
Measuring Patient Safety Culture
Patient safety culture refers to the shared values, beliefs, and norms about the importance of patient safety within a healthcare organization. It reflects how safety is perceived, managed, and prioritized in daily healthcare practices.
Understanding key metrics in patient safety culture is essential for healthcare organizations to assess the various dimensions of safety culture. It helps to identify strengths and areas for improvement, implement targeted strategies, and measure effectiveness over time to foster a culture of safety.
There are several standardized survey tools available to assess patient safety culture, such as AHRQ Survey on Patient Safety Culture. It is widely used for its comprehensive assessment across multiple dimensions. You may want to refer to it when creating your own patient safety culture survey.
In this blog, we highlight eight key dimensions for assessing patient safety culture. Each aspect has several metrics and survey questions. These metrics and surveys on staff perceptions provide valuable insights into attitudes, behaviors, and practices that contribute to a culture of safety.
Table of Contents
Key Dimensions and Metrics
1. Response to Error
An organization’s response to errors says a great deal about its patient safety culture. It shows whether the organization treats errors as opportunities for learning or focuses on assigning blames to individuals. A blame-free environment fosters open communication and encourages staff to report errors. This is critical for identifying systemic issues and preventing future harm.
Metrics / survey questions:
- Staff perception of whether the organization focuses on learning or blaming individuals
- Whether staff feel like their mistakes are held against them
- Willingness of staff to report errors without fear of punishment or retribution
2. Reporting Patient Safety Events
The number of incidents reported on adverse events, errors, and near misses is a good indicator of patient safety culture. High reporting rates often indicate a culture where staff feel safe to report incidents and near misses. It is also a measure of safety awareness.
Metrics / survey questions:
- Number of reported safety incidents over a specific period, categorized by type and severity (e.g. per 1,000 patient days)
- Number of reported near misses or good catches
- How often do staff report mistakes caught and corrected before reaching the patient
3. Hospital Management Support for Patient Safety
Leadership commitment to safety sets the tone for the entire organization. Hospital management support is vital for establishing safety priorities, allocating resources, and modeling safe practices for staff. When management prioritizes patient safety, it sets the safety culture for the organization.
Metrics / survey questions:
- The actions of hospital management show that patient safety is a top priority
- Hospital management provides adequate resources for patient safety initiative
- Hospital management is only interested in patient safety after an adverse event happens.
4. Supervisor, Manager or Clinical Leader Support for Patient Safety
The actions of supervisors, managers and clinical leaders (mid-level managers) are also a good indicator of an organization’s patient safety culture. Mid-level managers set examples. Their attitude and practices directly influence staff behaviors.
Metrics / survey questions:
- Do mid-level managers seriously consider staff suggestions for improving patient safety
- Do mid-level managers take immediate actions to address patient safety concerns that are brought to their attention
- Are staff allowed to take shortcuts during busy times or when short-handed
5. Teamwork Within and Across Units
Strong teamwork enhances the ability to manage complex patient care, reduces errors, and fosters a supportive work environment. The level of collaboration and support within and across departments within the organization is a measure of patient safety culture.
Metrics / survey questions:
- How well unit members work as an effective team and cooperate within and cross-department
- Do team members help each other during busy times
- Frequency of multidisciplinary meetings and joint training sessions
6. Communication Openness
An environment of open communication whereby staff feel comfortable speaking up about safety concerns is a good measure of patient safety culture. Effective and open communication is vital for preventing errors and ensuring safety and the delivery of quality care. Establishing channels for receiving and responding to feedback on safety issues is a useful first step.
Metrics / survey questions:
- Staff perception that they can speak up or ask questions about patient safety concerns without fear
- How often do staff speak up if they see something that may negatively affect patient care
- When staff speak up, does the unit manager seriously address their patient safety concerns
7. Staffing and Workload
Healthcare organizations should always ensure staffing levels and workloads are adequate to provide patient care safely. This reflects hospital management’s commitment to prioritize patient safety over other considerations. Overworked or understaffed teams are more prone to make mistakes.
Metrics / survey questions:
- Percentage of staff who agree that “staffing levels are adequate to handle the workload safely.”
- Frequency of staff having to work long hours and overtime
- Is the work pace in the unit so rushed that it negatively affects patient safety
8. Organizational Learning and Continuous Improvement
Lastly, assessing the organization’s ability to learn from errors and implement improvements. Continuous learning is an essential part of patient safety culture. It fosters a proactive approach to preventing future errors.
Metrics / survey questions:
- Staff perception that “the organization learns from its mistakes and makes necessary changes.”
- Regularly review work processes to determine if changes are needed to improve patient safety
- Whether the same patient safety problems keep happening
In Summary
Understanding key metrics in patient safety culture can help you assess and measure the multiple dimensions of patient safety culture to drive improvements. Admittedly, there are challenges and barriers in conducting patient safety culture surveys and formulating a composite measure (a topic we will discuss in our future blogs). This, however, should not stop you from measuring patient safety culture in your organization to drive improvements. Start with incident and near miss reporting rates and the ability to learn from errors and implement improvements. What gets measured gets improved!
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