Advancing the Measurement of Patient Safety Culture: Development and Psychometrics of the AHRQ SOPS Hospital Survey Version 2.0

Advancing the Measurement of Patient Safety Culture: Development and Psychometrics of the AHRQ SOPS Hospital Survey Version 2.0 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Advancing the Measurement of Patient Safety Culture: Development and Psychometrics of the AHRQ SOPS Hospital Survey Version 2.0 Joann Sorra, Katarzyna Zebrak, Naomi Yount, Theresa Famolaro This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7829818/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 18 You are reading this latest preprint version Abstract Background: Establishing a culture of patient safety is essential to delivering safe and high quality care within healthcare organizations. Understanding the importance of measuring patient safety culture using a standardized tool, the Agency for Healthcare Research and Quality (AHRQ) released the Surveys on Patient Safety Culture ® (SOPS ® ) Hospital Survey (HSOPS 1.0) in 2004. Based on input from various sources, the goals of this study were to develop and pilot test a shorter, updated version of the survey, the SOPS Hospital Survey 2.0 (HSOPS 2.0), and assess the new survey’s psychometric properties. Methods: Survey development included survey user feedback, a literature review, 56 cognitive interviews, and two multi-site pilot studies using web-based surveys. The first pilot in 2017 resulted in further edits to the HSOPS 2.0 survey and led to a second and final pilot in 2018-2019. Psychometric analysis was conducted on the final pilot test with data from 4,345 provider and staff respondents in 25 hospitals. Results: Overall, the psychometric properties of the HSOPS 2.0 survey were good for the 32 survey items grouped into 10 composite measures and two single-item measures. All but one of the composite measures had acceptable internal consistency reliability, and site-level reliability was also acceptable for all but one composite measure, which was slightly below the criterion. Construct validity was supported by acceptable CFA fit indices and statistically significant, moderate to high hospital-level correlations among most of the measures. Conclusions: The goals of the HSOPS 2.0 survey were to improve upon the original 1.0 survey by developing an updated, shorter, reliable instrument while measuring similar core concepts as the 1.0 version. The HSOPS 2.0 survey demonstrates good psychometric properties and is a reliable and valid instrument for assessing patient safety culture. Health systems, hospitals, and researchers can use the HSOPS 2.0 survey to raise awareness about patient safety among hospital providers and staff, assess patient safety culture to identify areas of strength and opportunities for improvement, and to ultimately improve the overall safety and quality of care. patient safety culture survey patient safety safety culture psychometrics hospital patient safety culture hospital safety culture Background Patient safety culture is the extent to which an organization’s culture supports and promotes patient safety. It refers to the beliefs, values, and norms shared by healthcare practitioners and other staff throughout the organization, which influence their actions and behaviors. Patient safety culture can be measured by determining what is rewarded, supported, expected, and accepted in an organization as it relates to patient safety 1 . Establishing a culture of patient safety with a systems-based approach is essential to the delivery of high quality and safe care within healthcare organizations. To further emphasize the importance of patient safety culture, the 2020 National Action Plan to Advance Patient Safety identified culture as one of the foundational areas which are essential to create total systems safety 2 . Understanding the importance of measuring patient safety culture using a standardized tool to enable comparisons across hospitals, the Agency for Healthcare Research and Quality (AHRQ) funded the development of the Surveys on Patient Safety Culture® (SOPS®) Hospital Survey (HSOPS 1.0) 3 . The 1.0 survey was released in 2004 to enable hospitals to assess patient safety culture from the perspectives of providers and staff. AHRQ also established a survey benchmarking database, released tools and patient safety culture improvement resources, and offered webinars and in-person survey user meetings to further support hospitals in their efforts to advance and improve patient safety culture. The HSOPS 1.0 survey has demonstrated reliability and construct validity 4 and research has established relationships between the HSOPS 1.0 and other important measures. More positive HSOPS 1.0 patient safety culture scores have been linked to a number of positive outcomes, including lower rates of surgical site infections after colon surgery 5 ; lower rates of hospital acquired conditions 6 ; lower readmission rates 7 ; better financial performance/operating margin 7 ; higher performance on hospital value-based purchasing metrics 8 ; lower rates of adverse events 9 ; higher Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience scores 10 , 11 ; and higher Consumer Reports Hospital Safety Scores. 12 The HSOPS 1.0 survey has been widely adopted in the U.S. and internationally 13 . However, over the years since its initial release, survey users and stakeholders provided AHRQ with feedback about suggested changes to the survey. Under contract with AHRQ, researchers at Westat gathered this feedback along with input from a technical expert panel (TEP) at several key points in the development process along with input from hospital providers and staff, researchers, patients, and other constituents, to help develop and pilot test an updated version of the survey, the SOPS Hospital Survey 2.0 (HSOPS 2.0). The new 2.0 version sought to incorporate the following changes: (1) reduce the number of survey items to shorten the survey; (2) reword complex survey items and survey items that were difficult to translate because of item phrasing; (3) add a “Does not apply or Don’t know” (NA/DK) response option which was included in more recently updated SOPS surveys; (4) revise the Response to Error composite measure to include a focus on learning rather than blame 14 and support for staff involved in patient safety errors 15 ; (5) revise the staff positions and units/work areas for more specificity; and (6) reduce the number of negatively worded items to improve item comprehension and response as well as the reporting and interpretation of results. In this article, we summarize the development of the 2.0 survey, pilot testing, and psychometric analysis of the survey composite measures and single item measures. Methods All study procedures were approved by the Institutional Review Board at Westat (FWA 00005551). The study protocol was carried out in accordance with relevant guidelines and regulations. Survey Development and Initial Pilot Study The survey items were developed using an iterative process starting with summarizing feedback from HSOPS 1.0 survey users and stakeholders. We obtained user feedback about proposed changes to the survey from HSOPS Database submitters (supplemental table 1 ) and sought input from SOPS TEP members at various points in the development process. We also reviewed recent literature on patient safety culture, including organizational and system factors that affect the safety of care. Next, we drafted survey items that included rewording or dropping some HSOPS 1.0 items, developing new items, modifying response options as needed, and modifying background demographic questions. To evaluate the comprehension, relevance, and ease of responding to the survey items, we conducted multiple rounds of cognitive interviews with 30 hospital providers and staff. Cognitive interview participants were regionally diverse within the U.S. and worked in different positions within their hospitals. All cognitive interviews were conducted by telephone and involved retrospective probing, a technique that involves interviewers asking follow-up questions (probes) after respondents completed the survey 17 . After each round of cognitive testing, we revised the items based on the results of the cognitive interviews or continued testing them, as appropriate. An initial web-based pilot test was conducted in 44 hospitals in 2017, randomly assigning providers and staff within units within each hospital to either the HSOPS 1.0 and HSOPS 2.0 survey versions to enable a comparison of survey scores across the two versions. Results showed that HSOPS 2.0 scores were, on average, 17 percentage points higher, or more positive, than HSOPS 1.0 scores. Given the large overall differences in survey scores resulting from changes made on the 2.0 survey, Westat, AHRQ, and the SOPS TEP concluded that the differences between the 1.0 and 2.0 versions were too significant to allow hospitals to migrate easily to the new 2.0 version, thus necessitating additional edits. We therefore further revised the HSOPS 2.0 survey items and response options, in some cases reverting back to wording that more closely crosswalked to the HSOPS 1.0. We conducted additional rounds of cognitive interviews with a total of 26 hospital providers and staff. Based on results from the cognitive testing, we finalized a revised HSOPS 2.0 draft survey to be administered in a second pilot study in 2018–2019. The remainder of the paper describes results from the second and final pilot study. An 18-member SOPS TEP provided feedback throughout the survey development process. TEP members represented major hospitals and healthcare systems in the U.S. and included patient safety experts and advocates. The TEP also provided expert input on which composite measures and items to retain in the final version of the 2.0 survey. Measures The version of the HSOPS 2.0 survey pilot tested in the second pilot study in 2018–2019 included 43 survey items measuring 10 unique but conceptually related areas of patient safety culture (Table 1 ). Composite measures included two or more survey items that measure the same area of patient safety culture. We drafted multiple survey items to assess areas of patient safety culture more comprehensively and to provide sufficient information to make the survey feedback actionable for improvement purposes. Table 1 Draft SOPS Hospital Survey 2.0 patient safety culture composite measures Composite Measures Description of Survey Item Content Number of Survey Items Communication About Error Staff are informed when errors occur, discuss ways to prevent errors, and are informed when changes are made. 3 Communication Openness Staff speak up if they see something unsafe, feel comfortable asking questions, and are encouraged to come up with ideas. 5 Handoffs and Information Exchange Important patient care information is transferred across hospital units and during shift changes and staff follow standardized procedures. 5 Hospital Management Support for Patient Safety Hospital management shows that patient safety is a top priority and provides adequate resources for patient safety. 4 Organizational Learning—Continuous Improvement Work processes are regularly reviewed, changes are made to keep mistakes from happening again, and changes are evaluated. 5 Reporting Patient Safety Events Mistakes of the following types are reported: (1) mistakes caught and corrected before reaching the patient and (2) mistakes that could have harmed the patient but did not. 2 Response to Error Staff are treated fairly when they make mistakes and there is a focus on learning from mistakes and supporting staff involved in errors. 7 Staffing and Work Pace There are enough staff to handle the workload, staff work appropriate hours and do not feel rushed, and there is appropriate reliance on temporary, float, or PRN staff. 4 Supervisor, Manager, or Clinical Leader Support for Patient Safety Supervisors, managers, or clinical leaders consider staff suggestions for improving patient safety, do not encourage taking shortcuts, and take action to address patient safety concerns. 4 Teamwork Staff work together as an effective team, help each other during busy times, and are respectful to one another. 4 [INSERT Table 1 HERE] Likert scales were used for draft survey items. This included either 5-point agreement response scales (1 = Strongly disagree to 5 = Strongly agree) or frequency response scales (1 = Never to 5 = Always). A Does not apply or Don’t know (DNA/DK) response option was added to all the composite measure items. The draft survey also included two single item measures: Unit/work area patient safety rating (1 = Poor to 5 = Excellent) and the number of patient safety events reported by the respondent in the past year (1 = None to 5 = Eleven or more). Final Pilot Study The final pilot study was conducted from November 2018 to January 2019 in 25 hospitals across 16 states. Pilot hospitals were recruited to vary by multiple characteristics (e.g., bed size, geographic region, ownership). Similar to the initial pilot test, hospitals provided staff lists that indicated the staff position and work area for each person. We randomly assigned providers and staff within units within each hospital to receive a web-based version of either HSOPS 1.0 or HSOPS 2.0 to enable comparisons of scores across the two versions. There were 4,393 respondents for HSOPS 1.0 (39% response rate) and 4,345 respondents for HSOPS 2.0 (38% response rate). A comparison of results on items measuring the same or similar patient safety culture constructs showed that HSOPS 2.0 scores were higher than HSOPS 1.0 scores on most items, with an average of seven percentage points higher. But on a few items, HSOPS 2.0 scores were lower, with an average of four percentage points lower. There was no discernable pattern for when 2.0 scores were higher versus lower than 1.0 scores on crosswalked items. Because score differences between the versions were deemed acceptable, that is, not large enough to cause concern for hospitals adopting the new version, Westat, AHRQ, and the SOPS TEP, decided to proceed with psychometric analysis of the HSOPS 2.0 data from the second and final pilot study. Analyses Psychometric analyses included (1) item analysis and examining missing data patterns, (2) internal consistency reliability, (3) site-level reliability, (4) confirmatory factor analysis, and (5) hospital-level correlations on the survey’s composite measures and single items. Each analysis is described in the sections that follow. Item Analysis and Missing Data Patterns. We examined respondent-level item frequencies to review the variability of responses and identify items with high percentages of missing data or Does not apply/Don’t know (DNA/DK) responses. Items with low variability are not useful when attempting to differentiate between higher-scoring and lower-scoring hospitals. Items with more than 90 percent of respondents responding positively (e.g., those answering Strongly agree/Agree or Always/Most of the time for positively worded items and Strongly Disagree/Disagree for negatively worded items) were considered to have low variability. If more than 30% of respondents left an item missing or answered DNA/DK, we considered dropping the item since it was not relevant to a large proportion of respondents. Internal Consistency Reliability Analysis. Internal consistency reliability indicates the extent to which items within a composite measure assess the same construct or area of patient safety culture by assessing how closely those items are correlated. Internal consistency reliability was assessed using Cronbach’s alpha (α), which ranges from 0.00 to 1.00, with higher values indicating greater internal consistency. The minimum criterion for acceptable reliability is an alpha of 0.70 17 . Site-Level Reliability. We calculated site-level reliability to examine the variability of item and composite measure scores among hospitals. Site-level reliability indicates the extent to which responses within the same hospital were more similar to each other than they were to responses from other hospitals. It assesses how well a measure differentiates hospitals by comparing between-hospital variability to within-hospital variability. Site-level reliability was computed using the following formula: $$\:Site-Level\:Reliability=\frac{between\:hospital\:variance}{between\:hospital\:variance+\frac{within\:hospital\:variance}{n}}$$ In the formula, \(\:n\) is the number of respondents in a given hospital. Site-level reliability for each measure was first calculated for individual hospitals and then averaged across hospitals. Similar to internal consistency reliability, values of 0.70 or higher are considered acceptable for site-level reliability 17 . Confirmatory Factor Analysis (CFA). CFA is used to confirm a particular pattern of relationships among survey items based on past research and theory by assessing how well a proposed factor structure fits the data 18 . A CFA was conducted on the proposed composite measures and their associated items. We examined standardized factor loadings for each item on its respective composite measure. Factor loadings above 0.40 indicate that the item’s relationship to the composite measure is acceptable 19 . Several model fit indices were also examined to determine how well the hypothesized factor structure fit the data including chi-square divided by its degrees of freedom (criteria: values less than 5.0 20 ; comparative fit index (CFI) (criteria: values 0.95 or greater 21 ), root mean square error of approximation (RMSEA) (criteria: values less than 0.06 22 ), and the standardized root mean square residual (SRMR) (criteria: values less than 0.08 23 ). The indices and their criteria are displayed in Table 2 . Table 2 Criteria used to evaluate CFA model fit CFA Model Fit Criteria \(\:{\varvec{\chi\:}}^{2}/\varvec{d}\varvec{f}\) CFI RMSEA SRMR < 5.00 ≥ 0.95 < 0.06 < 0.08 [INSERT Table 2 HERE] Hospital-Level Correlations on the Survey Composite Measures and Single Items. Hospital-level percent positive scores were calculated for each item as the percentage of respondents within a hospital who answered positively (e.g., % Strongly agree/Agree or Always/Most of the time for positively worded items, and % Strongly Disagree/Disagree for negatively worded items). Percent positive scores can range from 0 to 100. Hospital-level composite scores were calculated by equally weighting and averaging the percent positive responses for each item included within the proposed composite measures. We examined Spearman’s rank order correlations among the composite measures and single item measures. The survey measures should be correlated because they are designed to assess aspects of patient safety culture. Moderate to moderately high correlations are evidence of convergence among similar concepts. Results Of the 11,292 providers and staff invited to participate across 25 pilot hospitals, 4,345 completed the HSOPS 2.0 survey, for an overall response