Surveys on Patient Safety Culture - Hospital Survey

This survey asks for your opinion about patient safety issues, medical errors, and event reporting at Healthpoint and will take about 10-15 minutes to complete. Please be as honest as possible, your feedback will help us immeasurably. 


If the question does not apply to you, please make sure to select "Not Applicable". The submission deadline for this survey is September 15th, 2019.


·     An eventis 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.


SECTION A: Your Work Area/Unit In this survey, think of your “unit” as the work area, department, or clinical area of the hospital where you spend most of your work time or provide most of your clinical services.

Please indicate your agreement or disagreement with the following statements about your work area/unit. Think about your hospital work area / unit.

People support one another in this unit.
We have enough staff to handle the workload
When a lot of work needs to be done quickly, we work together as a team to get the work done
In this unit, people treat each other with respect
Staff in this unit work longer hours than is best for patient care
We are actively doing things to improve patient safety
We use more agency/temporary staff than is best for patient care
Staff feel like their mistakes are held against them
Mistakes have led to positive changes here
It is just by chance that more serious mistakes don’t happen around here
When one area in this unit gets really busy, others help out
When an event is reported, it feels like the person is being written up, not the problem
After we make changes to improve patient safety, we evaluate their effectiveness
We work in "crisis mode" trying to do too much, too quickly
Patient safety is never sacrificed to get more work done
Staff worry that mistakes they make are kept in their personnel file
We have patient safety problems in this unit
Our procedures and systems are good at preventing errors from happening

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.

My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures
My supervisor/manager seriously considers staff suggestions for improving patient safety
Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts
My supervisor/manager overlooks patient safety problems that happen over and over

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

We are given feedback about changes put into place based on event reports
Staff will freely speak up if they see something that may negatively affect patient care
We are informed about errors that happen in this unit
Staff feel free to question the decisions or actions of those with more authority
In this unit, we discuss ways to prevent errors from happening again
Staff are afraid to ask questions when something does not seem right

SECTION D: Frequency of Events Reported In your hospital work area/unit, when the following mistakes happen, how often are they reported?

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 E: Patient Safety Grade

Please give your work area/unit in this hospital an overall grade on patient safety.

SECTION F: Your Hospital Please indicate your agreement or disagreement with the following statements about your hospital.

Hospital management provides a work climate that promotes patient safety
Hospital units do not coordinate well with each other
Things “fall between the cracks” when transferring patients from one unit to another
There is good cooperation among hospital units that need to work together
Important patient care information is often lost during shift changes
It is often unpleasant to work with staff from other hospital units
Problems often occur in the exchange of information across hospital units
The actions of hospital management show that patient safety is a top priority
Hospital management seems interested in patient safety only after an adverse event happens
Hospital units work well together to provide the best care for patients
Shift changes are problematic for patients in this hospital

SECTION G: Number of Events Reported

SECTION H: Background Information This information will help in the analysis of the survey results.

SECTION I: Your Comments Please feel free to write any comments about patient safety, error, or event reporting in your hospital.

Reference: Accessed January 24, 2018.
American Hospital Association (AHA) Annual Survey of Hospitals database. Chicago: Health Forum; multiple years (data used from 2015).
Sorra J, Gray L, Franklin M, et al. Action Planning Tool for the AHRQ Surveys on Patient Safety Culture. (Prepared by Westat, Rockville, MD, under Contract No. HHSA290201300003C). Rockville, MD: Agency for Healthcare Research and Quality; January 2016. AHRQ Publication No. 16-0008-EF. Accessed January 24, 2018.