Surveying Your Center’s Culture of Safety (March 3, 2021)




ASCA Chief Executive Officer Bill Prentice is joined by fellow ASCA Board member and Past ASCA President David Shapiro, MD, for a discussion about ASCA’s Culture of Safety Survey, which is now available to ASCs. Charlie Leonard of ASCA’s public affairs team moderates this timely conversation that provides ASCs with all they need to know to register for and complete this short but essential survey. [Please note: ASCs must subscribe by March 31, 2021, to participate in the 2021 survey.]

Narrator: 0:06
Welcome to the Advancing Surgical Care Podcast brought to you by ASCA, the Ambulatory Surgery Center Association. ASCA represents the interests of outpatient surgery centers of every specialty and provides advocacy and resources to assist them in delivering safe, high-quality, cost-effective patient care. As with all of ASCA’s communications, please check to make sure you are listening to or viewing our most up-to-date podcasts and announcements.

Charlie Leonard: 0:37
Hi, I’m Charlie Leonard, a member of the ASCA public affairs team. This recording is taking place on February 25, 2021. I'm joined on this podcast by Bill Prentice, ASCA’s CEO, and Dr. David Shapiro for a discussion about a Culture of Safety Survey that ASCA will be offering to ASCs during March and April of this year. Both Bill and David should be well known to ASCA members but since David has only recently rejoined the ASCA Board of Directors, I'd like to quickly reintroduce him to everyone listening. David Shapiro is an anesthesiologist with extensive experience in ASC management. In addition to being a current member of the Board of Directors, David is a past president of ASCA. Among his many credentials, David is CASC certified, Certified Professional in Health Risk Management and certified in Healthcare Quality Management. David is also a member of the Ambulatory Surgery Center Quality Collaboration, and in that capacity he worked with the Centers for Disease Control and the National Quality Forum to promote ASC quality measure reporting. With that introduction, let me welcome Bill Prentice and David Shapiro. Bill, welcome to the podcast.

Bill Prentice: 1:44
Thank you, Charlie, and pleased to be here.

Charlie Leonard: 1:47
David, welcome to you as well.

David Shapiro: 1:49
And thank you, Sir. I'm very happy to be here with you both.

Charlie Leonard: 1:52
So Bill and David, before we get into the particulars of the upcoming ASCA survey, I think it would be helpful for our listeners if you could give a brief introduction to this culture of safety concept: how it began, what it asks from surgery centers and their staffs, and why ASCA remains committed to promoting its principles. Bill, you want to take it first?

Bill Prentice: 2:13
Sure. Thanks, Charlie. I'm sure that many of the listeners are now familiar with the concept of the Culture of Safety Survey. It's something certainly that ASCA has been talking about for a long time. In terms of this permutation of it, we worked very closely, along with a lot of other organizations, with a federal agency, the Agency for Healthcare Research and Quality, a few years ago to develop a Culture of Safety Survey that mirrors the one that we're going to be talking about today that we'll be offering starting in March, that has a variety of sections on it that are completed by everyone who works in the surgery center, to give a real good image of how the staff communicates with each other, and how they're aligned in terms of trying to protect the patient by ensuring good lines of communication. So, we worked very closely with AHRQ, as I mentioned, in developing this survey. That agency actually has a window of opportunity each year in the summer for surgery centers to complete its version. And one of the things we realized is that limited window made it less likely that every surgery center that would want to participate and do one of these culture surveys would have that opportunity. So we worked internally to develop with an outside vendor a version of this survey that will be available to our members.

Charlie Leonard: 3:45
David, is there anything you'd like to add to that again?

David Shapiro: 3:48
Yeah, I think Bill touched on the high points. This survey in some way has been around Agency for Healthcare Research and Quality (AHRQ) as Bill mentioned, for quite a while. Some of us in the ASC industry, we're gonna hold a bit, about a decade ago and started working with AHRQ to develop one that was specific for surgery centers. I'm pleased with where we ended up on that but, as we'll explore a little bit further, I think that the idea of ASCA offering a slightly different version of that, but still geared towards surgery centers, is really the way to go to both encourage participation as well as increase awareness of the value of the survey. So I think it's a great thing that ASCA has been able to put together on behalf of their members and I think it will really go a long way towards ensuring patient safety, which of course is the point of all of our activities.

Charlie Leonard: 4:39
So Bill and David, lots more to talk about in terms of the actual survey, but before we do, I'm going to ask if we can take a short break here to secure a few words from our podcast sponsor. If you'll just stand by, we'll be back shortly.

