Patient Safety, 2009

The New York City Health and Hospitals Corporation

November 2008

The New York City Health and Hospitals Corporation (HHC) has integrated the use of AHRQ's Hospital Survey on Patient Safety Culture as a core component of its corporate-wide patient safety program. In early 2006, HHC embarked on an aggressive, multi-year campaign to improve the culture of safety across the organization and reduce chances for patient harm.

The AHRQ survey was conducted in 2007 and 2008 across the HHC system, which includes 11 acute care hospitals, 4 skilled nursing facilities, 6 large diagnostic and treatment centers, and a certified home health agency. HHC has shared individual organization results with each location. Each organization, in turn, selected one or two areas on which to focus improvement efforts.

Caroline M. Jacobs, Senior Vice President for Patient Safety, Accreditation, and Regulatory Services, believes the AHRQ survey is useful not only as a measurement tool, but in encouraging staff to feel comfortable raising questions and concerns about patient safety on their units and within their organization. "We are striving to create a culture where staff feels comfortable and compelled to report risks to patient safety and where they are supported for reporting."

Staff participation in the surveys over the two-year period increased significantly. In 2007, just 44 percent of all staff in the 22 HHC organizations responded to the survey. When the survey was repeated in 2008, 63 percent responded to the survey. The response rates from direct care providers improved from 27 percent in 2007 to 38 percent in 2008.

The second survey also showed an increase in the percentage of employees who rated patient safety in their work site as "excellent to very good"—from 56 percent in 2007 to 64 percent in 2008. Throughout the system, more areas of strength were reported in 2008 than in 2007.

Both years' results showed that across all levels of care, employees perceive HHC to be a learning organization committed to continuous improvement, where management support for patient safety is visible. Staff also rated teamwork within their assigned units as stronger than teamwork across various units. Consistent with other health care organizations in the U.S., both surveys noted areas for improvement that include non-punitive response to error. However, there was a three to four percent "overall improvement" in the three items included in that survey composite area over the two years.

The HHC Corporate Patient Safety Gateway intranet site links to AHRQ's Web site, and HHC staff are encouraged to use all of the AHRQ resources. Clinicians are encouraged to use the WebM&M for continuing education credits. In addition, as part of HHC's year-long Patient Safety Awareness Campaign, blast E-mails and other literature are regularly sent to staff on patient safety topics and frequently include material from AHRQ.

Of these AHRQ resources and tools, Jacobs says, "AHRQ has a variety of excellent reports, articles, data, and other patient safety information that clinicians can easily get their arms around, understand, and use."

HHC is the largest municipal hospital and health care system in the country with approximately 39,000 employees. The system serves 1.3 million New Yorkers, nearly 400,000 of whom are uninsured.

The Joint Commission and the National Quality Forum recently selected HHC as a 2008 recipient of the John M. Eisenberg Patient Safety and Quality Award for Local Innovation in Patient Safety. The award specifically recognizes HHC for its work to promote public accountability and transparency in the areas of patient safety and health care quality, as exemplified on its public Web site "HHC in Focus."

For more information about HHC, visit http://www.nyc.gov/html/hhc.

Impact Case Study Identifier: CQuIPS 09-01
AHRQ Product(s): Hospital Survey on Patient Safety Culture, WebM&M
Topic(s): Patient Safety
Scope: New York

Hospital Survey on Patient Safety Culture. Update. March 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/hospculture

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