Form
Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX
Thank you for accessing this questionnaire. It is intended to obtain your perceptions of the Agency for Healthcare Research and Quality’s/VA’s Patient Safety Improvement Corps (PSIC) training program. As part of this questionnaire, you, as a leader in your organization, are being asked to assess the usefulness of the training program to your organization and to identify the types of patient safety improvement activities in which your organization has engaged since your staff attended the PSIC training. Please note that we are also sending a questionnaire to PSIC participants for their input.
It is important to note that AHRQ is interested in learning about the ease of using and implementing the various PSIC program tools, resources, information, concepts, and techniques in your real world settings. This is not an evaluation of you or your progress in implementing the PSIC tools and concepts or your ability to share them with others. Rather, the information you provide regarding these tools, resources, information, concepts, and techniques will be used to enhance AHRQ’s patient safety tools and resources as well as future training initiatives. Your candid feedback is the only way that these enhancements can be achieved.
Please note that if you do not wish to answer a specific question, you can skip it. We do, however, encourage you to respond to all questions. Please note that all of your information will remain confidential and that all information provided to AHRQ as a result of this questionnaire will be reported at the aggregate level to ensure your confidentiality.
Should you have any questions or comments about this questionnaire or the PSIC evaluation project, please do not hesitate to contact Dr. Laura Steighner of the American Institutes for Research (AIR) at 202-403-5064 or lsteighner@air.org. Dr. Steighner is the project director for the PSIC evaluation contract, which AHRQ awarded to AIR in September 2007.
If you have concerns or questions about your rights as a participant, contact AIR’s Institutional Review Board (which is responsible for the protection of project participants) at IRB@air.org toll free at 1-800-634-0797 or c/o IRB, 1000 Thomas Jefferson Street, NW, Washington, DC 20007.
Public
reporting burden for this collection of information is estimated to
average 15
minutes per response, the estimated time required to complete
the survey. An agency may not conduct or sponsor, and a person
is not required to respond to, a collection of information unless it
displays a currently valid OMB control number. Form Approved: OMB
Number 0935-XXXX Exp. Date xx/xx/20xx. Send
comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing
this burden, to: AHRQ Reports Clearance Officer Attention: PRA,
Paperwork Reduction Project (0935-XXXX) AHRQ,
540 Gaither Road, Room # 5036, Rockville, MD 20850.
Please read carefully each question on this questionnaire. There are five primary sections:
Participant Characteristics
Transfer of PSIC Training to Your Organization
Post-PSIC Activities
Barriers and Facilitators to Use of PSIC Material in the Workplace
Outcomes of PSIC Participation
Note that the response scale for each question will vary from section to section. For example, in the Transfer of PSIC Training section you may be asked to respond to a given statement using a response scale wherein 1=Disagree, 2 = Neutral, 3= Agree, and 4=Don’t Know. By contrast, in the Post-PSIC Activities section, you will be asked to indicate whether a statement is applies for your organization using a response scale wherein 1=Yes, 2=No, and 3=Unsure. Please read each question carefully, and make sure that your selected response is what you intended.
In this section, you will be asked to provide information about yourself, your organization’s participation in the PSIC program, and your organization. Please answer candidly and note that your information will not be provided to any entity. All information will be reported to AHRQ on an aggregate level.
When did your organization participate in the Patient Safety Improvement Corps (PSIC) training program? [Select one]
2003-2004
2004-2005
2005-2006
2007-2008
Which of the following best characterizes your organization? [Select one]
State health department
Hospital or health care system
Quality Improvement Organization (QIO)
Hospital association
Patient safety center/commission
Long term care facility, assisted living facility, or home health agency
Critical access health system
Regional or state-based healthcare professional association or institution
Other: [Fill in the blank]
In what state is your organization located? [Provide drop-down menu of states]
What is your role within your organization? [Select one]
Chief Executive Officer
Chief Operations Officer
Director of Patient Safety or Quality Improvement
Patient Safety Officer
Administrator of Patient Safety or Quality Improvement
Director of Standards and Compliance
Medical Director
Chief Medical Officer
Other: [Fill in the blank]
How long have you served in this role (at your organization?)
0-1 years
2-5 years
6-10 years
11 or more years
How long has your organization been actively engaged in patient safety initiatives?
0-1 years
2-5 years
6-10 years
11 or more years
In this section, you, as a leader in your organization, are being asked to assess the ease with which your organization has been able to transfer the PSIC concepts, tools, information, techniques, and resources into the workplace or to other organizations you support.
To what extent do you agree with the following statements about the PSIC training in relation to the patient safety needs of your organization?
Statements |
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2 Neutral |
3 Agree
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4 Don’t Know |
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For QIO and State Health Department Leaders Only: To what extent do you agree with the following statements about the PSIC training in relation to the patient safety needs of the organizations you support?
