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Safety culture surveys are useful for measuring organizational conditions that can lead to adverse events and patient harm in healthcare organizations. Organizations that want to assess their existing culture of patient safety should consider conducting a safety culture survey. Safety culture surveys can be used to:

• Raise staff awareness about patient safety.
• Assess the current status of patient safety culture.
• Identify strengths and areas for patient safety culture improvement.
• Examine trends in patient safety culture change over time.
• Evaluate the impact of patient safety initiatives and interventions.

The ������ƵSurveys on Patient Safety Culture® (�����ʳ�®) have several advantages. They are:

1. Free—available to the public. The surveys were developed by ������Ƶand are available free of charge, and free technical assistance is provided.
2. An organization wide instrument. The surveys were designed to be administered to all types of staff, including clinical and nonclinical staff in hospitals, nursing homes, medical offices, community pharmacies, and ambulatory surgery centers. They can be used to assess individual units or departments or can be administered organization wide.
3. Reliable and valid. The survey development process was rigorous, based on a review of existing research and other culture surveys. The survey items have demonstrated reliability and validity (for more details, refer to the survey Toolkit materials available on the ������ƵSOPS website).
4. Comprehensive and specific. The surveys cover several areas of patient safety culture, providing a level of detail that helps organizations identify specific areas of strength and areas for improvement. In addition, there are supplemental items users may add to assess content in areas not included in the core questionnaire (i.e., Workplace Safety, Diagnostic Safety, Health Information Technology (Health IT) Patient Safety, and Value and Efficiency).
5. Easy to use. Each survey has accompanying resource materials:
   1. Survey Forms.
   2. Survey Items and Composite Measures.
   3. A Survey User's Guide: Gives step-by-step instructions on how to select a sample, administer the survey and obtain high response rates, and how to analyze and report results.
   4. Data Entry and Analysis Tool: A data entry and analysis tool that works with Microsoft® Excel and makes it easy to input your individual-level data from the survey. The tool then automatically creates tables and graphs to display your survey results. To request the tool for any of the SOPS surveys or supplemental items, send an email.
6. Databases. ������Ƶestablished the SOPS Databases as central repositories for survey data from each of the SOPS surveys. Healthcare organizations that administer one of the ������Ƶpatient safety culture surveys can voluntarily submit their data to the appropriate database and get a feedback report comparing their survey results with the Database.

On average, hospitals that have submitted to the SOPS Hospital Database readminister the survey every 24 months. Although ������Ƶdoes not provide any set recommendations for how often to administer the surveys, the Centers for Medicaid & Medicare Services (CMS)  Attestation Guide includes an option for hospitals to conduct a hospital-wide culture of safety survey annually, or every two years, with pulse surveys on target units during non-survey years. The pulse survey could be a subset of the SOPS composite measures and single item measures from the full survey. If administering a pulse survey, we highly recommend including all items within each selected SOPS composite measure to ensure reliability and enable comparisons to SOPS Database results. 

We caution against administering the full survey less than 6 months apart because it is important to allow time for sharing the results, action planning, and development of initiatives. This guidance would apply for all SOPS survey settings.

������Ƶdoes not currently have a web survey version available for healthcare organizations to use for any of the ������ƵSurveys on Patient Safety Culture. Survey users must program their own web surveys or hire a vendor. For guidance on how to administer a web survey, please see the respective Survey User's Guide located on the ������Ƶwebsite.

The Surveys on Patient Safety Culture survey items are grouped into areas of patient safety culture that they are intended to measure. These areas, measured by two or more survey items, are referred to as composite measures. The terms composite measure and dimension are used interchangeably to refer to this grouping of survey items that measure the same patient safety culture area.

Please contact the Surveys on Patient Safety Culture team to request AHRQ's permission to translate and/or use the surveys internationally. For more information about international use of the Surveys on Patient Safety Culture, visit the AHRQ SOPS website.

The ������ƵSurveys on Patient Safety Culture for hospitals, nursing homes, medical offices, community pharmacies, and ambulatory surgery centers and all of their related materials are free and available for public use in the United States. You may locate and download them from the AHRQ SOPS website.

More information about using the SOPS name.

For permission to use the surveys outside the United States, contact the Surveys on Patient Safety Culture team.

