Ambulatory Surgery Center Survey: 2020 User Database Report

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Surveys on PatientSafety CultureTM(SOPSTM)AmbulatorySurgery CenterSurvey: 2020User DatabaseReportPATIENTSAFETY

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Surveys on Patient Safety CultureTM (SOPSTM)Ambulatory Surgery Center Survey:2020 User Database ReportPart IPrepared for:Agency for Healthcare Research and QualityU.S. Department of Health and Human Services5600 Fishers LaneRockville, MD 20857www.ahrq.govContract No. HHSP233201500026IManaged and prepared by:Westat, Rockville, MDTheresa Famolaro, M.P.S., M.S., M.B.A.Ryan HareShakia ThorntonNaomi Dyer Yount, Ph.D.Lei Fan, M.D., Ph.D.Helen LiuJoann Sorra, Ph.D.AHRQ Publication No. 20-0016January 2020

Public Domain Notice. This product is in the public domain and may be used and reprintedwithout permission in the United States for noncommercial purposes, unless materials areclearly noted as copyrighted in the document. No one may reproduce copyrighted materialswithout the permission of the copyright holders. Users outside the United States must getpermission from AHRQ to reprint or translate this product. Anyone wanting to reproduce thisproduct for sale must contact AHRQ for permission.Surveys on Patient Safety Culture and SOPS are trademarks of AHRQ.Suggested Citation:Famolaro T, Hare R, Thornton S, Yount ND, Fan L, Liu H, Sorra J. Surveys on Patient SafetyCultureTM (SOPSTM) Ambulatory Surgery Center Survey: 2020 User Database Report. (Preparedby Westat, Rockville, MD, under Contract No. HHSP233201500026I). Rockville, MD: Agencyfor Healthcare Research and Quality; January 2020. AHRQ Publication No. 20-0016.The authors of this report are responsible for its content. Statements in thereport should not be construed as endorsement by the Agency for HealthcareResearch and Quality or the U.S. Department of Health and Human Services.No investigators have any affiliations or financial involvement (e.g.,employment, consultancies, honoraria, stock options, expert testimony, grantsor patents received or pending, or royalties) that conflict with materialpresented in this report.ii

Table of ContentsSectionPageOverview . 1Purpose and Use of This Report . 31Introduction . 4Survey Content.52345Survey Administration Statistics . 6Facility Characteristics.7Respondent Characteristics . 9Overall Results . 11Composite Measure and Item Charts . 12Composite Measure Results . 12Item Results . 12Near-Miss Documentation . 12Overall Ratings on Patient Safety . 12Communication in the Surgery/Procedure Room . 126Comparing Facility Results . 19Composite Measure and Item Tables . 197What’s Next? Action Planning for Improvement . 26AHRQ Action Planning Tool. 26Resource List for Users of the AHRQ Ambulatory Surgery Center Survey .27Notes: Description of Data Cleaning, Calculations, and Data Limitations . 28Data Cleaning. 28Response Rates . 28Calculation of Percent Positive Scores. 29Statistically “Significant” Differences Between Scores . 31Data Limitations . 34Appendixes A and B: Overall Results by Facility Characteristics and RespondentCharacteristics . 36Highlights From Appendix A: Overall Results by Facility Characteristics.37Highlights From Appendix B: Overall Results by Respondent Characteristics .372020 SOPS Ambulatory Surgery Center Database Reportiii

