DEPARTMENT
OF DEFENSE
2019 TRI-SERVICE SURVEY ON PATIENT SAFETY
Thank you for participating in this survey! Your perspective on patient safety matters is important to the Military Health System (MHS).
Description of this Survey
The 2019 Tri-Service Survey on Patient Safety (Culture Survey) is sponsored by the Department of Defense Patient Safety Program. 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. Survey questions ask for your opinions about patient safety issues, error, and event reporting in your MHS facility.
For more information on the background and purpose of this survey, please click here.
Pop-up box content: |
What is the purpose of the survey? The purpose of this survey is to gather honest staff opinions regarding the culture of safety across our MHS facilities. The survey will assist in raising awareness about patient safety matters and prioritize efforts to provide safe care. |
What is the survey about? The survey asks for your opinions about areas deemed essential for maintaining a culture of patient safety, which includes: reporting errors, communicating feedback on an error, learning from errors, working with teams, handling care transitions and ensuring management support for patient safety. |
How will information from this survey be used? Survey results will be used to identify areas where we shine as well as areas that may need improvement. The results will help prioritize activities promoting patient safety.
Why was I selected for the survey? All staff – military, civilian, and contractors – working in direct care facilities are invited to participate. |
Who
determined the questions?
I am retiring or I am new to this facility. Do you still want me to take this survey? Yes, your experiences and opinions are highly valued.
Why should I participate? Every individual working within an MTF provides a unique perspective on how we can deliver safe care to our patients. Your responses will help provide a comprehensive picture to help us continue delivering safe care to our patients. When will the survey results be ready? Results are expected in TBD.
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How will the results be reported? Reports will be produced at various levels, for example, overall, by Service, and work area. |
IF YOU HAVE QUESTIONS
For questions about this survey, click here for Service points of contact.
Pop-up box content: Army:
Col. Kimberly Kesling, email: [email protected] NCR:
Ms. Lisa Lewis, email: [email protected]
Navy:
Ms. Carmen Birk, email: [email protected]
Air Force:
Col. Allen Kidd, email: [email protected]
DOD: Mr.
Mike Datena, email: [email protected]
PRIVACY ADVISORY
Your responses are voluntary and your decision to participate or not will not affect your employment or any opportunity to receive future benefits. Your responses to this Survey about your opinions about patient safety issues, medical errors, and event reporting will allow us to maintain or improve the quality of the patient care provided to all receiving treatment at your facility. If you do not wish to answer a question, or if a question does not apply to you, you may leave your answer blank.
OMB CLEARANCE
This survey has been approved by the Office of Management and Budget (OMB Number 0720-0034, Expiration Date X/XX/XXXX). 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: Dr. Kimberley Marshall, Senior Health Care Research Analyst, Defense Health Agency Decision Support (DHADS); email: [email protected].
For more information on the confidentiality associated with your survey responses, please click here.
Pop-up box
content: Will
anyone be able to link my survey responses to me? This
is a confidential and anonymous survey.
Responses
will not be tracked to specific individuals nor will responses be
reported that may breach confidentiality. Only group statistics will
be prepared from the survey results, such as “70 percent of
staff gave their work area an overall patient safety grade of B, or
very good.” Will
my answers be reported to my commanding officer or be put in my
personnel file? Because
the survey is anonymous, none of your survey answers can be tracked
to you. Therefore, your survey answers will not be reported to your
commanding officer, nor will they be put in your personnel file. How
will demographic data be used in reporting survey results? Survey
results will only be reported in terms of group statistics, such as
“70 percent of staff gave their work area an overall patient
safety grade of B or very good.” Because the survey is
anonymous, no one will match your survey responses to you. If you do
not wish to answer a demographic question, you may leave it blank. What
authority do you have to ask me to provide you with demographic
data? This
is a voluntary survey. We have authority to conduct the survey
under 10 U.S.C., Chapter 55, Public Law 102- 484, E.O. 9397. The
survey has been approved by the Office of Management and Budget (OMB
Number 0720-0034,
Expiration Date 9/30/2018).
In
accordance with the Privacy Act of 1974 (Public Law 93-579), the
providing of personal information is completely voluntary. If you do
not wish to answer a question, or if a question does not apply to
you, you may leave your answer blank.
What is YOUR Service affiliation?
For more information about reporting your Service information, click here.
Pop-up box content:
I work at a facility that isn’t commanded by my Service. Should I report my Service or the Service that commands the facility in which I work?