rate of 38%. On average, there were 174 respondents per hospital (range: 29 to 527) with an average response rate across hospitals of 42% (range: 21% to 67%). Pilot Test Hospital Characteristics As shown in Table 3 , 40% percent of the pilot study hospitals had between 100 and 299 licensed beds. The majority of the pilot study hospitals were non-teaching (56%) and nongovernment not for profit (72%). Approximately two-thirds of the hospitals were from the South and Midwest regions. Table 3 Characteristics of the 2018–2019 HSOPS 2.0 pilot hospitals Bed Size Pilot Hospitals (N = 25) Number Percent 6–99 8 32% 100–299 10 40% 300 or more 7 28% Teaching Status Teaching 11 44% Non-Teaching 14 56% Ownership Government (Federal and non-Federal) 5 20% Nongovernment, not for profit 18 72% Investor-owned (for profit) 2 8% Census Region Northeast 3 12% South 8 32% Midwest 8 32% West 6 24% States are categorized into regions as follows: • Northeast: CT, MA, ME, NH, RI, VT, NJ, NY, PA • South: AL, AR, DC, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, WV • Midwest: IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI, • West: AK, AZ, CA, CO, HI, ID, MT, NM, OR, NV, UT, WA, WY [INSERT Table 3 HERE] Characteristics of the Respondents The largest proportion of hospital respondents were nursing staff (40%), followed by support staff (19%); other clinical staff (18%); other positions (13%); supervisor, manager, clinical leader, or senior leader (8%); and physician, physician assistant, or resident (3%) (Table 4 ). The largest percentage of respondents worked primarily in patient care units (30%), while the smallest worked primarily in surgical services (6%). Table 4 Characteristics of respondents in the 2018–2019 HSOPS 2.0 pilot hospitals Respondents Number Percent Hospital Staff Position Nursing Staff (RN, LVN, LPN, Nurse Practitioner) 1,740 40% Support Staff (Receptionist, Clerical Staff, Housekeeping Staff) 787 19% Other Clinical Staff (Pharmacist, Therapist, Technologist) 776 18% Other Position 549 13% Supervisor, Manager, Clinical/ Senior Leader 365 8% Physician, Physician Assistant, Resident 121 3% Total 4,338 100% Missing 7 -- Overall total 4,345 -- Unit/Work Area Patient Care 1303 30% Clinical Services 546 13% Administration/Management 516 12% Other Unit/Work Area 492 11% Medical/Surgical 429 10% Multiple Units/No Specific Unit 408 9% Support Services 352 8% Surgical Services 275 6% Total 4,321 100% Missing 24 -- Overall total 4,345 -- Note: Percentages may not add to 100 percent due to rounding. [INSERT Table 4 HERE] Item Analysis Table 5 shows the average percent positive, percent missing, and Does not apply/Don’t know (DNA/DK) responses for all survey items at the respondent level. None of the HSOPS 2.0 items were over 90 percent positive (range: 40% to 88%). None of the items had high levels of missing data (range: < 1% to 10%). The percentages of DNA/DK responses ranged from 30%). Three of these items were from Handoffs and Information Exchange : “When transferring patients from one unit to another, important information is often left out” (34%); “During shift changes, important patient care information is often left out” (32%); and “During shift changes, there is adequate time to exchange all key patient care information” (34%). The remaining two items were from Reporting Patient Safety Events : “When a mistake is caught and corrected before reaching the patient, how often is this reported?” (35%); and “When a mistake reaches the patient and could have harmed the patient, but did not, how often is this reported?” (35%). Further investigation revealed that most of the respondents who did not answer these items had no interaction with patients, suggesting that the DNA/DK response was being selected appropriately based on item applicability. Table 5 Pilot item analysis results (N = 4,345) Composite Measures and Items % Positive % MI % NA/DK Communication About Error (3 items) We are informed about errors that happen in this unit. 68% 1% 8% When errors happen in this unit, we discuss ways to prevent them from happening again. 74% 1% 7% In this unit, we are informed about changes that are made based on event reports. 68% < 1% 13% Communication Openness (5 items) In this unit, staff are encouraged to come up with ideas about ways to improve patient safety. 70% < 1% 10% In this unit, staff speak up it they see something that may negatively affect patient care. 83% 7% 9% When staff in this unit see someone with more authority doing something unsafe for patients, they speak up. 71% 7% 22% When staff in this unit speak up, those with more authority are open to their patient safety concerns. 73% 8% 16% In his unit, staff are afraid to ask questions when something does not seem right. (negatively worded) * 71% 7% 9% Handoffs and Information Exchange (5 items) Problems often occur in the exchange or information across hospital units. (negatively worded) * 23% 4% 23% When transferring patients from one unit to another, important information is often left out. (negatively worded) * 47% 4% 34% During shift changes, important patient care information is often left out. (negatively worded) * 57% 4% 32% During shift changes, there is adequate time to exchange all key patient care information. 72% 10% 34% Staff follow standardized procedures when conducting handoffs. 77% 10% 27% Hospital Management Support for Patient Safety (4 items) The actions of hospital management show that patient safety is a top priority. 83% 3% 5% Hospital management regularly walks around units to ask staff about patient safety issues. 44% 4% 22% Hospital management provides adequate resources to improve patient safety. 71% 10% 14% Hospital management seems interested in patient safety only after an adverse event happens. (negatively worded) * 55% 10% 14% Composite Measures and Items % Positive % MI % NA/DK Organizational Learning – Continuous Improvement (5 items) This unit regularly reviews work processes to determine if changes are needed to improve patient safety. 72% 7% 7% When a patient safety error happens in this unit, changes are made to prevent it from happening again. 82% 3% 11% In this unit, changes to improve patient safety are evaluated to see how well they worked. 70% 5% 12% This unit tries out new work processes before making a permanent change. 63% 5% 7% This unit lets the same patient safety problems keep happening. (negatively worded) * 77% 5% 12% Reporting Patient Safety Events (2 items) When a mistake is caught and corrected before reaching the patient , how often is this reported? 68% 1% 35% When a mistake reaches the patient and could have harmed the patient, but did not , how often is this reported? 74% 3% 35% Response to Error (7 items) In this unit, staff feel like their mistakes are held against them. (negatively worded) * 53% 3% 5% When an event is reported in this unit, it feels like the person is being written up, not the problem. (negatively worded) * 50% 3% 12% When staff make errors, this unit focuses on learning rather than blaming individuals. 69% 4% 3% When a patient safety error happens in this unit, someone is blamed. (negatively worded) * 53% 4% 14% In this unit, there is a lack of support for staff involved in patient safety errors. (negatively worded) * 64% 5% 13% After a patient safety error happens in this unit, work processes are reviewed to see if they contributed to the error. 74% 5% 16% Staff in this unit worry that mistakes they make are kept in their personnel file. (negatively worded) * 40% 5% 14% Staffing and Work Pace (4 items) In this unit, we have enough staff to handle the workload. 50% 7% < 1% Staff in this unit work longer hours than is best for patient care. (negatively worded) * 49% 8% 10% This unit relies too much on temporary, float, or PRN staff. (negatively worded) * 62% 3% 14% The work pace in this unit is so rushed that it negatively affects patient safety. (negatively worded) * 58% 4% 9% Composite Measures and Items % Positive % MI % NA/DK Supervisor, Manager, or Clinical Leader Support for Patient Safety (4 items) My supervisor, manager, or clinical leader seriously considers staff suggestions for improving patient safety. 80% 5% 6% My supervisor, manager, or clinical leader wants us to work faster during busy times, even if it means taking shortcuts. (negatively worded) 76% 5% 5% My supervisor, manager, or clinical leader overlooks patient safety problems that happen again and again. (negatively worded) (ITEM DROPPED) 78% 6% 9% My supervisor, manager, or clinical leader takes action to address patient safety concerns that are brought to their attention. 86% 5% 7% Teamwork (4 items) In this unit, we work together as an effective team. 88% 6% < 1% In this unit, staff treat each other with respect. (ITEM DROPPED) 81% 8% < 1% During busy times, staff in this unit help each other. 85% 3% 2% There is a problem with disrespectful behavior by those working in this unit. (negatively worded) 69% 4% 2% Number of Events Reported (single item measure) In the past 12 months , how many patient safety events have you reported? 45% 1% — Patient Safety Grade (single item measure) How would you rate your unit/work area on patient safety? 66% 1% — Notes: % Positive = Strongly agree/ Agree or Always/Most of the time for positively worded items and Strongly disagree/ Disagree or Never/Rarely for negatively worded items; MI = missing; DNA/DK = Does not apply or Don’t know . * % Positive are those who Strongly disagree/ Disagree [INSERT Table 5 HERE] Initial Internal Consistency Reliability Analysis All proposed composite measures had initial internal consistency reliability above criterion (α ≥ 0.70), except for Staffing and Work Pace (α = 0.67). We found that dropping any of the items in Staffing and Work Pace would not increase the reliability of the composite measure. Cronbach’s alpha for the remaining composite measures ranged from 0.72 ( Handoffs and Information Exchange ) to 0.89 ( Communication About Error ). TEP Review and Input Initial analysis results were presented to the SOPS TEP to obtain their input on which items to retain or drop based on the item analysis and initial internal consistency reliability analysis results. To shorten the survey, we also asked the TEP to identify other potential items to drop based on the importance of the content and the item’s relevance. After TEP feedback, 11 of the HSOPS 2.0 pilot survey items were dropped. The items in the Staffing and Work Pace composite measure were retained, even though initial reliability was slightly below the criterion, given how important the concepts are for patient safety culture. A listing of the items that were dropped is provided in Supplemental Table 2. We then ran all psychometric analyses on the final items. Final Internal Consistency Reliability Analysis We re-calculated Cronbach’s alpha for the final composite measures. As shown in Table 6 , the alpha coefficients for all but one composite measure were above the 0.70 criterion; ranging from 0.72 ( Handoffs and Information Exchange ) to 0.89 ( Communication About Error ). One composite measure, Staffing and Work Pace , had lower reliability (α = 0.67). For three composite measures ( Handoffs and Information Exchange, Hospital Management Support for Patient Safety , and Teamwork ), deleting one of the items would have increased the alpha slightly. Upon careful review, we determined that the conceptual importance of those items to the composite measures outweighed any increase in reliability that would result from item removal. Table 6 CFA standardized factor loadings, final internal consistency reliability, and site-level reliability Composite Measures and Items CFA Standardized factor loading Cronbach’s alpha (alpha if item deleted) Site- level reliability Communication About Error (3 items) 0.89 0.81 We are informed about errors that happen in this unit. 0.82 (0.86) 0.79 When errors happen in this unit, we discuss ways to prevent them from happening again. 0.89 (0.82) 0.80 In this unit, we are informed about changes that are made based on event reports. 0.84 (0.85) 0.77 Communication Openness (4 items) 0.83 0.78 In this unit, staff speak up it they see something that may negatively affect patient care. 0.74 (0.78) 0.73 When staff in this unit see someone with more authority doing something unsafe for patients, they speak up. 0.77 (0.75) 0.71 When staff in this unit speak up, those with more authority are open to their patient safety concerns. 0.77 (0.77) 0.75 In this unit, staff are afraid to ask questions when something does not seem right. (negatively worded) 0.66 (0.82) 0.76 Handoffs and Information Exchange (3 items) 0.72 0.79 When transferring patients from one unit to another, important information is often left out. (negatively worded) 0.75 (0.57) 0.72 During shift changes, important patient care information is often left out. (negatively worded) 0.82 (0.50) 0.77 During shift changes, there is adequate time to exchange all key patient care information. 0.55 (0.80) 0.67 Hospital Management Support for Patient Safety (3 items) 0.77 0.86 The actions of hospital management show that patient safety is a top priority. 0.78 (0.65) 0.86 Hospital management provides adequate resources to improve patient safety. 0.82 (0.62) 0.83 Hospital management seems interested in patient safety only after an adverse event happens. (negatively worded) 0.66 (0.80) 0.76 Composite Measures and Items CFA Standardized factor loading Cronbach’s alpha (alpha if item deleted) Site- level reliability Organizational Learning – Continuous Improvement (3 items) 0.76 0.79 This unit regularly reviews work processes to determine if changes are needed to improve patient safety. 0.78 (0.67) 0.75 In this unit, changes to improve patient safety are evaluated to see how well they worked. 0.78 (0.63) 0.75 This unit lets the same patient safety problems keep happening. (negatively worded) 0.75 (0.74) 0.76 Reporting Patient Safety Events (2 items) 0.75 0.69 When a mistake is caught and corrected before reaching the patient , how often is this reported? 0.74 --- 0.74 When a mistake reaches the patient and could have harmed the patient, but did not , how often is this reported? 0.76 --- 0.64 Response to Error (4 items) 0.83 0.85 In this unit, staff feel like their mistakes are held against them. (negatively worded) 0.75 (0.77) 0.81 When an event is reported in this unit, it feels like the person is being written up, not the problem. (negatively worded) 0.76 (0.76) 0.82 When staff make errors, this unit focuses on learning rather than blaming individuals. 0.72 (0.80) 0.78 In this unit, there is a lack of support for staff involved in patient safety errors. (negatively worded) 0.78 (0.80) 0.81 Staffing and Work Pace (4 items) 0.67 0.86 In this unit, we have enough staff to handle the workload. 0.68 (0.58) 0.80 Staff in this unit work longer hours than is best for patient care. (negatively worded) 0.44 (0.66) 0.79 This unit relies too much on temporary, float, or PRN staff. (negatively worded) 0.54 (0.63) 0.79 The work pace in this unit is so rushed that it negatively affects patient safety. (negatively worded) 0.82 (0.55) 0.80 Supervisor, Manager, or Clinical Leader Support for Patient Safety (3 items) 0.77 0.79 My supv, mgr, or clinical leader seriously considers staff suggestions for improving patient safety. 0.86 (0.61) 0.75 My supv, mgr, or clinical leader wants us to work faster during busy times, even if it means taking shortcuts. (negatively worded) 0.66 (0.79) 0.78 My supv, mgr, or clinical leader takes action to address patient safety concerns that are brought to their attention. 0.78 (0.67) 0.71 Composite Measures and Items CFA Standardized factor loading Cronbach’s alpha (alpha if item deleted) Site- level reliability Teamwork (3 items) 0.76 0.79 In this unit, we work together as an effective team. 0.83 (0.61) 0.72 During busy times, staff in this unit help each other. 0.83 (0.65) 0.70 There is a problem with disrespectful behavior by those working in this unit. (negatively worded) 0.64 (0.78) 0.80 Number of Events Reported (single item measure) In the past 12 months , how many patient safety events have you reported? --- --- 0.79 Patient Safety Rating (single item measure) How would you rate your unit/work area on patient safety? --- --- 0.80 Notes: Composite measure scores at the respondent level were calculated as means of their respective constituent items. All factor loadings were statistically significant (p < 0.05) Site-Level Reliability Table 6 also shows site-level reliability estimates on the final items. For the composite measures, estimates ranged from 0.69 to 0.86. Only one composite measure had site-level reliability slightly below the criterion of 0.70: Reporting Patient Safety Events (reliability = 0.69). Only two of the 32 items in the composite measures had site-level reliability below the criterion of 0.70: “During shift changes, there is adequate time to exchange all key patient care information” (reliability = 0.67) in Handoffs and Information Exchange and “When a mistake reaches the patient and could have harmed the patient, but did not, how often is this reported?” (reliability = 0.64) in Reporting Patient Safety Events . For single item measures, the site-level reliability was 0.79 for Number of Events Reported and 0.80 for overall Patient Safety Rating . [INSERT Table 6 HERE] Confirmatory Factor Analysis (CFA) To test the construct validity of the ten composite measures, we conducted a CFA using the individual-level data. Table 6 shows the standardized factor loadings for the final HSOPS 2.0 items on their respective composite measures. All standardized factor loadings were statistically significant (p < 0.05) with magnitudes greater than 0.40, indicating that the items adequately loaded on the composite measures. The factor loadings ranged from 0.44 to 0.89, with an average of 0.74. Three of the four fit indices met the criteria for acceptable fit of the model to the data (Table 7 ). Specifically, the chi-square value divided by the degrees for freedom was 3.35 (criterion is < 5.00), SRMR score was 0.05 (criterion is < 0.08), and the RMSEA was 0.05 (criterion is < 0.06). The CFI was 0.94, which is very slightly below the criterion of 0.95. However, the CFI did meet the less stringent criterion of at least 0.90. Table 7 Confirmatory factor analysis: Model fit indices CFA Model Fit Indices \(\:{\varvec{\chi\:}}^{2}\) \(\:\varvec{d}\varvec{f}\) \(\:{\varvec{\chi\:}}^{2}/\varvec{d}\varvec{f}\) CFI RMSEA (CI) SRMR 1404.55 419 3.35 0.94 0.05 (0.048–0.053) 0.05 * Chi-square is significant at p < 0.05. CI = 90% confidence intervals. CFI = Comparative Fit Index. RMSEA = Root Mean Square Error of Approximation. SRMR = Standardized Root Mean Square Residual. [INSERT Table 7 HERE] Hospital-Level Percent Positive Scores and Correlations Table 8 shows percent positive scores and Spearman correlations for the final HSOPS 2.0 composite measure and single items at the hospital level. The mean percent positive scores were based on the average of the hospital-level composite measure