Department of Defense (DoD) Patient Safety Culture Survey

TRI-SERVICE SURVEY ON PATIENT SAFETY

DEPARTMENT OF DEFENSE 200_ * [SERVICE]

Description of this Survey

The DOD 200_ Tri-Service Survey on Patient Safety is sponsored by TRICARE Management Activity (TMA) and was approved by the TMA Chief Medical Officer and the Services Surgeons General for DOD-wide dissemination with staff in Army, Navy, and Air Force Military Health System (MHS) facilities.

Military and civilian staff with email access in MHS facilities, including Military Treatment Facilities (MTFs) and DENTACs (Dental Activities/DTFs), are being asked to complete this survey. It asks for your opinions about patient safety issues, error, and event reporting in your MHS facility.

• It will take about 10 minutes to complete this web-based survey and your individual

responses will be anonymous. Only group-level results will be reported.

Your response to this survey is very important and will help the DOD assess patient safety improvement efforts in MHS facilities.

IF YOU HAVE QUESTIONS

For questions about this survey, please email [Name a point-of-contact and provide email] or call [provide phone].

PRIVACY ACT STATEMENT

According to the Privacy Act of 1974 (Public Law 93-579), the Department of Defense is required to inform you of the purposes and use of this survey. Please read the following carefully:

Authority: 10 U.S.C., Chapter 55, Public Law 102-484, E.O. 9397.

Purpose: This individually anonymous survey asks staff in Military Health System (MHS) facilities (including MTFs and DTFs) for their opinions about patient safety issues, medical error, and event reporting in their facilities. The data will help the DOD assess patient safety improvement efforts in MHS facilities.

Routine Uses: None.

Disclosure: Voluntary. Failure to respond will not result in any penalty to the respondent. However, maximum participation is encouraged so that data will be as complete and representative as possible.

OMB CLEARANCE

This survey has been approved by the Office of Management and Budget (OMB Number 0720-0034, Expiration Date __________). It is estimated that it takes 10 minutes to complete. If you have comments about the survey, its length, or any other aspects of this collection of information, send them to: TRICARE Management Activity, Information Management Control Officer, HPA&E, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041.

SAMPLE OF 200_ WEB SURVEY

1. The Military Health System (MHS) facility where you work is in what country and state (if applicable)?

[NOTE: A drop-down list of by country and state is provided on the web survey. This question is MANDATORY and must be answered before moving on in the web survey.]

Country:________________________________________________

State (if applicable): _______________

2. What is the name and DMIS Code of your Military Treatment Facility (MTF) or DENTAC (Dental Activity/DTF)? [NOTE: A drop-down list of MTF/DENTAC names is provided on the web survey. This question is MANDATORY and must be answered before moving on in the web survey.]

MTF or DENTAC Name:__________________________________________________________

DMIS Code: _____________________

3. In what area of your Military Treatment Facility (MTF) do you work? [NOTE: A respondent will receive this question only if they work in an MTF hospital. This question will be MANDATORY for staff in an MTF hospital and must be answered before moving on in the web survey.]

 1. Hospital

 2. Ambulatory/outpatient clinic

 3. Dental clinic

When completing this survey, keep in mind the following definitions:

• An “event” is defined as any type of error, mistake, incident, accident, or deviation, regardless of whether or not it results in patient harm.

• “Patient safety” is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of health care delivery.

SECTION A: Your Work Area/Duty Area

In this survey, think of your work area or duty area as the section, department, clinical unit, or area of the Military Health System (MHS) facility where you spend most of your work time or provide most of your clinical services.

Ai. What is your primary work area/duty area in your MHS facility?

[See Appendix A for a list of work areas]

From this point forward, if you do not wish to answer a question, or if a question does not apply to you, you may leave your answer blank.

SECTION A: Your Work Area, continued

Please indicate your agreement or disagreement with the following statements about your work area.