For this question, you should report the Service with which you are affiliated—NOT the Service that commands your work facility (which will be reported in a separate question.)
I am in the Army, but my facility is commanded by the Navy. Should I report my Service affiliation as Army or Navy?
For this question, you should report the Service affiliation as Army. A separate question will ask about the Service which commands your facility.
The survey will not let me go further without choosing my Service. Do I have to answer this question to complete the survey?
Yes. To provide information that can be used to improve patient safety at a particular facility, we need to know which facility a particular respondent is from. This information is not used to identify individuals and individual respondents will still remain anonymous. Survey feedback will only be provided at the group level if 20 or more responses are received from a particular facility.
\\
Air Force
Army
Navy
National Capital Region Medical Directorate (NCR MD)
[Question is mandatory—survey respondents cannot proceed without answering this question.
Which Service commands the facility in which you work?
For more information about reporting which Service commands your work facility, click here.
Pop-up box
content: I
work at a facility that isn’t commanded by my Service. Should
I report my Service or the Service that commands the facility in
which I work? For
this question, you should report the Service that commands your work
facility—NOT the Service with which you are affiliated (which
should have been reported in the previous question.) I
am in the Army, but my facility is commanded by the Navy. Should I
report Army or Navy for this question? For
this question, you should report Navy since it commands the facility
in which you work. The previous question asks about your Service
affiliation. I’m
not sure if my work facility is a National Capital Region Medical
Directorate (NCR MD) facility. What should I report? The
email that accompanied the link to this survey should specify
whether your work facility is commanded by NCR MD. If you are
unsure, contact your patient safety manager. The
survey will not let me go further without choosing my Service. Do I
have to answer this question to complete the survey? Yes.
To provide information that can be used to improve patient safety at
a particular facility, we need to know which facility a particular
respondent is from. This information is not used to identify
individuals and individual respondents will still remain anonymous.
Survey feedback will only be provided at the group level if 20 or
more responses are received from a particular facility.
Air Force
Army
Navy
NCR MD Go to NCR MD facility list.
[Question is mandatory—survey respondents cannot proceed without answering this question.]
What is the region of your work facility?
For more information about reporting your region information, click here.
Pop-up box content:
I’m not sure which region I’m in. What should I report?
The email that accompanied the link to this survey should specify your facility’s region. If you are unsure, contact your patient safety manager.
The survey will not let me go further without answering which region I am from. Do I have to answer this question to complete the survey?
Yes. To provide information that can be used to improve patient safety at a particular facility, we need to know which region and facility a particular respondent is from. This information is not used to identify individuals and individual respondents will still remain anonymous. Survey feedback will only be provided at the group level if 20 or more responses are received from a particular facility.
[Please create drop-down list of MTF/DENTAC regions by Service using the lists from the “Zogby Patient Safety Drop Down List” Excel spreadsheet. Respondents should only see those facilities that correspond to their answers from Q2.]
[Question is mandatory—survey respondents cannot proceed without answering this question. If respondent does not answer this question, please input the following message:
“Please answer this question in order to move forward with the rest of the survey.”]
Please select your Parent Facility.
[NOTE: This question should only appear for Army and Navy. If a respondent selects Air Force in Q2, the survey should skip to Q5.]
[Please create drop-down list of MTF/DENTAC Parent Facility by Service and Region using the lists from the “Drop Downs” Excel spreadsheet. Respondents should only see those facilities that correspond to their answers from Q2 and Q3.]
[Question is mandatory—survey respondents cannot proceed without answering this question. If respondent does not answer this question, please input the following message:
“Please answer this question in order to move forward with the rest of the survey.”]
Please select your Facility.
[Please create drop-down list of MTF/DENTAC Parent Facility by Service, Region, and Parent Facility using the lists from the “Drop Downs” Excel spreadsheet. Respondents should only see those facilities that correspond to their answers from Q2, Q3, and Q4.]
[Question is mandatory—survey respondents cannot proceed without answering this question. If respondent does not answer this question, please input the following message:
“Please answer this question in order to move forward with the rest of the survey.”]
[“Drop Downs” Excel spreadsheet lists whether each facility is a hospital, clinic, or DENTAC/Dental Clinic. Based on the respective type, skip to the appropriate question as designated below:
If MTF Hospital Go to question 6
If Army/Navy & Clinic Go to question Ai, Clinic work area drop-down list
If Air Force & Clinic Go to “Clinic Area Survey” instrument
If DENTAC or Dental Clinic Go to question Ai, DENTAC/Dental Clinic work area drop-
down list]
In what area of your Military Treatment Facility (MTF) do you work?
