According to the most recent survey on hospital culture by the Agency for Healthcare Research and Quality (AHRQ), provider perception of a positive hospital safety culture was the lowest for questions concerning the presence of non-punitive response to errors, effective handoffs and transitions, and adequate staffing. These results are detailed by the AHRQ in the “Hospital Survey on Patient Safety Culture 2016 User Comparative Database Report.”The AHRQ has been measuring data on patient safety culture since 2004. Surveys are now available for medical offices, nursing homes, community pharmacies, and surgery centers. The data base includes information obtained from thousands and thousands of healthcare workers. AHRQ’s objective is fourfold:
- Allow hospitals to make comparisons with similar organizations
- Facilitate assessment and education
- Identify areas of both weakness and strengths
- Detail current trends.
The 2016 survey obtained information from 680 hospitals and included 447,584 staff personnel. The survey asks questions on a composite of 12 patient safety areas and issues. The data base is comprised of various size hospitals with multiple geographic locations throughout the United States. Over one half (56%) of those surveyed worked in facilities with more than 300 beds. The largest group responding to the survey was nursing, comprising 36% of the total. Of all respondents, 77% worked in settings with direct patient contact.
Results of the 2016 survey outlined both strengths and weaknesses of current patient safety culture:
Areas of Strength (highest positive responses):
- Teamwork within an individual unit (82% positive)
- Supervisor/Manager Expectations and Actions Promoting Patient Safety (78% positive)
- Continuous Improvement and Organizational Learning (73% positive)
It also should be noted that 76% of those hospital workers surveyed gave their individual units a patient safety evaluation of “Excellent” or “Very Good.” In addition, 72% gave positive scores to management concerning support for patient safety.
On the other hand, the survey also detailed areas of weakness which had the lowest positive responses:
- Non-punitive Response to Error (45% positive)
- Handoffs and Transitions (48% positive)
- Staffing (54% positive)
One of the key features of a safety culture according to AHRQ is “a blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment.” Perhaps the greatest barrier to successful creation of a safety culture is the perception that errors will be punished. One concept that has gained favor in dealing with this problem is that of a “Just Culture.” A “Just Culture” adds the feature of “accountability” to the “blame-free” environment. In a “Just Culture,” providers are taught that there is zero tolerance for behavior that is reckless. However, management’s response to an error must be related to the associated behavior, rather than to the type or seriousness of an event. For example, staff members must know that a distinction is made between 1) human errors or “slip-up” mistakes, 2) errors caused by at-risk behavior, such as the use of “work-a-rounds” or shortcuts, and 3) mistakes due to reckless behavior, such as the refusal to follow safety policies and protocols.
Inefficient communication during healthcare handoffs and transitions is frequently the cause of medical errors. Fortunately, there are many targeted strategies and techniques to improve communication during these key moments in patient care. New handoff methods such as I-PASS, now integrate the electronic medical record into the handoff process by printing out a computer generated handoff sheet. This handoff work sheet contains vital patient medical information to be discussed and handed-off by the sending provider to the receiving provider.
In addition, multiple organizations and healthcare agencies have developed “Transition of Care Models,” which educate and assist patients as they transition from setting to setting in the hospital. Members of an interdisciplinary team work to organize an effective discharge and post discharge process, which is coordinated with the primary care provider.
Although adequate hospital staffing has been an ongoing issue for many organizations, the data from the above survey indicates that a significant percentage of respondents perceive this as a patient safety issue. Healthcare administrators should consider this information when appropriating funds for staffing in yearly budgets.
The National Patient Safety Foundation published a report in 2016 which evaluated advances in patient safety over a fifteen year period. The publication was titled “Free From Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human.” The authors made multiple recommendations to improve future patient safety and clinical care. Of the eight recommendations suggested, the foundation considered the first and perhaps the most important to be “Ensuring that leaders establish and sustain a safety culture.” It is therefore incumbent on healthcare leadership to consider the results of patient safety surveys as future initiatives are developed.
- Agency for Healthcare Research and Quality (AHRQ). “HOSPITAL SURVEY ON PATIENT SAFETY CULTURE 2016 User Comparative Database Report” AHRQ Publication No. 16-0021-EF March 2016. Accessed February 17, 2017
- Agency of Healthcare Research and Quality (AHRQ). “Safety Culture.” Patient Safety Primers. Accessed February 19, 2017
- National Patient Safety Foundation “Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human” National Patient Safety Foundation. 2016. Accessed February 21, 2017