On-line Patient Safety Climate Survey: Tool Development and Lessons Learned

Objective: A key tenet of patient safety programs is the elimination of the “culture of blame.” The On-line Patient Safety Climate Survey was developed to evaluate the corporate safety climate of the U.S. Army Medical Department (AMEDD). Methods: The survey tool was designed to measure willingness to report errors, problem-solving processes, and perceptions of the leadership’s concern for patient safety. The survey included two demographic questions, 19 items using a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree), and one text item that asked respondents to identify the number one safety issue at their facility. After the instrument was tested to evaluate its psychometric properties, it was administered at 37 military hospitals and clinics in an effort to establish a systemwide baseline. Results: In 2001, staff at 37 medical treatment facilities (MTFs) participated in the survey (N = 10,769). The overall systemwide score (all respondents) was positive (2.96), and analyses of specific items demonstrated that error reporting was an area of concern. Conclusions: The OnLine Patient Safety Survey demonstrated adequate psychometric properties and the ability to provide an accurate assessment of the overall safety climate across the various clinical treatment facilities of an organized health care system. The results provided information useful for establishing a corporate baseline and identifying specific quality improvement needs. Introduction There has been a great deal of recent media and consumer attention focused on the health care industry’s response to a national imperative aimed at improving hospital patient safety. As a result, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has published patient safety standards emphasizing the critical role of organizational leaders in the development of a safety culture. In addition, former President Bill Clinton issued an executive order during his tenure mandating actions on the part of all Federal agencies involved with patient care to reduce medical errors and improve clinical safety. In support of these regulatory requirements, the Army Medical Department (AMEDD) took a health care leadership role and implemented a proactive, standardized, and integrated corporate patient safety campaign. The AMEDD leadership made a priority of collecting baseline data on staff perceptions related to the organizational safety climate prior to developing and implementing its quality improvement project. To this end, an Internet-based survey tool was created to maximize staff participation and ensure anonymity. Advances in Patient Safety: Vol. 4 416 The tool evaluated three safety climate factors: (1) staff willingness to report medical errors, (2) organizational problem-solving processes, and (3) perceptions regarding the organizational leadership’s concern for patient safety. This initiative supported the AMEDD’s comprehensive strategy for establishing an environment that encourages all personnel to identify actual and near-miss patient safety events, places a high value on the analyses of systems issues contributing to such events, and supports identification and redesign of vulnerable patient care processes.