Hospital Go to question Ai, Hospital work area drop-drop down list
Ambulatory/outpatient clinic
Army and Navy Go to question Ai, Clinic work area drop-down list
Air Force Go to “Clinic Area Survey” instrument
DENTAC or Dental Clinic Go to question Ai, DENTAC/Dental Clinic work area drop-
down list
[Question is mandatory for those who select an MTF hospital. If respondent does not answer this question, please input the following message: “Please answer this question in order to move forward with the rest of the survey.”]
SECTION A: Your Work Area/Duty Area
For the purposes of this survey, please consider the following definitions of key terms:
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.
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.
Ai. What is your primary work area/duty area in your MHS facility?
For more information on selecting your primary work area/duty, please click here. [Clicking on link will open a pop-up box with the following content:]
Pop-up box
content: My
primary work area is not listed. How should I answer this question? You
should check "Other" and type in the name of your specific
work area in the text box. I
am not sure if someone in my work area or type of staff position
should answer the survey. Can you tell me? Every
individual who works in an MTF is invited to participate in the
survey. Individuals from different work areas within a military
treatment facility provide unique perspectives and can help provide
a comprehensive picture of the culture of patient safety to help us
continue delivering safe care to our patients. If some questions do
not appear applicable, individuals may choose not to respond to
those. All
staff in MHS facilities with email access are being asked to
complete the survey. This includes Military Treatment Facilities and
Dental Treatment Facilities. It includes clinical and house staff
(interns, residents, fellows); non-clinical staff; active duty and
reservist military; GS and civilian contractors; volunteers; and
local nationals.
The
survey will not let me go further without answering which work area
I am from. Do I have to answer this question to complete the survey? Yes.
To provide information that can be used to improve patient safety at
a particular facility, we need to know which facility a particular
respondent is from. This information is not used to identify
individuals and individual respondents will still remain anonymous.
Survey feedback will only be provided at the group level if 20 or
more responses are received from a particular facility.
[Please create separate drop-down lists of work areas depending on whether the respondent works in the hospital, an outpatient clinic, or a dental clinic (Respondents should only see the drop down list that corresponds to their answers in questions 2 and 3). In this way, only relevant work areas will be listed. Please use work areas listed in tab titled “Q Ai-Primary Work Area” of the “Patient Safety Survey Instrument Drop Downs” Excel spreadsheet.]
[Question is mandatory—survey respondents cannot proceed without answering this question. If
respondent does not answer this question, please input the following message: “Please answer this question in order to move forward with the rest of the survey.”]
Question Ai Drop-down menu (Respondent will see a particular list based on their answer to the previous question)
[Before the following rating scale questions, please display this message: “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.”]
Please indicate your agreement or disagreement with the following statements about your work area.
[All rating scale questions should contain a box for each category (5 boxes per question) in which an “x” appears when participants select it]
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Strongly Disagree |
Disagree |
Neither |
Agree |
Strongly Agree |
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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.
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Strongly Disagree |
Disagree |
Neither |
Agree |
Strongly Agree |
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SECTION C: Communications
How often do the following things happen in your work area?
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Never |
Rarely |
Sometimes |
Most of the time |
Always |
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SECTION D: Frequency of Events Reported
In your work area, when the following mistakes happen, how often are they reported?
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Never |
Rarely |
Sometimes |
Most of the time |
Always |
G2-1. When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported? |
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G2-2. When a mistake is made, but has no potential to harm the patient, how often is this reported? |
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SECTION E: Patient Safety Grade
Please give your work area an overall grade on patient safety.
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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.
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Strongly Disagree |
Disagree |
Neither |
Agree |
Strongly Agree |
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SECTION G: Number of Events Reported
In the past 12 months, how many event reports have you filled out and submitted?
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SECTION H: Workplace Burnout
Using your own definition of “burnout,” please select one of the answers below:
a. I enjoy my work. I have no symptoms of burnout.
b. I am under stress, and don’t always have as much energy as I did, but I don’t feel burned out.
c. I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion.
d. The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot.
e. I feel completely burned out. I am at the point where I may need to seek help.
Which number best describes the atmosphere in your primary work area?
a. 1 - Calm
b. 2
c. 3 - Busy, but reasonable
d. 4
e. 5 - Hectic, chaotic
To what extent do you agree or disagree with the following: “Burnout” has a negative impact on patient safety in my work area.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
[IF AGREE OR STRONGLY AGREE] How has “burnout” impacted patient safety?