Narrator: 4:54
This episode of the Advancing Surgical Care Podcast is brought to you by in2itive Business Solutions, a revenue cycle management company who has served the ASC community for over 10 years. in2itive Business Solutions works with existing billing systems to streamline your processes and maximize your centers reimbursements. Visit in2itive today at

Charlie Leonard: 5:20
Okay, Bill, David, before the break, we were talking about the origins of the culture of safety concept. Well, let's turn to our upcoming survey. Bill, can you tell us when and how an ASCA member can sign up and participate in the survey, and what it will cost them in terms of both time and expense?

Bill Prentice: 5:35
Sure, happy to do that. First, the data submission period for this new survey that ASCA will be offering begins March 1, and runs through April 15. And as you can register right now, to get the survey, if you go to the ASCA website,, it will direct them to where they can go to purchase the survey. An ASC has to subscribe by March 31 in order to be able to participate in the 2021 survey. So even though you have 'til April 15 to submit your survey, you've got to sign up by the end of next month. The per facility fee for the survey is $100. So regardless if you have five staff or 50 staff, it's still just $100 to access the survey. And obviously the idea is, and I think David can probably speak to this a little bit later, is everyone in the surgery center, from the front office person to all the surgeons, need to complete this survey for it really to work. I think it's probably worth mentioning that the survey, as you'd mentioned, it doesn't take a long time for each individual to fill it out. But there are eight really short sections and it's 32 multiple choice questions that can be answered. You don't need to have access to any data, it's completely you sit down in front of the screen, you can answer those questions without having to refer to anything. Those sections include: 1. culture of safety in your facility, 2. the teamwork and training in your facility, 3. organizational learning and response to mistakes, 4. near miss documentation, 5. management support for patient safety, 6. overall facility rating, and 7. some background questions and an opportunity to submit an optional comment by the staff person if they want to.

Charlie Leonard: 7:32
Bill, that's a great introduction and overview of the actual survey. I'm sure a lot of listeners are also curious about how ASCA intends to use the survey data and how the confidentiality of surveys will be protected.

Bill Prentice: 7:45
Sure, that's one thing we're going to ensure is that each facility’s individual data is going to be protected. That facility will obviously get a report that shows their responses and also allow you to compare them and benchmark them against other respondents. So I think it'll be really good for facilities to be able to do that. I think David can probably speak to the value both of looking at it internally and seeing how your responses will hopefully change over time, because the idea is to do this survey routinely. And then also be able to compare how those responses compare to other facilities in your area or around the country. The one last thing I want to mention, though, before we move on to that is that there are the AHRQ survey, which facilities are still going to be able to use. If they're already using the AHRQ survey and doing that in the summertime, they're still going to be able to do that. I think ours is going to be a little more user friendly. I think the turnaround time for being able to get in your report and your responses will be much quicker than it is using the one through the federal government. We also it’s largely similar, but we did make four small changes that I think make the questions more understandable. So it is largely the same survey, just slightly different in terms of the way the questions are asked. But I think that they're both really good products. And if you're comfortable using the AHRQ one and you have been, certainly you can continue to do that. I think the fact that ours is going to be a little more customer friendly, you're going to get your report faster, and I think makes it better. But I think both are still good products.

Charlie Leonard: 9:26
David, is there anything you'd like to add?

David Shapiro: 9:28
Yeah, just to come in on Bill's last point, which is I think that this has really shined the light from ASCA to our surgery center members, and really helped them access what I think is a very important tool for all the reasons that Bill mentioned as well as others. I think it's been a little bit difficult in the past to actually get this data collected and submitted to the federal government. But in this instance, we're really going to be able to keep it within our own industry and allow ourselves to benchmark against other very similar facilities. So I think that's going to add a lot of value to the time and very minor expense that a facility will incur to produce this survey and to get it done at their facility.

Charlie Leonard: 10:16
Thanks very much, David. Let me ask you this: It's 2021 and I'm sure there must be some listeners who are wondering why in this modern day a surgical center would need to be spending time on a curriculum or a survey on the culture of safety in their facilities, given the very high quality of care they are already delivering. Can you explain how surgical teams can benefit from participating in a survey like this?

David Shapiro: 10:38
I think as soon as a facility, especially if they haven't seen this survey before, starts looking at it, they'll realize that it really goes to the heart of one of the most important aspects of providing safe surgical care for our patients in our ASCs, and that is the culture of safety that is established and that pervades the entire organization. That's one of the highlights that we get from giving this survey out to all people who are affiliated with a given organization, from the back office workers to folks that maybe patients don't even see, let's say, the people that work in central supply or sterile processing. And it really can give us a very honest opinion because the responses are anonymized in terms of what all of the employees in a given organization are thinking about how that organization approaches the very, very difficult topic of delivering safe patient care. And it's those perceptions that I think will give leaders in the organization a really good handle on areas that they might need to improve on, even ones where they think that they may have been doing well in the past. We are going to be able to provide both an internal and external barometer, if you will, of the perceptions of revolving around patient safety within a given organization. And that I think will really set the stage for some good discussions, real strong work to improve the care that's really for our patients.