	Strongly Disagree 	Disagree 	Neither 	Agree 	Strongly Agree 
1. People support one another in this work area					
2. We have enough staff to handle the workload					
3. When a lot of work needs to be done quickly, we work together as a team to get the work done					
4. In this work area, people treat each other with respect					
5. Staff in this work area work longer hours than is best for patient care					
6. We are actively doing things to improve patient safety					
7. We use more agency/temporary staff than is best for patient care					
8. Staff feel like their mistakes are held against them					
9. Mistakes have led to positive changes here					
10. It is just by chance that more serious mistakes don’t happen around here					
11. When one section in this work area gets really busy, others help out					
12. When an event is reported, it feels like the person is being written up, not the problem					
13. After we make changes to improve patient safety, we evaluate their effectiveness					
14. We work in "crisis mode" trying to do too much, too quickly					
15. Patient safety is never sacrificed to get more work done					
16. Staff worry that mistakes they make are kept in their personnel file					
17. We have patient safety problems in this work area					
18. Our procedures and systems are good at preventing errors from happening					

SECTION B: Your Supervisor/Manager

Please indicate your agreement or disagreement with the following statements about your immediate supervisor/manager or person to whom you directly report.

	Strongly Disagree 	Disagree 	Neither 	Agree 	Strongly Agree 
1. My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures					
2. My supervisor/manager seriously considers staff suggestions for improving patient safety					
3. Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts					
4. My supervisor/manager overlooks patient safety problems that happen over and over					

SECTION C: Communications

How often do the following things happen in your work area?

	Never 	Rarely 	Some-times 	Most of the time 	Always 
1. We are given feedback about changes put into place based on event reports					
2. Staff will freely speak up if they see something that may negatively affect patient care					
3. We are informed about errors that happen in this work area					
4. Staff feel free to question the decisions or actions of those with more authority					
5. In this work area, we discuss ways to prevent errors from happening again					
6. Staff are afraid to ask questions when something does not seem right					

SECTION D: Frequency of Events Reported

In your work area, when the following mistakes happen, how often are they reported?

	Never 	Rarely 	Some-times 	Most of the time 	Always 
1. When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported?					
2. When a mistake is made, but has no potential to harm the patient, how often is this reported?					
3. When a mistake is made that could harm the patient, but does not, how often is this reported?					

SECTION E: Patient Safety Grade

Please give your work area an overall grade on patient safety.

				
A Excellent	B Very Good	C Acceptable	D Poor	E Failing

SECTION F: Your Military Health System (MHS) Facility

Please indicate your agreement or disagreement with the following statements about your MHS facility.

	Strongly Disagree 	Disagree 	Neither 	Agree 	Strongly Agree 
1. Management in this facility provides a work climate that promotes patient safety					
2. Work areas in this facility do not coordinate well with each other					
3. Things “fall between the cracks” when transferring patients from one work area to another					
4. There is good cooperation among areas that need to work together					
5. Important patient care information is often lost during shift changes					
6. It is often unpleasant to work with staff from other work areas in this facility					
7. Problems often occur in the exchange of information across work areas in this facility					
8. The actions of management in this facility show that patient safety is a top priority					
9. Management in this facility seems interested in patient safety only after an adverse event happens					
10. Work areas in this facility work well together to provide the best care for patients					
11. Shift changes are problematic for patients in this facility					

SECTION G: Number of Events Reported

In the past 12 months, how many event reports have you filled out and submitted?

 a. No event reports	 d. 6 to 10 event reports
 b. 1 to 2 event reports	 e. 11 to 20 event reports
 c. 3 to 5 event reports	 f. 21 event reports or more

SECTION H: Background Information

This background information will help in the analysis of the survey results.

1. How long have you worked in this Military Health System (MHS) facility?

 a. Less than 1 year	 d. 11 to 15 years
 b. 1 to 5 years	 e. 16 to 20 years
 c. 6 to 10 years	 f. 21 years or more

2. How long have you worked in your current work area?

 a. Less than 1 year	 d. 11 to 15 years
 b. 1 to 5 years	 e. 16 to 20 years
 c. 6 to 10 years	 f. 21 years or more

3. Typically, how many hours per week do you work in this MHS facility?

 a. Less than 20 hours per week	 d. 60 to 79 hours per week
 b. 20 to 39 hours per week	 e. 80 to 99 hours per week
 c. 40 to 59 hours per week	 f. 100 hours per week or more

4. What is your staff position in this MHS facility? Select ONE answer that best describes your staff position.

[See Appendix B for a list of staff positions]

5. In your staff position, do you typically have direct interaction or contact with patients?

 a. YES, I typically have direct interaction or contact with patients.

 b. NO, I typically do NOT have direct interaction or contact with patients.

