Hospital Survey on Patient Safety (Version 2.0)

This survey asks for your opinions about patient safety issues, medical error, and event reporting in your hospital and will take about 10-15 minutes to complete. If a question does not apply to you or your hospital or you don’t know the answer, please select “Does Not Apply or Don’t Know.”

• “Patient safety” is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of healthcare delivery.
• A “patient safety event” is defined as any type of healthcare-related error, mistake, or incident, regardless of whether or not it results in patient harm.

This survey is multiple pages, please click continue at the bottom of the page to progress through the survey. The last page will have a submit button.

1Section A > 2Sections B & C > 3Sections D, E, & F > 4Background Questions
Please select your direct leader (manager/director).

This information will remain anonymous within the Organizational Development Department. However, common trends in the responses collected will be shared with the appropriate leadership team. *
Please, specify other *
1. What is your position in this hospital?

Select ONE answer. *
Other, please specify: *
2. Think of your “unit” as the work area, department, or clinical area of the hospital where you spend most of your work time. What is your primary unit or work area in this hospital?

Select ONE answer. *
Other, please specify: *

Section A: Your Unit/Work Area

How much do you agree or disagree with the following statements about your unit/work area?
	Strongly Disagree (1)	Disagree (2)	Neither Agree nor Disagree (3)	Agree (4)	Strongly Agree (5)	Does Not Apply or Don't Know (9)
1. In this unit, we work together as an effective team	1. In this unit, we work together as an effective teamStrongly Disagree (1)	1. In this unit, we work together as an effective teamDisagree (2)	1. In this unit, we work together as an effective teamNeither Agree nor Disagree (3)	1. In this unit, we work together as an effective teamAgree (4)	1. In this unit, we work together as an effective teamStrongly Agree (5)	1. In this unit, we work together as an effective teamDoes Not Apply or Don't Know (9)
2. In this unit, we have enough staff to handle the workload	2. In this unit, we have enough staff to handle the workloadStrongly Disagree (1)	2. In this unit, we have enough staff to handle the workloadDisagree (2)	2. In this unit, we have enough staff to handle the workloadNeither Agree nor Disagree (3)	2. In this unit, we have enough staff to handle the workloadAgree (4)	2. In this unit, we have enough staff to handle the workloadStrongly Agree (5)	2. In this unit, we have enough staff to handle the workloadDoes Not Apply or Don't Know (9)
3. Staff in this unit work longer hours than is best for patient care	3. Staff in this unit work longer hours than is best for patient careStrongly Disagree (1)	3. Staff in this unit work longer hours than is best for patient careDisagree (2)	3. Staff in this unit work longer hours than is best for patient careNeither Agree nor Disagree (3)	3. Staff in this unit work longer hours than is best for patient careAgree (4)	3. Staff in this unit work longer hours than is best for patient careStrongly Agree (5)	3. Staff in this unit work longer hours than is best for patient careDoes Not Apply or Don't Know (9)
4. This unit regularly reviews work processes to determine if changes are needed to improve patient safety	4. This unit regularly reviews work processes to determine if changes are needed to improve patient safetyStrongly Disagree (1)	4. This unit regularly reviews work processes to determine if changes are needed to improve patient safetyDisagree (2)	4. This unit regularly reviews work processes to determine if changes are needed to improve patient safetyNeither Agree nor Disagree (3)	4. This unit regularly reviews work processes to determine if changes are needed to improve patient safetyAgree (4)	4. This unit regularly reviews work processes to determine if changes are needed to improve patient safetyStrongly Agree (5)	4. This unit regularly reviews work processes to determine if changes are needed to improve patient safetyDoes Not Apply or Don't Know (9)
5. This unit relies too much on temporary, float, or PRN staff	5. This unit relies too much on temporary, float, or PRN staffStrongly Disagree (1)	5. This unit relies too much on temporary, float, or PRN staffDisagree (2)	5. This unit relies too much on temporary, float, or PRN staffNeither Agree nor Disagree (3)	5. This unit relies too much on temporary, float, or PRN staffAgree (4)	5. This unit relies too much on temporary, float, or PRN staffStrongly Agree (5)	5. This unit relies too much on temporary, float, or PRN staffDoes Not Apply or Don't Know (9)
6. In this unit, staff feel like their mistakes are held against them	6. In this unit, staff feel like their mistakes are held against themStrongly Disagree (1)	6. In this unit, staff feel like their mistakes are held against themDisagree (2)	6. In this unit, staff feel like their mistakes are held against themNeither Agree nor Disagree (3)	6. In this unit, staff feel like their mistakes are held against themAgree (4)	6. In this unit, staff feel like their mistakes are held against themStrongly Agree (5)	6. In this unit, staff feel like their mistakes are held against themDoes Not Apply or Don't Know (9)
