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  1. Surveys
  2. 2011
  3. February
  4. H
  5. Hospital Survey on Patient Safety
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Exit Survey »
 
 
* SECTION A: Your Work Area/Unit


In this survey, think of your “unit” as the work area, department, or clinical area of the hospital where you spend most of your work time or provide most of your clinical services.
What is your primary work area or unit in this hospital? Select ONE answer.
 
a. Many different hospital units/No specific unit
 
b. Medicine (non-surgical)
 
c. Surgery
 
d. Obstetrics
 
e. Pediatrics
 
f. Emergency department
 
g. Intensive care unit (any type)
 
h. Psychiatry/mental health
 
i. Rehabilitation
 
j. Pharmacy
 
k. Laboratory
 
l. Radiology
 
m. Anesthesiology
 
Other:
 

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


Think about your hospital work area/unit…


Strongly Disagree Disagree Neither Agree Strongly 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 unit, 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 their 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
Strongly Disagree Disagree Neither Agree Strongly Agree
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
13. After we make changes to improve patient safety, we evaluate their effectiveness
14. We work in "crisis mode" trying to do too much, too quickly
15. Patient safety is never sacrificed to get more work done
16. Staff worry that mistakes they make are kept in their personnel file
17. We have patient safety problems in this unit
18. Our procedures and systems are good at preventing errors from happening
 
 
SECTION B: Your Supervisor/Manager


Please indicate your agreement or disagreement with the following statements about your immediate supervisor/manager or person to whom you directly report.
Strongly Disagree Disagree Neither Agree Strongly Agree
1.My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures
2.My supervisor/manager seriously considers staff suggestions for improving patient safety
3.Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts
4.My supervisor/manager overlooks patient safety problems that happen over and over
 
 
SECTION C: Communications


How often do the following things happen in your work area/unit?
Think about your hospital work area/unit…
Never Rarely Sometimes Most of the time Always
1.We are given feedback about changes put into place based on event reports
2.Staff will freely speak up if they see something that may negatively affect patient care
3.We are informed about errors that happen in this unit
4.Staff feel free to question the decisions or actions of those with more authority
5.In this unit, we discuss ways to prevent errors from happening again
6.Staff are afraid to ask questions when something does not seem right
 
 
SECTION D: Frequency of Events Reported


In your hospital work area/unit, when the following mistakes happen, how often are they reported?
Never Rarely Sometimes Most of the time Always
1.When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported?
2.When a mistake is made, but has no potential to harm the patient, how often is this reported?
3.When a mistake is made that could harm the patient, but does not, how often is this reported?
 
 
SECTION E: Patient Safety Grade
Excellent Very Good Acceptable Poor Failing
Please give your work area/unit in this hospital an overall grade on patient safety.
 
 
SECTION F: Your Hospital


Please indicate your agreement or disagreement with the following statements about your hospital.
Think about your hospital…
Strongly Disagree Disagree Neither Agree Strongly Agree
1. Hospital management provides a work climate that promotes patient safety
2. Hospital units do not coordinate well with each other
3. Things “fall between the cracks” when transferring patients from one unit to another
4. There is good cooperation among hospital units that need to work together
5. Important patient care information is often lost during shift changes
6. It is often unpleasant to work with staff from other hospital units
7. Problems often occur in the exchange of information across hospital units
8. The actions of hospital management show that patient safety is a top priority
9. Hospital management seems interested in patient safety only after an adverse event happens
10. Hospital units work well together to provide the best care for patients
11. Shift changes are problematic for patients in this hospital
 
 
 
SECTION G: Number of Events Reported


In the past 12 months, how many event reports have you filled out and submitted?
 
No event reports
 
1 to 2 event reports
 
3 to 5 event reports
 
6 to 10 event reports
 
11 to 20 event reports
 
21 event reports or more
 
 
 
SECTION H: Background Information


This information will help in the analysis of the survey results.


1. How long have you worked in this hospital?
 
Less than 1 year
 
1 to 5 years
 
6 to 10 years
 
11 to 15 years
 
16 to 20 years
 
21 years or more
 
 
 
2. How long have you worked in your current hospital work area/unit?
 
Less than 1 year
 
1 to 5 years
 
6 to 10 years
 
11 to 15 years
 
16 to 20 years
 
21 years or more
 
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