AHRQ's Patient Safety Culture Survey Used to Set Baselines for Improvements at Chicago Hospital

In December 2004, Northwestern Memorial Hospital in Chicago administered AHRQ's Hospital Survey on Patient Safety Culture to establish a baseline for assessment of culture and culture change as part of ongoing initiatives to improve patient safety. AHRQ's survey yielded a 28 percent response rate among clinicians, which was quadruple the rate from a shorter paper survey administered in 2002.

"We chose AHRQ's Hospital Survey on Patient Safety Culture for its validated questions and specific domains that are of particular interest to our hospital, such as teamwork, leadership, and handoffs," says Cynthia Barnard, MBA, MSJS, CPHQ, Director of Quality Strategies at Northwestern Memorial. She and Marilyn K. Szekendi, RN, MSN, APRN, BC, Research Coordinator for the patient safety team, led the project.

Using an institution-funded, Web-based system, the anonymous survey was disseminated by Email to every hospital employee, totaling over 6,000 staff. In addition, the survey was sent to over 1,400 medical staff and 500 residents and fellows.

The results of the survey were highly congruent with informal assessments of leaders and patient safety staff. Staff generally rated their own work groups and management very highly, while voicing greater concern about handoffs, communication between workgroups, and lack of feedback about reported issues. Importantly, the survey also highlighted that staff were more uncomfortable with filing reports of adverse events than was previously recognized.

With the data gathered from the survey, the patient safety team targeted its initiatives to address three specific dimensions of patient safety: reporting of adverse events, handoffs and communication, and feedback and awareness of adverse events. Strategies in place so far include new processes and technical support to improve communication and handoffs, team training projects to improve interdisciplinary cooperation, and new monthly patient safety morbidity and mortality conferences to solicit improvement ideas and provide feedback.

"When we present the data from the survey at staff patient safety workshops and conferences, it is very important that we can emphasize, 'This is what you told us.' There is much to be said for the act of asking. The results, though not entirely surprising, are much more powerful than merely reporting data from the literature, and they provide us with a good baseline to gauge the success of our efforts," says Barnard.

Northwestern plans to repeat the survey approximately every 18 months to continue to collect this useful data and follow the progress of culture change.

In March 2005, Barnard and Szekendi shared their experiences and implementation plan in a presentation titled, "Survey Administration Logistics," during AHRQ's Second Technical Assistance Conference Call for the Hospital Survey on Patient Safety Culture. Their presentation included information about designing a user-friendly electronic version of the survey, suggestions for data collection, and a timeline for planning and administration. Following the call, Barnard and Szekendi advised 10 hospitals, in addition to commenting for articles in industry publications.

Northwestern Memorial Hospital is located in downtown Chicago. It is a 744-bed academic medical center and primary teaching hospital for Northwestern University's Feinberg School of Medicine. In addition to being a major Midwest referral center, it is Chicago's only academic medical center participating in city and state Level I trauma networks.

The Hospital Survey on Patient Safety Culture can be accessed at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/index.html.