The Survey on Patient Safety CultureTM (SOPS®), developed by the Agency for Healthcare Research & Quality, helps hospitals, medical offices, and other healthcare organizations understand how providers and staff perceive aspects of their culture of safety.
Organizations use the SOPS Assessment tool to:
Raise staff awareness about patient safety.
Assess the current status of patient safety culture.
Identify strengths and areas for patient safety culture improvement.
Examine trends in patient safety culture change over time.
Evaluate the cultural impact of patient safety initiatives and interventions.
All your efforts to create a High Reliability Organization are for naught if patient safety is not embraced at every level, from system to individual. And the only way to quantify your patient safety culture, and to identify problem areas, is by asking.
One of the most vetted measurement tools for this is the Survey on Patient Safety CultureTM (SOPS®) developed by the Agency for Healthcare Research and Quality (AHRQ).
While the AHRQ survey tool has been available since 2004, in recent years it’s gained more attention with the focus from accreditation organizations like The Joint Commission (TJC) and public-scoring watchdogs like Leapfrog.
An organization will be expected to include its most recent Safety Culture Survey with the required documents listed in the Survey Activity Guide. The surveyors will want to review this prior to the opening conference (or as early in the survey process as possible).
Surveyors will be tracing safety culture as a part of other survey activities and asking questions to assess safety culture. See Table 2 for sample questions for assessing a safety culture.
“Hospitals can earn up to 120 points for measuring culture of safety, providing feedback to staff, and creating new plans to prevent errors.”
But AHRQ’s survey is not a one-size-fits-all process. The flexibility — how often to survey, who to survey, how to survey, and what to do with the results — recognizes the enormous variations in size and resources of patient-care organizations. But it also means a large number of decisions have to be made in-house.
Here are 6 best practices for your next SOPS to both fulfill accreditor and watchdog expectations and, more importantly, to make the process pay off in the form of an improved safety culture for your organization:
Best Practice #1: Give Due-Diligence Consideration to the Benefits of Outsourcing Survey Administration and Analysis
Many organizations have continued to feel the strain of the healthcare staffing crisis since the pandemic. So even if you have handled the survey process in-house in the past, your capacity to do so now may have changed. And if you haven’t administered a SOPS in recent years, you might be hesitant to add it to your plate given that AHRQ’sUser Guide for Hospital SOPS Version 2.0outlines a 10-week timeline for planning, creating, conducting, and analyzing the survey.
Some advantages to outsourcing are obvious: The process doesn’t interrupt your normal duties and projects, and you don’t have to reinvent the tools or train someone in-house for a process that only happens every other year.
Some are less obvious: The right outsourcing partner can help you (1) achieve much higher response rates that enrich the results, and (2) receive a more sophisticated and enlightening analytics report faster than you might otherwise. (Our team turns the report around in less than 30 days.)
AHRQ points out several benefits of using an outsourcing partner in the User Guide:
Working with an outside vendor may help ensure the neutrality and credibility of your results.
Staff may feel their responses will be more confidential when their surveys are returned to an outside vendor.
Vendors typically have experienced staff to perform all necessary activities and tasks. A professional and experienced vendor may be able to provide your hospital with better quality results faster than if you were to do the tasks yourself.
When considering these benefits and the fact that outsourcing is very affordable, it’s often worth a brief conversation before you go too far down the road of investing a lot of internal time and resources in administering the SOPS yourself.
Online surveying has virtually replaced paper surveys for many good reasons: online surveys prevent participants from giving two answers to the same question; they can capture responses if the survey-taker fails to finish all questions; and, most appealing, online survey responses are automatically compiled, resulting in actionable results within days rather than months.
Design elements that really matter include a proper grid layout, alternating row shading to help respondents move smoothly through the answer options, easy buttons for moving back and forth through the questions, and a progress bar to encourage the user to complete the survey. Also crucial is developing a survey that is easy to complete on a mobile device, not just a desktop computer.
