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Culture of Safety Survey

Instructions

This survey asks for your opinions about patient safety issues, medical error, and event reporting in your hospital and will take about 10 to 15 minutes to complete.
All answers are defaulted to N/A, please answer all questions that apply to you

  • An “event” is defined as any type of error, mistake, incident, accident, or deviation, regardless of whether or not it results in patient harm
  • Patient safety” is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of health care delivery.
  • Culture of Safety:
    In a culture of safety the focus is on effective systems and teamwork to accomplish the mutual goal of safe, high-quality performance. When something goes wrong, the focus is on what, rather than who, is the problem. The intent is to bring process failures and system issues to light, and to solve them in a non-biased non-threatening way.
    An organization with a culture of safety encourages acknowledgement of error and actively attributes such primarily to process/system failures. Lessons learned from analysis of errors are shared as the best known methods to mitigate future errors.
    The Center for Disease Control (CDC) has defined a culture of safety as the shared commitment of leadership, management and employees to ensure the safety of the work environment that ensures the safety of its consumers.

 

SECTION A: Your Work Area/Unit(Required)
In this survey, think of your “unit” as the work area, department, or clinical area of the hospital where you spend most of your work time or provide most of your clinical services
Where are you filling this survey out?

Required

What is your primary department, work area or unit in this hospital? Select ONE filling out the drop-down menu.


Please select an item.

Please indicate your agreement or disagreement with the following statements about your work area/unit. Mark your answer by filling in the circle.

Think about your hospital work area/unit…

Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

N/A

1. People support one another in this unit

2. We have enough staff to handle the workload

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

4. In this unit, people treat each other with respect

5. Staff in this unit work longer hours than is best for patient care

6. We are actively doing things to improve patient safety

7. We use more agency/temporary staff than is best for  patient care

8. Staff feel like their mistakes are held against them

9. Mistakes have led to positive changes here

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

11. When one area in this unit gets really busy, others help out

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

13. After we make changes to improve patient safety, we evaluate their effectiveness

14. We work in "crisis mode" trying to do too much, too quickly

15.Patient safety is never sacrificed to get more work done

16. Staff worry that mistakes they make are kept in their personnel file

17. We have patient safety problems in this unit

18. Our procedures and systems are good at preventing errors from happening

 

SECTION B: Your Supervisor/Manager
Please indicate your agreement or disagreement with the following statements about your immediate supervisor/manager or person to whom you directly report. Mark your answer by filling in the circle.

 

Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

N/A

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

20. My supervisor/manager seriously considers staff suggestions for improving patient safety

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

22. My supervisor/manager overlooks patient safety problems that happen over and over

 

SECTION C: Communications

How often do the following things happen in your work area/unit? Mark your answer by filling in the circle

 

Never

Rarely

Sometimes

Most of the time

Always

N/A

23. We are given feedback about changes put into place based on event reports

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

25. We are informed about errors that happen in this unit

26.Staff feel free to question the decisions or actions of those with more authority

27. In this unit, we discuss ways to prevent errors from happening again

28. Staff are afraid to ask questions when something does not seem right

 

SECTION D: Frequency of Events Reported
In your hospital work area/unit, when the following mistakes happen, how often are they reported? Mark your answer by filling in the circle.

 

Never

Rarely

Some-times

Most of the time

Always

N/A

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

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

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

 

SECTION E: Culture of Safety Grade
32. Please give your work area/unit in this hospital an overall grade on the culture of safety.  Mark ONE answer.

A

B

C

D

E

N/A

Excellent

Very Good

Acceptable

Poor

Failing

 

 

SECTION F: Your Hospital
Please indicate your agreement or disagreement with the following statements about your hospital.  Mark your answer by filling in the circle.

