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Surveys
2013
August
H
Hospital Survey on Patient Safety
Hospital Survey on Patient Safety
0%
Questions marked with an
*
are required
Exit Survey
*
What is your PRIMARY work area or unit in this hospital? Select ONE answer.
a. Administration (Non clinical care-Example: Exec Offices, HR, Patient Access, Quality, Med Staff, Marketing, IT, HIM, CM, etc... )
b. Cardiac Services
c. CCU / ICU
d. Emergency Department
e. Facilities / Plant Operations
f. Food and Nutrition Services
g. Housekeeping
h. Laboratory
i. Marketing
j. Medical Acute
k. Medical Surgical / Telemetry
l. Pharmacy
m.Purchasing (Materials Mgmt, Central Supply)
n. Radiology Services
o. Respiratory Therapy
p. Security Services (Security, Operators, Dispatch)
q. Surgery Services (Pre-Op, Peri-Op, PACU, Sterile Supply)
r. Women’s Services (PP, L&D, Nursery)
s. Anonymous
t. Chaplain Services
u. Volunteer Services
TEAMWORK
SECTION A: Your work area / unit.
How satisfied are you with the following:
Strongly disagree
Disagree
Neither
Agree
Strongly Agree
*
People support one another in this unit
*
We have enough stuff 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.
PATIENT SAFETY
SECTION A: Your work area / unit.
How satisfied are you with the following
Strongly disagree
Disagree
Neither
Agree
Strongly Agree
*
We are actively doing things to improve patient safety.
*
Mistakes have led to positive changes here.
*
Patient safety is never sacrificed to get more work done.
*
After we make changes to improve patient safety, we evaluate the effectiveness.
*
Our procedures and systems are good at preventing errors from happening.
*
Staff feel like their mistakes are held against them.
*
When an event is reported, it feels like the person is being written up, not the problem.
LEADERSHIP
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
*
My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures.
*
My supervisor/manager seriously considers staff suggestions for improving patient safety.
*
Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts.
*
My supervisor/manager overlooks patient safety problems that happen over and over.
COMMUNICATION
SECTION C: Communication
How often do the following things happen in your work area / unit?
Never
Rarely
Sometimes
Most of the time
Always
*
We are given feedback about changes put into place based on event reports.
*
Staff will freely speak up if they see something that may negatively affect patient care.
*
In this unit, we discuss ways to prevent errors from happening again.
*
We are informed about errors that happen in this unit.
*
Staff feel free to question the decisions or actions of those with more authority.
*
Staff are afraid to ask questions when something does not seem right.
EVENTS REPORTED
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
*
When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported?
*
When a mistake is made, but has no potential to harm the patient, how often is this reported?
*
When a mistake is made that could harm the patient, but does not, how often is this reported?
*
In the past 12 months, how many event reports have you filled out and submitted?
*
SECTION E: PATIENT SAFETY RATING
WORK AREA/UNIT
Please give your work area / unit in this hospital an overall grade on patient safety.
A. Excellent
B. Very Good
C. Acceptable
D. Poor
E. Failing
SECTION E: PATIENT SAFETY RATING
HOSPITAL
Strongly disagree
Disagree
Neither
Agree
Strongly Agree
*
Hospital management provides a work climate that promotes patient safety.
*
Hospital units do not coordinate well with each other.
*
Things “fall between the cracks” when transferring patients from one unit to another.
*
There is good cooperation among hospital units that need to work together
BACKGROUND
SECTION F: Your Background
This information will help in the analysis of the survey results.
a. RN
b. LVN/LPN
c. CNA
d. Pharmacist
e. Dietician
f. Unit Assistant/Clerk/Secretary
g. Respiratory Therapist
h. Physical, Occupational, or Speech Therapist
i. Technician (e.g., EKG, Lab, Radiology)
j. Administration/Management
k. Security
l. Other, please specify:
BACKGROUND
SECTION F: Your Background
This information will help in the analysis of the survey results.
How long have you worked in this hospital?
a. Less than 1 year
b. 1 to 2 years
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