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Newman Memorial Hospital, a 79-bed acute hospital in Oklahoma, first implemented AHRQ's "Hospital Survey on Patient Safety Culture" in 2006, when concern about the hospital's patient safety arose as a result of worker injuries. Since using the survey, the facility has shown a significant decrease in both the incidence of reportable injuries and errors throughout the hospital.

Gary W. Mitchell, FACHE, Chief Executive Officer at Newman Memorial Hospital, says, "We chose AHRQ's 'Hospital Survey on Patient Safety Culture' because we needed an evaluation tool that was thorough and that came with benchmarking for a large group. We were pleased to find that ÂÜÀòÊÓƵoffered the product, and it was available without charge."

Newman Memorial Hospital has been involved with numerous State-level Quality Improvement Organization (QIO) projects, but none involving safety evaluation. Mitchell adds, "We also felt this was a terrific opportunity to evaluate our programs and to validate program performance, while establishing areas for improvement."

AHRQ's "Hospital Survey on Patient Safety Culture" was implemented by establishing an onsite coordinator who reported to administration. Management staff was educated on the tool and its significance. Ongoing monthly meetings were used to further staff education. The facility has seven active medical staff members and various visiting specialists, but 84 full-time employees took the survey.

Survey forms were distributed to staff through both payroll and management, with the latter method directly to managers with a request for support found to be more effective. An anonymous collection site was provided for employees and results were reviewed at the board, management, and staff levels. Internal reviews by administration, safety, and organizational improvement departments provided insight into some key issues, which the facility has worked to resolve.

According to Mitchell, staff were initially hesitant about completing the survey because of the small size of the facility and perceived lack of anonymity. This hesitancy led to a lower than expected response rate. Mitchell says, "By altering the completion process, the response rate improved and has been stable over the ensuing survey periods."

Newman Memorial's policy is to provide a nonpunitive response to safety reports and concerns in the belief that significant and real change to negative processes cannot be achieved without sharing knowledge in confidence. The responses reflect that staff still have reservations that they will be punished for completing the survey. Newman continues to focus attention on this concern through discussion and a broadened involvement with staff.

Following implementation of AHRQ's "Hospital Survey on Patient Safety Culture" at Newman Memorial Hospital, only one incident of a reportable injury in 3 years has been noted at the facility.

Other results include the following:

• Inclusion of safety as a core value in the hospital's value statement.
• Reporting improvements to the board of directors.
• Development of a Council on Quality and Safety for the State Hospital Association and involvement in the Oklahoma QIO effort.
• Improved education for all staff and recognition of staff concerns.
• Cultural shift in patient safety, with improved safety awareness and reporting of issues and recommendations.

Mitchell says, "We are pleased with our participation in the ÂÜÀòÊÓƵsurvey and plan to continue in the future. It has provided us with a tool to assess and improve our safety environment and culture, which ultimately delivers higher quality of care. We look forward to using the tool to continue our improvement and to show validation of numerous processes that are in place and working well."