6. How long have you worked in your current specialty or profession?

 a. Less than 1 year	 d. 11 to 15 years
 b. 1 to 5 years	 e. 16 to 20 years
 c. 6 to 10 years	 f. 21 years or more

7. Please select your staff type below:

 a. Military—Active duty

 b. Military—Reservist

 c. Civilian—GS employee

 d. Civilian—Contractor

 e. Volunteer

 f. Other, please specify: ______________________________________________________

SECTION I: Your Comments

Please feel free to write any comments about patient safety, error, or event reporting in your MHS facility. Do not write any comments associated with individual patients or event identifiable information.

NOTE: Verbatim comments will be reviewed at the Service level.

THANK YOU FOR COMPLETING THIS SURVEY.

CLICK ON THE "SUBMIT SURVEY" BUTTON BELOW

TO COMPLETE THE SURVEY PROCESS.

Appendix A: 2008 Work Areas for Hospitals, Clinics, and Dental Clinics

For Hospitals only		For Outpatient Clinics only		For Dental Clinics only
a.	Many different work areas/No specific work area	a.	Many different work areas/No specific work area	a.	Dental Clinic
b.	Administration/Management (Education, Medical Records, QA/QC, Safety, Other Management)	b.	Administration/Management (Education, Medical Records, QA/QC, Safety, Other Management)	b.	Laboratory
c.	Aerospace Medicine/BioMedical Engineering	c.	Aerospace Medicine/BioMedical Engineering	c.	Oral Surgery
d.	Anesthesiology	d.	Allergy & Immunology	d.	Other work area/duty area, please specify:
e.	Dietary	e.	Anesthesiology
f.	Emergency Department	f.	Cardiology
g.	Facilities & Logistics	g.	Dermatology
h.	Gastroenterology	h.	Facilities & Logistics
i.	Information Technology (IT) Services	i.	Family Practice/Family Medicine
j.	Intensive care unit (e.g. Adult, Coronary Care, Neonatal, Pediatric, Other ICU)	j.	Gastroenterology
k.	Labor & Delivery/Obstetrics	k.	Internal Medicine
l.	Medical-Surgical Unit/Ward	l.	Information Technology (IT) Services
m.	Medicine (Non-surgical)	m.	Neurology/Neurological Surgery
n.	Oncology	n.	Nuclear Medicine
o.	Pathology/Laboratory	o.	Obstetrics/Gynecology
p.	Pediatrics	p.	Occupational Medicine
q.	Pharmacy	q.	Oncology
r.	Psychiatry/Mental Health	r.	Ophthalmology
s.	Radiology	s.	Orthopedics/Orthopedic Surgery
t.	Rehabilitation/Physical Medicine	t.	Otolaryngology
u.	Surgery	u.	Pathology/Laboratory
v.	Other work area/duty area, please specify:	v.	Pediatrics/Other Pediatric Specialty Area
		w.	Preventive Medicine/Public Health
		x.	Psychiatry/Mental health
		y.	Pulmonology
		z.	Radiology
		aa.	Rehabilitation/Physical Medicine
		bb.	Surgery
		cc.	Urology
		dd.	Vascular Medicine
		ee.	Other work area/duty area, please specify:

Appendix B: 2008 Staff Positions

a.	Administration/Management/Executive Staff/Commander
b.	Aerospace/BioMedical Engineering Specialist
c.	Assistant/Clerk/Secretary/Administrative Technician
d.	Dental assistant
e.	Dental hygienist
f.	Dentist
g.	Dietician
h.	Information Technology (IT) Services Staff
i.	Lab Technician
j.	LVN/LPN
k.	Medical Technician
l.	Nurse Practitioner
m.	Patient Care Assistant/Nursing Aid
n.	Pharmacist
o.	Pharmacy Technician
p.	Physical/Occupational/Speech Therapist
q.	Physician Assistant
r.	Physician/Attending Physician
s.	Registered Nurse (RN)
t.	Resident/Intern/Medical Student
u.	Respiratory Therapist
v.	Other provider (Clinical Psychologist, Optometrist, Social Worker, etc.)
w.	Other staff position, please specify:

9

SAMPLE OF 200_ WEB SURVEY