Archive December 2018 XIX, No. 12

Safety: Need Help Establishing a Culture of Safety?

This survey self-assessment tool will identify areas of needed improvement.

Kecia Norling

Kecia Norling, RN, MBA, CNOR, CASC


Shirin Towfigh, MD
GROUP PARTICIPATION Staff surveys provide invaluable insights into ways you can protect patients from harm.

Creating a culture of safety demands more than performing time outs and signing surgical sites. It requires raising staff awareness about protecting patients, identifying strengths and areas of needed culture improvement, and measuring how new initiatives improve patient safety. The Agency for Healthcare Research and Quality has done the heavy lifting for you by creating the Ambulatory Surgery Center Survey on Patient Safety Culture (see “Take the ASC Survey on Patient Safety Culture”).

The 30-question survey asks staff to check 1 of 5 boxes — which gauge their feedback from “never” to “always” — next to a variety of safety-related questions, such as how comfortable they feel speaking up when patients are in jeopardy and how well surgeons communicate with other team members in the OR to how near-misses and mistakes are handled to the level of support management puts behind safety initiatives. I’ve asked my staff and surgeons to complete the survey annually for the past 4 years. The survey ( has proved to be an invaluable tool because we dive into the results instead of simply reading over the responses.

1 Assign and discuss

Creating and maintaining a culture of safety requires setting aside time to communicate with your staff and surgeons about what a safe culture is and what it looks like in practice. Permitting staff and surgeons to complete the survey during work time emphasizes that you support its use and value their feedback. Administer the survey to specific departments — pre-op, the OR, post-op — and present staff with the results in department-specific three-ring binders. Have each staff member initial the binders to ensure they have read through the findings. After everyone has read through the binders, schedule a staff meeting to discuss the survey results. Review the responses to the survey’s open-ended questions and allow staff to clarify their remarks, add perspective or expound on their insights. Reassure staff that all comments made in the survey are confidential, even to leadership. These comments are taken very seriously, and we encourage staff to provide additional feedback during the meeting. You’ll learn a lot about how staff view your facility’s safety culture during those conversations.

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