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AHRQ's assessment tools for supporting patient safety and quality improvement extend beyond the U.S. health care system, benefiting users in other countries. Two hospitals in Colombia have implemented AHRQ's "Hospital Survey on Patient Safety Culture." AHRQ's tool helps hospitals assess their patient safety culture, track changes in patient safety over time, and evaluate the impact of patient safety interventions.

AHRQ's survey is being used by Fundación Santa Fe de Bogotá in its University Hospital in Bogotá as one of several strategies to promote and strengthen its patient safety culture. Specifically, the survey has been instrumental in helping create a baseline and to further evaluate progress of the implemented strategies.

Henry Gallardo, MD, University Hospital Director at Fundación Santa Fe de Bogotá, says, "We began using AHRQ's 'Hospital Survey on Patient Safety Culture' in 2007 at our hospital to measure the impact of our strategy on patient safety."

A pilot project was implemented with 1 percent of the hospital staff before initiating the survey in all clinical areas. Following the pilot, the survey was administered to 87 percent of staff, representing more than 950 employees.

The survey findings enabled University Hospital to compare its results with survey data from U.S. hospitals that have administered AHRQ's survey. Comparing the 2007 baseline results with results obtained in 2010 showed progress and improvement in most areas surveyed. The results obtained for organizational learning and continued improvement and for hospital leadership support were both 80 percent, which is better than the 72 percent average for U.S. hospitals. Regarding widespread recognition of patient safety, the results for University Hospital were equal (85 percent) to the average reported for hospitals in the United States. The hospital also made significant changes in important clinical practices and policies as a result of the survey findings, such as fostering and managing a nonpunitive culture and improving the level of event and risk reporting.

Gallardo says, "The survey is great! When we talked to Joint Commission evaluators about our approach, they do like it a lot—they were impressed. We are continuing to use AHRQ's 'Hospital Survey on Patient Safety Culture' to monitor the impact of our patient safety program. We have a systematic approach to patient safety with positive trends and results."

University Hospital is a 205-bed, high-complexity general hospital. It is equipped with 11 operating rooms and provides emergency care to over 85,000 patients annually. University Hospital uses electronic medical records in all of its areas, including radiology and laboratory information systems. It is also accredited by the Joint Commission International.

Another hospital in Colombia using AHRQ's survey is Imbanaco Medical Center (IMC) in Cali, which redesigned its strategic platform in 2003 to include its first patient safety program. The success of IMC's patient safety program caught the attention of the Colombian Department of Health, which now uses it as a model for other clinics and hospitals around the country.

Astolfo Franco, MD, Patient Safety Officer at IMC, says, "Even though there are other patient safety measurement tools available, Imbanaco selected AHRQ's 'Hospital Survey on Patient Safety Culture' because of its rigorous development standards and proven implementation record in over 380 hospitals in the United States." IMC adapted 21 of the 44 dimensions of AHRQ's survey in 2006, when the first survey was conducted. Subsequent surveys, using the same 21 dimensions, were completed in 2009 and in 2011.

Franco says, "The patient safety surveys conducted at IMC are not mandatory. However, the last survey implemented had a general acceptance rate of 89.2 percent. This showed a significant increase compared to previous years (76.5 percent in 2006 and 85.4 percent in 2009) and reflected the growth of IMC's patient safety program since its creation in 2003."

Overall, in 2011 IMC surveyed 257 individuals, including 36 doctors and specialists and over 140 nurses and other clinic personnel, including rehabilitation therapists and imaging technicians. A large majority of the survey participants were from hospital admissions, surgery, and emergency departments, as well as the intensive care units for adults and newborns.

The three dimensions with highest acceptance were:

1. If I was a patient from my specialty or service, I would feel safe (98.4 percent).
2. In my area of service or specialty, it is clear that you can ask questions freely about the decisions or actions of those with more authority (97.1 percent).
3. In my area of service or specialty, it is common, in order to ensure better outcomes, that a preliminary meeting is conducted regarding the procedure that will take place (96.9 percent).

IMC, founded in 1976, is a 117-bed facility serving highly-complex patients, including all medical specialties. Fifty percent of its patients have prepaid health plans and insurance. The rest are private patients or participate in a health maintenance organization program.