Unfortunately, while any facility is free to use the survey, the ������ƵSurveys on Patient Safety Culture Databases are currently accepting data only from U.S. facilities.

Spanish versions are available for all of the ������ƵSurveys on Patient Safety Culture core surveys and supplemental items. The Spanish translations are designed for U.S. Spanish-speaking respondents from different countries. Translation guidelines are available on the ������Ƶwebsite. For more information on translating the surveys, contact the Surveys on Patient Safety Culture team to request AHRQ's permission to translate and/or use the surveys internationally.

When using any of the SOPS surveys, reference the full name with the registered trademark symbol “Surveys on Patient Safety Culture^® (SOPS^®)." In the text of written documents (journal articles, press coverage, etc.), spell out the name the first time it appears, followed by SOPS in parentheses: "Surveys on Patient Safety Culture^® (SOPS^®) Program." Indicate that this is a program of the ������Ƶ.

If you are administering a patient safety culture survey that is based on a SOPS survey or uses items from a SOPS survey, refer to the guidelines on modifying and naming SOPS surveys in in Using the SOPS Name.

Any changes made to modify the survey may affect the reliability and overall validity of the survey and may make comparisons with other facilities difficult. To maintain comparability and consistency across SOPS surveys, ������Ƶoffers the following guidelines regarding the impact of changes to a SOPS survey:

• Changing the core survey: We strongly recommend that the SOPS surveys are administered in their entirety without modifications or deletions to the core survey items. If any of the following changes are made, then the survey data will not be accepted into any of the SOPS Databases and your survey results will not be comparable with other organizations in the SOPS Databases: (1) changing the wording of items or response options, (2) changing the order of items or response options, (3) deleting one or more items, and (4) adding supplemental or custom questions among (not after) the core items within a SOPS survey.
  • Exceptions for pulse survey version: If organizations decide to administer a pulse survey using the SOPS Hospital Survey to meet requirements for the Centers for Medicaid & Medicare Services (CMS) Patient Safety Structural Measures, Domain 3, Statement A “Our hospital conducts a hospital-wide culture of safety survey using a validated instrument annually, or every two years with pulse surveys on target units during non-survey years,” then hospitals may create a pulse version of the SOPS Hospital Survey including a subset of the measures. A subset of the measures would include:
• Selected SOPS composite measures:
  • However, we recommend ALL items within the selected composite measures should be administered.

• Selected SOPS single item measures:

  • You can include or exclude any single item measures. 

  Selected SOPS composite measures and single item measures should be included in the order in which they are presented in the core SOPS survey, as outlined in the SOPS Hospital 2.0 Items and Composite Measures document. 

• Modifying work areas or staff positions: Your facility may wish to modify the responses to these background questions so that they reflect the names of work units and staff position titles used within your facility. Modifications to the work areas and staff positions are acceptable; however, if your facility plans to submit to any of the SOPS Databases, it must recode the modified units/work areas or staff positions so they crosswalk back to the original survey's units/work areas or staff positions.
• Adding items: Facilities may use the supplemental items developed under the SOPS Program, items from other surveys, or custom items, for your own purposes, including open-ended questions. Any supplemental items or additional items from other surveys must be added to the end of the SOPS surveys, just before the Background Questions section. When inserting supplemental items, remember to include the appropriate subheadings for each supplemental item.

������Ƶhas developed supplemental items that can be added to the SOPS Hospital, Medical Office, and Nursing Home surveys to assess content in areas not covered by the core questions. These supplemental items are optional. Currently, there are supplemental items for Health Information Technology (Health IT) Patient Safety for hospitals, Workplace Safety for hospitals and nursing homes, Value and Efficiency for hospitals and medical offices, and Diagnostic Safety for medical offices.

Any supplemental items must be added to the end of the SOPS Hospital, Medical Office, or Nursing Home Survey, just before the Background Questions section. Be sure to include the definitions of terms and subheadings.

For the SOPS supplemental items, organizations may decide to administer all composite measures and single item measures, or only a subset of the measures.

A subset of the supplemental measures would include:

• Selected composite measures:
  • However, all items within the selected composite measures must be administered.
• Selected single item measures:
  • You can include or delete any single item measures. 

SOPS supplemental items that are included in your survey must not be reordered. 

