Hospital Survey on Patient Safety Culture

INSTRUCTIONS
This survey asks for your opinions about patient safety issues, medical error, and event reporting in
your hos pital and will take about 10 to 15 minutes to complete.
If you do not wish to answer a question, or if a question does not apply to you, you ma y leave your answe r blank.
An “eventis defined as any type of error, mistake, incident, accident, or
deviation, regardless of whether or not it results in patient harm.
Patient safetyis defined as the avoidance and prevention of patient injuries
or adverse events resulting from the processes of health care delivery.
SECTION A: Your Work Area/Unit
In this survey, think of your “unit as the work area, department, or clinical area of the hospital where
you s pend most of your work time or provide mos t of your clinical services
.
What is your primary work area or unit in this hospital? Mar k ONE answer by filling in the circle.
a. Man y different hospital units/No specific unit
b. Med icine (nonsurgical)
g. Intensive care unit (any type)
l. Radiology
c. Surgery
h. Psychiatry/mental health
m. Anesthesiology
d. Obstetri cs
i. Rehabilitation
n. Other, pl ease speci fy:
e. Pediatrics
j. Pharmacy
f. Emergency department
k. Laboratory
Please indicate your agreement or disagreement with the following statements about your work
area/unit. Mark your answer by filling in the circle.
Strong ly
Strong ly
Think about your hospital work area/unit…
Disagre e
Disagre e
Neither
Agree
Agree
1. People support one another in this unit .......................................
2. We have enough staff to handle the workload.............................
3. When a lot of work needs to be done quickly, we work together
as a team to get the work done...................................................
4. In this uni t, people treat each other with respect..........................
5. Staff in this unit work longer hours than is best for patient care....
6. We are actively doing things to improve patient safety ................
7. We use more agency/temporary staff than is best for
patient care ................................................................................
8. Staff feel like the ir mistakes are held against them ......................
9. Mistakes have led to positive changes here ................................
10. It is just by chance that more serious mistakes don’t happen
around here................................................................................
11. When one area in this unit gets really busy, others help out ........
12. When an event is reported, it feels like the person is being
written up, not the problem..........................................................
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