Culture of safety

Safety, our first commitment

The We ARE (Accountable, Reliable and Empowered) Safe initiative establishes a framework to create a culture of safety for CTCA patients. As an organization committed to eliminating preventable harm through the detection and correction of system weaknesses, we have implemented high-reliability strategies such as self checking (Stop-Think-Act-Review), peer checking, communication tools (Situation-Background-Assessment-Recommendation), Leader Rounding and Daily Safety Check-ins. In this effort, CTCA has engaged Press Ganey Healthcare Performance Improvement (HPI), a national leader in patient safety, which works with over 600 hospitals across the U.S. Further, CTCA is committed to the National Patient Safety Goals established by The Joint Commission, which accredits more than 19,000 health care organizations and programs nationally.

To assess our success in establishing a culture committed to patient safety, CTCA hospitals utilize the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on the Culture of Patient Safety, a validated staff survey considered among the top-cited and most well-respected instruments in the country. The most recent comparative results are based on 2018 data during which more than 600 hospitals utilized the instrument, constituting a comparative data set of over 382,000 responses.

Conducting the survey every 24 months and contributing to the national database, CTCA hospitals’ most recent Patient Safety Grade and composite scores are presented in comparison to the AHRQ 2018 national norms.

patient safety grade 2019

patient safety culture composite scores 2019

AHRQ hospital survey on the culture of patient safety
Graph labels Questions included in patient safety culture composite scores
(1) Teamwork within units
• People support one another in this unit
• We work together as a team to get the work done
• People treat each other with respect
• When really busy, others help out
(2) Supervisor/manager expectations & actions promoting patient safety
• Says a good word when he/she sees a job done according to safety procedures
• Considers staff suggestions for improving patient safety
• Wants us to work faster, even if that means taking shortcuts*
• Overlooks patient safety problems that happen over and over*
(3) Organizational learning - continuous improvement
• We are actively doing things to improve patient safety
• Mistakes have led to positive changes here
• After we make changes to improve patient safety, we evaluate their effectiveness
(4) Management support for patient safety
• Provides a work climate that promotes patient safety
• Shows that patient safety is a top priority
• Seems interested in patient safety only after an adverse event happens*
(5) Overall perceptions of patient safety
• Just by chance that more serious mistakes don’t happen around here*
• Safety is never sacrificed to get more work done
• We have patient safety problems in this unit*
• Procedures and systems are good at preventing error
(6) Feedback & communication about error
• Given feedback about changes put into place based on event reports
• Informed about errors that happen
• Discuss ways to prevent errors from happening again
(7) Communication openness
• Staff will speak freely if they see something that may negatively affect patient care
• Staff feel free to question those with more authority
• Staff are afraid to ask questions when something does not seem right*
(8) Frequency of events reported
• Mistake is made, but is caught and corrected, how often is this reported?
• Mistake is made, but has no potential for harm, how often is this reported?
• Mistake is made that could harm the patient, but does not, how often is this reported?
(9) Teamwork across units
• Units do not coordinate well with each other*
• Good cooperation among units that need to work together
• Unpleasant to work with staff from other units*
• Units work well together to provide the best care
(10) Staffing
• Enough staff to handle the workload
• Staff work longer hours than is best for patient care*
• Use more agency/temporary staff than is best*
• Work in "crisis mode" trying to do too much, too quickly*
(11) Handoffs and transitions
• Things "fall between the cracks" from one unit to another*
• Important information is often lost during shift changes*
• Problems occur in the exchange of information across hospital unit*
• Shift changes are problematic for patients in the hospital*
(12) Nonpunitive response to error
• Staff feel like their mistakes are held against them*
• When an event is reported, it feels like the person is being written up, not the problem*
• Staff worry that mistakes they make are kept in their personnel file*
* Inverse Questions: Responses associated with these questions are converted such that a higher score is always preferred.