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AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Data FileSpecificationsAHRQAmbulatory Surgery Center Survey on Patient SafetyCultureSurvey Data File SpecificationsASC - 0519

AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Data File SpecificationsAHRQ Ambulatory Surgery Center on Patient Safety CultureSurvey Data File SpecificationsThese specifications are for preparing your respondent-level data from the Ambulatory SurgeryCenter Survey on Patient Safety Culture. The instructions below tell you how to prepare yourExcel data file for submission to the Ambulatory Surgery Center on Patient Safety CultureDatabase.INSTRUCTIONS (Excel File Only):Step 1: Include a header row with the variable name for each column.Step 2: Submit individual survey response data using the response values indicated in thisdocument (beginning on page 4).Step 3: Check your data before submitting for the following things: SKIP PATTERNThere is one skip pattern in this survey. If a respondent answers 2 No, to question GA,“Are you typically in the surgery/procedure room during surgeries, procedures, ortreatments?”, then questions G1 – G3 should be blank. OUT-OF-RANGE VALUESYou should clean your data before submitting to the database to ensure that there areno out-of-range values and that the data submitted are free from error. Make sure allresponse values match the response value for the question. REVERSE CODED ITEMSDo not submit reverse coded data on the survey’s negatively worded items—simplysubmit each individual’s unmodified responses to the survey items.For example, survey item A5, “Key information about patients is missing when it isneeded” is negatively worded. Regardless, the data should be submitted so that 1 Neverand 5 Always, as originally indicated in the survey, as follows:1 Never2 Rarely3 Sometimes4 Most of the time5 Always9 Does not apply or Don’t knowASC - 05192

AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Data File Specifications STAFF POSITIONSIf your ambulatory surgery center modified or added a new staff position (H1) category,you MUST RECODE your specific staff positions back to the survey’s original staffposition category. If you added staff positions that do not match any of the survey’soriginal staff positions, re-code your specific staff positions as “OTHER” (H1 “j”),before submitting your data. OTHER, PLEASE SPECIFY TEXTDo not include Other-Please Specify data and comments (question H1 and Section I).While you may find it useful to review this text, it should not be submitted to theDatabase. SPANISH VERSION OF THE SURVEYPlease indicate which respondents (if any) completed a Spanish version of the safetyculture survey, if you have this information available. You should do so by adding an ‘S’to the Individual Unique Record ID, e.g. 001S. OTHER LANGUAGE VERSION OF THE SURVEYPlease indicate which respondents (if any) completed the safety culture survey in a languagethat was not English or Spanish, if you have this information available. You should do so byadding an ‘N’ to the Individual Unique Record ID (UNIQUEID), e.g. 001N.ASC - 05193

AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Data File Layout –EXCELRecord IdentifierVariableNameColumn PositionSite IDSITEIDColumn AIndividual Unique Record IDUNIQUEIDColumn BResponse ValuesIf you are submitting data formultiple ambulatory surgery center,then each site should have a uniqueSite ID. If you have data for only oneambulatory surgery center, then itsSite ID can be 1.Each individual record in the datasetshould have a unique ID, e.g. 001,002, 003. NOTE: If an individualcompleted a Spanish survey, add an‘S’ at the end of the Record ID, e.g.001S. If an individual completed asurvey in another language otherthan English or Spanish, add an “N”at the end of the Record ID, e.g.001NSECTION A: Working in This FacilitySurvey QuestionVariableNameColumnPosition1. Important patient careinformation is clearlycommunicated acrossareas in this facilityA1Column C2. We feel comfortableasking questions whensomething doesn’tseem rightA2Column D3. We have enough staffto handle theworkloadA3Column EASC - 0519Response Values1 2 3 4 5 9 blank 1 2 3 4 5 9 blank 1 2 3 4 5 9 blank NeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissingNeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissingNeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissing4

AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Data File Layout –EXCELSurvey QuestionVariableNameColumnPosition4. When we see someonewith more authoritydoing somethingunsafe for patients, wespeak upA4Column F5. Key information aboutpatients is missingwhen it is neededA5Column G6. Our ideas andsuggestions are valuedin this facilityA6Column H7. We share keyinformation aboutpatients as soon as itbecomes availableA7Column I8. There is enough timebetween procedures toproperly prepare forthe next oneA8Column J9. Within this facility,we do a good jobcommunicatinginformation thataffects patient careA9Column KASC - 0519Response Values1 2 3 4 5 9 blank 1 2 3 4 5 9 blank 1 2 3 4 5 9 blank 1 2 3 4 5 9 blank 1 2 3 4 5 9 blank 1 2 3 4 5 9 blank NeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissingNeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissingNeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissingNeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissingNeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissingNeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissing5

AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Data File Layout –EXCELSurvey Question10. We feel rushed whentaking care of patientsVariableNameA10ColumnPositionColumn LResponse Values1 2 3 4 5 9 blank NeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissingSECTION B: Teamwork and TrainingSurvey QuestionVariableNameColumnPosition1 2 3 4 5 9 blank 1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissingStrongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissingColumnO1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissingColumnP1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissing1. When someone in thisfacility gets really busy,others help outB1ColumnM2. Staff who are new to thisfacility receive adequateorientationB2ColumnN3. Staff feel pressured to dotasks they haven’t beentrained to do4. Doctors and staff clearlyunderstand each other’sroles and responsibilitiesASC - 0519B3B4Response Values6

AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Data File Layout –EXCELSurvey QuestionVariableNameColumnPosition1 2 3 4 5 9 blank 1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissingStrongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissingColumnS1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissingColumnT1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissing5. We get the on-the-jobtraining we need in thisfacilityB5ColumnQ6. Our facility allowsdisrespectful behavior bythose working hereB6ColumnR7. Staff get the refreshertraining they need8. We work together as aneffective teamB7B8Response ValuesSECTION C: Organizational Learning/Response to MistakesSurvey Question1. This facility activelylooks for ways toimprove patient safetyASC - 0519VariableNameC1ColumnPositionColumnUResponse Values1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissing7

AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Data File Layout –EXCELSurvey QuestionVariableNameColumnPosition1 2 3 4 5 9 blank 1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissingStrongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissingColumnX1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissingColumnY1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissingColumnZ1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissing2. Staff are treated fairlywhen they makemistakesC2ColumnV3. We make improvementswhen someone pointsout patient safetyproblemsC3ColumnW4. Learning, rather thanblame, is emphasizedwhen mistakes are made5. Staff are told aboutpatient safety problemsthat happen in thisfacility6. We are good at changingprocesses to make surethe same patient safetyproblems don’t happenagainASC - 0519C4C5C6Response Values8

AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Data File Layout –EXCELSECTION D: Near-Miss DocumentationSurvey Question1. When somethinghappens that could harmthe patient, but does not,how often is itdocumented in anincident or nAAResponse Values1 2 3 4 5 9 blank NeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissingSECTION E: Management Support for Patient SafetySurvey QuestionVariableNameColumnPosition1. Managers encourageeveryone to suggestways to improve patientsafetyE1ColumnAB2. Management examinesnear-miss events thatcould have harmedpatients but did notE2ColumnAC3. Management providesadequate resources toimprove patient safetyE3ColumnADVariableNameColumnPositionResponse Values1 2 3 4 5 9 blank 1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissing or properly skippedStrongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissing or properly skipped1 2 3 4 5 9 blank Strongly disagreeDisagreeNeither agree nor disagreeAgreeStrongly agreeDoes not apply or Don’t knowMissing or properly skippedSECTION F: Overall RatingSurvey Question1. Please give your facilityan overall rating onpatient safety.ASC - 0519F1ColumnAEResponse Values1 2 3 4 5 blank PoorFairGoodVery goodExcellentMissing9

AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture Data File Layout –EXCELSECTION G: Communication in the Surgery/Procedure RoomSurvey QuestionVariableNameColumnPositionA. Are you typically in thesurgery/procedure roomduring surgeries,procedures, ortreatments?GAColumnAFResponse Values1 Yes2 Noblank MissingIf question GA (Column AF) 2 (No) then skip to section H.1 Never2 Rarely1. Just before the start of3 Sometimesprocedures, all teamColumn4 Most of the timeG1members stopped toAG5 Alwaysdiscuss the overall plan9 Does not apply or Don’t knowof what was to be doneblank Missing2. Just before the start ofprocedures, the doctorencouraged all teammembers to speak up atany time if they had anyconcernsG2ColumnAH3. Immediately afterprocedures, teammembers discussed anyconcerns for patientrecoveryG3ColumnAIASC - 05191 2 3 4 5 9 blank 1 2 3 4 5 9 blank NeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissingNeverRarelySometimesMost of the timeAlwaysDoes not apply or Don’t knowMissing10