Culture Measurement as Key Improvement Tool

September 10, 2015    |   By: Calevir

A success story from Cox Health

The survey of patient safety culture has become a key improvement tool for CoxHealth, a health system across 5 campuses with 954 licensed beds. CoxHealth spans 83 clinics and serves 25 counties across southwestern Missouri. They have used the survey administered by the Center for Patient Safety (CPS) since 2010. All clinicians in the inpatient and outpatient settings as well as the clinics and EMS agency are encouraged to participate. While participation is a challenge, it has steadily increased over the years to 47% average due to improved communication. The surveys are discussed in the corporate newsletter as well as at leader meetings. Senior leaders discuss the surveys with staff during their regular rounding and encourage participation.

Download this article in the full Fall 2015 Newsletter.


Survey results are aggregated and distributed by CPS, including department level reports for those units large enough to ensure anonymity. Vice presidents and department leaders are responsible for discussing results at staff meetings and identifying opportunities for improvement. Departments using the TeamSTEPPS module use the survey results to identify needs and focus education. Rachel Wells, Patient Safety Officer, advised, “The survey is used as a tool. It helps open the door for us to guide patient care departments and can assist them in focusing their priorities.”


There have been many successes at CoxHealth!

  • The Radiation Oncology department had significant improvement, going from zero survey areas scoring above the 90th percentile, to seven survey areas above the 90th percentile in the last survey.
  • The overall non-punitive response to error score was above the 90th percentile in 2014, which shows a high level of staff trust with management. Patient safety culture has been nurtured as management is supportive and consistently improves processes when opportunities are identified. Jeff Robinson, Radiation Oncology Director, reveals, “Safety Surveys tend to turn the invisible into the visible. Once we saw where we are at, we came together to make the needed improvements.”
  • Cox Monet Hospital stands out as a benchmark within the system. It is a critical access hospital, and the staff’s access to senior leaders is outstanding. When opportunities for patient safety improvement are identified, teams work together to make improvements, which are communicated across the hospital to close the loop. The system is working to replicate this workflow model across all facilities.


Wells’ words of advice based on her experience with the culture surveys: “Patient safety is a journey and the survey is a tool to measure our progress and help us focus along the way. Doing the survey once is not enough. It needs to be routinely offered to see how we’re doing.”

Congratulations to CoxHealth for their focus and improvements in patient safety!


For more information, contact the CoxHealth Office of Patient Safety at 417-269-6589.


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