| Course | HA 645 Quality Improvement and Patient Safety in Healthcare |
|---|---|
| Unit | Unit 7 |
| Paper type | Safety culture assessment |
| Length | About 940 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MS in Healthcare Administration |
| Updated | October 2026 |
Free sample paper for HA 645 Unit 7
Open in the Survey, Quiet in the Reporting System: A Safety Culture Assessment of Northfield by Dimension and by Unit, With Four Commitments
Student Name
Health Care Administration, Herzing University
HA 645: Quality Improvement and Patient Safety in Healthcare
Instructor Name
February 26, 2026
Open in the Survey, Quiet in the Reporting System: A Safety Culture Assessment of Northfield by Dimension and by Unit, With Four Commitments
Instrument, Period and Response Rate
From October 6 to October 31, 2025, Northfield ran the second edition of the hospital safety culture survey published by a federal health research agency (Agency for Healthcare Research and Quality [AHRQ], 2019). The survey measures ten dimensions of safety culture, each reported as the percentage of positive responses. It was offered online to all 1,610 employees and employed physicians with patient contact or direct influence on patient care.
612 responded, a response rate of 38%. That rate is a finding, not a footnote. It is lower than Northfield's 2023 rate of 51%, and it varied from 71% in the intensive care unit to 22% among emergency department physicians and 24% in radiology. Low response in exactly the areas involved in the missed nodule follow-up reviewed earlier this term means the survey is least informative where the hospital most needs information. Staff interviews suggested two reasons: survey fatigue after three other surveys in 2025, and a belief, voiced in the emergency department, that the 2023 results led to no visible change.
Results by Dimension
Hospital-wide percentage positive for each dimension, with the lowest-scoring unit.
| Dimension | Hospital-wide | Lowest unit | Lowest unit score |
|---|---|---|---|
| Teamwork | 78% | Medical-surgical 3 | 69% |
| Supervisor, manager or clinical leader support for patient safety | 72% | Emergency department | 58% |
| Organizational learning and continuous improvement | 64% | Radiology | 51% |
| Communication about error | 63% | Emergency department | 49% |
| Communication openness | 66% | Emergency department | 55% |
| Reporting patient safety events | 61% | Radiology | 47% |
| Hospital management support for patient safety | 57% | Emergency department | 41% |
| Handoffs and information exchange | 49% | Emergency department | 36% |
| Response to error | 48% | Emergency department | 32% |
| Staffing and work pace | 39% | Medical-surgical 2 | 27% |
Three Dimensions Kept Apart
Response to error, handoffs and staffing are the three lowest dimensions, and they are discussed separately because different actions fix each.
Response to error, 48%, measures whether staff believe mistakes are held against them. In the emergency department, only 32% responded positively. Comments pointed to a specific practice: the names of staff involved in events have been discussed at the department's monthly meeting. That is a leadership practice, and it can be stopped.
Handoffs and information exchange, 49%, measures whether important information is lost when patients move between units or shifts. The emergency department, 36%, and radiology, 44%, scored lowest. This is the dimension most directly connected to the incidental nodule event, in which a final report's new information did not reach anyone who acted on it. It is fixed by systems such as structured reports and tracking lists, not by exhortation, consistent with the system view of error that locates the causes of most failures in the conditions people work in (Reason, 2000).
Staffing and work pace, 39%, is low across every unit and reflects vacancy rates and census. It is real, but it is a resource question addressed through the budget, not through culture work, and treating it as a culture problem would frustrate staff.
What Staff Say Against What They Do
Survey answers were set beside event reports filed by the same units in the same fiscal year.
| Unit | Communication openness, % positive | Reporting patient safety events, % positive | Reports filed, fiscal year 2025 | Reports per 1,000 patient days or visits |
|---|---|---|---|---|
| Intensive care unit | 74% | 70% | 288 | 72 per 1,000 patient days |
| Medical-surgical units combined | 68% | 64% | 1,210 | 38 per 1,000 patient days |
| Emergency department | 55% | 52% | 402 | 9 per 1,000 visits |
| Radiology | 69% | 47% | 14 | Under 1 per 1,000 exams |
Reading the Gap
The intensive care unit's answers and behavior agree: high openness, high reporting. The emergency department's also agree, in the other direction: lower openness and a low rate of reporting relative to its volume. Radiology is the notable mismatch. Staff rate communication openness at 69%, above the hospital average, but only 47% respond positively on reporting and the department filed 14 reports all year, in a service performing more than 60,000 exams. Interviews suggested that radiologists and technologists consider discrepancies and missed follow-ups a matter of peer review rather than event reporting, and that the reporting form does not suit events that cross departments, as the reporting audit also found. Radiology is not hiding events; its events are going somewhere other than the safety system, where no one outside the department learns from them.
Limits of This Assessment
The results should be read with three limits in mind. First, with a 38% response rate, the respondents may differ from those who did not answer; staff who feel most strongly, positively or negatively, are often the most likely to respond. Second, unit-level percentages for small groups, such as the 23 radiology respondents, move by several points with each answer and should be read as direction rather than precise level. Third, the survey measures perceptions at one time. It cannot show whether culture is improving; only a repeated survey with better response, alongside behavioral measures such as reporting rates and the time taken to give reporters feedback, can do that. For that reason the commitments above are judged partly by those behavioral measures, which are available every month rather than every two years.
Commitments
Four commitments, each tied to a leader and a date. The evidence that specific culture interventions change survey results is limited, although leadership walk rounds and multi-faceted unit programs have shown some effect (Morello et al., 2013), so each commitment is chosen to address a specific finding and its success will be read in what people do, not only in the next survey.