NOTE: Verbatim comments will be shared at the respective Service Headquarters level.
[IF AGREE OR STRONGLY AGREE] What can be done to minimize “burnout” among hospital staff?
NOTE: Verbatim comments will be shared at the respective Service Headquarters level.
SECTION I: Background Information
[All respondents, including Air Force clinic respondents, should be directed here after completing Section G from their respective survey.]
This background information will help in the analysis of the survey results.
How long have you worked in this Military Health System (MHS) facility?
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How long have you worked in your current work/clinic area?
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Typically, how many hours per week do you work in this MHS facility?
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4. What is your staff position in this MHS facility?
Select ONE answer that best describes your staff position.
For
questions related to being a local national, please click here.
[Clicking on link will open
a pop-up box with the following content:]
Pop-up box
content: I
am a local national and don’t see my staff type listed. How
should I answer? You
should check “Other” and specify your staff type in the
text box.
[Please create a drop down menu using list in tab titled, “Q H4 Staff Position” of “Patient Safety Survey Instrument Drop Downs” Excel spreadsheet.]
5. In your staff position, do you typically have direct interaction or contact with patients?
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6. How long have you worked in your current specialty or profession?
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Please select your staff type below:
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SECTION I: Your Comments
Please share with us any thoughts or comments about patient safety that were not covered in this survey or that would benefit patient safety improvement efforts. Do not include any comments that identify individuals (patient, staff, providers, etc.) or events.
NOTE: Verbatim comments will be shared at the respective Service Headquarters level.
Closing:
Thank you for completing this survey. Click the submit survey button below to complete the survey process.
Then redirect to patient safety survey Web site:
[Clinic area Survey: ONLY for survey respondents who are Air Force and the respondent-selected MTF is designated as a ‘clinic’ by the AF mapping file.]
SURVEY INSTRUCTIONS
Think about the way things are done in your clinic area (primary care clinic, internal medicine clinic, etc) and provide your opinions on issues that affect the overall safety and quality of the care provided to patients in your clinic area.
In this survey, the term provider refers to physicians, physician assistants, pharmacists and nurse practitioners who diagnose, treat patients, and prescribe medications. The term staff refers to all others who work in the clinic area.
If a question does not apply to you or you don’t know the answer, please check “Does Not Apply or Don’t Know.”
If you work in more than one clinic area, when answering this survey answer only about the clinic area where you received this survey—do not answer about the entire facility.
If your clinic area is in a building with other clinic areas, answer only about the specific clinic area where you work—do not answer about any other clinic areas in the building.
In which clinic area of your Military Treatment Facility (MTF) do you work?
For more information on selecting your primary work area/duty, please click here.
Pop-up box
content: My
primary Clinic Area is not listed. How should I answer this
question? You
may not notice the exact name of your specific work area. Please
review the list of options available and choose the one that best
describes the area where you spend most of your work day. I
am not sure if someone in my Clinic Area or type of staff position
should answer the survey. Can you tell me? Every
individual who works in an MTF is invited to participate in the
survey. Individuals from different work areas within a military
treatment facility provide unique perspectives and can help provide
a comprehensive picture of the culture of patient safety to help us
continue delivering safe care to our patients. If some questions do
not appear applicable, individuals may choose not to respond to
those. All
staff in MHS facilities with email access are being asked to
complete the survey. This includes Military Treatment Facilities
and Dental Treatment Facilities. It includes clinical and house
staff (interns, residents, fellows); non-clinical staff; active
duty and reservist military; GS and civilian contractors;
volunteers; and local nationals.
The
survey will not let me go further without answering which clinic
area I am from. Do I have to answer this question to complete the
survey? Yes.
To provide information that can be used to improve patient safety
at a particular facility, we need to know which facility a
particular respondent is from. This information is not used to
identify individuals and individual respondents will still remain
anonymous. Survey feedback will only be provided at the group level
if 20 or more responses are received from a particular facility.
[Please create drop-down list of clinic areas from “Clinic” column listed in “Q Ai Primary Work Area” of the “Drop Downs” Excel spreadsheet.]
[Question is mandatory—survey respondents cannot proceed without answering this question. If respondent does not answer this question, please input the following message: “Please answer this question in order to move forward with the rest of the survey.”]
SECTION J: List of Patient Safety and Quality Issues
The following items describe things that can happen in clinics that affect patient safety and quality of care. In your best estimate, how often did the following things happen in your clinic area OVER THE PAST 12 MONTHS?
