1. 1 1 The AHRQ Surveys on Patient Safety Culture Setting the Standard for Patient Safety Culture Around the Globe AHRQ Annual Meeting September 19, 2011 Joann Sorra, Ph.D Senior Study Director Westatjoannsorra@westat.com

2. 2 2 Objectives Define patient safety culture Discuss reasons to assess patient safety culture Discuss international use of the AHRQ Surveys on Patient Safety Culture

3. 3 3 What is Patient Safety Culture? “The way we do things around here” Shared by staff Beliefs, values & norms Exists at multiple levels: System Organization Department Unit What is Rewarded Supported Expected

4. 4 4 AHRQ SOPS Surveys Assess provider & staff opinions about patient safety culture in Hospitals (2004) Nursing homes (2008) Medical offices (2009) Retail pharmacies (Expected Summer 2012)

5. 5 5 Dimensions Assessed Teamwork Staffing Training Handoffs Communication Organizational learning Management support for patient safety Nonpunitive response to mistakes Overall perceptions of patient safety

6. 6 6 Why Assess Patient Safety Culture? Raise staff awareness Diagnose & assess the status of patient safety culture Identify strengths & areas for improvement Evaluate the impact of patient safety initiatives Examine trends & track change over time Satisfy directives or regulatory requirements Compare with other organizations

7. 7 7 Free Toolkit Materials User’s guide Survey feedback report PPT template Resource list of patient safety initiatives Reference list ( coming soon—includes international publications ) Data entry & analysis tool Comparative database reports Research data sets (for de-identifiable data) Translation guidelines International users contact the User Network  To connect with other international users  Obtain information about existing translations www.ahrq.gov/qual/patientsafetyculture

8. 41 Countries

9. 9 9

10. 10 22 Languages 10

11. 11 International Initiatives The European Network for Patient Safety (EUNetPaS) World Health Organization (WHO) High 5s Patient Safety Initiative Other regional collaboratives 11

12. 12 EUNetPaS 78% of EU citizens consider medical errors to be an important issue in their country Officially launched in 2008 in Utrecht, Netherlands Aims to establish an umbrella network of all 27 EU Member States to encourage collaboration in patient safety 12

13. 13 EUNetPaS Goals 1)Establish common principles at the EU level  Integrating knowledge, experiences and expertise from Member States 2)Facilitate the development of patient safety programs in Member States 3)Support countries less advanced in patient safety 13

14. 14 Key Topic Areas Promoting a culture of patient safety Structuring education and training in patient safety in Member States Proposing a core European curricula for patient safety in higher education Implementing reporting and learning systems Piloting the implementation of medication safety programs in hospitals 14

15. 15 AHRQ Survey Endorsement EUNetPaS published a two-volume report in 2010 reviewing patient safety culture instruments AHRQ Hospital SOPS—One of only 3 patient safety culture instruments officially recommended after an extensive review of available tools 15

16. 16 WHO High 5s Launched in 2006 to reduce the frequency of 5 challenging patient safety problems in 5 countries over 5 years Focus has been on 3 initiatives  Medication reconciliation at transitions in care  Performing correct site surgery  Managing concentrated injectable medicines Seven countries  UK, France, Netherlands, Germany, Singapore, Australia & Canada 16

17. 17 High 5s & HSOPS Administered the HSOPS in 2009 and 2010 23,520 respondents from 59 hospitals in 6 countries Produced feedback reports  For participating hospitals, countries, and an international comparative report Hope to examine relationships between patient safety culture and implementation of the High 5s patient safety initiatives 17

18. 18 Other Regional Collaboratives Middle East Regional Network For Patient Safety Culture & Human Factors  Egypt, Jordan, Kuwait, Libya, Qatar, Saudi Arabia, United Arab Emirates  Over 20 researchers and representatives from hospitals and health systems  Goals: Obtain WHO & AHRQ support; hold regional meetings; establish a patient safety culture database for comparative purposes; adopt standard Arabic translations of the AHRQ SOPS surveys PaSCAL—Patient Safety Culture Alliance in Italy  Organized by the European Institute of Oncology (Instituto Europeo di Oncologia--IEO)  23 participating hospitals  Held a Quality Week conference in November 2010 18

19. 19 International Comparisons The general finding:  The U.S. typically scores higher on most dimensions  Notable exceptions where other countries have much higher scores than the U.S. 19

20. 20 Challenges of International Comparisons Quality and comparability of translations Translations have shown variable psychometric properties (factor structure & reliability) Differences in the structure and delivery of healthcare Cultural influences on how respondents interpret and answer survey questions 20

21. 21 AHRQ SOPS: Setting the Standard 2011 Hospital SOPS Comparative Database Report 1,032 hospitals and 472,397 staff Largest non-proprietary, free in the public domain, patient safety culture database in the world The Nursing Home and Medical Office SOPS surveys are likely to follow NH SOPS Database report released August 2012 MO SOPS Database open for data submission through Oct ober15—Report available Spring 2012 21

22. 22 Email: safetyculturesurveys@ahrq.hhs.gov joannsorra@westat.com