All of the SOPS surveys and supplemental item sets are available in Spanish:

• Hospital Survey on Patient Safety Culture (1.0 and 2.0)
• Nursing Home Survey on Patient Safety Culture (1.0 and 2.0)
• Medical Office Survey on Patient Safety Culture
• Community Pharmacy Survey on Patient Safety Culture
• Ambulatory Surgery Center Survey on Patient Safety Culture
• Diagnostic Safety Supplemental Items
• Health IT Patient Safety Supplemental Items
• Value and Efficiency Supplemental Items for hospitals and medical offices
• Workplace Safety Supplemental Items for hospitals and nursing homes

������Ƶhas established a process whereby researchers can request de-identified data files from the SOPS Databases. Those interested in obtaining the data must submit a completed Research Abstract Form and signed Data Release Agreement.

For the SOPS Hospital Database only, hospital-identifiable data files may be made available that include data that contain hospital identifiers, such as hospital name, address, and Medicare Provider ID. Valid purposes for using the hospital-identifiable data do not include the use of the data for public reporting, or for proprietary, commercial, or competitive purposes involving the participating organizations; or to determine the rights, benefits, or privileges of organizations participating in the Database. Researchers interested in obtaining hospital-identifiable data must submit a completed Hospital-Identifiable Research Abstract Form and Confidentiality Agreement.

More information and the forms.

The SOPS resource lists are available and contain references to websites that provide practical resources to improve patient safety culture and patient safety. The lists are not exhaustive but are meant to offer initial guidance for those looking for information on patient safety initiatives. Resource lists have been developed for all of the surveys and supplemental items. In addition, the Action Planning Tool helps healthcare organizations develop an action plan for improving patient safety culture in their facilities.

There are many ways to increase your survey response rate, but it will require effort and careful planning. Here are some strategies to consider:

1. Engage leadership.
2. Publicize the survey.
3. Use survey best practices.
4. Create a competitive spirit.
5. Provide survey incentives.

An audio podcast and tip sheet on improving response rates is available.

You may . Choose from the following Surveys on Patient Safety Culture Email subscription lists:

• Hospital Survey.
• Medical Office Survey.
• Nursing Home Survey.
• Community Pharmacy Survey.
• Ambulatory Surgery Center Survey.

If you have questions about the Surveys on Patient Safety Culture, please email SOPS Technical Assistance.

If you have questions or need assistance with the SOPS Databases, please email SOPS Databases Technical Assistance.

Hospitals can refer to the Results From the 2017 Pilot Study of the ������ƵSOPS Health Information Technology Patient Safety Supplemental Item Set for Hospitals (PDF, 1 MB), which are based on data from more than 9,000 staff in 44 hospitals that participated in a pilot test of the items in 2017.

������Ƶoriginally released the SOPS Hospital Survey in 2004 and it has been widely adopted in the United States and internationally. Over the years, users and stakeholders provided ������Ƶwith feedback about suggested changes to the survey. User feedback included:

• Rewording complex survey items and survey items difficult to translate.
• Adding a "Does Not Apply or Don't Know" response option.
• Shifting to a "Just Culture" framework to assess Response to Error.
• Revising the staff positions and units/work areas.
• Determining if the number of negatively worded items could be reduced.

Using this feedback, ������Ƶdeveloped and pilot tested a new version of the survey, the SOPS Hospital Survey 2.0 (HSOPS 2.0), released in 2019.

HSOPS 2.0 assesses many of the same areas of patient safety culture as HSOPS 1.0, but substantial changes were made to the survey. The final HSOPS 2.0 has 40 survey items compared with 51 survey items in HSOPS 1.0. The names of some composite measures (a group of 2 to 4 survey items that assess the same area of patient safety culture) were changed to align with changes to the content assessed in the measures. Five HSOPS 1.0 survey items were kept in HSOPS 2.0 unchanged, but the following changes were made to the remaining items:

• 21 HSOPS 1.0 survey items were dropped.
• 25 HSOPS 1.0 survey items were reworded or response options were changed.
• 10 new survey items were added to HSOPS 2.0.

HSOPS 2.0 now includes a "Does Not Apply or Don't Know" response option. Similar to HSOPS 1.0, HSOPS 2.0 still includes a mix of positively and negatively worded survey items. 