7. When an event is reported in this unit, it feels like the person is being written up, not the problem	7. When an event is reported in this unit, it feels like the person is being written up, not the problemStrongly Disagree (1)	7. When an event is reported in this unit, it feels like the person is being written up, not the problemDisagree (2)	7. When an event is reported in this unit, it feels like the person is being written up, not the problemNeither Agree nor Disagree (3)	7. When an event is reported in this unit, it feels like the person is being written up, not the problemAgree (4)	7. When an event is reported in this unit, it feels like the person is being written up, not the problemStrongly Agree (5)	7. When an event is reported in this unit, it feels like the person is being written up, not the problemDoes Not Apply or Don't Know (9)
8. During busy times, staff in this unit help each other	8. During busy times, staff in this unit help each otherStrongly Disagree (1)	8. During busy times, staff in this unit help each otherDisagree (2)	8. During busy times, staff in this unit help each otherNeither Agree nor Disagree (3)	8. During busy times, staff in this unit help each otherAgree (4)	8. During busy times, staff in this unit help each otherStrongly Agree (5)	8. During busy times, staff in this unit help each otherDoes Not Apply or Don't Know (9)
9. There is a problem with disrespectful behavior by those working in this unit	9. There is a problem with disrespectful behavior by those working in this unitStrongly Disagree (1)	9. There is a problem with disrespectful behavior by those working in this unitDisagree (2)	9. There is a problem with disrespectful behavior by those working in this unitNeither Agree nor Disagree (3)	9. There is a problem with disrespectful behavior by those working in this unitAgree (4)	9. There is a problem with disrespectful behavior by those working in this unitStrongly Agree (5)	9. There is a problem with disrespectful behavior by those working in this unitDoes Not Apply or Don't Know (9)
10. When staff make errors, this unit focuses on learning rather than blaming individuals	10. When staff make errors, this unit focuses on learning rather than blaming individualsStrongly Disagree (1)	10. When staff make errors, this unit focuses on learning rather than blaming individualsDisagree (2)	10. When staff make errors, this unit focuses on learning rather than blaming individualsNeither Agree nor Disagree (3)	10. When staff make errors, this unit focuses on learning rather than blaming individualsAgree (4)	10. When staff make errors, this unit focuses on learning rather than blaming individualsStrongly Agree (5)	10. When staff make errors, this unit focuses on learning rather than blaming individualsDoes Not Apply or Don't Know (9)
11. The work pace in this unit is so rushed that it negatively affects patient safety	11. The work pace in this unit is so rushed that it negatively affects patient safetyStrongly Disagree (1)	11. The work pace in this unit is so rushed that it negatively affects patient safetyDisagree (2)	11. The work pace in this unit is so rushed that it negatively affects patient safetyNeither Agree nor Disagree (3)	11. The work pace in this unit is so rushed that it negatively affects patient safetyAgree (4)	11. The work pace in this unit is so rushed that it negatively affects patient safetyStrongly Agree (5)	11. The work pace in this unit is so rushed that it negatively affects patient safetyDoes Not Apply or Don't Know (9)
12. In this unit, changes to improve patient safety are evaluated to see how well they worked	12. In this unit, changes to improve patient safety are evaluated to see how well they workedStrongly Disagree (1)	12. In this unit, changes to improve patient safety are evaluated to see how well they workedDisagree (2)	12. In this unit, changes to improve patient safety are evaluated to see how well they workedNeither Agree nor Disagree (3)	12. In this unit, changes to improve patient safety are evaluated to see how well they workedAgree (4)	12. In this unit, changes to improve patient safety are evaluated to see how well they workedStrongly Agree (5)	12. In this unit, changes to improve patient safety are evaluated to see how well they workedDoes Not Apply or Don't Know (9)
13. In this unit, there is a lack of support for staff involved in patient safety errors	13. In this unit, there is a lack of support for staff involved in patient safety errorsStrongly Disagree (1)	13. In this unit, there is a lack of support for staff involved in patient safety errorsDisagree (2)	13. In this unit, there is a lack of support for staff involved in patient safety errorsNeither Agree nor Disagree (3)	13. In this unit, there is a lack of support for staff involved in patient safety errorsAgree (4)	13. In this unit, there is a lack of support for staff involved in patient safety errorsStrongly Agree (5)	13. In this unit, there is a lack of support for staff involved in patient safety errorsDoes Not Apply or Don't Know (9)
14. This unit lets the same patient safety problems keep happening	14. This unit lets the same patient safety problems keep happeningStrongly Disagree (1)	14. This unit lets the same patient safety problems keep happeningDisagree (2)	14. This unit lets the same patient safety problems keep happeningNeither Agree nor Disagree (3)	14. This unit lets the same patient safety problems keep happeningAgree (4)	14. This unit lets the same patient safety problems keep happeningStrongly Agree (5)	14. This unit lets the same patient safety problems keep happeningDoes Not Apply or Don't Know (9)