Form 17 Attachment Q: Survey of Patient Safety Culture—HSOPS V.2

SOPS® Hospital Survey
Version: 2.0
Language: English

•

For more information on getting started, selecting a sample, determining data collection
methods, establishing data collection procedures, conducting a web-based survey, and
preparing and analyzing data, and producing reports, please read the Hospital Survey
Version 2.0 User’s Guide.

•

For the survey items grouped according to the safety culture composite measures they
are intended to assess, please refer to the Hospital Survey Version 2.0 Items and
Composite Measures document.

• To participate in the AHRQ Hospital Survey on Patient Safety Culture Database, you
must have administered the survey in its entirety without modifications or deletions:

o No changes to any of the survey item text and response options.
o No reordering of survey items.
o Questions added only at the end of the survey after Section F, before the
Background Questions section.
For assistance with this survey, please contact the SOPS Help Line at 1-888-324-9749 or
[email protected].

Hospital Survey on Patient Safety (Version 2.0)
Instructions

This survey asks for your opinions about patient safety issues, medical error, and event reporting in
your hospital and will take about 10-15 minutes to complete. If a question does not apply to you or
your hospital or you don’t know the answer, please select “Does Not Apply or Don’t Know.”

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

• A “patient safety event” is defined as any type of healthcare-related error,
mistake, or incident, regardless of whether or not it results in patient harm.

Your Staff Position
1. What is your position in this hospital?
Select ONE answer.
Nursing
1 Advanced Practice Nurse (NP, CRNA, CNS,
CNM)
2 Licensed Vocational Nurse (LVN), Licensed
Practical Nurse (LPN)
3 Patient Care Aide, Hospital Aide, Nursing
Assistant
4 Registered Nurse (RN)

Support
17 Facilities

Medical
5 Physician Assistant

18 Food Services
19 Housekeeping, Environmental Services
20 Information Technology, Health Information

6 Resident, Intern
7 Physician, Attending, Hospitalist
Other Clinical Position
8 Dietitian

9
10
11
12
13
14

Pharmacist, Pharmacy Technician
Physical, Occupational, or Speech Therapist
Psychologist

Supervisor, Manager, Clinical Leader, Senior
Leader
15 Supervisor, Manager, Department Manager,
Clinical Leader, Administrator, Director
16 Senior Leader, Executive, C-Suite

Services, Clinical Informatics
21 Security

22 Transporter
23 Unit Clerk, Secretary, Receptionist, Office
Staff
Other
24 Other, please specify:

Respiratory Therapist
Social Worker
Technologist, Technician (e.g., EKG, Lab,
Radiology)

1

Your Unit/Work Area
2. Think of your “unit” as the work area, department, or clinical area of the hospital where you spend
most of your work time. What is your primary unit or work area in this hospital?
Select ONE answer.
Multiple Units, No specific unit
1 Many different hospital units,
No specific unit
Medical/Surgical Units
2 Combined Medical/Surgical
Unit
3 Medical Unit (Non-Surgical)
4 Surgical Unit
Patient Care Units
5 Cardiology
6 Emergency Department,
Observation, Short Stay
7 Gastroenterology
8 ICU (all adult types)
9 Labor & Delivery, Obstetrics
& Gynecology
10 Oncology, Hematology
11 Pediatrics (including NICU,
PICU)
12 Psychiatry, Behavioral
Health
13 Pulmonology
14 Rehabilitation, Physical
Medicine
15 Telemetry

Surgical Services
16 Anesthesiology
17 Endoscopy, Colonoscopy
18 Pre Op, Operating
Room/Suite, PACU/Post Op,
Peri Op
Clinical Services
19 Pathology, Lab
20 Pharmacy
21 Radiology, Imaging
22 Respiratory Therapy
23 Social Services, Case
Management, Discharge
Planning
Administration/Management
24 Administration, Management
25 Financial Services, Billing
26 Human Resources, Training
27 Information Technology,
Health Information
Management, Clinical
Informatics
28 Quality, Risk Management,
Patient Safety

2

Support Services
29 Admitting/Registration
30 Food Services, Dietary
31 Housekeeping,
Environmental Services,
Facilities
32 Security Services
33 Transport
Other
34 Other, please specify:

SECTION A: Your Unit/Work Area
How much do you agree or disagree with the following statements about your unit/work area?

Think about your unit/work area:

Strongly
Disagree


Neither
Agree nor
Disagree Disagree



Agree


Strongly
Agree


Does Not
Apply or
Don’t
Know


1. In this unit, we work together as an effective
team..................................................................

1

2

3

4

5

9

2. In this unit, we have enough staff to handle
the workload .....................................................

1

2

3

4

5

9

3. Staff in this unit work longer hours than is best
for patient care .................................................

1

2

3

4

5

9

4. This unit regularly reviews work processes to
determine if changes are needed to improve
patient safety ....................................................

1

2

3

4

5

9

5. This unit relies too much on temporary, float,
or PRN staff ......................................................

1

2

3

4

5

9

6. In this unit, staff feel like their mistakes are
held against them .............................................

1

2

3

4

5

9

7. When an event is reported in this unit, it feels
like the person is being written up, not the
problem.............................................................

1

2

3

4

5

9

8. During busy times, staff in this unit help each
other .................................................................

1

2

3

4

5

9

9. There is a problem with disrespectful behavior
by those working in this unit .............................

1

2

3

4

5

9

10. When staff make errors, this unit focuses on
learning rather than blaming individuals...........

1

2

3

4

5

9

11. The work pace in this unit is so rushed that it
negatively affects patient safety .......................

1

2

3

4

5

9

12. In this unit, changes to improve patient safety
are evaluated to see how well they worked .....

1

2

3

4

5

9

13. In this unit, there is a lack of support for staff
involved in patient safety errors ......................

1

2

3

4

5

9

14. This unit lets the same patient safety
problems keep happening ...............................

1

2

3

4

5

9

3

SECTION B: Your Supervisor, Manager, or Clinical Leader
How much do you agree or disagree with the following statements about your immediate supervisor,
manager, or clinical leader?
Strongly
Disagree


Neither
Agree nor
Disagree Disagree



Agree


Strongly
Agree


Does Not
Apply or
Don’t
Know


1. My supervisor, manager, or clinical leader
seriously considers staff suggestions for
improving patient safety ..................................

1

2

3

4

5

9

2. My supervisor, manager, or clinical leader
wants us to work faster during busy times,
even if it means taking shortcuts .....................

1

2

3

4

5

9

3. My supervisor, manager, or clinical leader
takes action to address patient safety
concerns that are brought to their attention ....

1

2

3

4

5

9

SECTION C: Communication
How often do the following things happen in your unit/work area?

Never


Rarely


Sometimes


Most of
the time


Always


Does Not
Apply or
Don’t
Know


1. We are informed about errors that happen in
this unit ...........................................................

1

2

3

4

5

9

2. When errors happen in this unit, we discuss
ways to prevent them from happening again ..

1

2

3

4

5

9

3. In this unit, we are informed about changes
that are made based on event reports ...........

1

2

3

4

5

9

4. In this unit, staff speak up if they see
something that may negatively affect patient
care .................................................................

1

2

3

4

5

9

5. When staff in this unit see someone with more
authority doing something unsafe for patients,
they speak up .................................................

1

2

3

4

5

9

6. When staff in this unit speak up, those with
more authority are open to their patient safety
concerns ........................................................

1

2

3

4

5

9

7. In this unit, staff are afraid to ask questions
when something does not seem right .............

1

2

3

4

5

9

Think about your unit/work area:

4

SECTION D: Reporting Patient Safety Events

Never


Rarely


Sometimes


Most of
the time


Always


Does Not
Apply or
Don’t
Know


1. When a mistake is caught and corrected
before reaching the patient, how often is this
reported? ...........................................................

1

2

3

4

5

9

2. When a mistake reaches the patient and could
have harmed the patient, but did not, how often
is this reported? .................................................

1

2

3

4

5

9

Think about your unit/work area:

3. In the past 12 months, how many patient safety events have you reported?

a.
b.
c.
d.
e.

None
1 to 2
3 to 5
6 to 10
11 or more

SECTION E: Patient Safety Rating
1. How would you rate your unit/work area on patient safety?
Poor
▼

Fair
▼

Good
▼

Very Good
▼

Excellent
▼

1

2

3

4

5

SECTION F: Your Hospital
How much do you agree or disagree with the following statements about your hospital?

Think about your hospital:

Strongly
Disagree


Neither
Agree nor
Disagree Disagree



Agree


Strongly
Agree


Does Not
Apply or
Don’t
Know


1. The actions of hospital management show
that patient safety is a top priority ...................

1

2

3

4

5

9

2. Hospital management provides adequate
resources to improve patient safety ................

1

2

3

4

5

9

3. Hospital management seems interested in
patient safety only after an adverse event
happens ............................................................

1

2

3

4

5

9

4. When transferring patients from one unit to
another, important information is often left out .

1

2

3

4

5

9

5. During shift changes, important patient care
information is often left out ..............................

1

2

3

4

5

9

6. During shift changes, there is adequate time
to exchange all key patient care information ...

1

2

3

4

5

9

5

Background Questions
1. How long have you worked in this hospital?

a.
b.
c.
d.

Less than 1 year
1 to 5 years
6 to 10 years
11 or more years

2. In this hospital, how long have you worked in your current unit/work area?

a.
b.
c.
d.

Less than 1 year
1 to 5 years
6 to 10 years
11 or more years

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

a. Less than 30 hours per week
b. 30 to 40 hours per week
c. More than 40 hours per week
4. 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

Your Comments
Please feel free to provide any comments about how things are done or could be done in your
hospital that might affect patient safety.

Thank you for completing this survey.
6