Development, Pilot Study, and Psychometric Analysis of the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Workplace Safety Supplemental Items for Hospitals.

Workplace safety is critical for advancing patient safety and eliminating harm to both the healthcare workforce and patients. The purpose of this study was to develop and test survey items that can be used in conjunction with the Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey to assess how the organizational culture in hospitals supports workplace safety for providers and staff. After conducting a literature review and background interviews with workplace safety experts, we identified key areas of workplace safety culture (workplace hazards, moving/transferring/lifting patients, workplace aggression, supervisor/management support for workplace safety, workplace safety reporting, and work stress/burnout) and drafted survey items to assess these areas. Survey items were cognitively tested and pilot tested with the SOPS Hospital Survey 2.0 among providers and staff in 28 U.S. hospitals. We conducted psychometric analysis on data from 6684 respondents. Confirmatory factor analysis results (item factor loadings and model fit indices), internal consistency reliability, and site-level reliability were acceptable for the 16 survey items grouped into 6 composite measures. Most composite measures were significantly correlated with each other and with the overall rating on workplace safety, demonstrating conceptual convergence among survey measures. Hospitals and researchers can use the Workplace Safety Supplemental items to assess the dimensions of organizational culture that support provider and staff safety and to identify both strengths and areas for improvement.

Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices.

BACKGROUND: Given rising costs and changing payment models, healthcare organisations are increasingly focused on value and efficiency. The goal of our study was to develop survey items to assess clinician and staff perspectives about the extent to which the organisational culture in hospitals and medical offices supports value and efficiency. METHODS: Development began with a literature review and interviews with experts and clinicians and staff from hospitals and medical offices. We identified key areas of value and efficiency culture, drafted survey items and conducted cognitive testing. Using purposive sampling to select sites, the 36-item surveys were pilot tested in 47 hospitals and 96 medical offices. Psychometric analysis was conducted on data from 3951 hospital respondents (42% response) and 1458 medical office respondents (63% response). RESULTS: Factor loadings, multilevel confirmatory factor analysis model fit and reliability estimates were acceptable for the 13 items grouped into 4 composite measures: Empowerment to Improve Efficiency (3 items), Efficiency and Waste Reduction (3 items), Patient Centeredness and Efficiency (3 items) and Management Support for Improving Efficiency and Reducing Waste (4 items). All composite measures were significantly intercorrelated and related to the four Overall Ratings of Healthcare Quality, indicating adequate conceptual convergence among the measures. Eight items assessing Experiences With Activities to Improve Efficiency were also included. CONCLUSION: We developed psychometrically sound survey items measuring value and efficiency culture. When added to the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture, the item sets extend those surveys by assessing additional dimensions of organisational culture that affect care delivery. Healthcare organisations can use these item sets to assess how well their organisational culture supports value and efficiency and identify areas for improvement.

Linking Patient Safety Culture to Quality Ratings in the Nursing Home Setting.

There is limited evidence on the associations between patient safety culture and measures of health care quality in nursing homes. This study examines the relationship between scores on the Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey (NH SOPS) and Centers for Medicare and Medicaid Services Nursing Home Five-Star Quality Ratings. Using data from 186 nursing homes, we conducted multiple regression analyses predicting the Five-Star Quality Ratings from the NH SOPS survey measures. Five NH SOPS measures were related to the Overall, Health Inspections, and Quality Five-Star Ratings. Four NH SOPS measures were related to at least two of the four Five-Star Quality Ratings and three SOPS measures were related to one Five-Star Rating. None of the NH SOPS measures were significantly associated with the Staffing Five-Star Rating. Findings generally indicated that stronger patient safety culture is associated with higher quality ratings.

Development and psychometric properties of surveys to assess patient and family caregiver experience with care transitions.

