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Questionnaire template

Patient Safety Culture

Measures healthcare staff views on patient safety culture, protocols, training, communication and incident handling.

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Questions in this template

Safety Culture Today

  1. Thank you for taking part. Your anonymous, candid views on how we handle patient safety will help us make care safer.

  2. Overall, how would you rate the patient safety culture in our organisation?

    Choose one:

    • Excellent
    • Good
    • Fair
    • Poor
    • Very poor
  3. How often does each of the following happen in our organisation?

    • Managers invite staff to raise patient safety concerns
    • Concerns that staff raise are responded to constructively
    • Patient safety is weighed when decisions are made

    For each row: choose one:

    • Never
    • Rarely
    • Sometimes
    • Often
    • Always

Protocols and Compliance

  1. Has each of these protocols been explained to you clearly enough that you understand it?

    • Responding to emergencies
    • Preventing infection
    • Giving medication

    For each row: choose one:

    • Yes
    • Not sure
    • No
  2. In the past three months, how many lapses in following safety rules have you noticed?

    Choose one:

    • None
    • Very few
    • Some
    • Many
    • A great many

Communication and Training

  1. Which training formats do you find effective for building safety awareness? Select all that apply.

    Choose any that apply:

    • Workshops or seminars
    • Online courses
    • Hands-on demonstrations
    • Team discussions
    • None of these
  2. Any comments on the formats you selected? (optional)

    Condition: Shown when at least one format was selected

    Open answer

  3. How clear is management's communication about each of these?

    • Instructions on patient safety protocols
    • Updates about patient safety incidents

    For each row: choose one:

    • Very unclear
    • Unclear
    • Neither clear nor unclear
    • Clear
    • Very clear
  4. How do you find the amount of communication from management about each of these?

    • Instructions on patient safety protocols
    • Updates about patient safety incidents

    For each row: choose one:

    • Far too rare
    • Too rare
    • About right
    • Too frequent

Reporting and Resolving Incidents

  1. Think of a recent patient safety incident you know of. What happened, how was it dealt with, and what was learned? (optional)

    Open answer

  2. How could we handle safety incidents better? (optional)

    Open answer

  3. In the past 12 months, about how many patient safety incidents have you reported?

    A number from 0 to 500

  4. Of the incidents you reported, about how many have been resolved?

    Condition: Shown when at least one incident was reported

    A number from 0 to 500