Form 4 Data Files Submission

Ambulatory Surgery Center Survey on Patient Safety Culture Database

Attachment E - ASC Survey Data File Specifications 11.6.17

Data Files Submission

OMB: 0935-0242

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AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Database, Supporting Statement A


Attachment E: Survey Data File Specifications

AHRQ

Ambulatory Surgery Center Survey Survey on Patient Safety Culture

Survey Data File Specifications


AHRQ Ambulatory Surgery Center on Patient Safety Culture
Data Submission Specifications

These specifications are for preparing your respondent-level data from the Ambulatory surgery center Survey on Patient Safety Culture. The instructions below tell you how to prepare your Excel data file for submission to the Ambulatory Surgery Center on Patient Safety Culture Database.



INSTRUCTIONS (Excel File Only):

Step 1: Include a header row with the variable name for each column.

Step 2: Submit individual survey response data using the response values indicated in this document (beginning on page 4).

Step 3: Check your data before submitting for the following things:

  • SKIP PATTERN

There is one skip pattern in this survey. If a respondent answers 2 = No, to question GA, “Are you typically in the surgery/procedure room during surgeries, procedures, or treatments?”, then questions G1 – G3 should be blank.

  • OUT-OF-RANGE VALUES

You should clean your data before submitting to the database to ensure that there are no out-of-range values and that the data submitted are free from error. Make sure all response values match the response value for the question.

  • REVERSE CODED ITEMS

Do not submit reverse coded data on the survey’s negatively worded items—simply submit each individual’s unmodified responses to the survey items.

For example, survey item A5, “Key information about patients is missing when it is needed” is negatively worded. Regardless, the data should be submitted so that 1=Never and 5=Always, as originally indicated in the survey, as follows:

1=Never

2=Rarely

3=Sometimes

4=Most of the time

5=Always

9=Does Not Apply or Don’t Know



  • STAFF POSITIONS

If your ambulatory surgery center modified or added a new staff position (H1) category, you MUST RECODE your specific staff positions back to the survey’s original staff position category. If you added staff positions that do not match any of the survey’s original staff positions, re-code your specific staff positions as “OTHER” (H1 = “j”), before submitting your data.

  • OTHER, PLEASE SPECIFY TEXT

Do not include Other-Please Specify data and comments (question H1 and Section I). While you may find it useful to review this text, it should not be submitted to the Database.

  • SPANISH VERSION OF THE SURVEY

Please indicate which respondents (if any) completed a Spanish version of the safety culture survey, if you have this information available. You should do so by adding an ‘S’ to the Individual Unique Record ID, e.g. 001S.

  • OTHER LANGUAGE VERSION OF THE SURVEY

Please indicate which respondents (if any) completed the safety culture survey in a language that was not English or Spanish, if you have this information available. You should do so by adding an ‘N’ to the Individual Unique Record ID (UNIQUEID), e.g. 001N.

Record Identifier

Variable Name

Column Position

Response Values

Site ID

SITEID

Column A

5 digits or less

Individual Unique Record ID

UNIQUEID

Column B

4 digits or less

SECTION A: Working in This Facility

Survey Question

Variable Name

Column Position

Response Values

  1. Important patient care information is clearly communicated across areas in this facility

A1

Column C

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. We feel comfortable asking questions when something doesn’t seem right

A2

Column D

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. We have enough staff to handle the workload

A3

Column E

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. When we see someone with more authority doing something unsafe for patients, we speak up

A4

Column F

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. Key information about patients is missing when it is needed

A5

Column G

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. Our ideas and suggestions are valued in this facility

A6

Column H

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. We share key information about patients as soon as it becomes available

A7

Column I

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. There is enough time between procedures to properly prepare for the next one

A8

Column J

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. Within this facility, we do a good job communicating information that affects patient care

A9

Column K

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. We feel rushed when taking care of patients

