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This report presents the results of a two-year study carried out under a contract with the Agency for Healthcare Research and Quality (AHRQ), which documents and analyzes the extent to which patient safety practices are being adopted by U.S. health care providers, examines hospital experiences with AHRQ's patient safety culture survey, and assesses trends in patient safety outcomes. The focus was on local initiatives to establish effective patient safety practices in the hospital, ambulatory care, and long-term care sectors. Successful implementation of these actions should lead to improved practices by providers and fewer adverse events for patients. Researchers also interviewed hospitals that use AHRQ's patient safety culture survey to learn their experiences with it. They performed case studies of patient safety activities in four communities: Indianapolis, Indiana; Cleveland, Ohio; Seattle, Washington; and Greenville, South Carolina. They also studied the dynamics of patient safety activities by hospitals in those communities and gathered information on how they adopted specific safe practices. Despite the progress observed, more work is needed to develop tools and measures for patient safety in the ambulatory care and long-term care sectors, as well as to establish a national capability to monitor changes in patient safety infrastructure, practices, and effects on a variety of involved stakeholders.
Table of Contents
Chapter One
Introduction and Background
Chapter Two
Uptake of Patient Safety Practices in Four U. S. Communities
Chapter Three
Use of the Hospital Survey on Patient Safety Culture
Chapter Four
National Survey on Adoption of NQF Safe Practices
Chapter Five
Trends for Patient Safety Outcomes
Chapter Six
Suggested Approach for Monitoring Effects of the Patient Safety Initiative
Appendix A
Boundary Spanners Interviewed In the Community Study
Appendix B
Case Studies from the Community Study
Appendix C
Summary of Results from Roundtable Discussions on NQF Safe Practices
Appendix D
NQF Safe Practices Not Included in Survey
Appendix E
Final Version of the Survey
Appendix F
Rationale for Design of the Survey Items
This work was sponsored by the Agency for Healthcare Research and Quality (AHRQ). The research was conducted in RAND Health, a division of the RAND Corporation.
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