Appendix B. Guide to Administering the AHRQ Nursing Home Survey on Patient Safety Culture and Reviewing Results

The purpose of this guide is to provide you with information on how to administer the AHRQ Nursing Home Survey on Patient Safety Culture to your facility team and strategies for sharing the results and identifying areas of improvement and action plans for domains identified in the survey.

Purpose of This Guide

The purpose of this guide is to provide you with information on how to administer the AHRQ Nursing Home Survey on Patient Safety Culture to your facility team and strategies for sharing the results and identifying areas of improvement and action plans for domains identified in the survey.

How Can the Nursing Home Survey on Patient Safety Culture Help My Facility?

This survey is designed specifically for long-term care staff and asks for their opinions about the culture of resident safety in their facilities. The survey can help facilities assess staff perceptions of resident safety culture and track changes in safety culture over time. Moreover, these survey results are useful for measuring organizational conditions that can lead to adverse events and resident harm in the nursing home. These surveys can be used to:

• Raise staff awareness about resident safety and why it is so important;
• Assess the current status of the facility's safety culture;
• Identify strengths as well as areas for improvement;
• Evaluate the cultural impact of resident safety interventions; and
• Compare your facility findings with others.
• However, the survey is not designed for use in assisted living facilities, community care facilities, or independent living facilities.

How Do I Administer the Safety Culture Survey?

For more detailed information on how to administer the survey and collect the data, visit AHRQ Nursing Home Survey on Patient Safety User's Guide (PDF, 1 MB). The survey is available in English and Spanish in the Nursing Home Survey Toolkit.

How Do I Share the Survey Results with the Team?

Set a time to review results with staff six to eight weeks following survey completion, data collection, and analysis to review results and discuss actions related to the feedback. AHRQ provides a list of initiatives related to the survey areas entitled Improving Patient Safety in Nursing Homes: A Resource List for Users of the AHRQ Nursing Home Survey on Patient Safety Culture (PDF, 576 KB).

What Steps Do We Follow?

1. Schedule a team meeting and prepare for it.
   • Review the survey results prior to meeting with your team.
   • Determine the length of the meeting and draft an agenda. You may need at least two meetings to go through all the steps needed to develop your action plan. However, try not to allow more than a week or two to pass between meetings to discuss the safety culture results.
   • Communicate the importance of the meeting to all team members and try to schedule the meeting at a time when most team members can attend.
   • Invite all members of the team from front-line staff to the administrative, physician, and nursing champions.
   • Hold the meeting in a room with a white board or one that contains flip charts to record key discussion points.
   • Identify a team member to take notes during each discussion.
2. Assemble the team, explain the ground rules and set the tone for the work.
   • Thank all of the staff for their participation in assessing the current resident safety culture by taking the safety culture survey.
   • Explain the purpose of the meeting—to review the results and discuss next steps.
   • Describe what "safety culture" means and how it is measured.
   • Review the number of surveys that were completed and what percentage of staff participated.
   • Validate the staff's potential feelings of concern or awkwardness about openly discussing the results. Reassure staff that the goal is to learn about the facility's strengths and areas for improvement.
   • Start the meeting with a story of resident harm and spend a few minutes talking about your feelings associated with that harm.
   • Discussion questions:
     • Who else knows of a situation in which a resident has been inadvertently harmed?
     • Would you be comfortable having your loved one in this nursing home?
3. Review the areas in which your facility is doing well.
   Start with the areas in which your facility is excelling. This step should take the least amount of time at your meeting; however, it is worthwhile to get the conversation going by asking the following questions:
   • Why do you think we scored highly in these areas?
   • Did any of the results surprise you?
   • Celebrate your successes!
4. Review areas in need of improvement and reflect on potential solutions.
   Encourage the team to view the results with an open mind. Staff members need adequate time to reflect on why certain problem areas have appeared and what their potential solutions may be. This activity will help team members carefully assess all the areas in need of improvement and then help them narrow the list down to one or two safety culture priorities to address in the coming months. A note taker should objectively list the areas that the team identifies.
   Consider leading a group discussion by asking some of the following questions:
   • Did you expect these results?
   • Were any of the results surprising?
   • Have we begun to address solutions to any of these areas?
   • Do any of these areas have a common theme that might be addressed by similar approaches to improvement?
5. Pick 1-2 areas for improvement.
   Explain to the group that it is best to focus on one to two areas at a time and that the group should pick improvement areas based on potential impact on resident safety. Suggested discussion questions to engage staff in identifying opportunities for improvement are:
   • What are your top two improvement priorities? (If you have a large enough team, you can have each team member go up to the white board or flip chart and put a check mark next to their two top choices to identify improvement areas to develop an action plan for.
   • Do you have thoughts on potential solutions?
   • Have we already begun to develop solutions for any of these areas? If not, what are some next steps we need to take before we can address certain areas?
6. Develop an action plan for each improvement area.
   After deciding upon the areas to work on in the coming months, the team should develop an action plan for each area chosen. You may want to convene a focus group for each area before developing the action plan. Assign a staff member to champion each improvement area who will ensure that the action plan is followed, and that progress in reported to administration and the team. Monitor progress on each area regularly—ideally monthly and at a minimum quarterly. You may use whatever action planning tool you currently use or the action planning template that accompanies this guide; action planning templates are also available on the Internet. Whichever template you choose, you should document the following:
   • What actions or changes will occur in order to achieve the desired outcome?
   • Who will carry out these actions and changes?
   • Who will monitor whether these actions and changes are taking place?
   • By when will the actions and changes occur?
   • What resources are needed to carry out these actions and changes?
   • How will progress on these actions and changes be communicated to team members and facility champions (administrative, physician and nursing)?

Can our facility compare our results to other nursing homes in the country?
Many nursing homes using the AHRQ Nursing Home Survey on Patient Safety Culture have expressed interest in comparing their results to other nursing homes. In response, the AHRQ established the Nursing Home Survey on Patient Safety Culture Comparative Database. The database is a central repository for survey data from nursing homesⁱ that have administered the AHRQ safety culture survey instrument. Results from the AHRQ database track changes in staff perceptions of resident safety culture over time. Data are also broken out by nursing home characteristics such as bed size, ownership, urban/rural status and census region; and respondent characteristics such as job title, work area and tenure in the nursing home.

For questions about submitting your survey data to the AHRQ Nursing Home Survey on Patient Safety Culture comparative database, please email DatabasesOnSafetyCulture@westat.com or contact the helpline at 1-888-324-9790.

Additional Resources

AHRQ Survey User's Guide to Nursing Home Survey on Patient Culture

IHI White Paper: “Leadership Guide to Patient Safety”

ⁱThe survey and, subsequently, the database is not designed for use in assisted living facilities, community care facilities, or independent living facilities. Therefore, only nursing home facilities are eligible to participate in the database.