Charlie Leonard: 12:12
Thanks, David. Coming back, Bill and David, both of you are obviously very familiar with the demands that are placed on surgery centers’ staffs every day. They are asked a lot in terms of providing care for their patients, as well as complying with regulations and safety protocols. Now in this podcast, and in the couple of weeks ahead, we're asking them to step up and put another task on their plates. Any closing arguments for why ASCA members should answer this call? Bill?

Bill Prentice: 12:37
Sure, Charlie. If I wanted to be blunt about it, I would think that if the governing body of a surgery center did not want to ask these questions of their staff, that's a red flag that they should be. The whole purpose behind this is to ensure that everyone in the surgery center is focused on patient safety and that people feel comfortable communicating, regardless of where they are in the organization, to point out something that they think might impact patient safety negatively. So, what this really means is the ability of a tech or a nurse being able to stop a physician and ask a question in the hopes that it's going to protect the patient. So, I think that this is a really essential tool for a surgery center to use to make sure that that level of communication is there, and that they are solely focused on protecting the patient from the moment the patient walks into the facility to the moment that they leave. So, David, I think I'll turn it over to you and see if you have anything to add on that point.

David Shapiro: 13:44
I think he hit some of the really high points. And again, all the things that you mentioned are so crucial, things like reporting near misses. So, we want to make sure that everyone in the facility understands that not only communication with each other, but also communication about things that in the past might have incurred blame, or possibly are a write up in their file. If the employee feels comfortable enough to point out how that employee made a possible error or did indeed make an error or whether or not to cause any patient harm, we really want to know what that is so that we can address issues to really take a look at the organizational aspects that might have set the stage for not only that employee but other practitioners to make similar mistakes.

Bill Prentice: 14:37
David, if you don't mind, the last point I'd make on that front also is the fact that this is another way that the ASC model can differentiate itself because of our size and our nimbleness. I think we're better able to use a tool like this, and then obviously take corrective action where necessary, than a larger healthcare organization. So, I think this is a way that we can use this tool and then, obviously to the extent necessary, use different education and training to improve on it to create the safest space for outpatient surgery. And the last point to make is that one of the things that ASCA is pledging to do as part of this project is to offer the education and training that will assist the surgery center using this survey to improve and get better year after year after year.

David Shapiro: 15:27
Yeah, I completely agree. I think that because this survey so heavily focuses on not only the specific communication techniques, but also that kind of hidden aspect of what the culture is. Do folks in the facility feel comfortable and feel part of ensuring a safe patient experience within their facility? Or are they alienated and not really engaged in the process? If you look at the seven patient safety goals, actually, for this year of 2021 from The Joint Commission, this one survey, which really doesn't take that long to complete, hits upon almost every one of them, which certainly talks about staff communication, the goals, identifies things like medication administration, surgical mistake, patient identification, all of the things that are contemplated by and really given a lot of credence to by this survey. So, I think it's a really quick and dirty way, if you will, of uncovering some aspects in the facility that may otherwise have gone unnoticed until it's too late. And I think it can really, really not only improve the culture of the organization, but improve the level of patient care that we're delivering. So I think it is really worth the time and effort for any organization to use this survey, not only to administer it but to really take the results apart, not be too concerned about what the actual numbers are, but really try to look behind the numbers to try to figure out what it is that is going on behind the folks that subjective responses to all the questions that are posed that really do cover the waterfront involving patient safety and aspects of care that are so important in a high reliability organization such as an ASC.

Charlie Leonard: 17:19
Bill and David, thank you both for this discussion and for ASCA’s leadership on this important issue. And thanks to our listeners for tuning into the podcast. Bill and David, hopefully your words and encouragement will inspire everyone listening to go now to the ASCA website and sign up for the Culture of Safety Survey.

Bill Prentice: 17:35
Charlie, thanks for the opportunity. And I hope that our members will take advantage of this this new product.

David Shapiro: 17:40
And thanks to you both, Bill and Charlie, for allowing me to participate with you today.

Charlie Leonard: 17:47
Thanks, Bill. Thanks, David. Before we close, I would like to thank the sponsor of our Advancing Surgical Care Podcast, in2itive Business Solutions, a revenue cycle management company that has served the ASC community for more than 10 years. Until next time, please wear a mask, practice social distancing, wash your hands and please make sure you get vaccinated as soon as you're eligible so we can all stay healthy and safe.