List of FiguresFigureFigure 1.PagePatient Safety Culture. 4List of TablesTableTable 1-1.Table 2-1.Table 2-2.Table 3-1.Table 4-1.Table 6-1.Table 6-2.Table 6-3.Table 6-4.Table 6-5.Table N1.Table N2.Table N3.Table N4.Table N5.PagePatient Safety Culture Composite Measures and Definitions .5Overall Response Statistics – 2020 SOPS ASC Database . 6Survey Administration Mode Statistics – 2020 SOPS ASC Database . 6Distribution of 2020 SOPS ASC Database by Facility Characteristics . 8Distribution of 2020 SOPS ASC Database by Respondent Characteristics . 10Composite Measure Results – 2020 SOPS ASC Database . 20Item Results – 2020 SOPS ASC Database . 21Item Results on Near-Miss Documentation – 2020 SOPS ASC Database . 24Item Results on Overall Rating on Patient Safety – 2020 SOPS ASCDatabase . 24Item Results on Communication in the Surgery/Procedure Room – 2020SOPS ASC Database .25Example of Computing Item and Composite Measure Percent PositiveScores. 30Data Table for Example of How To Compute Percentiles . 32Interpretation of Percentile Scores . 33Sample Percentile Statistics . 34Distribution of AHRQ 2020 SOPS ASC Database Compared With Centersfor Medicare & Medicaid Services (CMS) Ambulatory Surgery Centers byRegion.352020 SOPS Ambulatory Surgery Center Database Reportiv

List of ChartsChartChart 5-1.Chart 5-2.Chart 5-3Chart 5-4.Chart 5-5.PageComposite Measure Results Average Percent Positive Response – 2020SOPS ASC Database . 13Item Results Average Percent Positive Response - 2020 SOPS ASCDatabase . 14Item Results Average Ratings on Near-Miss Documentation – 2020 SOPSASC Database . 17Item Results Average Overall Rating on Patient Safety - 2020 SOPS ASCDatabase . 17Item Results Average Percent Positive Response on Communication inthe Surgery/Procedure Room - 2020 SOPS ASC Database . 182020 SOPS Ambulatory Surgery Center Database Reportv

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OverviewThe ASC SOPS Database assesses provider and staff perceptions of their organization's patientsafety culture. The ASC SOPS Database includes data from:10,527282Participatingambu latory surgery centersRespondentsThe survey assesses 8 areas, or composite measures, of patient safety culture.Communication AboutPatient InformationCommunication OpennessManagement Support forPatient SafetyOrganizational LearningContinuous ImprovementResponse to MistakesStaff TrainingStaffing, Work Pressure,and PaceTeamwork74%92%of respondents reported that the facilityactively looks for ways to improve patientsafety and makes changes to ensure thatproblems do not recur.of respondents indicated that there are enoughstaff to handle the workload, they do not feelrushed, and they have enough time to properlyprepare for procedures.2020 SOPS Ambulatory Surgery Center Database Report1

OTHER FINDINGSCommunication in the Surgery/Procedure RoomIn the past 6 months, how often were the following actions done in your facility?93%of respondents reported that before the start ofprocedures, team members stopped to discuss theoverall plan.of respondents reported that before the start ofprocedures, the doctor encouraged team members tospeak up at any time.76%of respondents reported that immediately afterprocedures, team members discussed any concernsfor patient recovery.Overall Patient Safety Rating53%86%33%of respondentsrated their ASC"Excellent" or11%"Very good "ExcellentVery goodGood3%0%FairPoorWhat's Next? Action planning for improving patient safety culture1. Define your goals2.Plan your initiatives3.Communicate your action planThe Action Planning Tool for the AHRQ Surveys on Patient Safety Culture provides step-by-step instructions on howto develop an action plan to improve patient safety culture, available at www.ahrg.gov/sops.2020 SOPS Ambulatory Surgery Center Database Report2

Purpose and Use of This ReportIn response to requests from ambulatory surgery centers (ASCs) interested in comparing resultson the Surveys on Patient Safety CultureTM (SOPSTM) Ambulatory Surgery Center Survey withresults from other ASCs, the Agency for Healthcare Research and Quality (AHRQ) establishedthe SOPS Ambulatory Surgery Center Database.This report presents statistics (averages, standard deviations, minimum and maximum scores,and percentiles) on the patient safety culture composite measures and items from the survey. Italso includes two appendixes: Appendix A presents results by facility characteristics (number of operating/procedurerooms and geographic region).Appendix B presents results by respondent characteristics (staff position and hoursworked per week).2020 SOPS Ambulatory Surgery Center Database Report3

