72	51	85	9

Frequency of events reported	61	49	71	6	65	45	80	9

1.^d When a mistake is made but is caught and corrected before affecting the patient, how often is this reported?	48	33	61	7	54	29	79	12
2.^d When a mistake is made but has no potential to harm the patient, how often is this reported?	58	42	74	8	61	39	74	10
3.^d When a mistake is made that could harm the patient but does not, how often is this reported?	76	61	88	7	79	65	90	8

Supervisor/manager expectations & actions promoting patient safety	72	60	84	6	75	63	87	7

1.^b My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures.	63	34	81	10	67	44	85	11
2.^b My supervisor/manager seriously considers staff suggestions for improving patient safety.	73	58	86	8	75	51	92	11
3.^c Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts.	75	59	97	9	80	68	92	7
4.^c My supervisor/manager overlooks patient safety problems that happen over and over.	76	64	85	6	78	63	90	7

Organizational learning – continuous improvement	72	55	89	8	75	60	89	8

1.^b We are actively doing things to improve patient safety.	83	65	96	8	85	69	96	8
2.^b Mistakes have led to positive changes here.	65	52	84	8	68	53	84	9
3.^b After we make changes to improve patient safety, we evaluate their effectiveness.	67	42	88	10	72	46	88	11

Teamwork within departments	80	64	91	7	81	69	88	6

1.^b People support one another in this department.	86	64	97	7	86	76	97	6
2.^b When a lot of work needs to be done quickly, we work together as a team to get the work done.	89	73	100	7	89	69	98	6
3.^b In this department, people treat each other with respect.	77	60	91	9	77	61	90	8
4.^b When one area in this department gets really busy, others help out.	67	41	87	10	70	55	89	9

Communication openness	58	38	72	9	62	47	77	8

1.^b Staff will freely speak up if they see something that may negatively affect patient care.	72	42	89	10	74	53	87	9
2.^b Staff feel free to question the decisions or actions of those with more authority.	41	13	59	10	46	29	61	8
3.^c Staff are afraid to ask questions when something does not seem right.	61	42	78	11	66	50	89	9

Feedback and communication about error	59	44	73	7	62	45	83	10

1.^b We are given feedback about changes put into place based on event reports.	45	36	58	7	47	21	68	13
2.^b We are informed about errors that happen in this department.	63	39	82	9	67	51	90	10
3.^b In this department, we discuss ways to prevent errors from happening again.	68	50	85	9	71	51	90	9

Nonpunitive response to error	50	35	64	8	52	33	64	9

1.^c Staff feel like their mistakes are held against them.	59	44	84	9	59	39	79	9
2.^c When an event is reported, it feels like the person is being written up, not the problem.	50	31	62	8	52	25	67	11
3.^c Staff worry that mistakes they make are kept in their personnel file.	41	20	63	10	46	24	60	10

Staffing	67	45	88	10	69	52	87	10

1.^b We have enough staff to handle the workload.	68	49	95	12	70	42	98	15
2.^c Staff in this department work longer hours than is best for patient care.	62	46	84	11	64	49	86	10
3.^c We use more agency/temporary staff than is best for patient care.	75	37	97	14	77	46	91	11
4.^c We work in “crisis mode,” trying to do too much, too quickly.	62	48	88	11	65	42	90	12

Hospital management support for patient safety	73	56	87	9	74	52	92	11

1.^b Hospital management provides a work climate that promotes patient safety.	84	62	100	9	84	65	98	10
2.^b The actions of hospital management show that patient safety is a top priority.	73	46	91	11	74	55	94	11
3.^c Hospital management seems interested in patient safety only after an adverse event happens.	63	46	82	11	65	32	85	13

Teamwork across hospital departments	64	47	90	10	65	44	79	11

1.^b There is good cooperation among hospital departments that need to work together.	66	45	94	12	66	36	90	13
2.^b Hospital departments work well together to provide the best care for patients.	75	62	97	8	74	47	89	11
3.^c Hospital departments do not coordinate well with each other.	51	28	81	12	54	28	71	13
4.^c It is often unpleasant to work with staff from other hospital departments.	63	41	90	11	65	41	84	11

Hospital handoffs & transitions	57	38	85	10	58	28	76	12

1.^c Things “fall between the cracks” when transferring patients from one department to another.	57	40	87	11	58	34	84	13
2.^c Important patient care information is often lost during shift changes.	56	39	81	12	59	26	83	13
3.^c Problems often occur in the exchange of information across hospital departments.	52	29	84	12	54	29	74	12
4.^c Shift changes are problematic for patients in this hospital.	61	44	94	12	62	22	86	14