A10

Column L

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

SECTION B: Teamwork and Training

Survey Question

Variable Name

Column Position

Response Values

  1. When someone in this facility gets really busy, others help out

B1

Column M

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing


  1. Staff who are new to this facility receive adequate orientation

B2

Column N

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing


  1. Staff feel pressured to do tasks they haven’t been trained to do

B3

Column O

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing


  1. Doctors and staff clearly understand each other’s roles and responsibilities

B4

Column P

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing


  1. We get the on-the-job training we need in this facility

B5

Column Q

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing


  1. Our facility allows disrespectful behavior by those working here

B6

Column R

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing


  1. Staff get the refresher training they need

B7

Column S

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing


  1. We work together as an effective team

B8

Column T

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing



SECTION C: Organizational Learning/Response to Mistakes

Survey Question

Variable Name

Column Position

Response Values

  1. This facility actively looks for ways to improve patient safety

C1

Column U

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing

  1. Staff are treated fairly when they make mistakes

C2

Column V

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing

  1. We make improvements when someone points out patient safety problems

C3

Column W

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing

  1. Learning, rather than blame, is emphasized when mistakes are made

C4

Column X

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing

  1. Staff are told about patient safety problems that happen in this facility

C5

Column Y

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing

  1. We are good at changing processes to make sure the same patient safety problems don’t happen again

C6

Column Z

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing

SECTION D: Near-Miss Documentation

Survey Question

Variable Name

Column Position

Response Values

  1. When something happens that could harm the patient, but does not, how often is it documented in an incident or occurrence report?

D1

Column AA

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

SECTION E: Management Support for Patient Safety

Survey Question

Variable Name

Column Position

Response Values

  1. Managers encourage everyone to suggest ways to improve patient safety

E1

Column AB

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing or properly skipped

  1. Management examines near-miss events that could have harmed patients but did not

E2

Column AC

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing or properly skipped

  1. Management provides adequate resources to improve patient safety

E3

Column AD

1 = Strongly Disagree

2 = Disagree

3 = Neither Agree nor Disagree

4 = Agree

5 = Strongly Agree

9 = Does Not Apply or Don’t Know

blank = Missing or properly skipped

SECTION F: Overall Rating

Survey Question

Variable Name

Column Position

Response Values

  1. Please give your facility an overall rating on patient safety.

F1

Column AE

1 = Poor

2 = Fair

3 = Good

4 = Very good

5 = Excellent

blank = Missing

SECTION G: Communication in the Surgery/Procedure Room

Survey Question

Variable Name

Column Position

Response Values

A. Are you typically in the surgery/procedure room during surgeries, procedures, or treatments?

GA

Column AF

1 = Yes

2 = No

blank = Missing

If question GA (Column AF) = 2 (No) then skip to section H.

  1. Just before the start of procedures, all team members stopped to discuss the overall plan of what was to be done

G1

Column AG

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. Just before the start of procedures, the doctor encouraged all team members to speak up at any time if they had any concerns

G2

Column AH

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

  1. Immediately after procedures, team members discussed any concerns for patient recovery

G3

Column AI

1 = Never

2 = Rarely

3 = Sometimes

4 = Most of the time

5 = Always

9 = Does Not Apply or Don’t Know

blank = Missing

SECTION H: Background Questions

Survey Question

Variable Name

Column Position

Response Values

  1. What is your position in this facility? Check ONE category that best applies to your job.

H1

Column AJ

a = Anesthesiologist

b = Doctor/Physician (excluding Anesthisiologists) or Surgeon

c = Certified Registered Nurse Anesthetist (CRNA)

d = Physician Assistant or Nurse Practitioner

e = Managemnet

f = Nurse

g = Technician

h = Other Clinical Staff or Clinical Support Staff

i = Administrative, Clerical, or Business Staff

j = Other Position

blank = Missing

TEXT FOR OTHER, SPECIFY [H1jos]* - DO NOT SUBMIT TO DATABASE

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


H2

Column AK

a = 1 to 16 hours per week

b = 17 to 31 hours per week

c = 32 to 40 hours per week

d = More than 40 hours per week

blank = Missing



TEXT FOR YOUR COMMENTS [Section I]* - DO NOT SUBMIT TO DATABASE




Two examples of SECTION G: Communication in the Surgery/Procedure Room questions are displayed below. Columns C - AE are omitted for display purposes.


Example 1: Are you typically in the surgery/procedure room during surgeries, procedures, or treatments?

1=Yes

2=No


G1 through G3 are left blank because GA is 2 (No).

Shape1



Example 2: Are you typically in the surgery/procedure room during surgeries, procedures, or treatments?

1=Yes

2=No


G1 through G3 are filled in because GA was 1 (Yes).

Shape2

ASC - 1117

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File TitleAHRQ Medical Office Survey on Patient Safety Culture Data File Layout
Authorragan_m
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File Created2021-01-20

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