Perceptions of Patient Safety Culture in Six Canadian Healthcare ...

Perceptions of Patient Safety Culture in Six Canadian Healthcare Organizations

Final Report Prepared From a Grant from the Canadian Patient Safety Institute (CPSI) November 2007

Principal Investigators:

Liane R. Ginsburg MOHLTC Career Scientist

Associate Professor School of Health Policy & Management

York University [email protected]

Deborah Tregunno Assistant Professor School of Nursing York University

[email protected]

Co-Investigators:

Mark Fleming Director, CN Centre for Occupational Health and Safety

Saint Mary's University [email protected]

Ward Flemons

V.P., Quality, Safety & Health Information Calgary Health Region [email protected]

Debra Gilin

Assistant Professor Department of Psychology

Saint Mary's University [email protected]

Peter Norton

Professor, Department of Family Medicine, University of Calgary

Head, Western Node, Safer Healthcare Now! [email protected]

This research was funded by a grant from the Canadian Patient Safety Institute (CPSI).

Patient Safety Culture in 6 Healthcare Organizations…/1 05/11/2007

Executive Summary In the Fall of 2006 four organizations representing six hospitals and health regions from across Canada participated in a study funded by the Canadian Patient Safety Institute (CPSI) to look at the measurement of patient safety culture in healthcare organizations. A survey of patient safety culture in Healthcare Organizations was sent to all direct care providers, clinical care managers, direct and non-direct care support staff and non-direct care managers in all sectors including pre-hospital care, acute care, long term care, community care, and mental health in these six organizations. Staff in administrative departments were excluded as the survey instrument is not relevant to this group. The survey included items in five areas: (1) organizational leadership for safety; (2) unit leadership for safety; (3) perceived state of safety; (4) shame and repercussions of reporting; and (5) safety learning behaviours. Of 22,624 surveys that were sent out, 6243 were returned for a response rate of 28%. Response rates ranged from 18% to 34% across the six organizations. Data gathered through this initiative can be used to drive change initiatives in several ways: (1) looking at high and low performance on individual survey items, (2) focusing on questions that reflect areas that are the most important to staff, (3) using the data to stimulate discussion of safety culture through the organization. Results When data are rolled up to the organization level, we are seeing some organizations performing better than others on certain dimensions of patient safety culture. However, different organizations seem to do well on different dimensions of safety culture in the organizations in this study Results differed by staff group. Of these differences, the largest effects are seen with respect to nurses' lower perceptions of organizational leadership for safety and EMS staff concern around shame and repercussions. Sector differences on the five dimensions are less pronounced that those we see for staff group. However, the community sector (excluding community mental health) tends to score higher than the other sectors on both leadership dimensions and the perceived state of safety dimension. The mental health sector (including community and acute mental health) scores lower than most sectors on several of the five safety culture dimensions. Data are also presented for units and sites that had a certain number of respondents. Here data are presented that focus on the proportion of positive responses to individual questions on the survey. It is often these more detailed data that can best help drive specific change and improvement efforts. Although some of the sites and units scored significantly higher than others on most or all questions, suggesting some clear high performers, the same groups of questions seem to receive higher and lower proportions of positive responses across the dataset. The following four areas achieve the highest proportion of positive responses across all organizations (note that question numbers used throughout this report are different from what appeared on the 2006 survey):

Q8 Asking for help is a sign of incompetence 89.7 % disagree Q9 If I make a mistake that has significant consequences and nobody notices, I do

not tell anyone about it 93.0 % disagree

Q11 I am less effective at work when I am fatigued 85.0% agree Q16 I will suffer negative consequences if I report a patient safety problem 82.2 % disagree


In terms of identifying opportunities for improvement, it may be useful to consider the 12 areas where fewer than 50% positive responses were achieved:

Q4 Senior management has a clear picture of the risk associated with patient care 49.0 % agree Q12 Senior management considers patient safety when program changes are

discussed 49.1 % agree

Q29 My organization effectively balances the need for patient safety and the need for productivity

48.4 % agree

Q18 I am rewarded for taking quick action to identify a serious mistake 29.1 % agree Q33 My supervisor/manager says a good word when he/she sees a job done

according to established patient safety procedures 44.0 % agree

Q21 Loss of experienced personnel has negatively affected my ability to provide high quality patient care

37.8 % disagree

Q24 In the last year, I have witnessed a co-worker do something that appeared to me to be unsafe for the patient in order to save time

49.8 % disagree

Q25 I am provided with adequate resources (personnel, budget, and equipment) to provide safe patient care

41.0 % agree

Q27 I believe that health care error constitutes a real and significant risk to the patients that we treat

12.7 % disagree

Q28 I believe health care errors often go unreported 17.5 % disagree C36. A formal process for disclosure of major events to patients/families is

followed and this process includes support mechanisms for patients, family, and care/service providers.

46.4% agree

C38. The patient and family are invited to be directly involved in the entire process of understanding: what happened following a major event and generating solutions for reducing re-occurrence of similar events

34.8 % agree

Organizations tend to receive a higher proportion of positive responses to questions about shame and repercussions and about how safety is prioritized in the unit/organization and fewer positive responses to questions about the actual state of safety in their organization. These data are consistent with the idea that positive leadership support and cultural change around safety must precede real improvements in the state of safety.

Prioritizing areas for change and improvement can also be achieved by considering an item’s performance (percentage of positive responses) along with an item’s importance (measured using an item’s correlation with the overall patient safety rating). This approach helps organizations focus attention on areas where performance is lowest among those that are felt by staff to be the most critical for overall safety. Eight items were identified using this approach:

Q7 Senior management provides a climate that promotes patient safety Q2 Good communication flow exists up the chain of command regarding patient safety

issues Q29 My organization effectively balances the need for patient safety and the need for

productivity Q1 Patient safety decisions are made at the proper level by the most qualified people Q25 I am provided with adequate resources (personnel, budget, and equipment) to provide

safe patient care Q4 Senior management has a clear picture of the risk associated with patient care Q12 Senior management considers patient safety when program changes are discussed Q34 My supervisor/manager seriously considers staff suggestions for improving patient

safety


Complete Report Perceptions of Patient Safety Culture in Six Canadian Healthcare Organizations

In the Fall of 2006 four organizations representing six hospitals and health regions from across Canada participated in a study funded by the Canadian Patient Safety Institute (CPSI) to look at the measurement of patient safety culture in healthcare organizations. Each of these organizations collected questionnaire data from staff across their region/hospital to help examine patient safety culture in these organizations. This report provides a summary of the data collected as part of this initiative. Data presented in the main body of this report are considered to be the most useful for directing safety initiatives in the healthcare organizations in this study. Data presented in appendices are provided to meet organizations' wishes for more detailed organization-specific data. Caution should be used in interpreting the data presented in appendices given the small numbers for many of the groups reported there. Background A variety of instruments have been used to measure patient safety culture in healthcare organizations. In 2002 an instrument initially developed by Singer, Gaba, et al., (2003), was modified by a group of Canadian researchers and used in a study that examined the effects of a patient safety educational intervention on nurse leader perceptions of patient safety culture (Ginsburg, Norton, Casebeer, & Lewis, 2005). Since that time, the Modified Stanford Instrument (MSI) has been used in other Canadian settings, most notably by the Manitoba Institute for Patient Safety (MIPS) who implemented the MSI in four Manitoba health regions in 2005. In early 2006 the present study was funded by the Canadian Patient Safety Institute to more closely examine the properties of the MSI with multiple staff groups and different care settings (sectors). This study is also establishing a pan-Canadian database with data gathered using the MSI. Subjects The researchers worked with each of the six participating organizations to guide them in identifying all staff members in the organization whose role linked them with patient care (either directly or indirectly). This means that all staff in each organization, with the exception of support staff in administrative departments or research staff, were identified to receive the MSI Patient Safety Culture Survey. Staff were surveyed in the Fall of 2006. A three-stage mailing approach was used whereby all identified staff received a survey in late September, followed by a reminder card two weeks after the initial mailing. A second survey was sent to all staff three weeks after the reminder cards. Surveys were returned directly to the researchers at York University (ethics prevented the university from informing organizations which staff had returned a survey so all staff received a second survey). This approach led to the collection of data from direct care providers, clinical care managers, direct (e.g. unit clerk) and non-direct care support staff (e.g. maintenance staff) and non-direct care managers (e.g. food services supervisor). Data were collected from staff in all sectors including pre-hospital care, acute care, long term care, community care, and mental health. Questionnaire Staff were mailed a 46-item patient safety culture questionnaire (adapted from Singer, Gaba et al., 2003 and Ginsburg et al., 2005). The survey included items designed to measure five dimensions.


Variations of the first four were previously found to be valid, reliable, and meaningful1: (1) Organizational leadership for safety; (2) Unit leadership for safety; (3) Perceived state of safety; (4) Shame and repercussions; and (5) Safety learning behaviours. Questions in all five dimensions reported here were answered using a five-point agree-disagree Likert type scale. All of these items had a “not applicable” option. Box 1 shows the items in each of the five dimensions. The questionnaire also contained two items adapted from the AHRQ survey designed to provide an overall assessment of patient safety culture at the unit and organizational level. These two questions were answered using an A (excellent) through F (failing) rating scale. The questionnaire can be found in Appendix 1. Response Rates The response rate was 27.6% across all six organizations. Table 1 shows response rates by organization and by staff category. For the organizational response rates, the number of surveys mailed out and returned is not shown in order to avoid disclosing the identity of the six organizations that participated in the study.