For more information about differences between HSOPS 1.0 and HSOPS 2.0 and how to transition to the new 2.0 survey, review the document Transitioning to the SOPS Hospital Survey Version 2.0: What's Different and What To Expect (PDF, 776 KB).

HSOPS 2.0 has 32 survey items (compared with 42 survey items in HSOPS 1.0) assessing 10 composite measures. There are 2 single item measures and 6 background questions. The survey takes approximately 10–15 minutes to complete. Most of the survey items use Strongly Disagree/Strongly Agree or Never/Always response options. The survey also includes a "Does Not Apply or Don't Know" response option. A section for open-ended comments is at the end of the survey.

A single hospital location needs at least 10 completed surveys to submit to the SOPS Hospital Database.

HSOPS 2.0 has 10 composite measures (a group of 2 to 4 survey items that assess the same area of patient safety culture):

1. Communication About Error (3 items)
2. Communication Openness (4 items)
3. Handoffs and Information Exchange (3 items)
4. Hospital Management Support for Patient Safety (3 items)
5. Organizational Learning—Continuous Improvement (3 items)
6. Reporting Patient Safety Events (2 items)
7. Response to Error (4 items)
8. Staffing and Work Pace (4 items)
9. Supervisor, Manager, or Clinical Leader Support for Patient Safety (3 items)
10. Teamwork (3 items)

HSOPS 2.0 also includes several single item measures that assess:

1. How many patient safety events the respondent has reported.
2. An overall rating on patient safety for their unit/work area.
3. Background characteristics (staff position, unit/work area, hospital tenure, unit/work area tenure, work hours, and whether they have direct interaction with patients).

The survey development team reviewed the literature on patient safety in hospitals, interviewed hospital experts and researchers, identified appropriate survey topics, and drafted survey items for review by the SOPS Technical Expert Panel. The draft survey was cognitively tested with hospital providers and staff to ensure that the questions were easy to understand and answer and that the items were relevant.

An initial pilot test was conducted with 44 hospitals in 2017, but after further analysis and input from the SOPS Technical Expert Panel, additional revisions were made to the survey. A second pilot test was conducted in 2019 on the revised HSOPS 2.0 in 25 hospitals. The 2019 pilot data were analyzed to examine the survey's psychometric properties (reliability, factor structure, etc.), with the goal of shortening the survey by including only the best items. The final SOPS Hospital Survey 2.0 is therefore the product of extensive development and testing, demonstrates good psychometric properties, and is a reliable instrument to assess patient safety culture in hospitals.

A simultaneous administration involves administering HSOPS 1.0 and HSOPS 2.0 at the same time, with half of the providers and staff receiving HSOPS 1.0 and the other half receiving HSOPS 2.0. This option is only feasible for larger hospitals (with at least 1,000 providers and staff), because a large number of providers and staff are needed to produce reliable and accurate measurements on both surveys at the same time.

With simultaneous administration, staff are randomly assigned by units/work areas, and then by staff positions within units/work areas, to receive either HSOPS 1.0 or HSOPS 2.0; half receive HSOPS 1.0 and the other half receive HSOPS 2.0. The benefit of a simultaneous administration is that it enables hospitals to continue to trend against previous HSOPS 1.0 scores, while establishing a new baseline on HSOPS 2.0 at the same time. In future years, only HSOPS 2.0 would need to be administered for trending.

In addition, this option allows hospitals to compare their scores on the two survey versions, because differences in scores are likely due to changes in the HSOPS 2.0 survey rather than differences in patient safety culture. Comparing scores on the two survey versions helps hospitals understand how changes in the HSOPS 2.0 survey affect their scores.

For specific guidance, review Appendix B: How To Conduct Simultaneous Administration of HSOPS 1.0 and HSOPS 2.0 and Compare Scores, which is an appendix for the document Transitioning to the SOPS Hospital Survey Version 2.0: What’s Different and What To Expect (PDF, 776 KB).

To accompany HSOPS 2.0, there are new Version 2.0 resource materials, including a new Survey User’s Guide and Data Entry and Analysis Tool. However, no changes were needed to the Action Planning Tool, which was designed for users of all of the SOPS Surveys, regardless of the healthcare setting or survey version.

The SOPS Hospital Survey 1.0 is still available on the ������Ƶwebsite, but the use of HSOPS 2.0 is encouraged. Note that the SOPS Hospital Database will only accept data from HSOPS 2.0.