Think about your hospital…

Strongly
Disagree

Disagree

Neither

Agree

Strongly
Agree

N/A

33. Hospital management provides a work climate that promotes patient safety

34. Hospital units do not coordinate well with each other

35. Things “fall between the cracks” when transferring patients from one unit to another

36. There is good cooperation among hospital units that need to work together

37. Important patient care information is often lost during shift changes

38. It is often unpleasant to work with staff from other hospital units

39. Problems often occur in the exchange of information across hospital units

40. The actions of hospital management show that patient safety is a top priority

41. Hospital management seems interested in patient safety only after an adverse event happens

42. Hospital units work well together to provide the best care  for patients

43. Shift changes are problematic for patients in this hospital

 

SECTION G: Number of Events Reported
44. In the past 12 months, how many event reports have you filled out and submitted? Mark ONE answer.

a. No event reports

d. 6 to 10 event reports

 

 

b. 1 to 2 event reports

e. 11 to 20 event reports

N/A

c. 3 to 5 event reports

f. 21 event reports or more

 

 

 

SECTION H: Background Information
This information will help in the analysis of the survey results.  Mark ONE answer by filling in the circle.

45.       How long have you worked in this hospital?

a. Less than 1 year

d. 11 to 15 years

 

 

b. 1 to 5 years

e. 16 to 20 years

N/A

c. 6 to 10 years

f. 21 years or more

 

 

 

46.       How long have you worked in your current hospital work area/unit?

a. Less than 1 year

d. 11 to 15 years

 

 

b. 1 to 5 years

e. 16 to 20 years

N/A

c. 6 to 10 years

f. 21 years or more

 

 

 

47.       Typically, how many hours per week do you work in this hospital?

a. Less than 20 hours per week

d. 60 to 79 hours per week

 

 

b. 20 to 39 hours per week

e. 80 to 99 hours per week

N/A

c. 40 to 59 hours per week 

f. 100 hours per week or more

 

 

 

48.       What is your staff position in this hospital?  Mark ONE answer that best describes your staff position.

a. Registered Nurse/LPN

ab. Technician (e.g., EKG, Lab, Radiology, Phlebotomy)

b. Physician Assistant/Nurse Practitioner

ac. Administration/Management/AOD

c. Chaplin Services

ad. Environmental Services

d. Patient Care Assistant/Hospital Aide/Care Partner

ae. Quality Management/ Regualtory Affairs

e. Attending/Staff Physician/Resident/Intern

af. Risk Management

f. Resident Physician/Physician in Training

ag Performance Improvement

g Fellows ah. Patient Safety

h. Pharmacist/pharmicist Support

ai. ICL/Educational Staff

i. Pharmacy Technician

aj. Central Stores, Mail Services, Print Shop

j. Dietician/Dietary Services

ak. Patient Relations

k. Unit Assistant/Clerk/Secretary/Support Personnel/Messinger Service

al. Dialysis services

l. FM&D

am. Employee Health

m. Information Services an. Material Management, Central Sterile, Linen Services
n. Human Relations/Labor Relations/Personnel Development Services ao. Purchasing, Procurement and Contract, Account Receivable, Account Payable
o. Admitting Services ap. Biomedical/ SMIC
p. Ambulatory Services/Offsite Clinic aq. Public Safety/University Police
q. Benefits ar. Inpatient/Outpatient Registration Services
r. Data Management as. Health Science Library
s. Senior Administration & Management at. Case Manager/Documentation Improvement Specialist
t. Faculty Personnel au. Managed Care
u. Physiology & Pharmacology av. Library Personnel
v. Respiratory/Pulnonary Services aw. Care Management Personnel
w. Thoracic Center ax. Infection Control Personnel
x.Research Personnel ay. Library Personnel
y. Education Personnel az. Social Worker
z. Respiratory Therapist ba. Other
aa. Physical, Occupational, or Speech Therapist N/A

 

49.       In your staff position, do you typically have direct interaction or contact with patients?

a. YES, I typically have direct interaction or contact with patients.
b. NO, I typically do NOT have direct interaction or contact with patients.
N/A

50.       How long have you worked in your current specialty or profession?

a. Less than 1 year

d. 11 to 15 years

 

 

b. 1 to 5 years

e. 16 to 20 years

N/A

c. 6 to 10 years

f. 21 years or more

 

 

 

SECTION I: Your Comments
Please feel free to write any comments about the culture of safety, error, or event reporting in your hospital.
(Please limit your responses to 8000 characters)