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This survey asks for your opinions about patient safety issues, medical error, and event reporting in your hospital 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 may leave your answer blank.
- An "event" is defined as any type of error, mistake, incident, accident, or deviation, regardless of whether or not it results in patient harm.
- "Patient Safety" is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of health care delivery.
Please do NOT use the 'Back' or 'Refresh' buttons in your browser while taking the survey. This might create errors during filling up or submitting the 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.
Physicians - Please use your best judgment to select the unit where you provide the most service. |
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What is your primary work unit? |
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Please indicate your agreement or disagreement with the following statements about your work area/unit.
Think about your hospital work area/unit...
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Section B: Your Supervisor/Manager |
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Please indicate your agreement or disagreement with the following statements about your immediate supervisor/manager or person to whom you directly report.
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Section C: Communications |
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How often do the following things happen in your work area/unit?
Think about your hospital work area/unit...
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Section D: Frequency of Events Reported |
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In your hospital work area/unit, when the following mistakes happen, how often are they reported?
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Section E: Patient Safety Grade |
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Please give your work area/unit in this hospital an overall grade on patient safety. |
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Please indicate your agreement or disagreement with the following statements about your hospital.
Think about your hospital...
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Section G: Number of Events Reported |
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In the past 12 months, how many event reports have you filled out and submitted? |
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Section H: Background Information
This information will help in the analysis of the survey results. |
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How long have you worked in this hospital? |
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How long have you worked in your current hospital work area/unit? |
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Typically, how many hours per week do you work in the hospital? |
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What is your staff position in this hospital? |
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What is your primary work area or unit in this hospital? Select one answer. |
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In your staff position, do you typically have direct interaction or contact with patients? |
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How long have your worked in your current specialty or profession? |
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| Section I: Your Comments
Please feel free to write any comments about patient safety, error, or event reporting in your hospital. | | |
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