scores. The percent positive scores for the composite measures ranged from 56% to 81%. The percent positive scores for the single item measures were 45% for Number of Events Reported and 66% for overall Patient Safety Rating . Table 8 Hospital-level correlations for the final survey composite and single item measures Composite Measures and Single Items Mean Percent Positive Score SD (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Composite Measures 1. Communication About Error 68% 9% — 2. Communication Openness 75% 6% 0.66 — 3. Handoffs and Information Exchange 58% 9% 0.73 0.49 — 4. Hospital Management Support for Patient Safety 68% 9% 0.81 0.61 0.56 — 5. Organizational Learning – Continuous Improvement 72% 6% 0.83 0.63 0.51 0.77 — 6. Reporting Patient Safety Events 74% 8% 0.55 0.45 0.55 0.48 0.31 — 7. Response to Error 61% 8% 0.52 0.87 0.24 0.62 0.60 0.31 — 8. Staffing and Work Pace 56% 9% 0.57 0.70 0.28 0.64 0.68 0.30 0.67 — 9. Supervisor, Manager, or Clinical Leader Support for Patient Safety 81% 5% 0.58 0.85 0.26 0.67 0.63 0.26 0.85 0.79 — 10. Teamwork 81% 5% 0.61 0.75 0.31 0.67 0.62 0.52 0.79 0.62 0.75 — Single Item Measures 11. In the past 12 months, how many patient safety events have you reported? (D3) 45% 11% -0.17 -0.18 -0.35 -0.28 -0.14 -0.06 -0.17 -0.32 -0.20 0.00 — 12. How would you rate your unit/work area on patient safety? (E1) 66% 9% 0.64 0.74 0.24 0.75 0.73 0.41 0.84 0.75 0.80 0.89 -0.05 Notes: SD = standard deviation. Statistically significant correlations (p < 0.05) are bolded. Percent positive score for item D3 is two or more events reported; percent positive score for E1 is a rating of Excellent or Very Good. Thirty-seven of the 45 hospital-level correlations among the composite measures were statistically significant (p < 0.05). All statistically significant correlations among the composite measures were positive and ranged from 0.48 (between Hospital Management Support and Reporting Patient Safety Events ) to 0.87 (between Communication Openness and Response to Error ). The eight non-significant correlations were small to moderate in magnitude (range 0.24 to 0.31). All composite measure scores were significantly associated with the overall Patient Safety Rating except for Handoffs and Information Exchange ( r = 0.24, p = 0.24). The significant correlations with Patient Safety Rating ranged from 0.64 to 0.89 and indicated that more positive patient safety scores were related to higher overall Patient Safety Rating . None of the correlations with Number of Events Reported were statistically significant. [INSERT Table 8 HERE] Final SOPS Hospital Survey 2.0 The final HSOPS 2.0 survey consists of 40 items: (1) 32 survey items grouped into 10 composite measures; (2) two single-item measures (number of patient safety events reported and overall rating on patient safety); and (3) six survey items gathering background characteristics (staff position, unit/work area, hospital tenure, unit/work area tenure, work hours, and direct interaction with patients) 24 (AHRQ HSOPS 2.0 link). Table 9 shows a crosswalk of the composite measures in HSOPS 1.0 and HSOPS 2.0 and compares the number of survey items in each composite measure. The names of some composite measures were changed in HSOPS 2.0 to better align with changes to the content assessed in the retained items. Table 9 Comparison of HSOPS 1.0 and HSOPS 2.0 composite measures HSOPS 1.0 HSOPS 2.0 Number of HSOPS 1.0 Survey Items Number of HSOPS 2.0 Survey Items Communication Openness Communication Openness 3 4 Feedback and Communication About Error Communication About Error 3 3 Frequency of Events Reported Reporting Patient Safety Events 3 2 Handoffs and Transitions Handoffs and Information Exchange 4 3 Management Support for Patient Safety Hospital Management Support for Patient Safety 3 3 Nonpunitive Response to Error Response to Error 3 4 Organizational Learning – Continuous Improvement Organizational Learning—Continuous Improvement 3 3 Staffing Staffing and Work Pace 4 4 Supervisor/Manager Expectations and Actions Promoting Patient Safety Supervisor, Manager, or Clinical Leader Support for Patient Safety 4 3 Teamwork Within Units Teamwork 4 3 Overall Perceptions of Patient Safety* ------------------------- 4 0 Teamwork Across Units* ------------------------- 4 0 Subtotal* 42 32 Single-item measures 2 2 Background questions 7 6 TOTAL 51 40 *The Overall Perceptions of Patient Safety and Teamwork Across Units composite measures and associated survey items from HSOPS 1.0 were dropped in HSOPS 2.0. [INSERT Table 9 HERE] Discussion The final HSOPS 2.0 survey was the result of extensive development and testing. We obtained survey user feedback; conducted a literature review; conducted multiple rounds of cognitive interviews with 56 respondents; sought input from the SOPS TEP throughout the development process; and conducted two, multi-site pilot studies. Overall, the psychometric properties of the HSOPS 2.0 survey were good for both reliability and construct validity. All but one of the composite measures had acceptable internal consistency reliability, and site-level reliability was also acceptable for all but one composite measure, which was slightly below the criterion. Construct validity was supported by acceptable CFA fit indices and statistically significant, moderate to high hospital-level correlations among most of the measures. The 2.0 survey includes a new item assessing the extent to which healthcare professionals who have been involved in a patient safety error feel supported, which can be used to identify organizational needs in this important area. AHRQ programs such as the Communication and Optimal Resolution (CANDOR) program 25 , 26 and the RISE peer support program for caring for the caregiver 27 can be implemented by hospitals to address the support needs of healthcare professionals as well as the needs of patients and their family members. Given that HSOPS 2.0 is a relatively new survey, there has been limited research on its relationship with outcomes. However, one study conducted hospital-level regression analyses with data from 178 hospitals and found that hospitals with more positive patient safety culture scores on HSOPS 2.0 had patients who reported better experiences of care on the CAHPS Hospital Survey 28 . Hesgrove 29 found that provider and staff perceptions of their hospital’s workplace safety culture are significantly related to their perceptions of patient safety culture using HSOPS 2.0. The research also discovered that providers and staff with higher work stress and burnout had worse perceptions of patient safety culture on HSOPS 2.0. While these studies show promising results, more research is needed to examine relationships between HSOPS 2.0 and other important safety and quality outcomes. In addition to the HSOPS 2.0 core survey, SOPS supplemental items have been developed to measure additional areas of culture related to patient safety and quality. Supplemental items on hospital workplace safety culture for providers and staff assess protection from workplace hazards, moving and lifting patients, workplace aggression from patients or visitors, work stress/burnout, and turnover intentions 30 . Additional SOPS hospital supplemental measures focus on health information technology and patient safety 31 and measures of the culture of value, efficiency, and waste reduction 32 . Assessing patient safety culture with the HSOPS 2.0 survey can help hospitals address the underlying cultural aspects of their organizations that affect patient safety. As co-lead in the development of the National Action Plan to Advance Patient Safety, AHRQ played a major role in identifying culture as one of the foundational areas for safety. Recommendations in the action plan include ensuring that safety is a core value, assessing capabilities and resources to advance safety, widely sharing information about safety to promote transparency, and implementing competency-based governance and leadership to ensure that board members and senior leaders demonstrate the necessary competencies in safety, equity, and data literacy 2 (IHI report). The AHRQ HSOPS 2.0 survey can also enable hospitals to meet external requirements, including Joint Commission Leadership Standards and The Leapfrog Group requirement to regularly assess the culture of patient safety using a validated tool. In addition, the Centers for Medicare and Medicaid Services (CMS) recently introduced an attestation-based quality measure, the Patient Safety Structural Measure (PSSM) 33 , in which hospitals report the structural and cultural strategies and practices they have implemented to strengthen their systems for safety. Scores will be publicly available in the hope of driving hospitals to be more proactive and systematic in their approach to patient safety and reducing preventable harm. The PSSM Domain 3, Culture of Safety and Learning Health System, includes an attestation that hospitals conduct a hospital-wide culture of safety survey using a validated instrument annually, or every two years, with pulse surveys on target units during non-survey years. The AHRQ HSOPS survey is mentioned as one of the measures that can be used to fulfill this requirement. The PSSM also stipulates that results should be shared with the governing board and hospital staff and used to inform unit-based interventions to reduce harm (CMS PSSM), emphasizing the importance of following up on the survey results and taking action. Limitations Although the pilot hospitals were recruited to vary by a number of characteristics (e.g., bed size, geographic region, ownership), they participated voluntarily and were therefore not statistically representative of all hospitals in the United States. When examining the psychometric analysis results, one composite measure, Staffing and Work Pace , had low reliability (α = 0.67). The Staffing composite measure in HSOPS 1.0 similarly had low reliability (α = 0.62) 4 . This composite measure is designed to assess rather broad-ranging aspects of staffing and work pace, and thus the items may not correlate as highly as items within the other composite measures. The measure and its related items were retained given how important the concepts are for patient safety culture. In addition, several correlations among hospital-level scores were not statistically significant. Correlations with the single-item measure Number of Events Reported were small in magnitude and not statistically significant. The measure tends to be highly skewed with greater than 50% of respondents indicating they had reported no events over the past 12 months. Despite similar correlational findings for this question in HSOPS 1.0 4 , we retained this item since it is informative as a descriptive, single-item measure. In addition, Handoffs and Information Exchange and Reporting Patient Safety Events were not significantly correlated with several other composite measures (non-significant correlations ranged from 0.24 to 0.31). It is likely that the relatively small sample size for the hospital-level analysis (25 hospitals) resulted in diminished statistical power to detect significant effects for some of the hospital-level intercorrelations. In such cases, even moderate correlation coefficients may not be statistically significant. However, most of the intercorrelations were significant and demonstrated that the composite measures are related, yet distinct aspects of patient safety. Conclusions Despite a longstanding, national focus on the importance of patient safety culture and improving patient safety in healthcare, much work remains. Bates 34 found that adverse events were identified in almost one in four admissions, and approximately one fourth of the events were preventable, underscoring the importance of continuing to focus on patient safety improvement. In an editorial referring to the Bates study, Berwick 35 noted that while senior executives and boards in health care systems may feel overwhelmed by numerous priorities, “first do no harm” remains a sacred obligation, and success requires “constancy of purpose for improvement.” Since patient safety culture serves as the foundation upon which improvement efforts are based, it is critical to assess it regularly using validated instruments and implement improvement initiatives. The goals for the HSOPS 2.0 survey were to improve upon the original 1.0 survey with a streamlined and updated instrument. The final HSOPS 2.0 survey has 11 fewer items than HSOPS 1.0 and measures similar core concepts as the 1.0 version. The HSOPS 2.0 survey demonstrates good psychometric properties and is a reliable and valid instrument for assessing patient safety culture. Health systems, hospitals, and researchers can use the HSOPS 2.0 to raise awareness about patient safety among hospital providers and staff, assess patient safety culture to identify areas of strength and opportunities for improvement, and to ultimately improve the overall safety and quality of care. Abbreviations AHRQ – Agency for Healthcare Research and Quality CFA—Confirmatory Factor Analysis CFI—Comparative Fit Index CMS—Centers for Medicare and Medicaid Services EHR—Electronic Health Record HIT—Health Information Technology HSOPS—Hospital Survey on Patient Safety Culture PSSM—Patient Safety Structural Measure RISE—Resilience in Stressful Events RMSEA—Root Mean Square Error of Approximation SOPS—Surveys on Patient Safety Culture SRMR—Standardized Root Mean Square Residual TEP—Technical Expert Panel Declarations Ethics approval and consent to participate The study was approved by the Westat Human Research Protections Program Institutional Review Board (Westat IRB Federalwide Assurance Number—FWA 00005551). The study protocol was carried out in accordance with the Declaration of Helsinki. The study was voluntary for participating organizations and respondents. We received a waiver of written informed consent for the survey from the Westat Human Research Protections Program IRB. The approved informed consent language included on the survey was as follows: “The survey is voluntary, but your feedback will help your hospital identify areas for patient safety improvement. If you do not wish to answer a question, you may leave it blank. AHRQ and its contractor, Westat, will keep your individual responses to this survey private. Only group results will be reported.” All participants were free to stop the survey at any time or not submit their survey responses and contact information for Westat's IRB and the research team was provided. Consent for publication Not applicable. Availability of data and materials Some of the hospital de-identified datasets used for the current study are available from the corresponding author for research purposes. Competing interests None of the authors have any competing interests. Funding Funding for the study conducted by Westat was provided by the Agency for Healthcare Research and Quality under contracts HHSP233201500026I/HHSP23337004T and GS-00F-009DA/75Q80123F80005. Author contributions JS, KZ, NY, and TF conceptualized the study, conducted activities for the study, and drafted the manuscript. KZ conducted all analyses and prepared data tables. JS, KZ, NY and TF provided guidance on the analyses and reviewed and discussed the results. All authors reviewed and revised the manuscript for submission to the journal. All authors have read and agreed to the published version of the manuscript. Acknowledgements The authors would like to thank the SOPS Technical Expert Panel members and Westat project staff for their valuable input during various phases of survey development. Jonathan Bakdash, PhD, from AHRQ provided helpful comments on the manuscript. Caren Ginsberg, PhD, formerly at AHRQ, provided input and weighed in throughout the development process. We are also grateful to the hospitals and provider and staff respondents of the survey. References Sorra J, Yount N, Famolaro T, et al. AHRQ Hospital Survey on Patient Safety Culture Version 2.0: User’s Guide. (Prepared by Westat, under Contract No. HHSP233201500026I/ HHSP23337004T). Rockville, MD: Agency for Healthcare Research and Quality; June 2021. AHRQ Publication No. 19(21)-0076. Available at: https://www.ahrq.gov/sops/surveys/hospital/index.html. Institute for Healthcare Improvement (IHI). Safer Together: A National Action Plan to Advance Patient Safety. Boston, MA, USA, 2020; Available at: www.ihi.org/SafetyActionPlan. Accessed August 2025. Agency for Healthcare Research and Quality (AHRQ). SOPS Hospital Survey. Available at: https://www.ahrq.gov/sops/surveys/hospital/index.html. Accessed August 2025. Sorra, J.S., Dyer, N. Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture. BMC Health Serv Res 10 , 199 (2010). 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Kenny, D. A. (2015). Measuring model fit. Available at: http://davidakenny.net/cm/fit.htm. Agency for Healthcare Research and Quality. Surveys on Patient Safety Culture (SOPS) Hospital Survey 2.0. Available at: https://www.ahrq.gov/sops/surveys/hospital/index.html. Agency for Healthcare Research and Quality. Communication and Optimal Resolution (CANDOR). Available at: https://www.ahrq.gov/professionals/quality-patient-safety/patient-safetyresources/resources/candor/index.html. Boothman RC. CANDOR: The Antidote to Deny and Defend? Health Serv Res. 2016 Dec;51 Suppl 3(Suppl 3):2487-2490. doi: 10.1111/1475-6773.12626. PMID: 27892621; PMCID: PMC5134336. Edrees H, Connors C, Paine L, Norvell M, Taylor H, Wu AW. Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study. BMJ Open. 2016 Sep 30;6(9):e011708. doi: 10.1136/bmjopen-2016-011708. PMID: 27694486; PMCID: PMC5051469. Sorra, J. (2023). Linking Provider and Staff Perceptions of Patient Safety Culture with Patient Experience in Hospitals. CAHPS 2023 Research Meeting Summary. Rockville, MD. Available at: https://www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/2023-virtual-research-meeting-summary-patient-experience.pdf. Hesgrove, B., Zebrak, K., Yount, N., Sorra, J., & Ginsberg, C. (2024). Associations between patient safety culture and workplace safety culture in hospital settings. BMC health services research, 24(1), 568. Available at: https://doi.org/10.1186/s12913-024-10984-3. Zebrak, K. A., Yount, N. D., Sorra, J. A., Famolaro, T. E., Gray, L. C., Carpenter, D., & Caporaso, A. (2022). Development, pilot study, and psychometric analysis of the AHRQ Surveys on Patient Safety Culture™ (SOPS®) workplace safety supplemental items for hospitals. International Journal of Environmental Research and Public Health, 19(11), 6815. Available at: https://doi.org/10.3390/ijerph19116815. Agency for Healthcare Research and Quality. Health IT Patient Safety Supplemental Items for the SOPS Hospital Survey. Available at: https://www.ahrq.gov/sops/surveys/hospital/supplemental-items/health-it.html. Sorra, J., Zebrak, K., Yount, N., Famolaro, T., Gray, L., Franklin, M., Smith, S., & Streagle, S. (2022). Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices. BMJ Quality and Safety, 31(7), 493-502. Available at: https://doi.org/10.1136/bmjqs-2020-012407. Centers for Medicare and Medicaid Services (CMS). Patient Safety Structural Measure (PSSM). Available at: https://qualitynet.cms.gov/pch/measures/safety. Bates DW, Levine DM, Salmasian H, Syrowatka A, Shahian DM, Lipsitz S, Zebrowski JP, Myers LC, Logan MS, Roy CG, Iannaccone C, Frits ML, Volk LA, Dulgarian S, Amato MG, Edrees HH, Sato L, Folcarelli P, Einbinder JS, Reynolds ME, Mort E. The Safety of Inpatient Health Care. N Engl J Med. 2023 Jan 12;388(2):142-153. doi: 10.1056/NEJMsa2206117. PMID: 36630622. Berwick DM. Constancy of Purpose for Improving Patient Safety - Missing in Action. N Engl J Med. 2023 Jan 12;388(2):181-182. doi: 10.1056/NEJMe2213567. PMID: 36630628. Additional Declarations No competing interests reported. Supplementary Files SupplementalTable1.SurveyUserFeedbackandResponses.docx Supplemental Table 1- Survey User Feedback on Proposed Changes to the HSOPS 1.0 Survey From Registered Users During SOPS Hospital Database Submission SupplementalTable2.ListingofItemsDroppedFromFinalHSOPS2.0.docx Supplemental Table 2-Listing of items dropped from the final HSOPS 2.0 survey Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 12 Jan, 2026 Reviews received at journal 04 Jan, 2026 Reviews received at journal 31 Dec, 2025 Reviews received at journal 27 Dec, 2025 Reviewers agreed at journal 25 Dec, 2025 Reviews received at journal 23 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviews received at journal 21 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviewers agreed at journal 14 Dec, 2025 Reviewers agreed at journal 12 Dec, 2025 Reviewers agreed at journal 12 Dec, 2025 Reviewers invited by journal 12 Dec, 2025 Editor assigned by journal 24 Oct, 2025 Editor invited by journal 22 Oct, 2025 Submission checks completed at journal 22 Oct, 2025 First submitted to journal 22 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7829818","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":561064041,"identity":"4ca1df32-d526-4a85-9b6f-e6f2827a2033","order_by":0,"name":"Joann 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Yount","email":"","orcid":"","institution":"Westat","correspondingAuthor":false,"prefix":"","firstName":"Naomi","middleName":"","lastName":"Yount","suffix":""},{"id":561064045,"identity":"84e7a975-73d9-484a-97d6-2da38d6e7e20","order_by":3,"name":"Theresa Famolaro","email":"","orcid":"","institution":"Westat","correspondingAuthor":false,"prefix":"","firstName":"Theresa","middleName":"","lastName":"Famolaro","suffix":""}],"badges":[],"createdAt":"2025-10-10 19:24:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7829818/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7829818/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98419675,"identity":"5ea714a3-78ae-4d13-a2b5-d160de2e6ae4","added_by":"auto","created_at":"2025-12-17 15:25:01","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":109771,"visible":true,"origin":"","legend":"","description":"","filename":"HSOPS2.0PsychometricsPaperBMCHSRSubmission10202025.docx","url":"https://assets-eu.researchsquare.com/files/rs-7829818/v1/601f11a3a67466d60194a21a.docx"},{"id":98441322,"identity":"6ff4a389-e795-447c-9b0d-abed277f4f4f","added_by":"auto","created_at":"2025-12-17 17:05:12","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7266,"visible":true,"origin":"","legend":"","description":"","filename":"c04f7735af0840beb79a26213e140431.json","url":"https://assets-eu.researchsquare.com/files/rs-7829818/v1/625fce8655129e333f0f6ccd.json"},{"id":98419680,"identity":"68ec8c60-22d8-4aee-99bf-8b6e47414f9d","added_by":"auto","created_at":"2025-12-17 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15:24:59","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":204361,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7829818/v1/d85b817db861b3e66d971e3d.html"},{"id":98445725,"identity":"8fb93265-47cb-4581-9144-1427ea6c3c31","added_by":"auto","created_at":"2025-12-17 17:21:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2471906,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7829818/v1/ceb39ca2-d2f4-43e5-bb67-7c59f948eb8e.pdf"},{"id":98419666,"identity":"ecde3f21-6fdf-44b5-907e-ff41589a5405","added_by":"auto","created_at":"2025-12-17 15:24:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16996,"visible":true,"origin":"","legend":"\u003cp\u003eSupplemental Table 1- Survey User Feedback on Proposed Changes to the HSOPS 1.0 Survey\u003c/p\u003e\n\u003cp\u003eFrom Registered Users During SOPS Hospital Database Submission\u003c/p\u003e","description":"","filename":"SupplementalTable1.SurveyUserFeedbackandResponses.docx","url":"https://assets-eu.researchsquare.com/files/rs-7829818/v1/3df2d66bedb8eab763b454e9.docx"},{"id":98441196,"identity":"5d3e42b8-0664-40f3-a173-b179a6c198b6","added_by":"auto","created_at":"2025-12-17 17:05:02","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":18288,"visible":true,"origin":"","legend":"\u003cp\u003eSupplemental Table 2-Listing of items dropped from the final HSOPS 2.0 survey\u003c/p\u003e","description":"","filename":"SupplementalTable2.ListingofItemsDroppedFromFinalHSOPS2.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-7829818/v1/33f3c3675ef16d04e6d1eafd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAdvancing the Measurement of Patient Safety Culture: Development and Psychometrics of the AHRQ SOPS Hospital Survey Version 2.0\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003ePatient safety culture is the extent to which an organization\u0026rsquo;s culture supports and promotes patient safety. It refers to the beliefs, values, and norms shared by healthcare practitioners and other staff throughout the organization, which influence their actions and behaviors. Patient safety culture can be measured by determining what is rewarded, supported, expected, and accepted in an organization as it relates to patient safety\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Establishing a culture of patient safety with a systems-based approach is essential to the delivery of high quality and safe care within healthcare organizations. To further emphasize the importance of patient safety culture, the 2020 National Action Plan to Advance Patient Safety identified culture as one of the foundational areas which are essential to create total systems safety\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eUnderstanding the importance of measuring patient safety culture using a standardized tool to enable comparisons across hospitals, the Agency for Healthcare Research and Quality (AHRQ) funded the development of the Surveys on Patient Safety Culture\u0026reg; (SOPS\u0026reg;) Hospital Survey (HSOPS 1.0)\u003csup\u003e3\u003c/sup\u003e. The 1.0 survey was released in 2004 to enable hospitals to assess patient safety culture from the perspectives of providers and staff. AHRQ also established a survey benchmarking database, released tools and patient safety culture improvement resources, and offered webinars and in-person survey user meetings to further support hospitals in their efforts to advance and improve patient safety culture.\u003c/p\u003e \u003cp\u003eThe HSOPS 1.0 survey has demonstrated reliability and construct validity\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e and research has established relationships between the HSOPS 1.0 and other important measures. More positive HSOPS 1.0 patient safety culture scores have been linked to a number of positive outcomes, including lower rates of surgical site infections after colon surgery\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e; lower rates of hospital acquired conditions\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e; lower readmission rates\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e; better financial performance/operating margin\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e; higher performance on hospital value-based purchasing metrics\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e; lower rates of adverse events\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e; higher Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience scores\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e; and higher Consumer Reports Hospital Safety Scores.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe HSOPS 1.0 survey has been widely adopted in the U.S. and internationally\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. However, over the years since its initial release, survey users and stakeholders provided AHRQ with feedback about suggested changes to the survey. Under contract with AHRQ, researchers at Westat gathered this feedback along with input from a technical expert panel (TEP) at several key points in the development process along with input from hospital providers and staff, researchers, patients, and other constituents, to help develop and pilot test an updated version of the survey, the SOPS Hospital Survey 2.0 (HSOPS 2.0). The new 2.0 version sought to incorporate the following changes: (1) reduce the number of survey items to shorten the survey; (2) reword complex survey items and survey items that were difficult to translate because of item phrasing; (3) add a \u0026ldquo;Does not apply or Don\u0026rsquo;t know\u0026rdquo; (NA/DK) response option which was included in more recently updated SOPS surveys; (4) revise the \u003cem\u003eResponse to Error\u003c/em\u003e composite measure to include a focus on learning rather than blame\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e and support for staff involved in patient safety errors\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e; (5) revise the staff positions and units/work areas for more specificity; and (6) reduce the number of negatively worded items to improve item comprehension and response as well as the reporting and interpretation of results. In this article, we summarize the development of the 2.0 survey, pilot testing, and psychometric analysis of the survey composite measures and single item measures.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAll study procedures were approved by the Institutional Review Board at Westat (FWA 00005551). The study protocol was carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurvey Development and Initial Pilot Study\u003c/h2\u003e \u003cp\u003eThe survey items were developed using an iterative process starting with summarizing feedback from HSOPS 1.0 survey users and stakeholders. We obtained user feedback about proposed changes to the survey from HSOPS Database submitters (supplemental table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and sought input from SOPS TEP members at various points in the development process. We also reviewed recent literature on patient safety culture, including organizational and system factors that affect the safety of care. Next, we drafted survey items that included rewording or dropping some HSOPS 1.0 items, developing new items, modifying response options as needed, and modifying background demographic questions.\u003c/p\u003e \u003cp\u003eTo evaluate the comprehension, relevance, and ease of responding to the survey items, we conducted multiple rounds of cognitive interviews with 30 hospital providers and staff. Cognitive interview participants were regionally diverse within the U.S. and worked in different positions within their hospitals. All cognitive interviews were conducted by telephone and involved retrospective probing, a technique that involves interviewers asking follow-up questions (probes) after respondents completed the survey\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. After each round of cognitive testing, we revised the items based on the results of the cognitive interviews or continued testing them, as appropriate.\u003c/p\u003e \u003cp\u003eAn initial web-based pilot test was conducted in 44 hospitals in 2017, randomly assigning providers and staff within units within each hospital to either the HSOPS 1.0 and HSOPS 2.0 survey versions to enable a comparison of survey scores across the two versions. Results showed that HSOPS 2.0 scores were, on average, 17 percentage points higher, or more positive, than HSOPS 1.0 scores. Given the large overall differences in survey scores resulting from changes made on the 2.0 survey, Westat, AHRQ, and the SOPS TEP concluded that the differences between the 1.0 and 2.0 versions were too significant to allow hospitals to migrate easily to the new 2.0 version, thus necessitating additional edits. We therefore further revised the HSOPS 2.0 survey items and response options, in some cases reverting back to wording that more closely crosswalked to the HSOPS 1.0. We conducted additional rounds of cognitive interviews with a total of 26 hospital providers and staff. Based on results from the cognitive testing, we finalized a revised HSOPS 2.0 draft survey to be administered in a second pilot study in 2018\u0026ndash;2019. The remainder of the paper describes results from the second and final pilot study.\u003c/p\u003e \u003cp\u003eAn 18-member SOPS TEP provided feedback throughout the survey development process. TEP members represented major hospitals and healthcare systems in the U.S. and included patient safety experts and advocates. The TEP also provided expert input on which composite measures and items to retain in the final version of the 2.0 survey.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThe version of the HSOPS 2.0 survey pilot tested in the second pilot study in 2018\u0026ndash;2019 included 43 survey items measuring 10 unique but conceptually related areas of patient safety culture (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Composite measures included two or more survey items that measure the same area of patient safety culture. We drafted multiple survey items to assess areas of patient safety culture more comprehensively and to provide sufficient information to make the survey feedback actionable for improvement purposes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDraft SOPS Hospital Survey 2.0 patient safety culture composite measures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite Measures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription of Survey Item Content\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of Survey Items\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication About Error\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaff are informed when errors occur, discuss ways to prevent errors, and are informed when changes are made.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication Openness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaff speak up if they see something unsafe, feel comfortable asking questions, and are encouraged to come up with ideas.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHandoffs and Information Exchange\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImportant patient care information is transferred across hospital units and during shift changes and staff follow standardized procedures.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital Management Support for Patient Safety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital management shows that patient safety is a top priority and provides adequate resources for patient safety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganizational Learning\u0026mdash;Continuous Improvement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWork processes are regularly reviewed, changes are made to keep mistakes from happening again, and changes are evaluated.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReporting Patient Safety Events\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMistakes of the following types are reported: (1) mistakes caught and corrected before reaching the patient and (2) mistakes that could have harmed the patient but did not.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResponse to Error\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaff are treated fairly when they make mistakes and there is a focus on learning from mistakes and supporting staff involved in errors.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStaffing and Work Pace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThere are enough staff to handle the workload, staff work appropriate hours and do not feel rushed, and there is appropriate reliance on temporary, float, or PRN staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSupervisor, Manager, or Clinical Leader Support for Patient Safety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupervisors, managers, or clinical leaders consider staff suggestions for improving patient safety, do not encourage taking shortcuts, and take action to address patient safety concerns.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTeamwork\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaff work together as an effective team, help each other during busy times, and are respectful to one another.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[INSERT Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e HERE]\u003c/p\u003e \u003cp\u003eLikert scales were used for draft survey items. This included either 5-point agreement response scales (1\u0026thinsp;=\u0026thinsp;Strongly disagree to 5\u0026thinsp;=\u0026thinsp;Strongly agree) or frequency response scales (1\u0026thinsp;=\u0026thinsp;Never to 5\u0026thinsp;=\u0026thinsp;Always). A Does not apply or Don\u0026rsquo;t know (DNA/DK) response option was added to all the composite measure items. The draft survey also included two single item measures: Unit/work area patient safety rating (1\u0026thinsp;=\u0026thinsp;Poor to 5\u0026thinsp;=\u0026thinsp;Excellent) and the number of patient safety events reported by the respondent in the past year (1\u0026thinsp;=\u0026thinsp;None to 5\u0026thinsp;=\u0026thinsp;Eleven or more).\u003c/p\u003e\n\u003ch3\u003eFinal Pilot Study\u003c/h3\u003e\n\u003cp\u003eThe final pilot study was conducted from November 2018 to January 2019 in 25 hospitals across 16 states. Pilot hospitals were recruited to vary by multiple characteristics (e.g., bed size, geographic region, ownership). Similar to the initial pilot test, hospitals provided staff lists that indicated the staff position and work area for each person. We randomly assigned providers and staff within units within each hospital to receive a web-based version of either HSOPS 1.0 or HSOPS 2.0 to enable comparisons of scores across the two versions. There were 4,393 respondents for HSOPS 1.0 (39% response rate) and 4,345 respondents for HSOPS 2.0 (38% response rate). A comparison of results on items measuring the same or similar patient safety culture constructs showed that HSOPS 2.0 scores were higher than HSOPS 1.0 scores on most items, with an average of seven percentage points higher. But on a few items, HSOPS 2.0 scores were lower, with an average of four percentage points lower. There was no discernable pattern for when 2.0 scores were higher versus lower than 1.0 scores on crosswalked items. Because score differences between the versions were deemed acceptable, that is, not large enough to cause concern for hospitals adopting the new version, Westat, AHRQ, and the SOPS TEP, decided to proceed with psychometric analysis of the HSOPS 2.0 data from the second and final pilot study.