1IntroductionOrganizational culture refers to the beliefs, values, and norms shared by staff throughout theorganization that influence their actions and behaviors. Patient safety culture is the extent towhich these beliefs, values, and norms support and promote patient safety. Patient safetyculture can be measured by determining what is rewarded, supported, expected, and accepted inan organization as it relates to patient safety (see Figure 1).Figure 1. Patient Safety Culture2020 SOPS Ambulatory Surgery Center Database Report4

Survey ContentAHRQ funded the development of the SOPS Ambulatory Surgery Center Survey. The surveyincludes 27 items making up 8 composite measures of patient safety culture. Table 1-1 lists anddefines each of the 8 patient safety culture composite measures.Table 1-1. Patient Safety Culture Composite Measures and DefinitionsPatient Safety Culture Composite MeasuresCommunication About Patient InformationCommunication OpennessManagement Support for Patient SafetyOrganizational Learning—ContinuousImprovementResponse to MistakesStaff TrainingStaffing, Work Pressure, and PaceTeamworkDefinition: The extent to which Key information about patients is available and wellcommunicated within the ASC.Staff speak up when they see something unsafe, they feelcomfortable asking questions, and their suggestions are valued.Managers examine near-miss events, provide adequateresources, and encourage everyone to suggest ways to improvepatient safety.The facility actively looks for ways to improve patient safety andmakes changes to ensure that problems do not recur.Staff are told about patient safety problems, learning ratherthan blame is emphasized, and staff are treated fairly when theymake mistakes.Staff receive adequate orientation, get the refresher and on-thejob training they need, and do not feel pressured to do tasksthey are not trained to do.Staff do not feel rushed, they have enough time to properlyprepare for procedures, and there are enough staff to handlethe workload.Staff are respectful and help each other, work together as aneffective team, and understand each other’s roles andresponsibilities.In addition to the composite measure items, the survey includes a question about near-missdocumentation, a question that asks respondents to provide an overall rating of patient safety,and three questions about communication in the surgery/procedure room. The survey alsoincludes two background questions.2020 SOPS Ambulatory Surgery Center Database Report5

2Survey Administration StatisticsThis chapter presents descriptive information on the number of ASCs and survey respondentsincluded in the 2020 SOPS ASC Database and information about response rates (Table 2-1) andhow ASCs administered the survey (Table 2-2).Highlights28210,52787%Participating AmbulatorySurgery CentersNumber ofRespondentsAverage ASCResponse RateTable 2-1. Overall Response Statistics – 2020 SOPS ASC DatabaseOverall Response Rate InformationStatisticTotal number of respondentsTotal number of surveys administered10,52712,023Average Response InformationStatisticAverage number of respondents per ASC (range: 5 to 153)Average number of surveys administered per ASC (range: 6 to 154)Average ASC response rate (range: 10% to 100%)374487%Table 2-2. Survey Administration Mode Statistics – 2020 SOPS ASC DatabaseASCsSurvey Administration ModePaper onlyWeb onlyTotalRespondentsAverageResponse %100%2,0858,44210,52720%80%100%79%90%2020 SOPS Ambulatory Surgery Center Database Report6

3Facility CharacteristicsThis chapter presents information about the distribution of ASCs included in the 2020 SOPSASC Database by facility characteristics, including number of operating/procedure rooms,geographic region, and number of specialties (single vs. multispecialty) (Table 3-1).HighlightsNumber ofOperating/Procedure Rooms1 to 2 rooms15%3 rooms18%4 to5 rooms37%6 rooms 30%2020 SOPS Ambulatory Surgery Center Database Report77%Of ASCs WereMultispecialty7

