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Making ‘Patient Safety Culture’ Results Public

Imagine the staff within your organization being surveyed every two years to reveal just how successful your organization is when manufacturing or delivering safe services to your clients. Further, the results are then shared with the public.  As of July 1, the state of Florida is requiring hospitals and ambulatory surgery centers to do just that.

Over the years, I have written extensively on how having a healthy ‘culture’ is extremely important for any organization as it drives the right behaviors to successfully function internally and externally. In healthcare, having the right kind of ‘culture’ can make the difference between life and death for patients.  It’s that important.

Simply put, culture – both good and bad – is the DNA of any organization. If given truth serum, an organization’s staff can reveal just how functional (or not) it is. An organization’s culture ensures that its purpose and the purpose of its members are aligned. The compatibility of goals will drive the members to perform well, be self-directed and loyal to the organization.

In healthcare, a ‘culture of safety’ is paramount for patients trusting they will receive appropriate care.  When you think about it, who better to ask about quality of service within a hospital than the frontline workers themselves – staff, nurses, technicians, etc.? Research suggests that medical organizations with higher staff perceptions of working in a safe culture translated into better overall safety and quality outcomes.

Hospital Survey on Patient Safety Culture

A 2018 blog that I wrote touches on the importance of having patient safety culture information available on a public basis. In fact, this blog suggested a simple idea for Iowa policymakers and stakeholders to pursue:

Have ALL Iowa hospitals and outpatient surgery centers undertake the hospital staff survey generated from the Hospital Survey on Patient Safety Culture. The survey would happen every other year (biennial) with the results becoming public.

Having this state-wide policy, I argued, could put Iowa on the map as being one of the more proactive states on safety measures and patient outcomes. In 2018, no other state required this type of information to be reported publicly.

Florida Becomes First State

In early March, right before COVID-19 hit our state and country in full force, I learned that Florida lawmakers were about to pass legislation to require hospitals and ambulatory surgery centers to report – on a biennial basis – results from the standardized patient safety culture surveys that are developed by the federal Agency for Healthcare Research and Quality (AHRQ).

Fast forward to now. The proposed legislation was passed and approved by the Florida Governor and took effect July 1, 2020.  Iowa, unfortunately, will not be the first state to enact this patient-centric legislation.

Florida’s Agency for Health Care Administration, which licenses and regulates health facilities in that state, would receive the anonymous survey results from each facility and then display the results publicly by showing an aggregate of the composite measures by unit and at the facility overall. The composite measure includes teamwork and hospital management support for patient safety. This Agency provided me with the final version in s. 395.1012(4),F.S.

Florida lawmakers believe that displaying this critical information publicly will pressure hospitals and ambulatory surgery centers to change problematic safety cultures.

In addition to including the standardized core survey questions found in the Patient Safety Culture questionnaire, Florida’s law also requires that the survey includes whether or not each respondent would seek care for the “respondent and the respondent’s family at the surveying facility, both in general and, for hospitals, within the respondent’s specific unit or work area.” In other words, would staff members seek care from their own units or hospital system?  This can be quite compelling on whether the organization is fostering a safe culture of care.

Florida Hospital Association

Interestingly, the Florida Hospital Association (FHA) supported this legislation, only asking that composite results be used so that results would be easier for consumers to understand. The FHA also lobbied for a biennial requirement, to allow hospitals enough time to make changes based on the survey results. The Florida Society of Ambulatory Surgical Centers was not opposed to this legislation, but also did not lobby to have it enacted.

I give the Florida providers a great deal of credit for attempting to ensure that the care provided to Floridians will be the best possible care that is tied to a culture of safety. This new law provides the right intent needed to ensure that appropriate change is made in the healthcare delivery system.


I hope to see Iowa policymakers and providers do the same for Iowans. Iowa can still become the leader in safe, effective care, but it does require grit, honesty, and a great amount of passion to make transparent quality of care become wildly successful.

Marketing optics that care is always safe is not adequate. Florida has given Iowa a blueprint to implement practical steps to move best-in-nation care forward. Why can’t our state also embrace this approach?

Iowans certainly depend on it.

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Voices on Hospitals: Efficiency and Coordination of Care among Providers

Efficiency Level Conceptual MeterEvidence remains strong that the U.S. healthcare ‘system’ is not efficient. In fact, according to the Institute of Medicine, about one-third of the $2.6 trillion spent on healthcare in the U.S. in 2010 was identified as being wasteful and inefficient.

In healthcare, cost and quality do not correlate with one another. Some lower-cost physicians (and hospitals) can produce high-quality care, while some high-cost health providers produce low-quality care. As stated in our ‘Voices for Value’ white paper, rewarding and making transparent cost, quality and safety measures will lead to improved efficiency without adversely affecting quality.

Indicator #8: Efficiency

When assessing the efficiencies of hospitals within their communities, Iowa employers give statewide hospitals an un-weighted score of 6.5, or a grade of ‘C.’  When segmented into five regions using size-weighted scores, four regions received ‘D’ grades, while the northwest region received a ‘mid-C’ grade.

Regional - Efficiency Map-Master

Indicator #9: Coordination of Care among Providers

If there is one performance indicator that can be very frustrating to patients, care coordination among providers might be the one most widely criticized.

According to the Agency for Healthcare Research and Quality (AHRQ):
“Care coordination involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care. This means that the patient’s needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient.”

Within the five Iowa regions, employers view ‘coordination of care’ efforts similar to ‘efficiency’ standards – in other words, no ringing endorsements from employers. Employers give statewide hospitals an un-weighted score of 6.4, or a grade of ‘C.’ When segmented into five regions using size-weighted scores, the northwest region scored a ‘mid-C’ while the other regions received ‘Ds.’

Interestingly, hospitals in Polk County received a failing grade (‘F’) when graded by 144 Iowa employers within that county. Needless to say, key hospitals in Polk County have plenty of room for improvement in this category.

Regional - Coordination of Care Among Providers Map-Master

When Iowa employers experience annual premium increases that exceed the overall inflation rate, it is reasonable to expect health outcomes delivered to be at least commensurate with the inflated premiums they pay. Achieving high value for patients must become the overarching goal of our healthcare delivery system, with value simply being defined as “the health outcomes achieved per dollar spent.”

Without question, Iowa employers do not believe they are receiving top value healthcare for what they are expected to pay.

Next week, we will review how Iowa employers graded hospitals on ‘Transparency in Medical Outcomes’ – performance indicator #10 in our “Voices on Hospital” series.

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