\u003c/p\u003e\n\u003ch3\u003eAnalyses\u003c/h3\u003e\n\u003cp\u003ePsychometric analyses included (1) item analysis and examining missing data patterns, (2) internal consistency reliability, (3) site-level reliability, (4) confirmatory factor analysis, and (5) hospital-level correlations on the survey\u0026rsquo;s composite measures and single items. Each analysis is described in the sections that follow.\u003c/p\u003e \u003cp\u003e \u003cb\u003eItem Analysis and Missing Data Patterns.\u003c/b\u003e We examined respondent-level item frequencies to review the variability of responses and identify items with high percentages of missing data or Does not apply/Don\u0026rsquo;t know (DNA/DK) responses. Items with low variability are not useful when attempting to differentiate between higher-scoring and lower-scoring hospitals. Items with more than 90 percent of respondents responding positively (e.g., those answering \u003cem\u003eStrongly agree/Agree\u003c/em\u003e or \u003cem\u003eAlways/Most of the time\u003c/em\u003e for positively worded items and \u003cem\u003eStrongly Disagree/Disagree\u003c/em\u003e for negatively worded items) were considered to have low variability. If more than 30% of respondents left an item missing or answered DNA/DK, we considered dropping the item since it was not relevant to a large proportion of respondents.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInternal Consistency Reliability Analysis.\u003c/b\u003e Internal consistency reliability indicates the extent to which items within a composite measure assess the same construct or area of patient safety culture by assessing how closely those items are correlated. Internal consistency reliability was assessed using Cronbach\u0026rsquo;s alpha (α), which ranges from 0.00 to 1.00, with higher values indicating greater internal consistency. The minimum criterion for acceptable reliability is an alpha of 0.70\u003csup\u003e17\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSite-Level Reliability.\u003c/b\u003e We calculated site-level reliability to examine the variability of item and composite measure scores among hospitals. Site-level reliability indicates the extent to which responses within the same hospital were more similar to each other than they were to responses from other hospitals. It assesses how well a measure differentiates hospitals by comparing between-hospital variability to within-hospital variability. Site-level reliability was computed using the following formula:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:Site-Level\\:Reliability=\\frac{between\\:hospital\\:variance}{between\\:hospital\\:variance+\\frac{within\\:hospital\\:variance}{n}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn the formula, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n\\)\u003c/span\u003e\u003c/span\u003e is the number of respondents in a given hospital. Site-level reliability for each measure was first calculated for individual hospitals and then averaged across hospitals. Similar to internal consistency reliability, values of 0.70 or higher are considered acceptable for site-level reliability\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConfirmatory Factor Analysis (CFA).\u003c/b\u003e CFA is used to confirm a particular pattern of relationships among survey items based on past research and theory by assessing how well a proposed factor structure fits the data\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. A CFA was conducted on the proposed composite measures and their associated items. We examined standardized factor loadings for each item on its respective composite measure. Factor loadings above 0.40 indicate that the item\u0026rsquo;s relationship to the composite measure is acceptable\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSeveral model fit indices were also examined to determine how well the hypothesized factor structure fit the data including chi-square divided by its degrees of freedom (criteria: values less than 5.0\u003csup\u003e20\u003c/sup\u003e; comparative fit index (CFI) (criteria: values 0.95 or greater\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e), root mean square error of approximation (RMSEA) (criteria: values less than 0.06\u003csup\u003e22\u003c/sup\u003e), and the standardized root mean square residual (SRMR) (criteria: values less than 0.08\u003csup\u003e23\u003c/sup\u003e). The indices and their criteria are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCriteria used to evaluate CFA model fit\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eCFA Model Fit Criteria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\chi\\:}}^{2}/\\varvec{d}\\varvec{f}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCFI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRMSEA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eSRMR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[INSERT Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e HERE]\u003c/p\u003e \u003cp\u003e \u003cb\u003eHospital-Level Correlations on the Survey Composite Measures and Single Items.\u003c/b\u003e Hospital-level percent positive scores were calculated for each item as the percentage of respondents within a hospital who answered positively (e.g., % \u003cem\u003eStrongly agree/Agree\u003c/em\u003e or \u003cem\u003eAlways/Most of the time\u003c/em\u003e for positively worded items, and % \u003cem\u003eStrongly Disagree/Disagree\u003c/em\u003e for negatively worded items). Percent positive scores can range from 0 to 100. Hospital-level composite scores were calculated by equally weighting and averaging the percent positive responses for each item included within the proposed composite measures. We examined Spearman\u0026rsquo;s rank order correlations among the composite measures and single item measures. The survey measures should be correlated because they are designed to assess aspects of patient safety culture. Moderate to moderately high correlations are evidence of convergence among similar concepts.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 11,292 providers and staff invited to participate across 25 pilot hospitals, 4,345 completed the HSOPS 2.0 survey, for an overall response rate of 38%. On average, there were 174 respondents per hospital (range: 29 to 527) with an average response rate across hospitals of 42% (range: 21% to 67%).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePilot Test Hospital Characteristics\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, 40% percent of the pilot study hospitals had between 100 and 299 licensed beds. The majority of the pilot study hospitals were non-teaching (56%) and nongovernment not for profit (72%). Approximately two-thirds of the hospitals were from the South and Midwest regions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the 2018\u0026ndash;2019 HSOPS 2.0 pilot hospitals\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBed Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePilot Hospitals (N\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e100\u0026ndash;299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e300 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTeaching Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOwnership\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment (Federal and non-Federal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNongovernment, not for profit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvestor-owned (for profit)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCensus Region\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNortheast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidwest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eStates are categorized into regions as follows:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u0026bull; Northeast: CT, MA, ME, NH, RI, VT, NJ, NY, PA\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u0026bull; South: AL, AR, DC, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, WV\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u0026bull; Midwest: IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u0026bull; West: AK, AZ, CA, CO, HI, ID, MT, NM, OR, NV, UT, WA, WY\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[INSERT Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e HERE]\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCharacteristics of the Respondents\u003c/h3\u003e\n\u003cp\u003eThe largest proportion of hospital respondents were nursing staff (40%), followed by support staff (19%); other clinical staff (18%); other positions (13%); supervisor, manager, clinical leader, or senior leader (8%); and physician, physician assistant, or resident (3%) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The largest percentage of respondents worked primarily in patient care units (30%), while the smallest worked primarily in surgical services (6%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of respondents in the 2018\u0026ndash;2019 HSOPS 2.0 pilot hospitals\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e Respondents\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital Staff Position\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing Staff (RN, LVN, LPN, Nurse Practitioner)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupport Staff (Receptionist, Clerical Staff, Housekeeping Staff)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Clinical Staff (Pharmacist, Therapist, Technologist)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupervisor, Manager, Clinical/ Senior Leader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysician, Physician Assistant, Resident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnit/Work Area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministration/Management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Unit/Work Area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical/Surgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple Units/No Specific Unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupport Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote: Percentages may not add to 100 percent due to rounding.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[INSERT Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e HERE]\u003c/p\u003e\n\u003ch3\u003eItem Analysis\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the average percent positive, percent missing, and Does not apply/Don\u0026rsquo;t know (DNA/DK) responses for all survey items at the respondent level. None of the HSOPS 2.0 items were over 90 percent positive (range: 40% to 88%). None of the items had high levels of missing data (range: \u0026lt; 1% to 10%). The percentages of DNA/DK responses ranged from \u0026lt;\u0026thinsp;1% to 35%. Five items had high percentages of DNA/DK responses (i.e., \u0026gt; 30%). Three of these items were from \u003cem\u003eHandoffs and Information Exchange\u003c/em\u003e: \u0026ldquo;When transferring patients from one unit to another, important information is often left out\u0026rdquo; (34%); \u0026ldquo;During shift changes, important patient care information is often left out\u0026rdquo; (32%); and \u0026ldquo;During shift changes, there is adequate time to exchange all key patient care information\u0026rdquo; (34%). The remaining two items were from \u003cem\u003eReporting Patient Safety Events\u003c/em\u003e: \u0026ldquo;When a mistake is caught and corrected before reaching the patient, how often is this reported?\u0026rdquo; (35%); and \u0026ldquo;When a mistake reaches the patient and could have harmed the patient, but did not, how often is this reported?\u0026rdquo; (35%). Further investigation revealed that most of the respondents who did not answer these items had no interaction with patients, suggesting that the DNA/DK response was being selected appropriately based on item applicability.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePilot item analysis results (N\u0026thinsp;=\u0026thinsp;4,345)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite Measures and Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% Positive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003cp\u003eMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% NA/DK\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication About Error (3 items)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWe are informed about errors that happen in this unit.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen errors happen in this unit, we discuss ways to prevent them from happening again.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, we are informed about changes that are made based on event reports.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication Openness (5 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, staff are encouraged to come up with ideas about ways to improve patient safety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, staff speak up it they see something that may negatively affect patient care.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen staff in this unit see someone with more authority doing something unsafe for patients, they speak up.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen staff in this unit speak up, those with more authority are open to their patient safety concerns.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn his unit, staff are afraid to ask questions when something does not seem right. (negatively worded)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHandoffs and Information Exchange (5 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblems often occur in the exchange or information across hospital units. (negatively worded)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen transferring patients from one unit to another, important information is often left out. (negatively worded)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring shift changes, important patient care information is often left out. (negatively worded)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring shift changes, there is adequate time to exchange all key patient care information.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaff follow standardized procedures when conducting handoffs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital Management Support for Patient Safety (4 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe actions of hospital management show that patient safety is a top priority.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital management regularly walks around units to ask staff about patient safety issues.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital management provides adequate resources to improve patient safety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital management seems interested in patient safety only after an adverse event happens. (negatively worded)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite Measures and Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% Positive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003cp\u003eMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% NA/DK\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Learning \u0026ndash; Continuous Improvement (5 items)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThis unit regularly reviews work processes to determine if changes are needed to improve patient safety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen a patient safety error happens in this unit, changes are made to prevent it from happening again.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, changes to improve patient safety are evaluated to see how well they worked.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThis unit tries out new work processes before making a permanent change.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThis unit lets the same patient safety problems keep happening. (negatively worded)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReporting Patient Safety Events (2 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen a mistake is \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ecaught and corrected before reaching the patient\u003c/span\u003e, how often is this reported?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen a mistake reaches the patient and \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ecould have harmed the patient, but did not\u003c/span\u003e, how often is this reported?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResponse to Error (7 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, staff feel like their mistakes are held against them. (negatively worded)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen an event is reported in this unit, it feels like the person is being written up, not the problem. (negatively worded)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen staff make errors, this unit focuses on learning rather than blaming individuals.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen a patient safety error happens in this unit, someone is blamed. (negatively worded) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, there is a lack of support for staff involved in patient safety errors. (negatively worded) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter a patient safety error happens in this unit, work processes are reviewed to see if they contributed to the error.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaff in this unit worry that mistakes they make are kept in their personnel file. (negatively worded) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStaffing and Work Pace (4 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, we have enough staff to handle the workload.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaff in this unit work longer hours than is best for patient care. (negatively worded) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThis unit relies too much on temporary, float, or PRN staff. (negatively worded) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe work pace in this unit is so rushed that it negatively affects patient safety. (negatively worded) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite Measures and Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% Positive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003cp\u003eMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% NA/DK\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupervisor, Manager, or Clinical Leader Support for Patient Safety (4 items)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy supervisor, manager, or clinical leader seriously considers staff suggestions for improving patient safety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy supervisor, manager, or clinical leader wants us to work faster during busy times, even if it means taking shortcuts. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy supervisor, manager, or clinical leader overlooks patient safety problems that happen again and again. (negatively worded) (ITEM DROPPED)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy supervisor, manager, or clinical leader takes action to address patient safety concerns that are brought to their attention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTeamwork (4 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, we work together as an effective team.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, staff treat each other with respect. (ITEM DROPPED)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring busy times, staff in this unit help each other.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThere is a problem with disrespectful behavior by those working in this unit. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Events Reported (single item measure)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eIn the past 12 months\u003c/span\u003e, how many patient safety events have \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eyou\u003c/span\u003e reported?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient Safety Grade (single item measure)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow would you rate your unit/work area on patient safety?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNotes: % Positive\u0026thinsp;=\u0026thinsp;\u003cem\u003eStrongly agree/ Agree\u003c/em\u003e or \u003cem\u003eAlways/Most of the time\u003c/em\u003e for positively worded items and \u003cem\u003eStrongly disagree/ Disagree\u003c/em\u003e or \u003cem\u003eNever/Rarely\u003c/em\u003e for negatively worded items; MI\u0026thinsp;=\u0026thinsp;missing; DNA/DK\u0026thinsp;=\u0026thinsp;\u003cem\u003eDoes not apply or Don\u0026rsquo;t know\u003c/em\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003e % Positive are those who \u003cem\u003eStrongly disagree/ Disagree\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[INSERT Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e HERE]\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eInitial Internal Consistency Reliability Analysis\u003c/h2\u003e \u003cp\u003eAll proposed composite measures had initial internal consistency reliability above criterion (α\u0026thinsp;\u0026ge;\u0026thinsp;0.70), except for \u003cem\u003eStaffing and Work Pace\u003c/em\u003e (α\u0026thinsp;=\u0026thinsp;0.67). We found that dropping any of the items in \u003cem\u003eStaffing and Work Pace\u003c/em\u003e would not increase the reliability of the composite measure. Cronbach\u0026rsquo;s alpha for the remaining composite measures ranged from 0.72 (\u003cem\u003eHandoffs and Information Exchange\u003c/em\u003e) to 0.89 (\u003cem\u003eCommunication About Error\u003c/em\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTEP Review and Input\u003c/h2\u003e \u003cp\u003eInitial analysis results were presented to the SOPS TEP to obtain their input on which items to retain or drop based on the item analysis and initial internal consistency reliability analysis results. To shorten the survey, we also asked the TEP to identify other potential items to drop based on the importance of the content and the item\u0026rsquo;s relevance. After TEP feedback, 11 of the HSOPS 2.0 pilot survey items were dropped. The items in the \u003cem\u003eStaffing and Work Pace\u003c/em\u003e composite measure were retained, even though initial reliability was slightly below the criterion, given how important the concepts are for patient safety culture. A listing of the items that were dropped is provided in Supplemental Table\u0026nbsp;2. We then ran all psychometric analyses on the final items.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFinal Internal Consistency Reliability Analysis\u003c/h2\u003e \u003cp\u003eWe re-calculated Cronbach\u0026rsquo;s alpha for the final composite measures. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, the alpha coefficients for all but one composite measure were above the 0.70 criterion; ranging from 0.72 (\u003cem\u003eHandoffs and Information Exchange\u003c/em\u003e) to 0.89 (\u003cem\u003eCommunication About Error\u003c/em\u003e). One composite measure, \u003cem\u003eStaffing and Work Pace\u003c/em\u003e, had lower reliability (α\u0026thinsp;=\u0026thinsp;0.67). For three composite measures (\u003cem\u003eHandoffs and Information Exchange, Hospital Management Support for Patient Safety\u003c/em\u003e, and \u003cem\u003eTeamwork\u003c/em\u003e), deleting one of the items would have increased the alpha slightly. Upon careful review, we determined that the conceptual importance of those items to the composite measures outweighed any increase in reliability that would result from item removal.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCFA standardized factor loadings, final internal consistency reliability, and site-level reliability\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite Measures and Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCFA\u003c/p\u003e \u003cp\u003eStandardized factor loading\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCronbach\u0026rsquo;s alpha (alpha if item deleted)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSite-\u003c/p\u003e \u003cp\u003elevel reliability\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication About Error (3 items)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWe are informed about errors that happen in this unit.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen errors happen in this unit, we discuss ways to prevent them from happening again.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, we are informed about changes that are made based on event reports.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication Openness (4 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.83\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, staff speak up it they see something that may negatively affect patient care.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen staff in this unit see someone with more authority doing something unsafe for patients, they speak up.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen staff in this unit speak up, those with more authority are open to their patient safety concerns.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, staff are afraid to ask questions when something does not seem right. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHandoffs and Information Exchange (3 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.72\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen transferring patients from one unit to another, important information is often left out. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring shift changes, important patient care information is often left out. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring shift changes, there is adequate time to exchange all key patient care information.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital Management Support for Patient Safety (3 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.86\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe actions of hospital management show that patient safety is a top priority.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital management provides adequate resources to improve patient safety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital management seems interested in patient safety only after an adverse event happens. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite Measures and Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCFA\u003c/p\u003e \u003cp\u003eStandardized factor loading\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCronbach\u0026rsquo;s alpha (alpha if item deleted)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSite-\u003c/p\u003e \u003cp\u003elevel reliability\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Learning \u0026ndash; Continuous Improvement (3 items)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThis unit regularly reviews work processes to determine if changes are needed to improve patient safety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, changes to improve patient safety are evaluated to see how well they worked.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThis unit lets the same patient safety problems keep happening. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReporting Patient Safety Events (2 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.69\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen a mistake is \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ecaught and corrected before reaching the patient\u003c/span\u003e, how often is this reported?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen a mistake reaches the patient and \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ecould have harmed the patient, but did not\u003c/span\u003e, how often is this reported?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResponse to Error (4 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.83\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.85\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, staff feel like their mistakes are held against them. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen an event is reported in this unit, it feels like the person is being written up, not the problem. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen staff make errors, this unit focuses on learning rather than blaming individuals.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, there is a lack of support for staff involved in patient safety errors. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStaffing and Work Pace (4 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.86\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, we have enough staff to handle the workload.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaff in this unit work longer hours than is best for patient care. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThis unit relies too much on temporary, float, or PRN staff. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe work pace in this unit is so rushed that it negatively affects patient safety. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSupervisor, Manager, or Clinical Leader Support for Patient Safety (3 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy supv, mgr, or clinical leader seriously considers staff suggestions for improving patient safety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy supv, mgr, or clinical leader wants us to work faster during busy times, even if it means taking shortcuts. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy supv, mgr, or clinical leader takes action to address patient safety concerns that are brought to their attention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComposite Measures and Items\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCFA\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eStandardized factor loading\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eCronbach\u0026rsquo;s alpha (alpha if item deleted)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eSite-\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003elevel reliability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTeamwork (3 items)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn this unit, we work together as an effective team.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring busy times, staff in this unit help each other.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThere is a problem with disrespectful behavior by those working in this unit. (negatively worded)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Events Reported (single item measure)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eIn the past 12 months\u003c/span\u003e, how many patient safety events have \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eyou\u003c/span\u003e reported?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient Safety Rating (single item measure)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow would you rate your unit/work area on patient safety?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNotes: Composite measure scores at the respondent level were calculated as means of their respective constituent items. All factor loadings were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSite-Level Reliability\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e also shows site-level reliability estimates on the final items. For the composite measures, estimates ranged from 0.69 to 0.86. Only one composite measure had site-level reliability slightly below the criterion of 0.70: \u003cem\u003eReporting Patient Safety Events\u003c/em\u003e (reliability\u0026thinsp;=\u0026thinsp;0.69). Only two of the 32 items in the composite measures had site-level reliability below the criterion of 0.70: \u0026ldquo;During shift changes, there is adequate time to exchange all key patient care information\u0026rdquo; (reliability\u0026thinsp;=\u0026thinsp;0.67) in \u003cem\u003eHandoffs and Information Exchange\u003c/em\u003e and \u0026ldquo;When a mistake reaches the patient and could have harmed the patient, but did not, how often is this reported?\u0026rdquo; (reliability\u0026thinsp;=\u0026thinsp;0.64) in \u003cem\u003eReporting Patient Safety Events\u003c/em\u003e. For single item measures, the site-level reliability was 0.79 for \u003cem\u003eNumber of Events Reported\u003c/em\u003e and 0.80 for overall \u003cem\u003ePatient Safety Rating\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e[INSERT Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e HERE]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eConfirmatory Factor Analysis (CFA)\u003c/h2\u003e \u003cp\u003eTo test the construct validity of the ten composite measures, we conducted a CFA using the individual-level data. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows the standardized factor loadings for the final HSOPS 2.0 items on their respective composite measures. All standardized factor loadings were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) with magnitudes greater than 0.40, indicating that the items adequately loaded on the composite measures. The factor loadings ranged from 0.44 to 0.89, with an average of 0.74. Three of the four fit indices met the criteria for acceptable fit of the model to the data (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Specifically, the chi-square value divided by the degrees for freedom was 3.35 (criterion is \u0026lt;\u0026thinsp;5.00), SRMR score was 0.05 (criterion is \u0026lt;\u0026thinsp;0.08), and the RMSEA was 0.05 (criterion is \u0026lt;\u0026thinsp;0.06). The CFI was 0.94, which is very slightly below the criterion of 0.95. However, the CFI did meet the less stringent criterion of at least 0.90.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConfirmatory factor analysis: Model fit indices\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eCFA Model Fit Indices\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\chi\\:}}^{2}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\varvec{d}\\varvec{f}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\chi\\:}}^{2}/\\varvec{d}\\varvec{f}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCFI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRMSEA (CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSRMR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1404.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003cp\u003e(0.048\u0026ndash;0.053)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Chi-square is significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. CI\u0026thinsp;=\u0026thinsp;90% confidence intervals.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCFI\u0026thinsp;=\u0026thinsp;Comparative Fit Index. RMSEA\u0026thinsp;=\u0026thinsp;Root Mean Square Error of Approximation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSRMR\u0026thinsp;=\u0026thinsp;Standardized Root Mean Square Residual.