[Before the following rating scale questions, please display this message:
“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.”]
[All rating scale questions should contain a box for each category in which an “x” appears when participants select it]
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Daily |
Weekly |
Monthly |
Several
times in the past 12 months |
Once
or twice in the past 12 months |
Not
in the past 12 months |
Does Not Apply or Don’t Know
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Access to Care |
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Patient Identification |
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Charts/Medical Records |
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Medical Equipment |
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SECTION K: List of Patient Safety and Quality Issues (continued)
How often did the following things happen in your clinic area OVER THE PAST 12 MONTHS? |
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Daily |
Weekly |
Monthly |
Several times in the past 12 months
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Once or twice in the past 12 months
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Not
in the past 12 months |
Does Not Apply or Don’t Know
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Medication |
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Diagnostics & Tests |
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SECTION L: Information Exchange With Other Settings
Over the past 12 months, how often has your clinic area had problems exchanging accurate, complete, and timely information with:
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Problems daily
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Problems weekly
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Problems monthly
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Problems several times in the past 12 months
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Problems once or twice in the past 12 months
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No problems in the past 12 months
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Does Not Apply or Don’t Know
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SECTION M: Working in Your Clinic Area
How much do you agree or disagree with the following statements? |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know
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SECTION N: Communication and Follow-up
How often do the following things happen in your Clinic Area? |
Never |
Rarely |
Some-
times |
Most
of the time |
Always |
Does Not Apply or Don’t Know
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SECTION O: Leadership Support
A. Are you in a leadership position with responsibility for making financial decisions for your Clinic Area? ![]() 1 Yes Skip to Section F 2 No Answer items 1-4 below
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How much do you agree or disagree with the following statements about the leadership of your Clinic Area? |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know
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SECTION P: Your Clinic area
How much do you agree or disagree with the following statements? |
Strongly |
Disagree |
Neither
Agree
nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know
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SECTION Q: Overall Ratings
Overall, how would you rate your Clinic Area on each of the following areas of health care quality?
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Poor
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Fair
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Good
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Very good
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Excellent
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a. Patient centered |
Is responsive to individual patient preferences, needs, and values |
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b. Effective |
Is based on scientific knowledge |
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c. Timely |
Minimizes waits and potentially harmful delays |
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d. Efficient |
Ensures cost-effective care (avoids waste, overuse, and misuse of services) |
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e. Equitable |
Provides the same quality of care to all individuals regardless of gender, race, ethnicity, socioeconomic status, language, etc. |
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Overall, how would you rate the systems and clinical processes your Clinic Area has in place to prevent, catch, and correct problems that have the potential to affect patients?
Poor
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Fair
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Good
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Very good
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Excellent
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SECTION R: Frequency of Events Reported
In your Clinic Area, when the following mistakes happen, how often are they reported?
Never Rarely Sometimes Most of Always
the time
When
a mistake is made, but is caught
and
corrected before affecting the patient,
how
often is this reported?
When a mistake is made, but has no potential
to harm the patient, how often is this reported?
When a mistake is made that could harm the
patient, but does not, how often is this reported?
SECTION S: Number of Events Reported
In the past 12 months, how many event reports have you filled out and submitted?
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SECTION H: Workplace Burnout
Using your own definition of “burnout,” please select one of the answers below:
a. I enjoy my work. I have no symptoms of burnout.
b. I am under stress, and don’t always have as much energy as I did, but I don’t feel burned out.
c. I am definitely burning out and have one or more symptoms of burnout, e.g., emotional exhaustion.
d. The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot.
e. I feel completely burned out. I am at the point where I may need to seek help.
Which number best describes the atmosphere in your primary work area?
a. 1 - Calm
b. 2
c. 3 - Busy, but reasonable
d. 4
e. 5 - Hectic, chaotic
To what extent do you agree or disagree with the following: “burnout” has a negative impact on patient safety in my work area.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
[IF AGREE OR STRONGLY AGREE] How has “burnout” impacted patient safety?
NOTE: Verbatim comments will be shared at the respective Service Headquarters level.
[IF AGREE OR STRONGLY AGREE] What can be done to minimize “burnout” and its impact on patient safety?
NOTE: Verbatim comments will be shared at the respective Service Headquarters level.
[All respondentsGo to Section I of main survey.]
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | DoD Patient Safety Culture Survey |
Author | Ravi, Shreshta |
File Modified | 0000-00-00 |
File Created | 2022-01-27 |