Yes, you can still use any HSOPS 1.0 survey items that may have been dropped from HSOPS 2.0, but put the items at the end of the Version 2.0 survey before the background questions, along with any other supplemental item sets you want to include.

������Ƶestablished the SOPS Hospital Database as a central repository for survey data from the SOPS Hospital Survey 2.0. ������Ƶhas produced database reports, which aggregate data from over 400 hospitals that have voluntarily submitted their data to the Database. The Database serves as an important resource for patient safety culture improvement.

Information about eligibility requirements, registration procedures, and benefits of participating in the Database is available.

������Ƶhas developed supplemental items that can be added to the SOPS Hospital Survey 2.0 to assess content in areas not covered by the core questions. These supplemental items are optional. Currently, there are supplemental items for Health Information Technology (Health IT) Patient Safety, Workplace Safety, and Value and Efficiency.

Hospitals can refer to the 2024 Results for the ������ƵSOPS Workplace Safety Supplemental Items for Hospitals (PDF, 1.2 MB), which are based on data from more than 61,000 staff in 94 hospitals.

Hospitals can refer to the Results From the 2014 Pilot Study of the ������ƵSOPS Value and Efficiency Supplemental Item Set for the Hospital Survey (PDF, 1.4 MB), which are based on data from more than 4,000 staff in 47 hospitals that participated in a pilot test of the items in early 2014.

The SOPS Hospital Survey 1.0 (HSOPS 1.0) includes a total of 51 items. There are 42 items grouped into 12 composite measures.

The composite measures in the hospital survey are:

1. Communication Openness.
2. Feedback & Communication About Error.
3. Frequency of Events Reported.
4. Hospital Handoffs & Transitions.
5. Hospital Management Support for Patient Safety.
6. Nonpunitive Response to Error.
7. Organizational Learning-Continuous Improvement.
8. Overall Perceptions of Safety.
9. Staffing.
10. Supervisor/Manager Expectations & Actions Promoting Patient Safety.
11. Teamwork Across Hospital Units.
12. Teamwork Within Units.

In addition, the hospital survey includes:

1. One item that asks respondents to provide an overall grade on patient safety for their hospital.
2. One item measuring the number of events the respondent has reported over the past 12 months.
3. Seven items about respondent background characteristics.

HSOPS 1.0 has a total of 51 items and it takes approximately 10 minutes to complete. Most of the items use Agree/Disagree or Never/Always response categories, so they are easy to answer. There is room for written comments at the end of the survey.

A single hospital location needs at least 10 completed surveys to submit to the SOPS Hospital Database.

The SOPS Hospital Survey 1.0 is still available on the ������Ƶwebsite, but the use of HSOPS 2.0 is encouraged. Note that the SOPS Hospital Database stopped accepting data from HSOPS 1.0 in June 2022.

The SOPS Medical Office Survey includes a total of 62 items. There are 38 items measuring 10 composites.

The composite measures in the medical office survey are:

1. Communication About Error.
2. Communication Openness.
3. Office Processes and Standardization.
4. Organizational Learning.
5. Overall Perceptions of Patient Safety and Quality.
6. Owner/Managing Partner/Leadership Support for Patient Safety
7. Patient Care Tracking/Followup.
8. Staff Training.
9. Teamwork.
10. Work Pressure and Pace.

In addition, the medical office survey also includes several single item measures that assess:

1. Patient safety and quality issues.
2. Information exchange with other settings.
3. A screener question to determine if the respondent is an owner, managing partner, or in a leadership position
4. Overall ratings on quality and patient safety.
5. Background characteristics (tenure, hours worked, and job position).

The SOPS Medical Office Survey has a total of 62 items and it takes approximately 10 to 15 minutes to complete. Most of the items use response categories such as Daily/Not in the Past 12 Months, Agree/Disagree, or Never/Always, so they are easy to answer. There is room for written comments at the end of the survey.

The survey was designed to measure the culture of patient safety in medical offices with the following characteristics:

• A medical office should be an outpatient facility in one geographic location. A medical practice or health care system may have multiple medical offices in different locations, but each unique location would be considered a separate medical office for the purposes of the survey administration and for feedback.
• A medical office could be located in a building containing multiple medical offices, but each office in the building would be considered a separate medical office for the purposes of the survey. If providers in the medical office share some or all administrative staff, such as receptionists and schedulers, and share some or all clinical support staff, you may consider them one office.