Best Practice #3: Monitor the response rate
The ability to monitor responses in real-time is one of the great advantages of online surveying compared with paper surveys, but that advantage is wasted if no one is paying attention until the end of the survey period. A good outsourcing partner will monitor and update you frequently – ADN, for instance, provides response rates at least twice a week at the overall facility and individual department levels – so that targeted promotional efforts can be implemented in a timely manner via huddles or other staff meetings. Your response rate should not be a surprise ending.
Best Practice #4: Promote, promote, promote
Even a well-designed survey will have a low response rate without consistent, multi-channel efforts to promote, encourage, incentivize and remind employees and other desired respondents to start and finish the survey. That means emails, preferably from the CEO; posters in common areas, verbal reminders at routine staff huddles; links on your intranet; etc.
If partnering with ADN, we have a sequence of pre-written email templates with recommended distribution dates/times that have been proven effective.
Best Practice #5: Incentivize participation
Rewards for departments with the highest response rates are more effective than random individual winners. And the reward should reflect the value your organization places on patient safety: an extra day of vacation, a catered meal, or maybe both. Through experience, our team has learned some creative and motivating incentives that we share with clients.
Best Practice #6: Compile high-quality analysis for sharing with key stakeholders
With so much data from a facility-wide survey, the quality of your analytics report can mean the difference between a sea of raw data or a trove of distilled insight. Below are some best practices ADN recommends.
Compare to external benchmarks to identify strengths and opportunities. While understanding what’s going on at your facility is vital, make sure you gauge how your performance stacks up to other facilities. When outsourcing with ADN, the comprehensive report you receive includes comparisons to the most recently available AHRQ SOPS databases, as well as an executive overview and detailed breakdowns of the survey data to assist in communicating the results to all internal stakeholders
Look for differences from baseline and comparators at the department, position title, and work area levels to help further define priorities. Identifying opportunities for improvement is certainly a goal here, but don’t forget to identify top performers as well. Drilling down into the subculture of top-performers can provide a wealth of learning.
Don’t ignore unstructured data. A lot of intelligence can be buried in unstructured data like narrative answers. Deep-diving “other” responses and coding open-ended replies by themes are great ways to ensure you squeeze every last drop of insight out of your survey data.
Disseminate survey results at all levels to promote organizational learning and transparency. While the primary audience intended to act on the survey results may be senior leadership, disseminating some findings, strengths, and opportunities throughout other levels of the organization can be very beneficial. It can broaden buy-in, demonstrate everyone has a role to play in the improvement, promote transparency, show that data is being analyzed to be acted on (not just collected), and much more.
Facilitate multi-disciplinary feedback sessions to inform action planning. The frontline staff have an undeniable role in event detection and reporting but can have an even greater impact when their intimate knowledge of internal systems is leveraged in the PDSA cycle. Frontline can serve as subject matter experts to help identify and define cause-and-effect relationships. When analyzing survey results by work areas or position titles or themes, a cross-discipline team will be able to contribute unique perspectives that uncover or explain trends seen within the survey data. By including representation from all involved disciplines and levels, the team will likely be able to add more context and better match problems with actions and interventions.
Analyze survey findings in conjunction with other available safety data, such as internal event reports, public safety scores, and more. Some of the SOPS survey questions provide insights into the effectiveness of your existing interventions, such as safety education, event reporting systems, and communication among teams. Evaluating these relationships can inform improvement efforts and resource allocation for addressing aspects that directly affect staff perceptions of safety culture and indirectly benefit other safety-related processes (e.g., enhanced safety orientations and ongoing education, better communication about medications and discharges, etc.).
For more than 25 years, American Data Network (ADN), which is also the parent company to its Patient Safety Organization (ADNPSO), has worked with large data sets from various sources, aggregating and mining data to identify patterns, trends, and priorities within the clinical, financial, quality and patient safety arenas. ADN developed the Quality Assurance Communication (QAC) application, with which hospitals, clinics, rehabs, and other providers record and manage patient safety events. By entering events into ADN’s QAC application and submitting them to ADNPSO, information is federally protected and thereby privileged and confidential. These protections provide a safe harbor to learn from mistakes and improve patient safety.