Medical Safety Culture Survey

Grade/Rank

Your age

Your time in this unit

Your status

Your military affiliation

With which Service are you affiliated?

Your total number of deployments

Your primary position

Outpatient Primary work area

Inpatient Primary work area


Likert Items

   
Required publications and operating instructions are current and used in my organization.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Publications and operating instructions are enforced in my organization.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Violations of publications, operating instructions, and safety rules are rare in my organization.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Members of my organization do not cut corners to accomplish their job/mission.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Members of my section share information that enables timely decision making.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Individuals in my organization are comfortable reporting safety violations, unsafe behaviors, or hazardous conditions.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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My organization makes good use of special staff (e.g., legal, chaplain, family services, etc.) to help manage high-risk personnel.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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My duty day ends at a predictable time.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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The level of our unit's operational demands permits members to obtain sufficient rest to perform their jobs.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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The demands of additional duties do not affect team members' ability to perform our jobs safely and effectively.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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I find satisfaction in my current duties and opportunities.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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My organization has a reputation for high quality performance.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Leaders/Supervisors in my unit prohibit cutting corners to accomplish the job/mission.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Leaders/Supervisors in my organization set a good example for following standards.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Leaders/Supervisors in my organization care about my quality of life.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Members of my section speak up about potentially dangerous patient safety situations.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Effective time-outs in my section are conducted before patient procedures or operations.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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All members of my organization have the authority to "Stop the Line" during perceived unsafe activities until the hazard/risks are addressed.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Members of my section have no fear of reprisal when submitting a patient safety event in PSR.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Individuals in my organization are comfortable approaching their supervisor about personal issues/illness.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Members of my section follow SBAR in sharing information when handing-off patients/responsibilities.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Members of my section assist coworkers when workload is high.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
My team helps one another through emotional and physical problems.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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My present assignment allows me to practice my specialty to the full extent.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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My organization has enough experienced personnel to perform its current tasks.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Our Military Treatment Facility (MTF) leaders demonstrate commitment to patient safety before an adverse event occurs.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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The stress level in my work section is manageable.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Feedback among members of my section is delivered in a way that promotes positive interactions.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Personal conflicts between team members are addressed effectively.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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My supervisor views honest mistakes as learning opportunities.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Senior leaders view honest mistakes as learning opportunities.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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My supervisor shares information with team members.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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My supervisor models collaborative team behavior.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Our flight leaders model collaborative team behavior (e.g., team huddles).

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
Senior leaders conduct leadership rounds at least weekly.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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My leadership listens to front line workers regardless of rank, position, or title.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
I feel comfortable speaking up about concerning, uncomfortable, and patient safety issues.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
Leaders in my organization consistently respond to patient safety events in a fair manner.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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My team is held accountable for its actions.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
Leaders in my organization set clear expectations regarding patient safety.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
At my MTF, patients and families, speak-up about their care needs, preferences, and values.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
My MTF used patient feedback to improve care in the past 12 months.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
If a medical error occurred, my healthcare team has notified patients and families after it was discovered.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
At my MTF, patients (and/or family members) actively participate in making decisions about their care.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Nursing bedside shift reports promote patient safety.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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Unlimited visiting hours for family members promote patient-and-family-centered care.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
During the Continuous Process Improvement (CPI) project, leaders in my organization ask for data on processes before implementing solutions.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
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I am empowered to improve my work processes.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 

   
My leadership coaches our work team on how to improve processes.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 



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