These characteristics are essential because the survey asks respondents about patient safety and quality issues for a specific medical office location. The survey can be administered to multiple medical offices within a practice, healthcare system, or building, but each medical office would have to be identified as a separate office rather than being surveyed as one entity.

In small offices with a solo practitioner or two-providers, rather than administering the survey, it can be used as a tool to initiate open dialog or discussion about patient safety and quality issues among providers and staff. In health systems or multisite practices, the survey may be administered in smaller offices if the responses are aggregated and only reported at the larger practice or system level. Aggregating the responses would help maintain the confidential nature of individual responses in small offices.

The survey was designed to be appropriate for any specialty. Your office may provide primary care services only, other specialty care services only, or a mix of primary and specialty care services.

A single medical office location needs at least five completed surveys to submit to the SOPS Medical Office Database.

������Ƶestablished the SOPS Medical Office Database as a central repository for survey data from the SOPS Medical Office Survey. AHRQ has produced database reports, which aggregate data from hundreds of medical offices that have voluntarily submitted their data to the Database. The Database serves as an important resource for patient safety culture improvement.

Information about eligibility requirements, registration procedures, and benefits of participating in the Database is available.

������Ƶhas developed supplemental item sets that can be added to the SOPS Medical Office Survey to assess content in areas not covered by the core questions. These supplemental item sets are optional. Currently, there are supplemental item sets for Diagnostic Safety and Value and Efficiency.

Medical offices can refer to the Results From the 2014 Pilot Study of the ������ƵValue and Efficiency Supplemental Item Set for the Medical Office SOPS Survey, which are based on data from more than 1,400 providers and staff in 96 medical offices that participated in a pilot test of the items in early 2014.

Medical offices can refer to the 2024 Results for the ������Ƶ�����ʳ�® Diagnostic Safety Supplemental Item Set for Medical Offices (PDF, 1.6 MB), which are based on data from more than 700 providers and staff in 102 medical offices.

������Ƶoriginally released the SOPS Nursing Home Survey in 2008 and it has been adopted in the United States and internationally. Over the years, users and stakeholders provided ������Ƶwith feedback about suggested changes to the survey. User feedback included:

• Rewording survey items to improve respondent understanding.
• Reducing the survey length. 
• Revising the staff positions and units/work areas.
• Removing negatively worded items.

Using this feedback, ������Ƶdeveloped and pilot tested a new version of the survey, the SOPS Nursing Home Survey 2.0, released in 2025. Toolkit materials, including an Improvement Resource List, User’s Guide, and Data Entry and Analysis Tool, are also available.

The SOPS Nursing Home Survey Version 2.0 assesses many of the same areas of patient safety culture as SOPS Nursing Home Survey Version 1.0, but substantial changes were made to the survey. The final 2.0 survey has 30 survey items compared with 51 survey items in Version 1.0. The names of some composite measures (a group of 2 to 4 survey items that assess the same area of patient safety culture) were changed to align with changes to the content assessed in the measures. The following changes were made to the survey:

• 24 SOPS Nursing Home 1.0 survey items were dropped.
• 20 SOPS Nursing Home 1.0 survey items were reworded or response options were changed.
• 3 new survey items were added to SOPS Nursing Home 2.0.

Unlike Nursing Home Version 1.0, the 2.0 survey has no negatively worded items. 

Nursing Home 2.0 has a total of 30 survey items (compared with 51 survey items in Nursing Home 1.0) and it takes approximately 10–15 minutes to complete. Most of the survey items use Strongly Disagree/Strongly Agree or Never/Always response options. The survey also includes a "Does Not Apply or Don't Know" response option. A section for open-ended comments is at the end of the survey.

Nursing Home 2.0 has 8 composite measures (a group of 2 to 4 survey items that assess the same area of patient safety culture):

1. Teamwork (3 items).
2. Staffing (2 items).
3. Organizational Learning (2 items).
4. Response to Mistakes (3 items).
5. Handoffs and Information Exchange (3 items).
6. Speaking Up (2 items).
7. Supervisor Support for Resident Safety (3 items).
8. Management Support for Resident Safety (3 items).