Table 1 – Response Rates by Org & Staff Group

# returned/ #

sent out Response RateAcross Full Sample 6243/22624 27.6% By Organization

Organization 1 32.8% Organization 2 17.6% Organization 3 30.5% Organization 4 34.2% Organization 5 28.1% Organization 6 34.0%

By Staff Category Nurses 2320/7629 30.4% Care aides 951/3521 27.0% Allied & technicians 1164/4032 28.9% Clinical care managers 365/900 40.5% Ward clerks 270/1251 21.6% Physicians 386/1636 23.6% EMS staff 78/369 21.1% Non-clinical managers 97/332 29.2% Non-clinical support staff 546/2723 20.1% Other2 66/231 28.6%

1 The psychometric properties of dimensions 1, 3, and 4 were reported previously for nurses in clinical leadership

roles (Ginsburg et al., 2005). Dimension 2, unit leadership for safety, was adapted from the Supervisory leadership dimension on the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture (AHRQ, 2005). Items in the fifth dimension, safety behaviours, emerged from other patient safety research some of the study researchers are engaged in. All of the dimensions reported here were subjected to exploratory factor analysis and reliability analysis which yielded reasonably strong outcomes.

2 “Other” staff refers to staff roles relevant to patient safety that do not fit into the previous categories (eg. Safety officers, quality and risk staff, director level positions, etc)


Table 2 shows the number of respondents by sector. Response rates could not be calculated by sector as we relied on a combination of site information and respondent information to link respondents to sectors. Sector could not be defined for a high proportion of the database (27%) where staff did not attach themselves to a single sector or they indicated they work in more than one sector.

Table 2 – Respondents by Sector # returned in

sector Proportion of respondent

group By Sector

Acute inpatients 2518 40.4 Mental health (acute & community) 320 5.1 Long term care 884 14.2 Out-patient clinics 121 1.9 Community - general 625 10.0 Pre-hospital care 80 1.3 Unknown 1692 27.1 TOTAL Returns 6243 100

Ways of Using Patient Safety Culture Data to Drive Change and Improvement Survey items reflect perceptions of the importance of patient safety on the unit and in the organization, perceptions of how safety failures are handled, the state of attitudes and knowledge and perceptions of the state of patient safety in the organization, and engagement in safety learning behaviours. There are many ways to consider and approach data such as these when it comes to driving change.

(1) Looking at high and low performance on individual survey items. It is reasonable and may be important to examine items where a fairly low proportion of staff give positive responses while at the same time celebrating those areas where an organization achieves a very high percentage of positive responses (e.g where over 70 or 80% of staff agree or strongly agree with various individual survey items).

(2) Focusing on questions that reflect areas that are the most important to staff. Simple correlations between individual survey items and overall ratings of patient safety can be used to help prioritize which items make the most important contributions to overall safety ratings from staff members’ perspectives. Combining this knowledge with knowledge from (1) above can help organizations focus in on areas that are particularly important and are achieving fewer positive responses.

(3) Benchmarking - Looking for high performing groups. Looking to other groups for which similar data are available can, in theory, provide useful learning opportunities. While it may be of interest to see how other similar organizations perform using the same instrument, there is as much diversity within the kind of large multi-site organizations we studied as there is between them. Accordingly, it is likely more valuable to consider how specific sites or units within a health organization perform. There were 34 sites in this dataset with respondent groups large enough to permit meaningful comparisons (34 sites had >30 respondents).


(4) Using data to guide discussion of safety culture in different parts of an organization. An organization’s survey results can be used alongside qualitative typologies or frameworks that group units or organizations into different culture types. Survey data can be used by individuals and teams to locate their unit or organization on this kind of framework. Use of frameworks in this way can promote open discussion and raise awareness about patient safety, highlight differences in perception between staff, stimulate discussion regarding strengths and weaknesses of patient safety culture, and identify opportunities for improvement.

Data Analysis & Reporting In keeping with the above suggestions for how to use these data to foster change and improvement, data are reported in several ways. Comparing Mean Dimension Scores by Organization, Staff Group and Sector. First, data are presented for groups of questions that were used to measure each of the five dimensions of patient safety culture covered by the survey noted above: (1) organizational leadership for safety; (2) unit leadership for safety; (3) perceived state of safety; (4) shame and repercussions of reporting; and (5) safety learning behaviours (see Box 1 for questions in each dimension). Mean scores on each of these dimensions of patient safety culture are presented by organization, and by staff group and sector (for all six organizations combined). These high level data are designed to show broad differences across these groups. The 95% confidence interval (CI) of the mean is provided to help make it clear when differences between groups should be considered statistically significant. If the lower and upper bounds of the 95% CI for two groups overlap, then differences between the groups are NOT statistically significant3. These data are presented in tables 3, 4 and 5 and some discussion is provided indicating which differences are statistically significant as well as what level of difference should be considered clinically meaningful4. Organization-specific data by staff group and sector are not contained in this main report but can be found in your organization’s private appendix. Data for Individual Survey Questions. More detailed data are shown by reporting the percentage of positive responses for each of the individual questions that make up these five dimensions. The percentage of positive responses includes the percentage of respondents who agreed or strongly agreed with positively worded questions, and the percentage who disagreed or strongly disagree with negatively worded items. These data on individual questions are provided for all sites that had > 30 responders and for all units that had > 20 responders. Consistent with the suggestions above, organizations are encouraged to look at and learn from their own high and low performing questions. They can also look at their own lower-performing areas where others performed very well as these (a) provide an indication of minimally achievable levels of performance, and (b) provide potential opportunities for networking, data sharing and learning. The research team would be happy to facilitate this networking process by

3 A Confidence Interval of the mean reflects the fact that mean scores are actually estimates of the mean (E.g the

mean will vary from sample to sample of respondents with these 6 organizations). Instead of a single estimate for the mean, a confidence interval generates a lower and upper limit for the mean. The interval estimate gives an indication of how much uncertainty there is in the estimate of the true mean. The narrower the interval, the more precise the estimate. The smaller the size of the respondent group, the larger the confidence interval.

4 Effect sizes are used to comment on how clinically meaningful differences between groups are. See note 5.


brokering contacts between sites wishing to share current practice in these areas. Data on individual survey questions for each organization are provided in Appendix 2.

Box 1– Survey Items in Each of the Five Dimensions

Organizational leadership for safety Senior management provides a climate that promotes patient safety Patient safety decisions are made at the proper level by the most qualified people Good communication flow exists up the chain of command regarding patient safety issues Senior management has a clear picture of the risk associated with patient care My organization effectively balances the need for patient safety and the need for productivity Senior management considers patient safety when program changes are discussed I work in an environment where patient safety is a high priority Shame and repercussions of reporting Reporting a patient safety problem will result in negative repercussions for the person reporting it Asking for help is a sign of incompetence If I make a mistake that has significant consequences and nobody notices, I do not tell anyone about it I will suffer negative consequences if I report a patient safety problem

Safety learning behaviours Individuals involved in major events have quick and easy way to capture/report what happened Individuals involved in major events contribute to the understanding and analysis of the event and the generation of possible solutions A formal process for disclosure of major events to patients/families is followed and this process includes support mechanisms for patients, family, and care/service providers The patient and family are invited to be directly involved in the entire process of understanding: what happened following a major event and generating solutions for reducing re-occurrence of similar events Things that are learned from major events are communicated to staff on our unit using more than one method (e.g. communication books, in-services, unit rounds, emails) and/or at several times so all staff hear about it

Perceived state of safety Loss of experienced personnel has negatively affected my ability to provide high quality patient care (%disagree) I have enough time to complete patient care tasks safely In the last year, I have witnessed a co-worker do something that appeared to me to be unsafe for the patient in order to save time I am provided with adequate resources (personnel, budget, and equipment) to provide safe patient care I have made significant errors in my work that I attribute to my own fatigue I believe that health care error constitutes a real and significant risk to the patients that we treat I believe that health care errors often go unreported I am less effective at work when I am fatigued Personal problems can adversely affect my performance Unit leadership for safety My supervisor says a good word when he/she sees a job according to established patient safety procedures My supervisor seriously considers staff suggestions for improving patient safety Whenever pressure builds up, my supervisor wants us to work faster, even if it means taking shortcuts (% disagree) My supervisor overlooks patient safety problems that happen over and over (%disagree) My unit takes the time to identify and assess risks to patients My unit does a good job managing risks to ensure patient safety I am rewarded for taking quick action to identify a serious mistake

Results Comparing Mean Scores by Organization, Staff Group and Sector. Table 3 shows scores on each of the five safety culture dimensions by organization. Table 3 shows that organizations tend to score between 3.2 and 3.6 on both leadership dimensions (organization and unit) and the learning behaviours dimension, while scoring highest on the shame and repercussions of reporting dimension and lowest on the state of safety dimension. This shows that responses to questions in these dimensions tended to range between just under 3 and just over 4 on a five-point scale where 1 is strongly disagree, 3 is neutral and 5 is strongly agree (with the statements in the


dimension). Any negatively phrased items in the dimension were recoded so that a 1 = strongly agree and 5 = strongly disagree. Accordingly, a higher mean score is always a more desirable core.

Table 3 - Safety Culture Dimension Scores by Organization

N Mean Std.

