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  1. Surveys
  2. 2016
  3. January
  4. C
  5. Culture of Safety Survey
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Exit Survey
 
 
Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
This survey asks for your opinions about patient safety issues, medical error, and event reporting in your facility and will take about 10 to 15 minutes to complete.

If you do not with 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.
 
 
 
In this survey, think of your work area as the unit, department, or clinical area of your facility where you spend most of your work time or provide most of your clinical services.
 
 
 
What is your primary work area or unit in your facility? Select ONE answer.
 
Many different units/No specific unit
 
Medicine (non-surgical)
 
Surgery
 
Obstetrics
 
Pediatrics
 
Emergency department
 
Intensive care unit (any type)
 
Psychiatry/mental health
 
Rehabilitation
 
Pharmacy
 
Laboratory
 
Radiology
 
Anesthesiology
 
Other, please specify:
 
 
Please indicate your agreement or disagreement with the following statements about your work area/unit.

Think about your work area/unit...
Strongly Disagree Disagree Neither Agree Strongly Agree
People support one another in this unit.
We have enough staff to handle the workload.
When a lot of work needs to be done quickly, we work together as a team to get the work done.
In this unit, people treat each other with respect.
Staff in this unit work longer hours than is best for patient care.
 
 
Think about your work area/unit...
Strongly Disagree Disagree Neither Agree Strongly Agree
We are actively doing things to improve patient safety.
We use more agency/temporary staff than is best for patient care.
Staff feel like their mistakes are held against them.
Mistakes have led to positive changes here.
It is just by chance that more serious mistakes don't happen around here.
 
 
Think about your work area/unit...
Strongly Disagree Disagree Neither Agree Strongly Agree
When on area in this unit gets really busy, others help out.
When an event is reported, it feels like the person is being written up, not the problem.
After we make changes to improve patient safety, we evaluate their effectiveness.
We work in "crisis mode" trying to do too much, too quickly.
Patient safety is never sacrificed to get more work done.
 
 
Think about your work area/unit...
Strongly Disagree Disagree Neither Agree Strongly Agree
Staff worry that mistakes they make are kept in their personnel file.
We have patient safety problems in this unit.
Our procedures and systems are good at preventing errors from happening.