BACKGROUND: The purpose of this study was to develop and administer surveys that assess patient and family caregiver experiences with care transitions and examine the psychometric properties of the surveys. The surveys were designed to ask about 1) the transitional care services that matter most to patients and their caregivers and 2) care outcomes, including the overall quality of transitional care they received, patient self-reported health, and caregiver effort/stress. METHODS: Survey items were developed based on a review of the literature, existing surveys, focus groups, site visits, stakeholder and expert input, and patient and caregiver cognitive interviews. We administered mail surveys with telephone follow up to patients recently discharged from 43 U.S. hospitals. Patients identified the caregivers who helped them during their hospital stay (Time 1 caregiver) and when they were home (Time 2 caregiver). Time 1 and Time 2 caregivers were surveyed by telephone only. The psychometric properties of the survey items and outcome composite measures were examined for each of the three surveys. Items that performed poorly across multiple analyses, including those with low variability and/or a high missing data, were dropped except when they were conceptually important. RESULTS: The analysis datasets included responses from 9282 patients, 1245 Time 1 caregivers and 1749 Time 2 caregivers. The construct validity of the three proposed outcome composite measures-Overall Quality of Transitional Care (patient and caregiver surveys), Patient Overall Health (patient survey) and Caregiver Effort/Stress (caregiver surveys) -was supported by acceptable exploratory factor analysis results and acceptable internal consistency reliability. Site-level reliability was acceptable for the two patient outcome composite measures, but was low for Caregiver Effort/Stress (< 0.70). In all surveys, the Overall Quality of Transitional Care outcome composite measure was significantly correlated with other outcome composite measures and most of the single-item measures. CONCLUSIONS: Overall, the final patient and caregiver surveys are psychometrically sound and can be used by health systems, hospitals, and researchers to assess the quality of care transitions and related outcomes. Results from these surveys can be used to improve care transitions, focusing on what matters most to patients and their family caregivers.

Partnering with healthcare facilities to understand psychosocial distress screening practices among cancer survivors: pilot study implications for study design, recruitment, and data collection.

BACKGROUND: We sought to understand barriers and facilitators to implementing distress screening (DS) of cancer patients to inform and promote uptake in cancer treatment facilities. We describe the recruitment and data collection challenges and recommendations for assessing DS in oncology treatment facilities. METHODS: We recruited CoC-accredited facilities and collected data from each facility's electronic health record (EHR). Collected data included cancer diagnosis and demographics, details on DS, and other relevant patient health data. Data were collected by external study staff who were given access to the facility's EHR system, or by facility staff working locally within their own EHR system. Analyses are based on a pilot study of 9 facilities. RESULTS: Challenges stemmed from being a multi-facility-based study and local institutional review board (IRB) approval, facility review and approval processes, and issues associated with EHR systems and the lack of DS data standards. Facilities that provided study staff remote-access took longer for recruitment; facilities that performed their own extraction/abstraction took longer to complete data collection. CONCLUSION: Examining DS practices and follow-up among cancer survivors necessitated recruiting and working directly with multiple healthcare systems and facilities. There were a number of lessons learned related to recruitment, enrollment, and data collection. Using the facilitators described in this manuscript offers increased potential for working successfully with various cancer centers and insight into partnering with facilities collecting non-standardized DS clinical data.

Promising Practices for Improving Hospital Patient Safety Culture.

BACKGROUND: Patient safety culture has a positive influence on the effectiveness of patient safety and quality improvement interventions. A study was conducted to gain knowledge about promising best practices used by hospitals to improve patient safety culture hospitalwide. METHODS: Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™ (SOPS) Hospital Survey longitudinal results from 536 hospitals that submitted data to the Hospital SOPS database from 2007 to 2014 were analyzed. Composite-level and aggregate improvement was measured, resulting in the identification of "top-improving," large hospitals (400 + beds). Semistructured interviews were conducted with one to three interviewees (for example, Vice President of Clinical Quality, Patient Safety Officer, Chief Medical Officer) from six top-improving hospitals. The transcripts of the interviews were analyzed to identify common themes and best practices among the hospitals. RESULTS: The mean change in the all-composite percent positive culture score was a 1.7 percentage point increase. The six hospitals interviewed had an average increase of 8.6 percentage points (range, 6.5-10.6) in their culture score. The three most common practices for improving culture as described by the hospital quality leaders from the six hospitals were (1) goal setting and strong action planning for quality improvement, (2) implementation of well-known patient safety initiatives and programs, and (3) rigorous survey administration methods. CONCLUSION: Among six large hospitals that improved their hospitalwide culture score, the common best practices were the implementation of routine culture measurement with a wide dissemination of results, strong action planning for improvement that includes leadership support and involvement from all staff levels, and multifaceted patient safety programs and education.

Exploring relationships between patient safety culture and patients' assessments of hospital care.