Deviation Lower Bound

(95% CI) Upper Bound

(95% CI) Organizational leadership for safety (F1) Organization 1 3.58 .66 3.53 3.63 Organization 2 3.61 .74 3.57 3.65 Organization 3 3.34 .85 3.31 3.38

Organization 4 3.42 .85 3.36 3.49 Organization 5 3.20 .76 3.09 3.30

Organization 6 3.57 .78 3.53 3.62 All Organizations 6094 3.47 .78 3.45 3.49 Unit leadership for safety (F2) Organization 1 3.63 .61 3.58 3.67 Organization 2 3.61 .68 3.57 3.65 Organization 3 3.48 .70 3.45 3.51 Organization 4 3.43 .77 3.37 3.48 Organization 5 3.49 .70 3.40 3.58 Organization 6 3.60 .69 3.56 3.64 All Organizations 5931 3.54 .70 3.52 3.56 State of safety (F3) Organization 1 2.96 .50 2.92 2.99 Organization 2 2.85 .56 2.81 2.88

Organization 3 2.77 .58 2.75 2.80 Organization 4 2.74 .60 2.70 2.79 Organization 5 2.78 .56 2.70 2.85 Organization 6 2.79 .57 2.75 2.82

All Organizations 6060 2.81 .57 2.79 2.82 Shame and repercussions of reporting (F4) Organization 1 4.28 .53 4.24 4.31 Organization 2 4.16 .65 4.13 4.20 Organization 3 4.14 .60 4.12 4.17

Organization 4 4.03 .67 3.98 4.08 Organization 5 4.05 .61 3.97 4.13

Organization 6 4.12 .64 4.08 4.16 All Organizations 6107 4.14 .62 4.13 4.16 Safety learning behaviours (F5) Organization 1 3.37 .64 3.32 3.42 Organization 2 3.51 .71 3.47 3.56 Organization 3 3.30 .69 3.26 3.33 Organization 4 3.41 .74 3.35 3.46 Organization 5 3.30 .70 3.21 3.39 Organization 6 3.52 .67 3.48 3.56

All Organizations 5592 3.40 .70 3.38 3.42


Several of the differences between the organizations shown in Table 3 are statistically significant which means that when data are rolled up to the organization level, we are seeing some organizations performing better than others on certain dimensions of patient safety culture. Organizations 1, 2, and 6 score significantly higher than organizations 3, 4, and 5 on both leadership dimensions; organization 1 scores higher than all of the other organizations on the perceived state of safety and shame and repercussions of reporting dimension and organizations 2 and 6 score significantly higher than the other organizations on the safety learning behaviours dimension. It is important to note that statistical significance is a function of sample size so that with larger samples, very small differences become statistically significant. Effect sizes5 tell us about the clinical significance of these differences. Differences between groups of 0.2 or 0.3 on this 5-point scale would be considered small to medium effects. Differences between groups that approach 0.5 would be considered large effects. Table 4 shows scores on each of the five safety culture dimensions by staff group. There are several interesting differences between staff groups on these dimensions. For instance, nurses (RN and RPN) provide lower ratings of organizational and unit leadership for safety than most other staff groups. Care aides tend to score higher than clinical staff groups on both leadership dimensions and the perceived state of safety; however, care aides, along with non-clinical support staff score the lowest on the shame and repercussions of reporting dimension (F4). Clinical managers score significantly higher than other staff on the shame and repercussions of reporting dimension and the unit leadership—a finding that is consistent with other research showing this group tends to overestimate staff perceptions of safety culture (Huang, Clermont, Sexton et al., 2007). Physicians have the lowest perceptions (e.g. most concern) about the state of safety (F3) while nurses, physicians and EMS staff score significantly lower than most other groups on the safety learning behaviours dimension. Of these differences, the largest effects5 are seen with respect to nurses’ lower perceptions of organizational leadership for safety (F1) and EMS staff concern around shame and repercussions of reporting (F4).

Table 4 - Safety Culture Scale Scores by Staff Category

N Mean Std.

Deviation.Lower Bound


(95% CI) Organizational leadership for safety (F1)

Nursing 2312 3.30 0.81 3.27 3.34 Care aides 936 3.63 0.75 3.58 3.68 Allied & technicians 1136 3.52 0.74 3.48 3.57 Clinical care managers 365 3.55 0.80 3.47 3.64 Ward clerks 261 3.68 0.71 3.59 3.76 Non-clinical support staff 503 3.58 0.74 3.51 3.64 Physicians 379 3.43 0.77 3.35 3.51 EMS staff 77 3.46 0.77 3.28 3.63 Non-clinical managers 95 3.79 0.56 3.67 3.90 Other 62 3.72 0.68 3.55 3.89 Total 6126 3.47 0.78 3.45 3.49

Unit leadership for safety (F2) Nursing 2304 3.46 0.69 3.44 3.49

5 Effect sizes are differences expressed as a proportion of the standard deviation. 0.2 is considered a small

effect, 0.5 a medium effect and 0.8 a large effect (Cohen & Cohen, 1983)


N Mean Std.

Deviation.Lower Bound


(95% CI) Care aides 936 3.60 0.71 3.56 3.65 Allied & technicians 1114 3.54 0.67 3.50 3.58 Clinical care managers 346 3.77 0.62 3.70 3.83 Ward clerks 253 3.67 0.70 3.58 3.75 Non-clinical support staff 491 3.46 0.76 3.39 3.52 Physicians 298 3.55 0.66 3.48 3.63 EMS staff 77 3.57 0.68 3.41 3.72 Non-clinical managers 86 3.80 0.59 3.67 3.93 Other 58 3.78 0.69 3.60 3.96 Total 5963 3.54 0.70 3.52 3.56

State of safety (F3) Nursing 2315 2.77 0.57 2.75 2.79 Care aides 932 2.90 0.60 2.86 2.94 Allied & technicians 1140 2.85 0.54 2.82 2.88 Clinical care managers 359 2.71 0.56 2.65 2.77 Ward clerks 254 3.00 0.55 2.94 3.07 Non-clinical support staff 481 2.86 0.58 2.80 2.91 Physicians 384 2.66 0.52 2.61 2.71 EMS staff 77 2.82 0.61 2.68 2.96 Non-clinical managers 88 2.67 0.53 2.56 2.79 Other 62 2.67 0.60 2.52 2.82 Total 6092 2.81 0.57 2.79 2.82

Shame and repercussions of reporting (F4)

Nursing 2312 4.19 0.59 4.17 4.21 Care aides 931 4.09 0.67 4.05 4.13 Allied & technicians 1139 4.13 0.60 4.10 4.17 Clinical care managers 365 4.32 0.57 4.27 4.38 Ward clerks 261 4.19 0.53 4.12 4.25 Non-clinical support staff 515 3.89 0.75 3.83 3.96 Physicians 382 4.14 0.57 4.08 4.20 EMS staff 77 3.85 0.67 3.70 4.00 Non-clinical managers 93 4.19 0.53 4.08 4.30 Other 63 4.23 0.60 4.08 4.38 Total 6138 4.14 0.62 4.12 4.16

Safety learning behaviours (F5) Nursing 2237 3.30 0.71 3.27 3.33 Care aides 847 3.59 0.65 3.54 3.63 Allied & technicians 997 3.39 0.66 3.35 3.43 Clinical care managers 346 3.47 0.69 3.40 3.55 Ward clerks 218 3.56 0.69 3.47 3.65 Non-clinical support staff 415 3.47 0.68 3.40 3.53 Physicians 356 3.34 0.73 3.26 3.42 EMS staff 70 3.25 0.72 3.08 3.42 Non-clinical managers 78 3.58 0.56 3.46 3.71 Other 60 3.50 0.69 3.32 3.68 Total 5624 3.40 0.70 3.38 3.42


Table 5 shows the scores on each of the five safety culture dimensions by sector. While there appear to be some statistically significant differences between sectors on most dimensions, the differences are less pronounced that those we see for staff group.

Table 5 - Safety Culture Scale Scores by Sector

N Mean Std.

Deviation Lower Bound


(95% CI) Organizational leadership for safety (F1) Acute inpatients 2495 3.38 0.79 3.35 3.41 Mental health 317 3.28 0.89 3.18 3.38 LTC 881 3.54 0.80 3.49 3.60 Out-patient clinics 120 3.49 0.72 3.36 3.62 Community - general 608 3.68 0.70 3.63 3.74 Pre-hospital care 80 3.46 0.78 3.29 3.64 Total 4501 3.45 0.80 3.43 3.47

Unit leadership for safety (F2) Acute inpatients 2451 3.51 0.68 3.48 3.54 Mental health 312 3.45 0.77 3.37 3.54 LTC 876 3.57 0.72 3.52 3.62 Out-patient clinics 114 3.58 0.64 3.47 3.70 Community - general 588 3.66 0.68 3.61 3.72 Pre-hospital care 80 3.53 0.70 3.38 3.69 Total 4421 3.54 0.70 3.52 3.56

State of safety (F3) Acute inpatients 2491 2.77 0.58 2.75 2.80 Mental health 315 2.83 0.53 2.77 2.89 LTC 875 2.77 0.60 2.73 2.81 Out-patient clinics 118 2.94 0.51 2.85 3.04 Community - general 609 2.94 0.54 2.89 2.98 Pre-hospital care 80 2.78 0.60 2.65 2.92 Total 4488 2.80 0.58 2.79 2.82

Shame and repercussions of reporting (F4)

Acute inpatients 2491 4.20 0.58 4.17 4.22 Mental health 317 4.04 0.67 3.96 4.11 LTC 882 4.12 0.62 4.07 4.16 Out-patient clinics 120 4.18 0.63 4.06 4.29 Community - general 616 4.13 0.68 4.08 4.19 Pre-hospital care 80 3.84 0.66 3.69 3.98 Total 4506 4.15 0.62 4.14 4.17

Safety learning behaviours (F5) Acute inpatients 2376 3.32 0.69 3.29 3.35 Mental health 301 3.23 0.84 3.13 3.32 LTC 823 3.53 0.67 3.49 3.58 Out-patient clinics 103 3.46 0.62 3.34 3.58 Community - general 518 3.50 0.68 3.44 3.56 Pre-hospital care 73 3.26 0.72 3.10 3.43 Total 4194 3.38 0.71 3.36 3.40

Moreover, it is quite possible some of the sector differences we see are actually explained by staff group or other differences within these sectors. However, one trend suggested by these data is that


the community sector (excluding community mental health) tends to score higher than the other sectors on both leadership dimensions (F1 and F2) and the perceived state of safety dimension. In addition, the mental health sector (including community and acute mental health) scores lower than most sectors on the organizational leadership dimension (F1), the shame and repercussions of reporting dimension (F4) and the safety learning behaviours dimension (F5). The acute care sector scores higher than most sectors on the shame and repercussions of reporting dimension. Data for individual survey questions, by facility and by unit The remainder of the data presented focus on the proportion of positive responses to individual survey questions6 in the five dimensions of patient safety culture that were measured. As noted, it is often these more detailed data that can best help identify and drive specific change and safety improvement efforts. Table 6 shows the percentage of positive responses for those 34 facilities in the dataset that had > 30 respondents. Table 7 shows the percentage of positive responses for those 35 units in the data that had > 20 respondents. To reiterate, the percentage of positive responses includes the percentage of respondents who agreed or strongly agreed with positively worded questions, and the percentage who disagreed or strongly disagree with negatively worded items. Accordingly, a higher score is always better. Negatively worded items are marked with an asterisk in the list of questions that appears under each section of the table. For data shown in both of these tables, it is important to note that only differences of about 25% are significantly different from one another for sites or units with 30-35 respondents. Differences of about 18% are significant for sites or units with 60 respondents and, for sites with closer to 100 cases, differences of approximately 10% between sites are statistically significant. Only differences of 30% between units with 20 responders are statistically significant. In addition, caution is required in making straight comparisons as some sites or units may be community settings or may have more care aides—two groups that tend to score higher on several dimensions. For this reason, these data are more useful if used to compare how a single site or unit performs on different questions (rather than trying to make comparisons between sites or units). While tables 6 and 7 suggest differences between sites and units, respectively, on the proportion of positive responses for individual survey questions, it is also clear that the same groups of questions seem to receive higher and lower proportions of positive responses across most facilities and units. The bottom row in tables 6 & 7 shows the percentage of positive responses to each question across the entire respondent dataset. Box 2 suggests opportunities for celebration and for improvement based on a summary of tables 6 & 7. Box 2 highlights 4 questions where >80% positive responses were achieved and 12 areas where fewer than 50% positive responses were achieved. These items are coloured green and red, respectively, in tables 6 & 7.