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[INSERT Table \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e HERE]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eHospital-Level Percent Positive Scores and Correlations\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e shows percent positive scores and Spearman correlations for the final HSOPS 2.0 composite measure and single items at the hospital level. The mean percent positive scores were based on the average of the hospital-level composite measure scores. The percent positive scores for the composite measures ranged from 56% to 81%. The percent positive scores for the single item measures were 45% for \u003cem\u003eNumber of Events Reported\u003c/em\u003e and 66% for overall \u003cem\u003ePatient Safety Rating\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHospital-level correlations for the final survey composite and single item measures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"28\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c21\" colnum=\"21\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c22\" colnum=\"22\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c23\" colnum=\"23\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c24\" colnum=\"24\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c25\" colnum=\"25\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c26\" colnum=\"26\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c27\" colnum=\"27\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c28\" colnum=\"28\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite Measures and Single Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003cp\u003ePercent Positive Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e(1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e(2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e(3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e(4)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e(5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e(6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e \u003cp\u003e(7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c21\" namest=\"c20\"\u003e \u003cp\u003e(8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c23\" namest=\"c22\"\u003e \u003cp\u003e(9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c25\" namest=\"c24\"\u003e \u003cp\u003e(10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c27\" namest=\"c26\"\u003e \u003cp\u003e(11)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c28\" namest=\"c28\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite Measures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c21\" namest=\"c20\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c23\" namest=\"c22\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c25\" namest=\"c24\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c27\" namest=\"c26\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c28\" namest=\"c28\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e1. Communication About Error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e2. Communication Openness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e3. Handoffs and Information Exchange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.49\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e4. Hospital Management Support for Patient Safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e5. Organizational Learning \u0026ndash; Continuous Improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e72%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.83\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.63\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.51\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e6. Reporting Patient Safety Events\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.45\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.48\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e7. Response to Error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e61%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.52\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.87\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.62\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e\u003cb\u003e0.60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e8. Staffing and Work Pace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.57\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.70\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.64\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e\u003cb\u003e0.68\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e9. Supervisor, Manager, or Clinical Leader Support for Patient Safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e81%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.58\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.85\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e\u003cb\u003e0.63\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e\u003cb\u003e0.85\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e10. Teamwork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e81%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e\u003cb\u003e0.62\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u003cb\u003e0.52\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e\u003cb\u003e0.79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e \u003cp\u003e\u003cb\u003e0.62\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSingle Item Measures\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c21\" namest=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c23\" namest=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c25\" namest=\"c24\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c27\" namest=\"c26\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c28\" namest=\"c28\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e11. In the past 12 months, how many patient safety events have you reported? (D3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e-0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e-0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e-0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e \u003cp\u003e-0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e \u003cp\u003e-0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e12. How would you rate your unit/work area on patient safety? (E1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e66%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.64\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.74\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e\u003cb\u003e0.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e\u003cb\u003e0.41\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e\u003cb\u003e0.84\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c22\" namest=\"c21\"\u003e \u003cp\u003e\u003cb\u003e0.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e \u003cp\u003e\u003cb\u003e0.80\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c26\" namest=\"c25\"\u003e \u003cp\u003e\u003cb\u003e0.89\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c28\" namest=\"c27\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"28\"\u003eNotes: SD\u0026thinsp;=\u0026thinsp;standard deviation. Statistically significant correlations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) are bolded. Percent positive score for item D3 is two or more events reported; percent positive score for E1 is a rating of Excellent or Very Good.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThirty-seven of the 45 hospital-level correlations among the composite measures were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). All statistically significant correlations among the composite measures were positive and ranged from 0.48 (between \u003cem\u003eHospital Management Support\u003c/em\u003e and \u003cem\u003eReporting Patient Safety Events\u003c/em\u003e) to 0.87 (between \u003cem\u003eCommunication Openness\u003c/em\u003e and \u003cem\u003eResponse to Error\u003c/em\u003e). The eight non-significant correlations were small to moderate in magnitude (range 0.24 to 0.31). All composite measure scores were significantly associated with the overall \u003cem\u003ePatient Safety Rating\u003c/em\u003e except for \u003cem\u003eHandoffs and Information Exchange\u003c/em\u003e (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.24, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.24). The significant correlations with \u003cem\u003ePatient Safety Rating\u003c/em\u003e ranged from 0.64 to 0.89 and indicated that more positive patient safety scores were related to higher overall \u003cem\u003ePatient Safety Rating\u003c/em\u003e. None of the correlations with \u003cem\u003eNumber of Events Reported\u003c/em\u003e were statistically significant.\u003c/p\u003e \u003cp\u003e[INSERT Table \u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e HERE]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFinal SOPS Hospital Survey 2.0\u003c/h2\u003e \u003cp\u003eThe final HSOPS 2.0 survey consists of 40 items: (1) 32 survey items grouped into 10 composite measures; (2) two single-item measures (number of patient safety events reported and overall rating on patient safety); and (3) six survey items gathering background characteristics (staff position, unit/work area, hospital tenure, unit/work area tenure, work hours, and direct interaction with patients)\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e (AHRQ HSOPS 2.0 link). Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e shows a crosswalk of the composite measures in HSOPS 1.0 and HSOPS 2.0 and compares the number of survey items in each composite measure. The names of some composite measures were changed in HSOPS 2.0 to better align with changes to the content assessed in the retained items.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of HSOPS 1.0 and HSOPS 2.0 composite measures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHSOPS 1.0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHSOPS 2.0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of HSOPS 1.0 Survey Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of HSOPS 2.0 Survey Items\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication Openness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication Openness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeedback and Communication\u003c/p\u003e \u003cp\u003eAbout Error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication About Error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of Events Reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReporting Patient Safety Events\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandoffs and Transitions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHandoffs and Information Exchange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManagement Support for Patient Safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital Management Support for Patient Safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonpunitive Response to Error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse to Error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Learning \u0026ndash; Continuous Improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrganizational Learning\u0026mdash;Continuous Improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaffing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaffing and Work Pace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupervisor/Manager Expectations and Actions Promoting Patient Safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupervisor, Manager, or Clinical Leader Support for Patient Safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeamwork Within Units\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeamwork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Perceptions of Patient Safety*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-------------------------\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeamwork Across Units*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-------------------------\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSubtotal*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e32\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle-item measures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBackground questions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTOTAL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e51\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*The \u003cem\u003eOverall Perceptions of Patient Safety\u003c/em\u003e and \u003cem\u003eTeamwork Across Units\u003c/em\u003e composite measures and associated survey items from HSOPS 1.0 were dropped in HSOPS 2.0.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[INSERT Table \u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e HERE]\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe final HSOPS 2.0 survey was the result of extensive development and testing. We obtained survey user feedback; conducted a literature review; conducted multiple rounds of cognitive interviews with 56 respondents; sought input from the SOPS TEP throughout the development process; and conducted two, multi-site pilot studies. Overall, the psychometric properties of the HSOPS 2.0 survey were good for both reliability and construct validity. All but one of the composite measures had acceptable internal consistency reliability, and site-level reliability was also acceptable for all but one composite measure, which was slightly below the criterion. Construct validity was supported by acceptable CFA fit indices and statistically significant, moderate to high hospital-level correlations among most of the measures.\u003c/p\u003e \u003cp\u003eThe 2.0 survey includes a new item assessing the extent to which healthcare professionals who have been involved in a patient safety error feel supported, which can be used to identify organizational needs in this important area. AHRQ programs such as the Communication and Optimal Resolution (CANDOR) program\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e and the RISE peer support program for caring for the caregiver\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e can be implemented by hospitals to address the support needs of healthcare professionals as well as the needs of patients and their family members.\u003c/p\u003e \u003cp\u003eGiven that HSOPS 2.0 is a relatively new survey, there has been limited research on its relationship with outcomes. However, one study conducted hospital-level regression analyses with data from 178 hospitals and found that hospitals with more positive patient safety culture scores on HSOPS 2.0 had patients who reported better experiences of care on the CAHPS Hospital Survey\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Hesgrove\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e found that provider and staff perceptions of their hospital\u0026rsquo;s workplace safety culture are significantly related to their perceptions of patient safety culture using HSOPS 2.0. The research also discovered that providers and staff with higher work stress and burnout had worse perceptions of patient safety culture on HSOPS 2.0. While these studies show promising results, more research is needed to examine relationships between HSOPS 2.0 and other important safety and quality outcomes.\u003c/p\u003e \u003cp\u003eIn addition to the HSOPS 2.0 core survey, SOPS supplemental items have been developed to measure additional areas of culture related to patient safety and quality. Supplemental items on hospital workplace safety culture for providers and staff assess protection from workplace hazards, moving and lifting patients, workplace aggression from patients or visitors, work stress/burnout, and turnover intentions\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Additional SOPS hospital supplemental measures focus on health information technology and patient safety\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e and measures of the culture of value, efficiency, and waste reduction\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAssessing patient safety culture with the HSOPS 2.0 survey can help hospitals address the underlying cultural aspects of their organizations that affect patient safety. As co-lead in the development of the National Action Plan to Advance Patient Safety, AHRQ played a major role in identifying culture as one of the foundational areas for safety. Recommendations in the action plan include ensuring that safety is a core value, assessing capabilities and resources to advance safety, widely sharing information about safety to promote transparency, and implementing competency-based governance and leadership to ensure that board members and senior leaders demonstrate the necessary competencies in safety, equity, and data literacy\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (IHI report).\u003c/p\u003e \u003cp\u003eThe AHRQ HSOPS 2.0 survey can also enable hospitals to meet external requirements, including Joint Commission Leadership Standards and The Leapfrog Group requirement to regularly assess the culture of patient safety using a validated tool. In addition, the Centers for Medicare and Medicaid Services (CMS) recently introduced an attestation-based quality measure, the Patient Safety Structural Measure (PSSM)\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, in which hospitals report the structural and cultural strategies and practices they have implemented to strengthen their systems for safety. Scores will be publicly available in the hope of driving hospitals to be more proactive and systematic in their approach to patient safety and reducing preventable harm. The PSSM Domain 3, Culture of Safety and Learning Health System, includes an attestation that hospitals conduct a hospital-wide culture of safety survey using a validated instrument annually, or every two years, with pulse surveys on target units during non-survey years. The AHRQ HSOPS survey is mentioned as one of the measures that can be used to fulfill this requirement. The PSSM also stipulates that results should be shared with the governing board and hospital staff and used to inform unit-based interventions to reduce harm (CMS PSSM), emphasizing the importance of following up on the survey results and taking action.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eAlthough the pilot hospitals were recruited to vary by a number of characteristics (e.g., bed size, geographic region, ownership), they participated voluntarily and were therefore not statistically representative of all hospitals in the United States.\u003c/p\u003e \u003cp\u003eWhen examining the psychometric analysis results, one composite measure, \u003cem\u003eStaffing and Work Pace\u003c/em\u003e, had low reliability (α\u0026thinsp;=\u0026thinsp;0.67). The \u003cem\u003eStaffing\u003c/em\u003e composite measure in HSOPS 1.0 similarly had low reliability (α\u0026thinsp;=\u0026thinsp;0.62)\u003csup\u003e4\u003c/sup\u003e. This composite measure is designed to assess rather broad-ranging aspects of staffing and work pace, and thus the items may not correlate as highly as items within the other composite measures. The measure and its related items were retained given how important the concepts are for patient safety culture.\u003c/p\u003e \u003cp\u003eIn addition, several correlations among hospital-level scores were not statistically significant. Correlations with the single-item measure \u003cem\u003eNumber of Events Reported\u003c/em\u003e were small in magnitude and not statistically significant. The measure tends to be highly skewed with greater than 50% of respondents indicating they had reported no events over the past 12 months. Despite similar correlational findings for this question in HSOPS 1.0\u003csup\u003e4\u003c/sup\u003e, we retained this item since it is informative as a descriptive, single-item measure. In addition, \u003cem\u003eHandoffs and Information Exchange\u003c/em\u003e and \u003cem\u003eReporting Patient Safety Events\u003c/em\u003e were not significantly correlated with several other composite measures (non-significant correlations ranged from 0.24 to 0.31). It is likely that the relatively small sample size for the hospital-level analysis (25 hospitals) resulted in diminished statistical power to detect significant effects for some of the hospital-level intercorrelations. In such cases, even moderate correlation coefficients may not be statistically significant. However, most of the intercorrelations were significant and demonstrated that the composite measures are related, yet distinct aspects of patient safety.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDespite a longstanding, national focus on the importance of patient safety culture and improving patient safety in healthcare, much work remains. Bates\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e found that adverse events were identified in almost one in four admissions, and approximately one fourth of the events were preventable, underscoring the importance of continuing to focus on patient safety improvement. In an editorial referring to the Bates study, Berwick\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e noted that while senior executives and boards in health care systems may feel overwhelmed by numerous priorities, \u0026ldquo;first do no harm\u0026rdquo; remains a sacred obligation, and success requires \u0026ldquo;constancy of purpose for improvement.