OBJECTIVES: The purpose of this study was to examine relationships among 2 Agency for Healthcare Research and Quality measures of hospital patient safety and quality, which reflect different perspectives on hospital performance: the Hospital Survey on Patient Safety Culture (Hospital SOPS)--a hospital employee patient safety culture survey--and the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS Hospital Survey)--a survey of the experiences of adult inpatients with hospital care and services. Our hypothesis was that these 2 measures would be positively related. METHODS: We performed multiple regressions to examine the relationships between the Hospital SOPS measures and CAHPS Hospital Survey measures, controlling for hospital bed size and ownership. Analyses were conducted at the hospital level with each survey's measures using data from 73 hospitals that administered both surveys during similar periods. RESULTS: Higher overall Hospital SOPS composite average scores were associated with higher overall CAHPS Hospital Survey composite average scores (r = 0.41, P G 0.01). Twelve of 15 Hospital SOPS measures were positively related to the CAHPS Hospital Survey composite average score after controlling for bed size and ownership, with significant standardized regression coefficients ranging from 0.25 to 0.38. None of the Hospital SOPS measures were significantly correlated with either of the two single-item CAHPS Hospital Survey measures (hospital rating and willingness to recommend). CONCLUSIONS: This study found that hospitals where staff have more positive perceptions of patient safety culture tend to have more positive assessments of care from patients. This finding helps validate both surveys and suggests that improvements in patient safety culture may lead to improved patient experience with care. Further research is needed to determine the generalizability of these results to larger sets of hospitals, to hospital units, and to other settings of care.

Exploring relationships between patient safety culture and patients' assessments of hospital care.

OBJECTIVES: The purpose of this study was to examine relationships among 2 Agency for Healthcare Research and Quality measures of hospital patient safety and quality, which reflect different perspectives on hospital performance: the Hospital Survey on Patient Safety Culture (Hospital SOPS)-a hospital employee patient safety culture survey-and the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS Hospital Survey)-a survey of the experiences of adult inpatients with hospital care and services. Our hypothesis was that these 2 measures would be positively related. METHODS: We performed multiple regressions to examine the relationships between the Hospital SOPS measures and CAHPS Hospital Survey measures, controlling for hospital bed size and ownership. Analyses were conducted at the hospital level with each survey's measures using data from 73 hospitals that administered both surveys during similar periods. RESULTS: Higher overall Hospital SOPS composite average scores were associated with higher overall CAHPS Hospital Survey composite average scores (r = 0.41, P < 0.01). Twelve of 15 Hospital SOPS measures were positively related to the CAHPS Hospital Survey composite average score after controlling for bed size and ownership, with significant standardized regression coefficients ranging from 0.25 to 0.38. None of the Hospital SOPS measures were significantly correlated with either of the two single-item CAHPS Hospital Survey measures (hospital rating and willingness to recommend). CONCLUSIONS: This study found that hospitals where staff have more positive perceptions of patient safety culture tend to have more positive assessments of care from patients. This finding helps validate both surveys and suggests that improvements in patient safety culture may lead to improved patient experience with care. Further research is needed to determine the generalizability of these results to larger sets of hospitals, to hospital units, and to other settings of care.

Exploring relationships between hospital patient safety culture and adverse events.

OBJECTIVES: There has been very limited research linking staff perceptions of hospital patient safety culture with rates of adverse clinical events. This exploratory study examined relationships between the Agency for Healthcare Research and Quality's (AHRQ) Hospital Survey of Patient Safety Culture and rates of in-hospital complications and adverse events as measured by the AHRQ Patient Safety Indicators (PSIs). The general hypothesis was that hospitals with a more positive patient safety culture would have lower PSI rates. METHODS: We performed multiple regressions to examine the relationships between 15 patient safety culture variables and a composite measure of adverse clinical events based on 8 risk-adjusted PSIs from 179 hospitals, controlling for hospital bed size and ownership. All patient safety culture data were collected in 2005 and 2006 (except 1 late 2004 hospital), and all PSI data were collected in 2005. RESULTS: Nearly all of the relationships tested were in the expected direction (negative), and 7 (47%) of the 15 relationships were statistically significant. All significant relationships were of moderate size, with standardized regression coefficients ranging from -0.15 to -0.41, indicating that hospitals with a more positive patient safety culture scores had lower rates of in-hospital complications or adverse events as measured by PSIs. CONCLUSIONS: Our findings support the idea that a more positive patient safety culture is associated with fewer adverse events in hospitals. Further research is needed to determine the generalizability of these results to larger sets of hospitals and to examine the causal relationship between patient safety culture and clinical patient outcomes.