6 Please note that question numbers used throughout this report are not consistent with the question numbers that

appeared on the 2006 survey. Question numbering is consistent with the 2005 MSI.


Box 2 – Questions with the Highest and Lowest Percentage of Positive Responses Opportunities for celebration on four questions where >80% positive responses were achieved (these items are coloured green in tables 6 & 7):

Q8 Asking for help is a sign of incompetence 89.7 % disagree Q9 If I make a mistake that has significant consequences and nobody notices, I do not tell anyone about it

93.0 % disagree

Q11 I am less effective at work when I am fatigued 85.0% agree Q16 I will suffer negative consequences if I report a patient safety problem 82.2 % disagree

In terms of identifying opportunities for improvement, it may be useful to consider the 12 areas where the fewer than 50% positive responses were achieved (these items are coloured red in tables 6 & 7):

Q4 Senior management has a clear picture of the risk associated with patient care 49.0 % agree Q12 Senior management considers patient safety when program changes are discussed 49.1 % agree Q29 My organization effectively balances the need for patient safety and the need for

productivity 48.4 % agree

Q18 I am rewarded for taking quick action to identify a serious mistake 29.1 % agree Q33 My supervisor/manager says a good word when he/she sees a job done according to

established patient safety procedures 44.0 % agree

Q21 Loss of experienced personnel has negatively affected my ability to provide high quality patient care

37.8 % disagree

Q24 In the last year, I have witnessed a co-worker do something that appeared to me to be unsafe for the patient in order to save time

49.8 % disagree

Q25 I am provided with adequate resources (personnel, budget, and equipment) to provide safe patient care

41.0 % agree

Q27 I believe that health care error constitutes a real and significant risk to the patients that we treat

12.7 % disagree

Q28 I believe health care errors often go unreported 17.5 % disagree C36. A formal process for disclosure of major events to patients/families is followed and this

process includes support mechanisms for patients, family, and care/service providers. 46.4% agree


34.8 % agree


Table 6 - Percentage of Positive Responses on each Question, by Site Organizational leadership for safety (F1) Unit Leadership for Safety (F2) Facility

Number n q1 q2 q4 q7 q12 q29 q30 q5 q6 q18 q33 q34 q35 q36 1 782 69.4 61.8 50.3 62.2 46.1 52.5 80.3 81.4 82.9 28.1 38.8 62.2 75.0 80.92 590 66.3 59.4 51.9 64.6 48.8 50.9 76.9 77.9 80.3 29.9 48.5 65.1 64.0 71.83 342 63.3 64.9 53.2 59.6 47.3 49.2 76.5 75.8 78.5 29.2 47.5 62.2 65.9 70.84 283 67.5 65.7 56.9 68.4 49.0 56.4 80.1 77.4 85.0 26.1 40.9 67.8 68.0 75.65 1619 59.5 50.9 43.6 51.6 43.4 43.3 70.3 74.8 75.4 27.4 38.7 61.5 67.6 72.96 171 53.0 42.3 36.7 40.5 38.5 38.0 56.9 70.9 75.6 21.7 33.3 52.6 58.4 62.37 114 66.7 57.0 42.6 55.1 46.0 38.7 67.9 75.7 75.5 34.3 55.2 63.8 66.4 79.08 77 67.5 62.3 49.4 67.5 51.9 50.7 75.0 83.3 87.8 43.4 53.5 64.3 71.4 78.99 36 70.6 70.6 51.5 65.6 45.2 50.0 80.6 82.9 91.2 20.6 37.5 58.1 46.9 80.615 33 51.5 43.8 36.4 46.9 40.6 33.3 51.6 65.6 64.5 24.2 40.6 51.5 63.6 66.716 150 78.9 77.6 70.1 71.2 73.0 66.2 85.3 80.0 86.5 31.2 67.1 72.1 72.6 83.817 104 39.8 23.5 20.8 27.2 24.8 20.8 48.0 57.0 60.0 19.0 17.3 23.5 40.2 46.918 61 65.5 54.2 51.7 55.2 50.0 41.7 64.9 72.9 78.0 31.7 40.7 53.4 53.3 59.319 35 60.6 44.1 32.4 36.4 33.3 25.8 44.1 55.2 65.5 35.3 39.4 34.4 34.4 46.720 33 75.0 59.4 56.3 53.1 58.1 36.7 63.6 78.8 84.4 19.4 37.5 56.3 81.3 74.223 31 58.1 48.4 54.8 54.8 64.5 48.4 74.2 70.0 72.4 13.3 29.0 48.4 64.5 64.533 74 42.6 30.6 14.1 23.9 20.0 29.4 60.0 80.0 76.5 29.2 45.2 61.6 64.8 71.034 54 67.3 61.5 35.8 60.8 43.8 53.8 75.0 86.0 80.8 22.9 38.5 49.1 68.0 69.835 34 71.9 68.8 69.7 73.3 60.6 67.7 75.0 69.7 81.3 42.4 61.3 69.7 75.9 63.336 33 48.5 48.5 36.4 57.6 39.4 40.0 63.6 80.6 71.0 21.9 38.7 64.5 54.8 58.139 67 53.0 40.3 53.0 56.9 63.6 31.7 61.2 69.7 66.7 24.6 50.8 59.1 66.7 56.740 65 72.3 77.8 58.7 81.0 61.7 61.7 81.0 87.3 92.2 27.9 36.5 56.9 64.1 79.041 59 75.9 72.4 56.9 70.7 60.0 49.1 78.9 82.1 75.0 31.0 55.2 73.7 67.8 71.942 59 63.8 49.2 37.3 62.1 53.4 42.9 80.7 82.8 94.8 26.3 42.6 45.5 48.2 66.143 56 62.5 66.7 50.0 66.0 62.3 52.8 77.8 76.5 84.9 37.7 43.4 58.8 54.7 74.044 54 66.7 70.6 59.6 59.2 60.8 58.7 76.5 76.1 73.5 30.6 52.1 48.9 65.3 65.245 45 61.0 47.6 52.3 55.8 46.5 52.4 65.9 76.2 81.4 20.5 38.1 51.2 61.0 69.046 44 72.7 60.5 55.8 64.3 73.8 51.2 70.5 74.4 83.7 27.9 54.5 67.4 62.8 79.547 41 73.2 65.9 53.7 70.7 56.1 55.0 85.0 90.0 90.0 26.8 47.4 65.0 66.7 67.548 40 64.9 52.6 44.7 55.6 48.7 44.7 82.5 89.5 78.9 38.5 46.2 46.2 69.2 71.849 40 89.7 87.2 64.1 81.6 63.2 73.7 94.9 94.6 94.7 41.7 64.1 81.1 86.8 87.250 37 76.5 75.0 62.9 86.1 55.9 69.4 89.2 97.2 97.3 37.1 60.0 70.3 72.2 82.451 37 57.1 52.8 59.5 58.3 57.6 45.7 70.3 83.3 80.6 25.0 29.4 61.8 72.2 69.452 33 77.4 62.5 46.9 56.3 62.5 51.6 75.8 75.0 81.3 37.5 54.5 63.6 63.6 65.6

Total 64.8 57.9 49.0 59.0 49.1 48.4 74.0 77.8 79.8 29.1 44.0 61.5 66.7 72.3

Organizational leadership for safety (F1) Q1 Patient safety decisions are made at the proper level by

the most qualified people Q2 Good communication flow exists up the chain of

command regarding patient safety issues Q4 Senior management has a clear picture of the risk

associated with patient care Q7 Senior management provides a climate that promotes

patient safety Q12 Senior management considers patient safety when

program changes are discussed Q29 My organization effectively balances the need for

patient safety and the need for productivity Q30 I work in an environment where patient safety is a high

priority

Unit Leadership for Safety (F2) Q5 My unit takes the time to identify and assess risks to patients Q6 My unit does a good job managing risks to ensure patient

safety Q18 I am rewarded for taking quick action to identify a serious

mistake Q33 My supervisor/manager says a good word when he/she sees a

job done according to established patient safety procedures Q34 My supervisor/manager seriously considers staff suggestions

for improving patient safety Q35 Whenever pressure builds up, my supervisor/manager wants

us to work faster, even if it means taking shortcuts * Q36 My supervisor/manager overlooks patient safety problems