Nursing Home 2.0 also includes several single item measures that assess:

1. Compliance with Procedures.
2. Training.
3. Willingness to Recommend their nursing home.
4. Overall Rating on Resident Safety.
5. Background Characteristics (staff position, tenure, hours worked per week, shift, and nursing home unit).

The survey development team reviewed the literature on patient safety in nursing homes, interviewed nursing home experts and researchers, identified appropriate survey topics, and drafted survey items for review by the SOPS Technical Expert Panel. The draft survey was cognitively tested with nursing home providers and staff to ensure that the questions were easy to understand and answer and that the items were relevant.

A pilot test was conducted with 27 nursing homes in 2024 and pilot data were analyzed to examine the survey's psychometric properties (reliability, factor structure, etc.), with the goal of shortening the survey by including only the best items. The final SOPS Nursing Home Survey 2.0 is therefore the product of extensive development and testing, demonstrates good psychometric properties, and is a reliable instrument to assess patient safety culture in nursing homes.

A nursing home is a facility or a special contained area of a facility that has only licensed nursing home beds and is not an assisted living, community care, or independent living facility. The survey was designed to measure resident safety culture in a nursing home facility or in a special contained area of a facility (e.g., a hospital) that includes only licensed nursing home beds, so it is important to understand the type of nursing home facility that the survey was designed for:

• It was not designed for use in assisted living facilities, community care facilities, or independent living facilities.
• If a nursing home is located on a large campus or facility that has a mix of nursing home and other long-term care programs (such as independent living, assisted living, and rehabilitation services), survey only the facilities or areas with nursing home beds. Exclude staff who work only in areas with independent living, assisted living, or rehabilitation beds.

Given the substantial changes made in NHSOPS 2.0, it is not possible to trend scores from a previous administration of NHSOPS 1.0 to a current administration of NHSOPS 2.0. If the two surveys are administered at different times, it is not possible to determine the extent to which differences in scores are due to changes in NHSOPS 2.0 or due to actual changes in patient safety culture over time.

Nursing homes have two options for transitioning from NHSOPS 1.0 to NHSOPS 2.0.

• Option 1: Administer NHSOPS 2.0—with no trending of previous NHSOPS 1.0 scores; or
• Option 2: Administer NHSOPS 1.0 One More Time—to trend previous NHSOPS 1.0 scores and then later administer NHSOPS 2.0 to establish a new baseline on NHSOPS 2.0.

A single nursing home location needs at least 10 completed surveys to submit to the SOPS Nursing Home Database.

The SOPS Nursing Home Survey 1.0 is still available on the ������Ƶwebsite, but the use of NHSOPS 2.0 is encouraged. Note that the SOPS Nursing Home Database will accept data from sites that administer either the Nursing Home Survey Version 1.0 or Version 2.0 in 2026.

Nursing homes can refer to the 2025 ������ƵSOPS Nursing Home 2.0 Survey Pilot Study Results, which are based on data from more than 1,300 staff in 27 nursing homes that participated in a pilot study of the items in 2024. 

Yes, you can still use any Nursing Home 1.0 survey items that may have been dropped from Nursing Home 2.0 but put the items at the end of the Version 2.0 survey before the background questions, along with any other supplemental items you want to include.

������Ƶhas developed supplemental items that can be added to the SOPS Nursing Home Survey 2.0 to assess content in areas not covered by the core questions. These supplemental items are optional. Currently, there are supplemental items for Workplace Safety.

Nursing homes can refer to the Pilot Study Results from the 2022 ������ƵSOPS Workplace Safety Supplemental Item Set for Nursing Homes (PDF, 3 MB), which are based on data from more than 2,500 staff in 48 nursing homes that participated in a pilot test of the items in 2022.

The SOPS Community Pharmacy Survey includes a total of 43 items. There are 36 items grouped into 11 composite measures.

The composite measures in the community pharmacy survey are:

1. Communication About Mistakes.
2. Communication About Prescriptions Across Shifts.
3. Communication Openness.
4. Organizational Learning—Continuous Improvement.
5. Overall Perceptions of Patient Safety.
6. Patient Counseling.
7. Physical Space and Environment.
8. Response to Mistakes.
9. Staff Training and Skills.
10. Staffing, