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Hospital Survey on Patient Safety
Instructions

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.

 
 
 
What is your primary Area/Unit of work?
 
Many/No specific
 
Medicine(non-surgical)
 
Surgery
 
Emergency department
 
Intensive care unit (any type)
 
Pharmacy
 
Laboratory
 
Radiology
 
Anesthesiology
 
Inpatient
 
Imaging
 
 
 
People support one another in this unit
 
Strongly Agree
 
Agree
 
Neither
 
Disagree
 
Strongly Disagree
 
 
 
We have enough staff to handle the workload
 
Strongly Agree
 
Agree
 
Neither
 
Disagree
 
Strongly Disagree
 
 
 
When a lot of work needs to be done quickly, we work together as a team to get the work done
 
Strongly Agree
 
Agree
 
Neither
 
Disagree
 
Strongly Disagree
 
 
 
In this unit, people treat each other with respect
 
Strongly Agree
 
Agree
 
Neither
 
Disagree
 
Strongly Disagree
 
 
 
Staff in this unit work longer hours than is best for patient care
 
Strongly Agree
 
Agree
 
Neither
 
Disagree
 
Strongly Disagree
 
 
 
We are actively doing things to improve patient safety
 
Strongly Agree
 
Agree
 
Neither
 
Disagree
 
Strongly Disagree
 
 
 
We use more agency/temporary staff than is best for patient care
 
Strongly Agree
 
Agree
 
Neither
 
Disagree
 
Strongly Disagree
 
 
 
Staff feel like their mistakes are held against them
 
Strongly Agree
 
Agree
 
Neither
 
Disagree
 
Strongly Disagree