that happen over and over *


…Table 6 Continued State of Safety (F3) Shame and Repercussions (F4) Facility

Number n q11 q13 q21 q22 Q24 q25 q26 q27 q28 q3 q8 q9 q16 1 782 86.1 54.1 41.9 65.4 66.4 52.8 85.3 12.0 17.2 85.1 93.4 95.1 88.2 2 590 82.5 50.2 32.7 52.1 47.5 44.8 78.3 10.0 15.8 77.0 89.1 90.7 81.5 3 342 77.4 44.6 38.4 54.3 51.6 35.7 80.7 8.2 20.4 74.8 87.9 91.3 82.5 4 283 84.6 55.6 41.3 58.9 57.3 51.2 80.1 9.6 18.1 79.8 89.1 94.2 84.1 5 1619 86.0 56.4 36.8 49.1 50.3 33.4 80.0 13.6 15.2 74.5 90.1 93.5 82.9 6 171 90.4 54.9 26.4 34.4 48.8 23.9 73.2 14.7 9.4 74.6 91.2 89.3 76.0 7 114 89.2 57.3 42.6 52.2 63.3 38.0 88.2 16.2 21.7 75.2 90.9 91.7 78.9 8 77 86.7 67.5 38.6 50.7 53.5 36.6 80.0 5.3 18.9 76.6 93.5 89.5 84.4 9 36 94.3 61.1 55.2 59.4 64.5 42.4 86.1 12.5 6.1 82.9 94.3 91.4 82.9 15 33 78.1 60.6 38.7 53.1 56.3 50.0 87.1 9.7 18.2 69.7 93.9 93.9 72.7 16 150 75.5 52.4 52.7 69.9 53.2 66.7 78.8 23.5 23.2 75.9 84.6 91.7 83.8 17 104 97.1 65.0 27.6 27.0 37.1 18.0 65.3 9.8 21.6 55.3 82.5 94.1 71.6 18 61 88.5 60.7 29.6 37.7 48.1 31.6 74.1 10.2 18.6 73.3 85.2 93.4 86.7 19 35 67.6 58.8 25.8 21.4 27.6 22.6 64.7 15.6 21.9 50.0 82.4 91.2 54.5 20 33 69.7 48.5 41.9 34.4 32.3 37.5 78.1 16.1 21.9 78.1 87.9 97.0 87.9 23 31 90.3 70.0 51.6 29.0 35.5 29.0 74.2 19.4 29.0 71.0 96.8 87.1 74.2 33 74 95.9 58.3 20.6 26.8 47.1 26.5 68.1 7.0 11.4 52.8 87.1 97.2 70.8 34 54 82.7 34.0 48.9 60.0 51.1 56.3 78.4 7.8 9.4 75.5 84.9 92.5 84.3 35 34 76.5 61.8 37.9 70.6 57.1 80.8 84.4 15.6 9.1 67.6 91.2 91.2 85.3 36 33 90.9 60.6 32.1 53.6 50.0 38.7 76.7 16.1 16.7 72.7 93.9 90.9 75.8 39 67 84.8 57.6 16.9 26.6 26.6 22.7 70.1 4.7 10.6 71.2 88.1 100.0 78.8 40 65 90.8 52.3 44.8 43.1 37.7 55.6 72.6 10.9 24.6 80.0 95.3 98.4 90.6 41 59 89.7 62.7 40.4 31.5 34.0 36.4 77.2 14.5 19.3 68.4 85.5 86.2 78.6 42 59 79.7 52.5 30.8 35.7 32.0 55.2 78.9 5.7 12.7 74.6 88.1 94.7 83.1 43 56 76.4 58.9 43.2 44.2 45.5 44.0 79.6 20.0 25.9 75.9 90.4 96.3 94.4 44 54 90.2 62.0 40.9 48.9 51.3 37.2 71.1 6.7 15.2 74.0 86.8 94.1 76.9 45 45 72.1 55.6 38.2 37.8 33.3 31.7 73.2 7.1 23.3 76.7 91.1 97.7 80.0 46 44 93.2 72.7 40.5 38.6 34.2 28.2 77.5 14.3 18.6 70.5 90.9 90.9 86.4 47 41 87.8 63.4 42.1 55.3 55.6 61.0 82.5 4.9 14.6 73.2 87.8 100.0 75.6 48 40 95.0 69.2 29.4 35.3 42.4 48.6 66.7 16.2 13.2 73.7 89.7 100.0 86.8 49 40 90.0 30.0 54.3 71.1 54.1 78.4 88.9 34.2 26.3 74.4 94.9 89.7 84.6 50 37 82.9 62.2 55.2 71.0 71.0 68.8 75.0 8.8 30.6 88.9 97.2 91.9 91.9 51 37 94.6 59.5 40.6 18.8 40.6 42.9 69.4 10.8 18.9 70.3 88.9 100.0 80.6 52 33 75.8 53.1 36.7 50.0 50.0 29.0 78.8 12.9 18.2 71.0 87.9 90.9 84.4

Total 85.0 55.5 37.8 50.3 49.8 41.0 79.3 12.7 17.5 75.3 89.7 93.0 82.2

Perceived State of Safety (F3) Q11 I am less effective at work when I am fatigued Q13 Personal problems can adversely affect my performance Q21 Loss of experienced personnel has negatively affected my ability to

provide high quality patient care * Q22 I have enough time to complete patient care tasks safely Q24 In the last year, I have witnessed a co-worker do something that

appeared to me to be unsafe for the patient in order to save time * Q25 I am provided with adequate resources (personnel, budget, and

equipment) to provide safe patient care Q26 I have made significant errors in my work that I attribute to my

own fatigue * Q27 I believe that health care error constitutes a real and significant risk

to the patients that we treat * Q28 I believe health care errors often go unreported *

Shame and repercussions of reporting (F4) Q3 Reporting a patient safety problem will

result in negative repercussions for the person reporting it *

Q8 Asking for help is a sign of incompetence *

Q9 If I make a mistake that has significant consequences and nobody notices, I do not tell anyone about it *

Q16 I will suffer negative consequences if I report a patient safety problem*


…Table 6 Continued

Safety Learning Behaviours (F5) Facility Number n c34 c35 c36 c38 c39

1 782 61.9 66.9 42.0 25.4 56.6 2 590 64.8 61.2 49.6 36.5 60.7 3 342 65.9 65.9 51.7 41.8 62.4 4 283 67.9 68.2 53.6 36.1 63.5 5 1619 64.3 56.5 38.6 25.5 52.6 6 171 67.1 60.5 31.9 27.5 41.5 7 114 64.1 64.4 48.5 28.9 50.0 8 77 61.6 61.1 43.1 37.1 49.3 9 36 82.1 77.8 29.2 8.7 53.8 15 33 48.5 33.3 24.1 27.6 43.8 16 150 71.9 67.2 61.5 65.3 63.2 17 104 51.0 35.0 28.1 20.4 41.0 18 61 66.7 63.6 42.6 30.6 58.9 19 35 48.4 46.9 18.5 12.0 37.9 20 33 83.9 63.3 66.7 63.3 71.0 23 31 63.3 64.5 64.3 55.6 45.2 33 74 44.1 45.3 32.3 19.0 40.3 34 54 60.0 55.1 46.8 43.5 47.1 35 34 71.0 75.9 59.3 62.1 66.7 36 33 79.3 55.2 50.0 32.1 46.7 39 67 69.4 51.6 54.0 58.1 46.0 40 65 76.7 75.0 70.0 45.3 60.3 41 59 75.0 65.3 59.6 31.3 71.2 42 59 49.0 51.9 54.9 37.3 55.8 43 56 62.0 72.9 62.2 47.9 62.5 44 54 64.6 67.4 67.4 34.9 61.7 45 45 56.4 57.5 48.6 48.6 58.5 46 44 65.0 50.0 52.6 51.4 54.8 47 41 64.1 73.7 64.9 37.8 51.3 48 40 62.2 67.6 51.4 41.7 62.2 49 40 82.4 67.6 59.4 56.3 74.3 50 37 83.3 75.9 72.4 73.3 66.7 51 37 80.6 64.9 51.4 38.2 59.5 52 33 66.7 66.7 55.6 41.4 60.0

Total 65.3 61.4 46.4 34.8 56.6

Safety Learning Behaviours (F5) C34. Individuals involved in major events have a quick and easy way to capture/report what happened C35. Individuals involved in major events contribute to the understanding and analysis of the event and the generation of possible solutions C36. A formal process for disclosure of major events to patients/families is followed and this process includes support mechanisms for patients, family, and care/service providers. C38. The patient and family are invited to be directly involved in the entire process of understanding: what happened following a major event and generating solutions for reducing re-occurrence of similar events C39. Things that are learned from major events are communicated to staff on our unit using more than one method (e.g. communication book, in-services, unit rounds, emails) and / or at several times so all staff hear about it


Table 7 - Percentage of Positive Responses on Each Question, by Unit Organizational leadership

for safety (F1)** Unit Leadership for Safety (F2) Unit Number n q1 q2 q30 q5 q6 q18 q33 q34 q35 q36