1. Stop discussing named individuals at emergency department event review meetings and adopt a just culture review format. Leader: emergency department medical director and nurse manager. Date: March 2026.
2. Route radiology discrepancies and missed follow-up findings from peer review into the event reporting system, in de-identified form where peer review protection requires it. Leader: chair of radiology with the patient safety officer. Date: May 2026.
3. Begin monthly leadership safety rounds in the emergency department and radiology, with a written reply to each concern within two weeks. Leader: chief medical officer and chief nursing officer. Date: first rounds in April 2026.
4. Report back to all staff, in April 2026, what has changed since this survey, before any new survey is sent, to address the belief that surveys lead nowhere. Leader: chief executive officer. The next survey, in October 2026, will aim for a response rate above 50% in every department.
References
Agency for Healthcare Research and Quality. (2019). Hospital Survey on Patient Safety Culture: Version 2.0. https://www.ahrq.gov/sops/surveys/hospital/index.html
Morello, R. T., Lowthian, J. A., Barker, A. L., McGinnes, R., Dunt, D., & Brand, C. (2013). Strategies for improving patient safety culture in hospitals: A systematic review. BMJ Quality & Safety, 22(1), 11-18. https://doi.org/10.1136/bmjqs-2011-000582
Reason, J. (2000). Human error: Models and management. BMJ, 320(7237), 768-770. https://doi.org/10.1136/bmj.320.7237.768
The Herzing HA 645 Unit 7 instructions
Unit 7 asks you to assess safety culture using survey results and other evidence. Expect to describe the instrument, period and response rate, report results by dimension and unit, examine the weakest dimensions separately, compare survey answers with behavior, interpret gaps, state limits and make commitments. Students often ask how to use survey data responsibly. Report response rates and treat low rates with caution. Look at units, not just hospital totals, since culture varies. Compare answers with behavior such as reporting rates. Keep the weakest dimensions apart, because each needs a different fix. Tie commitments to findings, owners and dates, and admit that evidence for culture interventions is limited.
How the HA 645 Unit 7 example is put together
The assessment opens with the survey edition, dates and response. A dimension table shows hospital-wide percent positive and the lowest-scoring unit. Response to error, handoffs and staffing each get their own section with unit figures and staff comments, such as the emergency department's low score on blame. A second table compares openness scores with reports per 1,000 patient days for each unit. The interpretation section shows that the intensive care unit and emergency department align, while radiology's high openness and low reporting suggest something else is happening. The limits section covers response bias, small units and timing. Four commitments name a leader, date and measure, such as walk rounds in radiology.
Where the points sit in the HA 645 Unit 7 rubric
Herzing's rubric for a safety culture assessment typically covers the instrument, results, analysis of weak dimensions, comparison with behavior, interpretation, limits and commitments. Comparing survey answers with behavior gets the closest reading, since a survey alone shows perception and the gap between perception and action is where risk hides. Instrument points reward the edition, dates and response rate. Result criteria look for unit-level figures. Dimension credit goes to separate treatment of the weakest areas. Limit points reward honest discussion of response bias. Commitments should match findings with owners and dates, plus a plan to repeat the survey and see whether the weakest units moved. AHRQ's hospital safety culture survey, Morello's review of culture interventions and Reason's model of error support the assessment.
HA 645 Unit 7 help: mistakes that cost points
Culture assessments in HA 645 Unit 7 run into trouble when only hospital-wide averages are reported. Another frequent problem is ignoring a low response rate. Students often treat survey scores as facts rather than perceptions. Behavior, such as reporting rates, is never compared. The weakest dimensions are lumped into one action plan. Limits are not discussed. Commitments are vague, such as improve culture. Evidence on what works is overstated. Small units are compared as if their percentages were stable, though a unit with eight respondents can swing twenty points when two people change their answers. Finally, set what people say beside what they do, because graders reward an assessment that finds the unit where the two disagree.
Get a HA 645 Unit 7 example written to your instructions
Send the Unit 7 instructions and the rubric from your HA 645 classroom, along with the survey instrument your section uses and any results you are permitted to share. We write a custom example that reads dimensions at unit level, sets attitudes against reporting behavior and closes on owned commitments, returned in 24 to 48 hours. The first custom sample is free.
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HA 645 Unit 7 questions, answered
Which safety culture instrument should the example use?
Use whichever your instructions name. Where they leave it open, a widely used published survey gives you named dimensions, a citation and comparison data that makes your reading defensible. Say which version you are working from and over what period, and resist mixing dimensions taken from two instruments, because the wording of the items is what gives each dimension its meaning.
What if I cannot get real survey results?
Illustrative results are normal for this work and most sections expect them. Build a set that behaves like a real one: uneven response across departments, one dimension clearly weaker than the rest, and a couple of scores that complicate the story rather than confirming it. Label the data as illustrative inside the assessment and keep every conclusion tied to the numbers you presented.
How much of this should be about leadership?
More than most drafts allow. Culture is measured in what happens after somebody reports, and that is decided by managers rather than by the staff answering the survey. An assessment describing attitudes without saying what leaders will do differently has produced a weather report, so give the response section real space and put a name and a date beside each commitment.
Where can I find a free HA 645 Unit 7 sample paper?
Read the complete HA 645 Unit 7 safety culture assessment here at no charge, survey dimensions by unit compared with event reporting and four commitments. Ask for a custom assessment for another hospital.
How do you assess patient safety culture in a hospital?
Use a validated survey, report results by dimension and unit with the response rate, compare answers with behavior such as event reporting and tie commitments to specific findings. This sample does that.