\u0026rdquo; Since patient safety culture serves as the foundation upon which improvement efforts are based, it is critical to assess it regularly using validated instruments and implement improvement initiatives.\u003c/p\u003e \u003cp\u003eThe goals for the HSOPS 2.0 survey were to improve upon the original 1.0 survey with a streamlined and updated instrument. The final HSOPS 2.0 survey has 11 fewer items than HSOPS 1.0 and measures similar core concepts as the 1.0 version. The HSOPS 2.0 survey demonstrates good psychometric properties and is a reliable and valid instrument for assessing patient safety culture. Health systems, hospitals, and researchers can use the HSOPS 2.0 to raise awareness about patient safety among hospital providers and staff, assess patient safety culture to identify areas of strength and opportunities for improvement, and to ultimately improve the overall safety and quality of care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAHRQ \u0026ndash; Agency for Healthcare Research and Quality\u003c/p\u003e\n\u003cp\u003eCFA\u0026mdash;Confirmatory Factor Analysis\u003c/p\u003e\n\u003cp\u003eCFI\u0026mdash;Comparative Fit Index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCMS\u0026mdash;Centers for Medicare and Medicaid Services\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEHR\u0026mdash;Electronic Health Record\u003c/p\u003e\n\u003cp\u003eHIT\u0026mdash;Health Information Technology\u003c/p\u003e\n\u003cp\u003eHSOPS\u0026mdash;Hospital Survey on Patient Safety Culture\u003c/p\u003e\n\u003cp\u003ePSSM\u0026mdash;Patient Safety Structural Measure\u003c/p\u003e\n\u003cp\u003eRISE\u0026mdash;Resilience in Stressful Events\u003c/p\u003e\n\u003cp\u003eRMSEA\u0026mdash;Root Mean Square Error of Approximation\u003c/p\u003e\n\u003cp\u003eSOPS\u0026mdash;Surveys on Patient Safety Culture\u003c/p\u003e\n\u003cp\u003eSRMR\u0026mdash;Standardized Root Mean Square Residual\u003c/p\u003e\n\u003cp\u003eTEP\u0026mdash;Technical Expert Panel\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Westat Human Research Protections Program Institutional Review Board (Westat IRB Federalwide Assurance Number\u0026mdash;FWA 00005551). The study protocol was carried out in accordance with the Declaration of Helsinki. The study was voluntary for participating organizations and respondents. We received a waiver of written informed consent for the survey from the Westat Human Research Protections Program IRB. The approved informed consent language included on the survey was as follows: \u0026ldquo;The survey is voluntary, but your feedback will help your hospital identify areas for patient safety improvement. If you do not wish to answer a question, you may leave it blank. AHRQ and its contractor, Westat, will keep your individual responses to this survey private. Only group results will be reported.\u0026rdquo; All participants were free to stop the survey at any time or not submit their survey responses and contact information for Westat\u0026apos;s IRB and the research team was provided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome of the hospital de-identified datasets used for the current study are available from the corresponding author for research purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors have any competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for the study conducted by Westat was provided by the Agency for Healthcare Research and Quality under contracts HHSP233201500026I/HHSP23337004T and GS-00F-009DA/75Q80123F80005.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJS, KZ, NY, and TF conceptualized the study, conducted activities for the study, and drafted the manuscript. KZ conducted all analyses and prepared data tables. JS, KZ, NY and TF provided guidance on the analyses and reviewed and discussed the results. All authors reviewed and revised the manuscript for submission to the journal. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the SOPS Technical Expert Panel members and Westat project staff for their valuable input during various phases of survey development. Jonathan Bakdash, PhD, from AHRQ provided helpful comments on the manuscript. Caren Ginsberg, PhD, formerly at AHRQ, provided input and weighed in throughout the development process. We are also grateful to the hospitals and provider and staff respondents of the survey.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSorra J, Yount N, Famolaro T, et al. AHRQ Hospital Survey on Patient Safety Culture Version 2.0: User\u0026rsquo;s Guide. (Prepared by Westat, under Contract No. HHSP233201500026I/ HHSP23337004T). Rockville, MD: Agency for Healthcare Research and Quality; June 2021. AHRQ Publication No. 19(21)-0076. Available at: https://www.ahrq.gov/sops/surveys/hospital/index.html.\u003c/li\u003e\n\u003cli\u003eInstitute for Healthcare Improvement (IHI). Safer Together: A National Action Plan to Advance Patient Safety. Boston, MA, USA, 2020; Available at: www.ihi.org/SafetyActionPlan. Accessed August 2025.\u003c/li\u003e\n\u003cli\u003eAgency for Healthcare Research and Quality (AHRQ). SOPS Hospital Survey. Available at: https://www.ahrq.gov/sops/surveys/hospital/index.html. Accessed August 2025.\u003c/li\u003e\n\u003cli\u003eSorra, J.S., Dyer, N. Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture. \u003cem\u003eBMC Health Serv Res\u003c/em\u003e\u003cstrong\u003e10\u003c/strong\u003e, 199 (2010). Available at: http://www.biomedcentral.com/1472-6963/10/199. Accessed August 2025.\u003c/li\u003e\n\u003cli\u003eFan, C. J., Pawlik, T. M., Daniels, T., Vernon, N., Banks, K., Westby, P., Wick, E. C., Sexton, J. B., \u0026amp; Makary, M. A. (2016). Association of safety culture with surgical site infection outcomes. Journal of the American College of Surgeons, 222(2), 122\u0026ndash;128. Available at: https://doi.org/10.1016/j.jamcollsurg.2015.11.008.\u003c/li\u003e\n\u003cli\u003eNoghrehchi P, Hefner JL, Stegall H, Walker DM. Exploring the Relationship Between Hospital Patient Safety Culture and Performance on Measures of Hospital-Acquired Conditions. J Patient Saf. 2024 Dec 1;20(8):549-555. doi: 10.1097/PTS.0000000000001281. PMID: 39565069.\u003c/li\u003e\n\u003cli\u003eUpadhyay S, Weech-Maldonado R, Lemak CH, Stephenson A, Mehta T, Smith DG. Resource-based view on safety culture\u0026apos;s influence on hospital performance: The moderating role of electronic health record implementation. Health Care Manage Rev. 2020 Jul/Sep;45(3):207-216. Available at: https://doi.org/10.1097/hmr.0000000000000217.\u003c/li\u003e\n\u003cli\u003eNoghrehchi P, Hefner JL, Walker DM. The relationship between hospital patient safety culture and performance on Centers for Medicare \u0026amp; Medicaid Services value-based purchasing metrics. Health Care Manage Rev. 2024 Oct-Dec 01;49(4):281-290. doi: 10.1097/HMR.0000000000000414.\u003c/li\u003e\n\u003cli\u003eMardon, R. E., Khanna, K., Sorra, J., Dyer, N., \u0026amp; Famolaro, T. (2010). Exploring relationships between hospital patient safety culture and adverse events. Journal of patient safety, 6(4), 226\u0026ndash;232. https://doi.org/10.1097/PTS.0b013e3181fd1a00.\u003c/li\u003e\n\u003cli\u003eSorra, J., Khanna, K., Dyer, N., Mardon, R., \u0026amp; Famolaro, T. (2012). Exploring relationships between patient safety culture and patients\u0026apos; assessments of hospital care. Journal of patient safety, 8(3), 131\u0026ndash;139. Available at: https://doi.org/10.1097/PTS.0b013e318258ca46.\u003c/li\u003e\n\u003cli\u003eAbrahamson, K., Hass, Z., Morgan, K., Fulton, B., \u0026amp; Ramanujam, R. (2016). The Relationship Between Nurse-Reported Safety Culture and the Patient Experience. \u003cem\u003eThe Journal of nursing administration\u003c/em\u003e,\u003cem\u003e 46\u003c/em\u003e(12), 662-668. Available at: https://pubmed.ncbi.nlm.nih.gov/27851708/.\u003c/li\u003e\n\u003cli\u003eSmith, S. A., Yount, N., \u0026amp; Sorra, J. (2017). Exploring relationships between hospital patient safety culture and Consumer Reports safety scores. BMC health services research, 17(1), 143. Available at: https://doi.org/10.1186/s12913-017-2078-6.\u003c/li\u003e\n\u003cli\u003eAgency for Healthcare Research and Quality (AHRQ). International Use of SOPS. Available at: https://www.ahrq.gov/sops/international/index.html. Accessed August 2025.\u003c/li\u003e\n\u003cli\u003eMarx, D. April 2001. Patient Safety and the \u0026quot;Just Culture\u0026quot;: A Primer for Health Care Executives. Available at: https://web.archive.org/web/20220120031819/http:/www.chpso.org/sites/main/files/file-attachments/marx_primer.pdf (PDF archived).\u003c/li\u003e\n\u003cli\u003eWu AW, Shapiro J, Harrison R, Scott SD, Connors C, Kenney L, Vanhaecht K. The Impact of Adverse Events on Clinicians: What\u0026apos;s in a Name? J Patient Saf. 2020 Mar;16(1):65-72. doi: 10.1097/PTS.0000000000000256. PMID: 29112025. Available at: https://pubmed.ncbi.nlm.nih.gov/29112025/.\u003c/li\u003e\n\u003cli\u003eLenzner, T., Hadler, P., \u0026amp; Neuert, C. (2023). An experimental test of the effectiveness of cognitive interviewing in pretesting questionnaires. \u003cem\u003eQuality \u0026amp; Quantity\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(4), 3199-3217.\u003c/li\u003e\n\u003cli\u003eNunnally J. C., \u0026amp; Bernstein, I. H. (1994). \u003cem\u003ePsychometric theory\u003c/em\u003e (3\u003csup\u003erd\u003c/sup\u003e ed.). New York: McGraw-Hill.\u003c/li\u003e\n\u003cli\u003eDeVellis, R. F. (2003). \u003cem\u003eScale development: Theory and applications\u003c/em\u003e (Vol. 26). Thousand Oaks, CA: Sage.\u003c/li\u003e\n\u003cli\u003eStevens, J. P. (2002). \u003cem\u003eApplied multivariate statistics for the social sciences\u003c/em\u003e (4\u003csup\u003eth\u003c/sup\u003e ed.). Mahwah, NJ: Lawrence Erlbaum.\u003c/li\u003e\n\u003cli\u003eSchumacker R., \u0026amp; Lomax, R. (2004). \u003cem\u003eA beginner\u0026rsquo;s guide to structural equation modeling (2\u003csup\u003end\u003c/sup\u003e ed.). Mahwah, NJ: Lawrence Erlbaum.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eHu L. T., \u0026amp; Bentler, P. M. (1999). Cutoff criteria for fit indices in covariance structure analysis: Conventional criteria versus new alternatives. \u003cem\u003eStructural Equation Modeling, 6\u003c/em\u003e, 1-55.\u003c/li\u003e\n\u003cli\u003eKline, R. B. (2005). \u003cem\u003ePrinciples and practice of structural equation modeling\u003c/em\u003e (2\u003csup\u003end\u003c/sup\u003e ed.) New York: The Guilford Press.\u003c/li\u003e\n\u003cli\u003eKenny, D. A. (2015). Measuring model fit. Available at: http://davidakenny.net/cm/fit.htm.\u003c/li\u003e\n\u003cli\u003eAgency for Healthcare Research and Quality. Surveys on Patient Safety Culture (SOPS) Hospital Survey 2.0. Available at: https://www.ahrq.gov/sops/surveys/hospital/index.html.\u003c/li\u003e\n\u003cli\u003eAgency for Healthcare Research and Quality. Communication and Optimal Resolution (CANDOR). Available at: https://www.ahrq.gov/professionals/quality-patient-safety/patient-safetyresources/resources/candor/index.html.\u003c/li\u003e\n\u003cli\u003eBoothman RC. CANDOR: The Antidote to Deny and Defend? Health Serv Res. 2016 Dec;51 Suppl 3(Suppl 3):2487-2490. doi: 10.1111/1475-6773.12626. PMID: 27892621; PMCID: PMC5134336.\u003c/li\u003e\n\u003cli\u003eEdrees H, Connors C, Paine L, Norvell M, Taylor H, Wu AW. Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study. BMJ Open. 2016 Sep 30;6(9):e011708. doi: 10.1136/bmjopen-2016-011708. PMID: 27694486; PMCID: PMC5051469.\u003c/li\u003e\n\u003cli\u003eSorra, J. (2023). Linking Provider and Staff Perceptions of Patient Safety Culture with Patient Experience in Hospitals. CAHPS 2023 Research Meeting Summary. Rockville, MD. Available at: https://www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/2023-virtual-research-meeting-summary-patient-experience.pdf.\u003c/li\u003e\n\u003cli\u003eHesgrove, B., Zebrak, K., Yount, N., Sorra, J., \u0026amp; Ginsberg, C. (2024). Associations between patient safety culture and workplace safety culture in hospital settings. BMC health services research, 24(1), 568. Available at: https://doi.org/10.1186/s12913-024-10984-3.\u003c/li\u003e\n\u003cli\u003eZebrak, K. A., Yount, N. D., Sorra, J. A., Famolaro, T. E., Gray, L. C., Carpenter, D., \u0026amp; Caporaso, A. (2022). Development, pilot study, and psychometric analysis of the AHRQ Surveys on Patient Safety Culture\u0026trade; (SOPS\u0026reg;) workplace safety supplemental items for hospitals. International Journal of Environmental Research and Public Health, 19(11), 6815. Available at: https://doi.org/10.3390/ijerph19116815.\u003c/li\u003e\n\u003cli\u003eAgency for Healthcare Research and Quality. Health IT Patient Safety Supplemental Items for the SOPS Hospital Survey. Available at: https://www.ahrq.gov/sops/surveys/hospital/supplemental-items/health-it.html.\u003c/li\u003e\n\u003cli\u003eSorra, J., Zebrak, K., Yount, N., Famolaro, T., Gray, L., Franklin, M., Smith, S., \u0026amp; Streagle, S. (2022). Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices. BMJ Quality and Safety, 31(7), 493-502. Available at: https://doi.org/10.1136/bmjqs-2020-012407.\u003c/li\u003e\n\u003cli\u003eCenters for Medicare and Medicaid Services (CMS). Patient Safety Structural Measure (PSSM). Available at: https://qualitynet.cms.gov/pch/measures/safety.\u003c/li\u003e\n\u003cli\u003eBates DW, Levine DM, Salmasian H, Syrowatka A, Shahian DM, Lipsitz S, Zebrowski JP, Myers LC, Logan MS, Roy CG, Iannaccone C, Frits ML, Volk LA, Dulgarian S, Amato MG, Edrees HH, Sato L, Folcarelli P, Einbinder JS, Reynolds ME, Mort E. The Safety of Inpatient Health Care. N Engl J Med. 2023 Jan 12;388(2):142-153. doi: 10.1056/NEJMsa2206117. PMID: 36630622.\u003c/li\u003e\n\u003cli\u003eBerwick DM. Constancy of Purpose for Improving Patient Safety - Missing in Action. N Engl J Med. 2023 Jan 12;388(2):181-182. doi: 10.1056/NEJMe2213567. PMID: 36630628.\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"patient safety culture, survey, patient safety, safety culture, psychometrics, hospital patient safety culture, hospital safety culture","lastPublishedDoi":"10.21203/rs.3.rs-7829818/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7829818/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Establishing a culture of patient safety is essential to delivering safe and high quality care within healthcare organizations. Understanding the importance of measuring patient safety culture using a standardized tool, the Agency for Healthcare Research and Quality (AHRQ) released the Surveys on Patient Safety Culture\u003csup\u003e®\u003c/sup\u003e (SOPS\u003csup\u003e®\u003c/sup\u003e) Hospital Survey (HSOPS 1.0) in 2004. Based on input from various sources, the goals of this study were to develop and pilot test a shorter, updated version of the survey, the SOPS Hospital Survey 2.0 (HSOPS 2.0), and assess the new survey’s psychometric properties.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eSurvey development included survey user feedback, a literature review, 56 cognitive interviews, and two multi-site pilot studies using web-based surveys. The first pilot in 2017 resulted in further edits to the HSOPS 2.0 survey and led to a second and final pilot in 2018-2019. Psychometric analysis was conducted on the final pilot test with data from 4,345 provider and staff respondents in 25 hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOverall, the psychometric properties of the HSOPS 2.0 survey were good for the 32 survey items grouped into 10 composite measures and two single-item measures. All but one of the composite measures had acceptable internal consistency reliability, and site-level reliability was also acceptable for all but one composite measure, which was slightly below the criterion. Construct validity was supported by acceptable CFA fit indices and statistically significant, moderate to high hospital-level correlations among most of the measures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The goals of the HSOPS 2.0 survey were to improve upon the original 1.0 survey by developing an updated, shorter, reliable instrument while measuring similar core concepts as the 1.0 version. The HSOPS 2.0 survey demonstrates good psychometric properties and is a reliable and valid instrument for assessing patient safety culture. Health systems, hospitals, and researchers can use the HSOPS 2.0 survey to raise awareness about patient safety among hospital providers and staff, assess patient safety culture to identify areas of strength and opportunities for improvement, and to ultimately improve the overall safety and quality of care.\u003c/p\u003e","manuscriptTitle":"Advancing the Measurement of Patient Safety Culture: Development and Psychometrics of the AHRQ SOPS Hospital Survey Version 2.0","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-17 15:24:02","doi":"10.21203/rs.3.rs-7829818/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-12T20:14:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-04T06:47:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-31T06:40:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-27T18:08:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136842192923672647030132881813541556576","date":"2025-12-25T07:42:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-23T17:59:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178909406085481710061116907964045649861","date":"2025-12-21T19:04:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-21T18:38:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69710118529382943260154051710645138979","date":"2025-12-19T18:59:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"322846401094706960275081513235667236608","date":"2025-12-16T09:19:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63332235846330641140806772033747719561","date":"2025-12-14T11:30:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131285014418380108966299225293624606420","date":"2025-12-12T11:20:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247761916569887494818783551748637454813","date":"2025-12-12T11:07:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-12T10:52:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-24T15:43:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-22T19:20:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-22T15:25:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-10-22T14:48:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"92eb2723-d4d3-4dc4-9e4b-829da02a0b93","owner":[],"postedDate":"December 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-17T15:24:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-17 15:24:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7829818","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7829818","identity":"rs-7829818","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}