Form 4 Data Files Submission

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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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
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).

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).

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