Table 3-1. Distribution of 2020 SOPS ASC Database by Facility CharacteristicsFacility CharacteristicNumber of Operating/Procedure Rooms1 to 2 rooms3 rooms4 to 5 rooms6 rooms or moreCensus Region 1NortheastMidwestSouthWestSingle Specialty vs. MultispecialtySingle specialtyMultispecialtyASCs(n ondents(n %21%39%27%Percent17%83%Note: Percentages may not add to 100 percent due to rounding. States are categorized into regions as follows: Northeast: CT, MA, ME, NH, NJ, NY, PA, RI, VT Midwest: IL, IN, IA, KS, MI, MN, MO, ND, NE, OH, SD, WI South: AL, AR, DC, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, WV West: AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, WY1Census regions and divisions of the United States. erence/us regdiv.pdf. Accessed October 3, 2019.2020 SOPS Ambulatory Surgery Center Database Report8

4Respondent CharacteristicsThis chapter describes respondent characteristics for 10,527 respondents in the 2020 SOPS ASCDatabase (Table 4-1).Highlights44%35%of respondents were nurses, the mostprevalent ASC staff positionof respondents worked32-40 hours per week in their ASC2020 SOPS Ambulatory Surgery Center Database Report9

Table 4-1. Distribution of 2020 SOPS ASC Database by Respondent CharacteristicsRespondent CharacteristicsStaff PositionAnesthesiologistDoctor/Physician (excluding Anesthesiologists) or SurgeonCertified Registered Nurse Anesthetist (CRNA)Physician Assistant or Nurse PractitionerManagementNurseTechnicianOther Clinical Staff or Clinical Support StaffAdministrative, Clerical, or Business StaffOtherTotalMissingOverall totalHours Worked per Week in ASC1 to 16 hours17 to 31 hours32 to 40 hoursMore than 40 hoursTotalMissingOverall 2110%10,122100%40510,527Note: Percentages may not add to 100 percent due to rounding.2020 SOPS Ambulatory Surgery Center Database Report10

5Overall ResultsThis chapter presents the overall survey results, which include the average percentage ofpositive responses across the ASCs on each of the survey’s composite measures and items.Reporting the average across all ASCs ensures that each ASC receives an equal weight. Analternative method would be to report a straight percentage of positive responses across allrespondents, but this method would give greater weight to larger ASCs. Reporting the data atthe ASC level is important because culture is considered a group characteristic and not anindividual characteristic.HighlightsHighest Scoring Composite MeasureOrganizational Learning-Continuous ImprovementLowest Scoring Composite MeasureStaffing, Work Pressure, and Pace92%respondentsofreported that the facility actively looksfor ways to improve patient safety and makes changesto ensure that problems do not recur.74%respondentsofindicated that there are enough staff tohandle the workload, they do not feel rushed, and theyhave enough time to properly prepare for procedures.Overall Rating onPatient Safety86%respondentsofgave their ASC an overall patient safetyrating of excellent or very good.2020 SOPS Ambulatory Surgery Center Database Report11

Composite Measure and Item ChartsThis section provides the composite measure and item results. The methods for calculating thepercent positive scores at the composite measure and item levels are described in the Notessection of this report.Composite Measure ResultsChart 5-1 shows the average percent positive response for each of the eight patient safety culturecomposite measures across ASCs in the database. The patient safety culture composite measuresare shown in order from the highest average percent positive response to the lowest.Item ResultsChart 5-2 shows the average percent positive response for each of the 27 composite measureitems. The items are grouped by the patient safety culture composite measure to which

Table 2-1. Overall Response Statistics 2020 SOPS ASC Database, Page 6. Table 2-2. Survey Administration Mode Statistics 2020 SOPS ASC Database, Page 6. Table 3-1. Distribution of 2020 SOPS ASC Database by Facility Characteristics, Page 8. Table 4-1. Distribution of 2020 SOPS ASC Database by Respondent Characteristics, Page 10. Table 6-1.

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