6 20 63.2 52.6 35.0 80.0 75.0 15.0 25.0 35.0 65.0 50.0 25 57 75.0 64.9 91.2 87.7 84.2 25.5 29.1 56.4 63.2 78.9 26 30 50.0 56.7 63.3 66.7 69.0 20.7 50.0 43.3 46.2 69.0 27 30 70.0 62.1 79.3 83.3 82.8 33.3 65.5 86.7 76.7 93.1 28 24 75.0 54.2 83.3 91.7 87.5 25.0 45.8 70.8 75.0 79.2 29 24 79.2 79.2 83.3 87.5 79.2 30.4 37.5 58.3 41.7 70.8 30 23 78.3 73.9 87.0 91.3 95.7 22.7 30.4 56.5 82.6 82.6 72 37 78.4 64.9 86.1 78.4 88.9 30.6 43.2 61.1 69.4 82.9 88 60 63.2 61.0 80.0 77.2 75.9 22.8 31.0 71.2 73.7 78.0 89 42 57.5 50.0 68.3 76.9 74.4 15.4 29.4 65.7 57.6 82.4 90 29 65.5 55.2 58.6 62.1 72.4 27.6 39.3 65.5 75.9 78.6 91 29 44.8 48.3 72.4 67.9 86.2 25.0 46.4 65.5 72.4 67.9 92 35 28.6 20.0 31.4 51.4 31.4 14.7 17.1 29.4 45.5 50.0 93 27 30.8 14.8 29.6 44.4 25.9 18.5 26.9 40.7 51.9 63.0 94 25 40.0 48.0 68.0 62.5 76.0 4.8 18.8 52.9 57.9 82.4 95 24 54.2 50.0 79.2 87.5 87.5 37.5 45.8 47.8 66.7 54.2 96 24 50.0 50.0 83.3 70.8 79.2 20.8 62.5 87.5 83.3 87.5 97 23 78.3 91.3 95.7 95.7 95.7 72.7 82.6 91.3 95.7 95.7 98 25 70.8 50.0 60.0 63.6 63.6 33.3 28.6 70.6 61.5 76.9 99 21 60.0 55.0 76.2 81.0 90.5 25.0 19.0 61.9 90.5 90.5 100 22 45.5 36.4 63.6 72.7 63.6 27.3 40.9 50.0 50.0 81.8 101 21 55.0 61.9 81.0 85.7 90.5 19.0 38.1 52.4 75.0 80.0 102 21 76.2 66.7 100.0 90.5 90.5 50.0 42.1 84.2 75.0 84.2 103 23 72.7 60.9 86.4 72.7 81.8 43.5 57.1 69.6 47.8 69.6 131 21 55.0 60.0 70.0 70.0 80.0 30.0 35.0 50.0 60.0 75.0 203 28 73.1 44.4 71.4 75.0 88.5 18.5 28.6 63.0 68.0 76.0 279 28 71.4 57.1 60.7 78.6 85.7 18.5 35.7 57.1 78.6 75.0 280 24 45.8 20.8 37.5 33.3 37.5 12.5 12.5 20.8 20.8 41.7 292 54 50.9 37.0 57.4 66.7 63.0 24.5 46.2 56.6 62.3 53.7 298 20 75.0 70.0 95.0 90.0 85.0 22.2 70.0 70.0 90.0 85.0 313 34 71.9 68.8 75.0 69.7 81.3 42.4 61.3 69.7 75.9 63.3 314 22 63.6 36.4 81.8 86.4 95.5 19.0 28.6 38.1 45.5 68.2 321 20 60.0 78.9 90.0 90.0 95.0 31.6 30.0 65.0 65.0 84.2 343 21 81.0 61.9 75.0 71.4 61.9 14.3 52.4 61.9 57.1 61.9 346 22 77.3 57.1 59.1 81.8 68.2 27.3 40.9 50.0 33.3 63.6

Total 64.8 57.9 74.0 77.8 79.8 29.1 44.0 61.5 66.7 72.3

Organizational leadership for safety (F1) Q1 Patient safety decisions are made at the proper level by

the most qualified people Q2 Good communication flow exists up the chain of

command regarding patient safety issues Q30 I work in an environment where patient safety is a high

priority ** For F1, questions 4,7,12 & 29 are missing because

they are less applicable for comparison at the unit level

Unit Leadership for Safety (F2) Q5 My unit takes the time to identify and assess risks to patients Q6 My unit does a good job managing risks to ensure patient

safety Q18 I am rewarded for taking quick action to identify a serious

mistake Q33 My supervisor/manager says a good word when he/she sees a

job done according to established patient safety procedures Q34 My supervisor/manager seriously considers staff suggestions

for improving patient safety Q35 Whenever pressure builds up, my supervisor/manager wants

us to work faster, even if it means taking shortcuts * Q36 My supervisor/manager overlooks patient safety problems

that happen over and over *


…Table 7 Continued State of Safety (F3) Shame and Repercussions (F4) Unit

Number n q11 q13 q21 q22 Q24 q25 q26 q27 q28 q3 q8 q9 q16 6 20 89.5 44.4 15.0 15.0 42.1 15.0 85.0 15.0 5.0 85.0 95.0 90.0 84.2 25 57 77.2 50.9 52.9 67.9 64.2 71.7 83.6 9.1 26.8 93.0 93.0 94.7 92.7 26 30 93.3 43.3 30.0 58.6 52.0 23.3 88.9 13.3 10.7 86.7 96.7 96.7 90.0 27 30 93.3 63.3 51.9 69.0 73.1 53.6 93.1 17.2 17.2 96.7 100.0 89.7 93.3 28 24 79.2 29.2 40.9 85.7 72.7 47.8 91.3 9.5 26.1 87.5 95.7 100.0 95.8 29 24 87.0 33.3 20.8 30.4 61.9 33.3 82.6 9.1 26.1 87.5 87.5 95.8 83.3 30 23 73.9 60.9 27.3 65.0 55.0 50.0 90.0 14.3 9.1 78.3 95.7 87.0 87.0 72 37 80.6 48.6 51.4 68.6 60.6 61.8 81.1 17.1 29.7 91.9 89.2 94.6 91.9 88 60 94.8 54.2 50.9 62.7 42.4 45.8 86.2 10.2 12.1 85.0 93.3 91.4 85.0 89 42 82.9 64.1 23.1 46.3 43.2 17.5 70.0 2.4 2.4 61.5 92.5 95.0 80.0 90 29 88.9 64.3 32.1 50.0 50.0 31.0 78.6 13.8 7.1 86.2 100.0 96.4 72.4 91 29 89.7 57.1 25.0 82.8 46.4 39.3 81.5 27.6 13.8 82.8 96.6 100.0 100.0 92 35 87.9 64.7 38.7 17.1 42.4 11.4 73.5 8.6 11.4 68.6 85.7 100.0 79.4 93 27 92.3 55.6 12.5 18.5 23.1 0.0 92.0 14.8 7.4 63.0 85.2 95.8 63.0 94 25 68.0 66.7 34.8 56.5 59.1 25.0 75.0 16.0 24.0 64.0 88.0 92.0 84.0 95 24 70.8 47.8 20.8 40.9 60.9 20.8 95.8 16.7 36.4 83.3 100.0 91.7 87.5 96 24 87.5 70.8 20.8 50.0 54.2 25.0 82.6 8.3 4.2 62.5 95.7 91.7 79.2 97 23 87.0 47.8 65.2 87.0 69.6 91.3 90.9 8.7 39.1 91.3 87.0 95.7 95.7 98 25 84.0 76.0 15.8 45.8 71.4 30.4 72.0 4.0 4.2 52.0 95.8 96.0 66.7 99 21 90.5 66.7 33.3 40.0 57.1 42.9 85.7 14.3 23.8 100.0 90.5 95.2 85.7 100 22 81.8 54.5 28.6 30.0 42.1 15.0 81.8 9.1 13.6 72.7 86.4 90.9 72.7 101 21 80.0 57.1 30.0 35.0 38.1 35.0 71.4 19.0 14.3 85.7 90.5 90.5 90.5 102 21 78.9 33.3 47.4 57.9 52.6 42.1 100.0 23.8 20.0 81.0 90.5 90.5 85.7 103 23 81.8 60.9 23.8 52.9 42.1 31.6 78.3 4.8 13.6 56.5 86.4 86.4 82.6 131 21 85.0 30.0 31.6 65.0 60.0 31.6 80.0 20.0 30.0 65.0 100.0 100.0 84.2 203 28 88.9 57.1 19.2 48.0 52.0 40.0 83.3 14.8 14.8 77.8 88.9 92.9 85.2 279 28 67.9 46.4 42.9 32.1 37.0 39.3 81.5 18.5 21.4 78.6 89.3 96.4 89.3 280 24 91.7 66.7 25.0 8.3 16.7 16.7 66.7 0.0 20.8 50.0 83.3 100.0 70.8 292 54 83.3 55.6 14.8 19.2 25.0 16.7 75.9 5.9 11.3 77.4 87.0 100.0 79.6 298 20 68.4 50.0 56.3 52.6 47.4 55.0 94.7 11.1 35.0 70.0 95.0 95.0 75.0 313 34 76.5 61.8 37.9 70.6 57.1 80.8 84.4 15.6 9.1 67.6 91.2 91.2 85.3 314 22 72.7 36.4 45.0 33.3 26.3 45.5 81.0 4.8 13.6 68.2 86.4 100.0 86.4 321 20 90.0 50.0 31.6 42.1 38.9 55.0 80.0 0.0 25.0 80.0 100.0 94.7 90.0 343 21 90.5 52.4 47.6 42.9 25.0 33.3 81.0 4.8 19.0 61.9 85.0 90.0 81.0 346 22 86.4 45.5 31.8 28.6 19.0 47.6 66.7 4.8 13.6 72.7 90.9 100.0 72.7

Total 85.0 55.5 37.8 50.3 49.8 41.0 79.3 12.7 17.5 75.3 89.7 93.0 82.2 Perceived State of Safety (F3) Q11 I am less effective at work when I am fatigued Q13 Personal problems can adversely affect my performance Q21 Loss of experienced personnel has negatively affected my ability to

provide high quality patient care * Q22 I have enough time to complete patient care tasks safely Q24 In the last year, I have witnessed a co-worker do something that

appeared to me to be unsafe for the patient in order to save time * Q25 I am provided with adequate resources (personnel, budget, and

equipment) to provide safe patient care Q26 I have made significant errors in my work that I attribute to my

own fatigue * Q27 I believe that health care error constitutes a real and significant risk

to the patients that we treat * Q28 I believe health care errors often go unreported *

Shame and repercussions of reporting (F4) Q3 Reporting a patient safety problem will

result in negative repercussions for the person reporting it *

Q8 Asking for help is a sign of incompetence *

Q9 If I make a mistake that has significant consequences and nobody notices, I do not tell anyone about it *

