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Exploring Relationships Between Patient Safety Culture and Patients’ Assessments of Hospital Care

Sorra, Joann PhD; Khanna, Kabir MA; Dyer, Naomi PhD; Mardon, Russ PhD; Famolaro, Theresa MPS

doi: 10.1097/PTS.0b013e318258ca46
Original Articles

Objectives The purpose of this study was to examine relationships among 2 Agency for Healthcare Research and Quality measures of hospital patient safety and quality, which reflect different perspectives on hospital performance: the Hospital Survey on Patient Safety Culture (Hospital SOPS)—a hospital employee patient safety culture survey—and the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS Hospital Survey)—a survey of the experiences of adult inpatients with hospital care and services. Our hypothesis was that these 2 measures would be positively related.

Methods We performed multiple regressions to examine the relationships between the Hospital SOPS measures and CAHPS Hospital Survey measures, controlling for hospital bed size and ownership. Analyses were conducted at the hospital level with each survey’s measures using data from 73 hospitals that administered both surveys during similar periods.

Results Higher overall Hospital SOPS composite average scores were associated with higher overall CAHPS Hospital Survey composite average scores (r = 0.41, P < 0.01). Twelve of 15 Hospital SOPS measures were positively related to the CAHPS Hospital Survey composite average score after controlling for bed size and ownership, with significant standardized regression coefficients ranging from 0.25 to 0.38. None of the Hospital SOPS measures were significantly correlated with either of the two single-item CAHPS Hospital Survey measures (hospital rating and willingness to recommend).

Conclusions This study found that hospitals where staff have more positive perceptions of patient safety culture tend to have more positive assessments of care from patients. This finding helps validate both surveys and suggests that improvements in patient safety culture may lead to improved patient experience with care. Further research is needed to determine the generalizability of these results to larger sets of hospitals, to hospital units, and to other settings of care.

From Westat, Rockville, Maryland.

Correspondence: Joann Sorra, PhD, Westat, 1600 Research Blvd, Rockville, MD 20850 (e-mail:

This work was supported by the Agency for Healthcare Research and Quality under AHRQ Contract Number: 233-02-0087, Task Order no. 18 and HHSA no. 290200710024C.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.