Patient safety grade

A – Excellent	22	8	38	8	25	11	41	8

B – Very Good	52	37	63	7	52	37	68	9

C – Acceptable	23	10	42	8	20	9	39	8

D – Poor	3	0	8	2	3	0	13	3

E – Failing	0	0	3	1	0	0	1	0

Number of events reported^e
No event report	63	51	79	9	49	28	70	11
1 to 2 event reports	16	4	34	8	24	11	33	7
3 to 5 event reports	13	5	31	8	15	8	31	6
6 to 10 event reports	5	0	6	2	7	0	14	4
11 to 20 event reports	2	0	6	2	4	0	17	5
21 event reports or more	1	0	6	2	2	0	7	2

Dimension and item

2005

2007

Mean (%)

Min (%)

Max (%)

SD^a (%)

Mean (%)

Min (%)

Max (%)

SD^a (%)

Overall perceptions of safety

1.^b Patient safety is never sacrificed to get more work done.

2.^b Our procedures and systems are good at preventing errors from happening.

3.^c It is just by chance that more serious mistakes don’t happen around here.

4.^c We have patient safety problems in this department.

Frequency of events reported

1.^d When a mistake is made but is caught and corrected before affecting the patient, how often is this reported?

2.^d When a mistake is made but has no potential to harm the patient, how often is this reported?

3.^d When a mistake is made that could harm the patient but does not, how often is this reported?

Supervisor/manager expectations & actions promoting patient safety

1.^b My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures.

2.^b My supervisor/manager seriously considers staff suggestions for improving patient safety.

3.^c Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts.

4.^c My supervisor/manager overlooks patient safety problems that happen over and over.

Organizational learning – continuous improvement

1.^b We are actively doing things to improve patient safety.

2.^b Mistakes have led to positive changes here.

3.^b After we make changes to improve patient safety, we evaluate their effectiveness.

Teamwork within departments

1.^b People support one another in this department.

2.^b When a lot of work needs to be done quickly, we work together as a team to get the work done.

100

3.^b In this department, people treat each other with respect.

4.^b When one area in this department gets really busy, others help out.

Communication openness

1.^b Staff will freely speak up if they see something that may negatively affect patient care.

2.^b Staff feel free to question the decisions or actions of those with more authority.

3.^c Staff are afraid to ask questions when something does not seem right.

Feedback and communication about error

1.^b We are given feedback about changes put into place based on event reports.

2.^b We are informed about errors that happen in this department.

3.^b In this department, we discuss ways to prevent errors from happening again.

Nonpunitive response to error

1.^c Staff feel like their mistakes are held against them.

2.^c When an event is reported, it feels like the person is being written up, not the problem.

3.^c Staff worry that mistakes they make are kept in their personnel file.

Staffing

1.^b We have enough staff to handle the workload.

2.^c Staff in this department work longer hours than is best for patient care.

3.^c We use more agency/temporary staff than is best for patient care.

4.^c We work in “crisis mode,” trying to do too much, too quickly.

Hospital management support for patient safety

1.^b Hospital management provides a work climate that promotes patient safety.

100

2.^b The actions of hospital management show that patient safety is a top priority.

3.^c Hospital management seems interested in patient safety only after an adverse event happens.

Teamwork across hospital departments

1.^b There is good cooperation among hospital departments that need to work together.

2.^b Hospital departments work well together to provide the best care for patients.

3.^c Hospital departments do not coordinate well with each other.

4.^c It is often unpleasant to work with staff from other hospital departments.

Hospital handoffs & transitions

1.^c Things “fall between the cracks” when transferring patients from one department to another.

2.^c Important patient care information is often lost during shift changes.

3.^c Problems often occur in the exchange of information across hospital departments.

4.^c Shift changes are problematic for patients in this hospital.

Patient safety grade

A – Excellent

B – Very Good

C – Acceptable

D – Poor

E – Failing

Number of events reported^e

No event report

1 to 2 event reports

3 to 5 event reports

6 to 10 event reports

11 to 20 event reports

21 event reports or more

From: The AHRQ Hospital Survey on Patient Safety Culture: A Tool to Plan and Evaluate Patient Safety Programs

Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 2: Culture and Redesign).

Henriksen K, Battles JB, Keyes MA, et al., editors.

Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Table 1Average percent-positive scores for 21 critical access hospitals in 2005 and 2007