Q16 I will suffer negative consequences if I report a patient safety problem*


…Table 7 Continued

Safety Learning Behaviours (F5) Unit Number n c34 c35 c36 c38 c39

6 20 73.7 68.4 38.9 31.6 42.1 25 57 64.3 58.9 42.9 27.3 70.9 26 30 53.3 60.0 43.3 21.4 37.9 27 30 64.3 72.0 34.6 28.6 74.1 28 24 75.0 78.3 33.3 23.8 73.9 29 24 66.7 69.6 45.5 18.2 69.6 30 23 59.1 68.2 22.7 18.2 63.6 72 37 75.0 83.3 61.8 15.6 80.6 88 60 74.1 59.6 30.8 18.0 60.8 89 42 47.4 56.8 40.5 32.4 40.0 90 29 61.5 50.0 21.7 4.2 28.0 91 29 51.7 41.4 24.1 13.8 44.8 92 35 30.3 25.8 27.6 20.7 24.2 93 27 51.9 48.1 42.3 23.1 48.1 94 25 50.0 54.2 41.7 12.5 25.0 95 24 79.2 60.9 45.8 45.8 50.0 96 24 54.2 30.4 26.1 21.7 59.1 97 23 81.8 68.2 69.6 66.7 95.7 98 25 45.5 54.5 40.0 33.3 31.6 99 21 66.7 57.1 28.6 38.1 57.1 100 22 50.0 54.5 36.4 18.2 54.5 101 21 70.0 50.0 35.0 61.9 85.7 102 21 56.3 62.5 35.7 7.1 50.0 103 23 56.5 52.4 35.0 42.9 52.4 131 21 75.0 63.2 47.4 31.6 73.7 203 28 66.7 46.2 37.0 37.5 55.6 279 28 85.2 61.5 69.2 65.4 73.1 280 24 62.5 20.8 26.1 30.4 25.0 292 54 74.0 54.0 54.9 56.9 46.2 298 20 80.0 60.0 65.0 47.4 73.7 313 34 71.0 75.9 59.3 62.1 66.7 314 22 57.9 45.0 60.0 30.0 42.9 321 20 68.4 80.0 65.0 27.8 63.2 343 21 70.0 50.0 63.2 35.0 55.0 346 22 71.4 57.1 47.6 28.6 68.2

Total 65.3 61.4 46.4 34.8 56.6

Safety Learning Behaviours (F5) C34. Individuals involved in major events have a quick and easy way to capture/report what happened

C35. Individuals involved in major events contribute to the understanding and analysis of the event and the generation of possible solutions C36. A formal process for disclosure of major events to patients/families is followed and this process includes support mechanisms for patients, family, and care/service providers.


C39. Things that are learned from major events are communicated to staff on our unit using more than one method (e.g. communication book, in-services, unit rounds, emails) and / or at several times so all staff hear about it


Identifying the Most Important Survey Questions Another approach to prioritizing areas for change and improvement is to try to identify which questions are the most important for patient safety. One way to do this is to look at those questions on the survey that contribute most to overall ratings of patient safety for the organization. To accomplish this, each of the survey questions was correlated with an index of overall safety (this index was computed as the mean of two survey questions about overall safety at the unit and the organization levels). Questions with the highest correlation to this index of overall safety can be considered to be among the most important contributors to respondents overall safety rating. Box 3 shows 11 questions that were among the most highly correlated7 with overall safety ratings for all six organizations combined. These items appear above the faint dotted line in Figure 1 (described below).

Considering Both Performance and Importance of each Survey Question Figure 1 combines data on each items performance and importance. The grid plots (1) an items performance (percentage of agree/strongly agree responses –or disagree/strongly disagree for negatively worded questions) as the percentage of positive responses on the X-axis, and (2) the item’s importance (an item’s correlation with the overall safety rating described above) on the Y-axis. This plot is useful for identifying items with strong performance and high importance to celebrate (top right yellow quadrant), items with strong performance but less importance (bottom right quadrant). Items with weaker performance and high importance (the top left red quadrant) may be the areas to prioritize and target for change and improvement. Items in the bottom left quadrant can also be targeted for action, though they are less important to overall patient safety ratings provided by staff. Note that the lines used to create these four quadrants are somewhat arbitrary and are suggested as a way to help group items into the four areas just described. This grid is

7 r = at least 0.45 for all 11 of these questions and r>0.4 (r-squared > 0.2)

Box 3 – High Importance Items

Q7 Senior management provides a climate that promotes patient safety Q30 I work in an environment where patient safety is a high priority Q2 Good communication flow exists up the chain of command regarding patient

safety issues Q6 My unit does a good job managing risks to ensure patient safety Q29 My organization effectively balances the need for patient safety and the need for

productivity Q1 Patient safety decisions are made at the proper level by the most qualified

people Q25 I am provided with adequate resources (personnel Q4 Senior management has a clear picture of the risk associated with patient care Q5 My unit takes the time to identify and assess risks to patients Q12 Senior management considers patient safety when program changes are

discussed Q34 My supervisor/manager seriously considers staff suggestions for improving

patient safety


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q36q35

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Percent Positive Responses100%90%80%70%60%50%40%30%20%10%0%

provided with all six organizations' data combined given the general lack of variation in performance and importance across these organizations. Organization-specific grids are provided in your organization’s private appendix.

Figure 1 – Performance Improvement Grid `

Ways to Use These Data Other Than Benchmarking!

Benchmarking is often hailed as one of the leading ways to use patient safety culture data for improvement (Sexton et al., 2006). However, given how large the differences need to be between comparison groups to be ‘real’ and the fact that we have yet to see widespread evidence of learning from best practice sites, we instead encourage units and organizations to resist the natural tendency to want to know how they “measure up” to others, and instead consider other internal uses of these data.

High importance, weaker performance

items High importance, high performance

items


The first approach focuses on using patient safety questionnaire data to help identify a few discrete potential problem areas that could be targeted for improvement. This is done by comparing performance across questions (rather than across any groups) as we have done and presented in Box 2 and in Figure 1.

The second approach involves considering patient safety survey results using the kind of qualitative framework suggested by Westrum (1993; 2004) and others in healthcare (Parker, Kirk, Claridge, & et al., 2002). The framework suggests a basic typology of cultures ranging from pathological to generative. The former is one extreme where messengers are shot, safety responsibilities shirked, safety problems concealed, and new ideas for safety are discouraged. The other extreme, generative environments, are characterized by high levels of cooperation and shared ownership of risk. and where there is an inherent emphasis on open problem identification and resolution. These frameworks can be used to diagnose and assess the progress of an organization (or area of an organization) in developing a patient safety culture (Westrum, 2004). Your organization’s survey results can be used together with this framework by individuals and teams to locate their unit or organization on the typology. Use of the framework in this way has been suggested to facilitate a number of important outcomes including promoting open discussion and raising awareness about patient safety, highlighting differences in perception between staff, stimulating discussion regarding strengths and weaknesses of patient safety culture, identifying areas for improvement, and evaluating safety interventions over time (Ashcroft et al., 2005).

Other Options for Considering These Data Provided that caution is used, the organizations may be interested to see how other hospitals have scored on some of these survey items. Singer, Gaba, and colleagues (2003) reported on data from 15 U.S hospitals where a similar questionnaire was completed. Raw data on a question-by-question basis are presented in their paper. When making any comparisons, it is important to recognize that personnel surveyed in the Singer et al. study may not be identical. Also note that Singer et al. report on the percentage of “problematic responses” (those who disagree and strongly disagree with positively worded items and agree to negatively worded items). Questions 33-36 in this report’s unit leadership for safety dimension can be looked at alongside data from AHRQ’s “Hospital Survey on Patient Safety Culture: 2007 Comparative Database Report”. Several tables in Appendices A and B of the report (at http://www.ahrq.gov/qual/hospsurveydb/) show percentage of positive responses on these four questions (see composite scale 2 (Supv/Mgr Expectations & Actions Promoting Patient Safety) by hospital characteristics and respondent characteristics, respectively. Frequency tables found in your organization's private appendix are the data that should be used if you are seeking staff group comparisons to the Singer et al. data or the AHRQ data. Frequencies for your organization, found in Appendix 2, can be used if you are comparing to entire organizations. Finally, as this instrument achieves more widespread use across Canada as part of this CPSI funded study, there will be additional hospitals and health organizations who will use this tool. A pan-Canadian database is being established from these data that will be made available on the study website. These data will not reveal any organization’s data but will provide percentages of positive responses on survey questions by staff group and various locations of care.


References

Agency for Healthcare Research and Quality. Hospital survey on patient safety culture: 2007 comparative database report. AHRQ publication no. 07-0025, April2007. Rockville, MD. Retrieved 5/31/2007, 2007, from http://www.ahrq.gov/qual/hospsurveydb/

Ashcroft, D. M., Morecroft, C., Parker, D., & Noyce, P. R. (2005). Safety culture assessment in community pharmacy: Development, face validity, and feasibility of the Manchester patient safety assessment framework. Quality and Safety in Health Care 14(6): 417-421.

Ginsburg, L., Norton, P. G., Casebeer, A., & Lewis, S. (2005). An educational intervention to enhance nurse leaders' perceptions of patient safety culture. Health Services Research, 40(4), 997-1020.

Huang, D. T., Clermont, G., Sexton, J. B., Karlo, C. A., Miller, R. G., Weissfeld, L. A., et al. (2007). Perceptions of safety culture vary across the intensive care units of a single institution. Critical Care Medicine, 35(1), 165-176.

Parker, D., Kirk, S., Claridge, T., & et al. (2002). The manchester patient safety assessment tool. National Primary Care Research and Development Centre, University of Manchester.

Sexton, J. B., Helmreich, R. L., Neilands, T. B., Rowan, K., Vella, K., Boyden, J., et al. (2006). The safety attitudes questionnaire: Psychometric properties, benchmarking data, and emerging research. BMC Health Services Research, 6, 44.

Singer, S. J., Gaba, D. M., Geppert, J. J., Sinaiko, A. D., Howard, S. K., & Park, K. C. (2003). The culture of safety: Results of an organization-wide survey in 15 California hospitals. Quality & Safety in Health Care, 12(2), 112-118.

Westrum, R. (1993). Cultures with requisite imagination. In J. Wise, V. Hopkin & P. Stager (Eds.), Verification and validation of complex systems: Human Factor Issues (pp. 401-416). New York: Springer-Verlag.

Westrum. (2004). A typology of organisational cultures. Quality and Safety in Health Care, 13 (suppl_2), ii22.