Statements |
1
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2 Neutral |
3 Agree
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4 Don’t Know |
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In this section, you are being asked to identify what post-PSIC training patient safety activities have begun or are underway at your organization and/or those organizations you support since your organization’s participation in the PSIC program.
In which of the following activities has your organization engaged since participating in the PSIC program?
As a result of PSIC training, I am aware that my organization has: |
1 Yes |
2 No |
3 Unsure |
Does Not Apply |
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FOR Hospital/Providers & QIOs Only |
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If you responded “1-Yes” to any of the statements listed above, please describe in detail the patient safety activity or activities and how the PSIC concepts, tools, information, techniques, and resources contributed to the effort.
For QIOs and State Health Department Leaders ONLY: Which of the following activities are true of the organizations you have supported with PSIC concepts, tools, information, techniques, and resources since your organization participated in the PSIC program?
As a result of PSIC training, I am aware that organizations we support have: |
1 Yes |
2 No |
3 Unsure |
Does Not Apply |
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FOR QIOs Only |
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If you responded “1-Yes” to any of the statements listed above, please describe in detail the patient safety activity or activities and how PSIC concepts, tools, information, techniques, and resources contributed to the effort.
In this section, you are being asked to identify any facilitators and barriers you have encountered when trying to use or support others in the use of PSIC concepts, tools, information, techniques, and resources. Please keep in mind that we ask you to select the facilitators and barriers that are most important or significant for you in your experience as an organizational leader.
Which of the following factors have helped your organization or organizations that you have supported implement the PSIC concepts, tools, information, and/or techniques? [Check all that apply]
Ample time or resources made available to support the use of PSIC concepts, tools, information, techniques, and resources
Information sharing between parties to support the use of PSIC concepts, tools, information, techniques, and resources
Organizational events that draw attention to the need for use of PSIC concepts, tools, information, techniques, and resources
Reported staff enthusiasm to engage in the use of PSIC concepts, tools, information, techniques, and resources
Reported staff work redistribution leading to willingness to engage in use of new concepts, tools, information, techniques, and resources
Please identify any other significant factors that have helped your organizational members implement PSIC concepts, tools, information, techniques, and/or resources in your organization or in the organizations you support since attending training.
Which of the following barriers has your organization or organizations that you have supported encountered when implementing the PSIC concepts, tools, information, techniques, and resources? [Check all that apply]
Lack of time or resources made available to support the use of PSIC concepts, tools, information, techniques, and resources
Lack of information sharing between parties to support the use of PSIC concepts, tools, information, techniques, and resources
Distractions or organizational events that draw priorities away from using the new PSIC concepts, tools, information, techniques, and resources
Reported work overload leading to resistance to using PSIC concepts, tools, information, techniques, and resources
Please identify any other significant barriers to the use of PSIC concepts, tools, information, techniques, and resources implementation you have experienced or that others have brought to your attention.
In this section, you are being asked to assess what patient safety changes have occurred in your organization or the organizations you support as a result of your organization’s participation in PSIC and post-PSIC patient safety activities. These outcomes can range from increased awareness to changes in processes or policies. Consider all potential outcomes of your organization’s participation in the PSIC and post-training activities.
As a result of your organization’s participation in the PSIC program and conducting post-PSIC patient safety activities, have the following aspects changed at your organization?
As a result of my organization’s participation in PSIC training and post-PSIC patient safety activities, I have noticed that in my organization, … |
1 Disagree |
2 Neutral |
3 Agree |
4 Don’t Know |
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For Hospital/Providers Only |
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For Hospital/Providers Only |
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For Hospital Providers Only |
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For Hospital/Providers Only |
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For Hospital/Providers Only
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For QIO & State Health Department Leaders Only: As a result of your organization’s participation in the PSIC program and conducting post-PSIC patient safety activities, have the following aspects changed at organizations you support?
As a result of my organization’s participation in PSIC training and post-PSIC patient safety activities, other organizations have reported that… |
1 Disagree |
2 Neutral |
3 Agree |
4 Don’t Know |
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3. As an organizational leader, think back upon your organization’s participation in the PSIC program and indicate the degree to which you agree with the following statements about the impact of the program as a whole.
Statements |
1 Disagree |
2 Neutral |
3 Agree |
4 Don’t Know |
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For State Health Department or QIOs only |
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4. As an organizational leader, please describe other major patient safety improvement initiatives taking place locally, regionally, or within your state.
File Type | application/msword |
File Title | Participant Characteristics |
Author | Alexander Alonso |
Last Modified By | wcarroll |
File Modified | 2008-11-04 |
File Created | 2008-11-04 |