Patient Safety Culture

Surveying hospital staff and physicians about patient safety culture is a useful means to assess the environment within a hospital for preventing patient harm. Preventing patient harm requires more than putting best practices into place. It also requires a culture that is characterized by effective communications, shared values about the importance of safety, and the presence of systems that help the organization learn from errors and prevent them from occurring. A poorly perceived safety culture has been linked to increases in errors. Higher patient safety culture scores are associated with lower rates of nurse turnover, infections, and pressure ulcers and other complications of care.

We survey our hospital employees and physicians every two years. Our first survey was conducted in 2005 and was used to develop strategies for improving our safety culture. We conducted additional surveys in 2007, 2009, and 2011 to evaluate our success and to identify additional strategies.

The Agency for Healthcare Research and Quality (AHRQ) developed the survey we use, called the Hospital Survey on Patient Safety Culture. The AHRQ also maintains a database that allows us to compare our results to those of other hospitals of similar size across the country. So, in addition to monitoring the trends in our safety culture survey results, we use the comparative data to evaluate our efforts to establish, improve, and maintain a culture of patient safety in our hospital.

The following graphs and table describe our hospital safety culture and demonstrate that UMHS' patient safety culture scores were often higher than those seen in similar hospitals.

Patient Safety Grade
Higher Value = Better Performance

Details

Why is This Measure Important?

The overall patient safety grade is a composite of the scores for each component (dimension) of patient safety culture survey. In other words, it is the overall score that combines the rates for each of the 12 dimensions shown in the next graph and in the table below (overall perception of patient safety, frequency of event reporting, supervisor/manager expectations and actions, etc.).

How is UMHS Performing?

The overall patient safety grade for the University of Michigan Health System improved from 2005 to 2009 but then declined in 2011. Our grade was better than the average for hospitals of similar size, but in 2011, it fell below this benchmark. As a consequence, we are stepping up efforts to address reasons for the decline. We are continuing to conduct biweekly patient safety rounds. These are meetings between the senior leaders and front-line care givers that are designed to identify patient safety concerns and implement rapid improvements.

UMHS Source: UMHS results from survey of safety culture using the AHRQ Hospital Survey on Patient Safety Culture.
Comparison Group Source: AHRQ Hospital Survey on Patient Safety Culture Comparative Database for 2007 (for hospitals greater than or equal to 400 beds), 2009, and 2011 (for hospitals greater than or equal to 500 beds).

Overall Perceptions of Safety
Higher Value = Better Performance

Details

Why is This Measure Important?

The overall perception of safety measures how strongly our hospital staff and physicians feel that we are good at preventing errors from happening. A higher score indicates better performance.

How is UMHS Performing?

The overall perception of safety at the University of Michigan Health System improved in 2007 to 2009 but then declined in 2011. Our results were better than the average for hospitalsof similar size, but in 2011, they fell below this benchmark. As a consequence, we are stepping up efforts to address reasons for the decline.

UMHS Source: UMHS results from survey of safety culture using the AHRQ Hospital Survey on Patient Safety Culture.
Comparison Group Source: AHRQ Hospital Survey on Patient Safety Culture Comparative Database for 2007 (for hospitals greater than or equal to 400 beds), 2009 and 2011(for hospitals greater than or equal to 500 beds).

Key
Measure Higher Values Equal Better Performance UMHS
(2009)
Comparison Group
(AHRQ 2009 Nat'l Avg
for Large Hospitals)
How We
Compare

Frequency of Events Reported

It is important for hospital staff and physicians to report problems when they occur, regardless of whether they affect a patient, so that they can learn from these problems and prevent them from occurring in the future. A higher percentage indicates better performance and means that hospital staff and physicians are reporting information that will help improve patient safety.

53% 57% Lower

Supervisor/Manager Expectations & Actions

This is a measure of the extent to which hospital staff and physicians feel that their supervisors and managers promote patient safety. A higher percentage indicates better performance and means that supervisors and managers are working with their staff to improve safety.

72% 72% Same

Organizational Learning - Continuous Improvement

This is a measure of the extent to which hospital staff and physicians are engaged in efforts to systematically learn from experience improve patient safety. A higher percentage indicates better performance and means that staff and faculty are engaged in continuous learning.

67% 68% Same

Teamwork Within Departments

Hospital staff and physicians work as a team to care for patients, which is important for delivering high quality, safe care. This is a measure of how well staff members work together as a team. A higher percentage indicates better performance.

78% 77% Same

Communication Openness

This is a measure of the willingness of hospital staff and physicians to speak up when they see something that does not seem right and may affect a patient's care. A higher percentage indicates better performance.

64% 60% Better

Feedback & Communication about Error

This is a measure of the perception of hospital staff and physicians that they discuss and receive information about problems and how they can be prevented. A higher percentage is better.

57% 60% Lower

Nonpunitive Response to Error

It is important for hospital staff and physicians to feel that they can report problems and mistakes without penalty, otherwise it will be difficult for them to learn and prevent these problems from occurring in the future. This is a measure of the perception of hospital staff and physicians that they can report problems without it being held against them. A higher percentage indicates better performance.

49% 38% Better

Staffing

This is a measure of the perception of hospital staff and physicians that there are enough staff to complete work that needs to be done. A higher percentage indicates better performance.

56% 49% Better

Hospital Management Support for Patient Safety

This is a measure of how strongly hospital staff and physicians feel that hospital management promotes patient safety and makes safety a top priority. A higher percentage indicates better performance.

67% 65% Better

Teamwork Across Departments

Hospital staff and faculty work as a team to care for patients, which is important for delivering high quality, safe care. This is a measure of cooperation and coordination among staff and physicians in different hospital units and departments that need to work together (e.g., emergency department, operating rooms, intensive care units, etc.). A higher percentage indicates better performance.

52% 50% Better

Hospital Handoffs & Transitions

This is a measure of how well staff and physicians communicate information with others within and between hospital units and departments (e.g., emergency department, operating rooms, intensive care units, etc). A higher percentage indicates better performance.

33% 38% Lower