Attachment F - SOPS® Hospital Survey with Diagnostic Safety Supplemental Item Set
Form
Approved
Hospital Survey on Patient Safety (Version 2.0)
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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.”
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This
survey is authorized under 42 U.S.C. 299a. This
information collection is voluntary and the
confidentiality of your responses to this survey is protected by
Sections 944(c) and 308(d) of the Public Health Service Act [42
U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)]. Information that could
identify you will not be disclosed unless you have consented to that
disclosure. Public reporting burden for this collection of
information is estimated to average
15 minutes
per response, the estimated time required to complete the survey. An
agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a
currently valid OMB control number. The data you provide will help
AHRQ’s mission to produce evidence to make health care safer,
higher quality, more accessible, equitable, and affordable. Send
comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this
burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork
Reduction Project (0935-xxxx) AHRQ, 5600 Fishers Lane, Room #07W42,
Rockville, MD 20857, or by email to the AHRQ MEPS Project Director
at [email protected].
Your Staff Position |
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)
Medical 5 Physician Assistant 6 Resident, Intern 7 Physician, Attending, Hospitalist
Other Clinical Position 8 Dietitian 9 Pharmacist, Pharmacy Technician 10 Physical, Occupational, or Speech Therapist 11 Psychologist 12 Respiratory Therapist 13 Social Worker 14 Technologist, Technician (e.g., EKG, Lab, Radiology)
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Supervisor, Manager, Clinical Leader, Senior Leader 15 Supervisor, Manager, Department Manager, Clinical Leader, Administrator, Director 16 Senior Leader, Executive, C-Suite
Support 17 Facilities 18 Food Services 19 Housekeeping, Environmental Services 20 Information Technology, Health Information Services, Clinical Informatics 21 Security 22 Transporter 23 Unit Clerk, Secretary, Receptionist, Office Staff
Other 24 Other, please specify:
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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 |
Support Services 29 Admitting/Registration 30 Food Services, Dietary 31 Housekeeping, Environmental Services, Facilities 32 Security Services 33 Transport
Other 34 Other, please specify: ![]()
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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 |
Agree |
Strongly |
Does Not Apply or Don’t Know |
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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?
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Strongly |
Disagree |
Neither
Agree nor Disagree |
Agree |
Strongly |
Does Not Apply or Don’t Know |
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SECTION C: Communication |
How often do the following things happen in your unit/work area?
Think about your unit/work area: |
Never |
Rarely |
Some-
times |
Most of the time |
Always |
Does Not Apply or Don’t Know |
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SECTION D: Reporting Patient Safety Events |
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In the past 12 months, how many patient safety events have you reported?
a. None
b. 1 to 2
c. 3 to 5
d. 6 to 10
e. 11 or more
SECTION E: Patient Safety Rating |
How would you rate your unit/work area on patient safety?
Poor ▼ |
Fair ▼ |
Good ▼ |
Very Good ▼ |
Excellent ▼ |
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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 |
Agree |
Strongly |
Does Not Apply or Don’t Know |
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9 |
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Your Unit/Work Area’s Processes Around Diagnosis |
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The following items ask about your unit/work area’s processes around diagnosis. The processes start when a patient seeks care for a health problem, and include:
Gathering, integrating, and interpreting information about the patient (e.g., clinical history, physical exam, test and imaging results, referrals),
Making an initial diagnosis,
Discussing the diagnosis with the patient, and
Following the patient and revising the diagnosis over time, as needed.
In this part of the survey, the term “provider” refers to physicians, physician assistants, and nurse practitioners who diagnose, treat patients, and prescribe medications. The term staff refers to all others who work in the unit.
SECTION A: Time Availability |
How much do you agree or disagree with the following statements? |
Strongly
Disagree |
Disagree |
Neither
Agree nor Disagree |
Agree |
Strongly
Agree |
Does Not Apply or Don’t Know □ |
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SECTION B: Testing and Referrals |
How much do you agree or disagree with the following statements? |
Strongly
Disagree |
Disagree |
Neither
Agree nor Disagree |
Agree |
Strongly
Agree |
Does Not Apply or Don’t Know □ |
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SECTION C: Provider and Staff Communication Around Diagnosis |
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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Background Questions |
1. How long have you worked in this hospital?
a. Less than 1 year
b. 1 to 5 years
c. 6 to 10 years
d. 11 or more years
2. In this hospital, how long have you worked in your current unit/work area?
a. Less than 1 year
b. 1 to 5 years
c. 6 to 10 years
d. 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.
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Thank you for completing this survey.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | SOPS® Diagnostic Safety Supplemental Item Set for the SOPS Medical Office Survey |
Subject | Diagnostic Safety |
Author | AHRQ SOPS User Network |
File Modified | 0000-00-00 |
File Created | 2024-08-05 |