Appendix 1 - 2006 MSI Patient Safety Culture Survey

We have blacked out the question numbers here as the question #s used throughout this report are based on question numbering from the 2005 MSI.


Appendix 2 – Question Responses by Organization

q1 Patient safety decisions are made at the proper level

% within OrgID Org ID OrgID Org ID

1 2 3 4 5 6 Total st. disagree 1.0% 2.6% 3.5% 4.3% 5.6% 3.4% 3.2%disagree 11.7% 12.3% 15.4% 13.9% 19.7% 12.8% 13.9%neutral 17.9% 19.2% 20.9% 13.6% 18.5% 14.7% 18.2%agree 50.2% 42.6% 45.9% 51.4% 43.3% 51.4% 47.3%

q1 Patient safety decisions are made at the proper level

st. agree 19.2% 23.3% 14.3% 16.7% 12.9% 17.7% 17.5%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q2 Good communication flow exists up the chain of command



q2 Good communication flow exists up the chain of command

st. agree 13.9% 19.3% 8.9% 12.7% 8.9% 14.7% 13.0%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q3 Reporting a patient safety problem negative repercussions



q3 Reporting a patient safety problem negative repercussions

st. agree 1.0% 3.4% 2.6% 3.8% 2.1% 4.2% 3.0%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q4 Senior management has a clear picture of the risk



q4 Senior management has a clear picture of the risk

st. agree 9.9% 14.3% 9.3% 12.2% 5.5% 12.0% 11.0%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


q5 My unit takes the time to identify and assess risks



q5 My unit takes the time to identify and assess risks

st. agree 24.6% 27.6% 19.7% 18.8% 20.8% 26.3% 23.0%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q6 My unit does a good job managing risks



q6 My unit does a good job managing risks

st. agree 26.2% 32.3% 22.2% 21.0% 20.3% 27.6% 25.4%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q7 Senior management provides a climate that promotes safety



q7 Senior management provides a climate that promotes safety

st. agree 11.3% 19.5% 11.2% 10.5% 10.3% 16.0% 13.6%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q8 Asking for help is a sign of incompetance



q8 Asking for help is a sign of incompetance

st. agree 1.0% 2.1% 1.8% 3.3% 2.5% 2.5% 2.1%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


q9 If I make a mistake that has significant consequences



q9 If I make a mistake that has significant consequences

st. agree 0.9% 1.4% 0.9% 1.7% 0.4% 1.1% 1.1%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q10 Telling others about my mistakes is embarrassing



q10 Telling others about my mistakes is embarrassing

st. agree 3.2% 3.6% 3.5% 2.8% 1.7% 2.8% 3.2%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q11 I am less effective at work when I am fatigued



q11 I am less effective at work when I am fatigued

st. agree 27.3% 32.3% 31.1% 33.4% 34.6% 29.0% 30.9%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q12 Senior management considers patient safety when program changes



q12 Senior management considers patient safety when program changes

st. agree 5.3% 10.4% 6.3% 9.7% 7.4% 9.9% 8.1%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


q13 Personal problems can adversely affect my performance



q13 Personal problems can adversely affect my performance

st. agree 7.2% 10.9% 10.9% 12.5% 10.8% 12.9% 10.9%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q16 Suffer negative consequences if report a patient safety problem



q16 Suffer negative consequences if report a patient safety problem

st. agree 0.8% 2.1% 1.4% 2.6% 0.4% 2.4% 1.7%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q17 If people find out I made a mistake I will be disciplined



q17 If people find out I made a mistake I will be disciplined

st. agree 0.7% 3.3% 2.1% 3.0% 3.0% 2.2% 2.3%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q18 Rewarded for taking quick action to identify a serious mistake



q18 Rewarded for taking quick action to identify a serious mistake

st. agree 4.9% 5.6% 3.9% 3.6% 3.9% 5.2% 4.5%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


q21 Loss of experienced personnel negatively affected patient care



q21 Loss of experienced personnel negatively affected patient care

st. agree 7.3% 12.3% 15.0% 15.3% 19.1% 12.4% 13.3%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q22 I have enough time to complete patient care tasks safely



q22 I have enough time to complete patient care tasks safely

st. agree 6.2% 8.5% 6.5% 5.9% 7.0% 6.1% 6.7%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q23 Clinicians who make serious mistakes are usually punished



q23 Clinicians who make serious mistakes are usually punished

st. agree 0.6% 2.3% 1.2% 1.3% 3.3% 1.5% 1.5%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q24 Witnessed co-worker do something unsafe for patient to save time



q24 Witnessed co-worker do something unsafe for patient to save time

st. agree 3.0% 6.5% 7.3% 14.3% 9.3% 9.7% 8.0%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


q25 Provided with adequate resources to provide safe patient care



q25 Provided with adequate resources to provide safe patient care

st. agree 7.3% 7.6% 4.2% 5.8% 6.4% 5.4% 5.7%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q26 I have made significant errors in my own work due to fatigue



q26 I have made significant errors in my own work due to fatigue

st. agree 0.5% 1.5% 1.5% 2.0% 1.7% 1.9% 1.5%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q27 Health care errror constitutes significant risk to patients



q27 Health care errror constitutes significant risk to patients

st. agree 23.5% 32.5% 24.3% 21.8% 25.7% 20.6% 25.0%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q28 I believe health care errors often go unreported



q28 I believe health care errors often go unreported

st. agree 14.4% 18.7% 19.1% 15.1% 12.4% 13.3% 16.7%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


q29 My organization balances need for patient safety and productivity



q29 My organization balances need for patient safety and productivity

st. agree 6.0% 11.1% 5.6% 6.7% 6.6% 7.4% 7.2%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q30 I work in an environment where patient safety is a high priority



q30 I work in an environment where patient safety is a high priority

st. agree 27.3% 31.6% 20.6% 20.8% 22.6% 25.0% 24.5%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q31 Most serious occurrences result of multiple small failures



q31 Most serious occurrences result of multiple small failures

st. agree 13.9% 16.6% 14.5% 9.4% 11.1% 9.3% 13.2%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q33 Supervisor says good word when job done according to safety procedures



q33 Supervisor says good word when job done according to safety procedures

st. agree 6.3% 10.6% 7.4% 8.6% 10.2% 10.0% 8.6%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


q34 Supervisor seriously considers staff suggestions for improving safety



q34 Supervisor seriously considers staff suggestions for improving safety

st. agree 11.9% 18.0% 12.6% 12.9% 11.8% 13.5% 13.7%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q35 When pressure builds supervisor wants us to work faster even if shortcuts



q35 When pressure builds supervisor wants us to work faster even if shortcuts

st. agree 2.7% 4.1% 4.4% 7.7% 3.9% 5.1% 4.6%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

q36 Supervisor overlooks patient safety problems that happen over and over



q36 Supervisor overlooks patient safety problems that happen over and over

st. agree 2.0% 3.1% 3.1% 7.5% 2.6% 4.9% 3.8%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

b32 Please give your unit an overall grade on patient safety


1 2 3 4 5 6 Total Excellent 16.2% 16.3% 10.0% 9.8% 10.9% 14.7% 12.8%Very good 52.3% 49.1% 44.9% 43.4% 44.1% 54.2% 48.1%Acceptable 27.6% 30.4% 36.5% 37.9% 34.9% 27.0% 32.6%Poor 3.5% 3.7% 7.4% 7.8% 9.2% 3.5% 5.6%

b32 Please give your unit an overall grade on patient safety

Failing 0.4% 0.6% 1.1% 1.1% 0.8% 0.6% 0.8%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


b33 Please give the organization an overall grade on patient safety


1 2 3 4 5 6 Total Excellent 9.7% 10.0% 3.8% 6.2% 7.1% 9.1% 7.1%Very good 50.1% 42.7% 29.2% 39.8% 30.5% 46.0% 38.7%Acceptable 35.7% 41.0% 51.3% 38.9% 43.5% 36.6% 43.0%Poor 3.6% 5.6% 13.1% 12.6% 14.6% 6.7% 9.3%

b33 Please give the organization an overall grade on patient safety

Failing 0.9% 0.8% 2.6% 2.5% 4.2% 1.6% 1.9%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

c34 Individuals involved in major events have a quick way to report



c34 Individuals involved in major events have a quick way to report

st. agree 10.8% 16.8% 10.2% 9.1% 8.0% 10.8% 11.5%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

c35 Individuals involved in major events contribute to understanding



c35 Individuals involved in major events contribute to understanding

st. agree 12.2% 14.5% 8.1% 7.5% 6.0% 9.2% 9.9%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

c36 A formal process for disclosure of major events is followed



c36 A formal process for disclosure of major events is followed

st. agree 6.1% 9.2% 5.2% 7.3% 3.8% 7.9% 6.8%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


c37 Discussion of major events focusses on system related issues


1 2 3 4 5 6 Total st. disagree 1.4% 2.3% 2.0% 3.8% 2.7% 2.2%disagree 7.9% 12.0% 14.9% 16.7% 17.9% 16.1% 14.0%neutral 37.2% 36.6% 36.4% 36.4% 41.3% 36.3% 36.7%agree 45.7% 39.9% 41.9% 38.9% 36.2% 39.5% 41.0%

c37 Discussion of major events focusses on system related issues

st. agree 7.6% 9.1% 4.9% 4.3% 4.6% 5.4% 6.1%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

c38 Patient and family directly involved in the processof understanding



c38 Patient and family directly involved in the processof understanding

st. agree 3.7% 8.7% 3.5% 7.2% 6.2% 7.3% 5.7%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

c39 Things learned from major events are communicated to staff



c39 Things learned from major events are communicated to staff

st. agree 7.1% 14.2% 7.3% 9.1% 8.0% 8.0% 9.0%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

c40 There is a pharmacist who is a full member of the patient care team



c40 There is a pharmacist who is a full member of the patient care team

st. agree 17.6% 32.9% 11.4% 4.2% 15.6% 6.6% 14.9%Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Perceptions of Patient Safety Culture in Six Canadian Healthcare ...

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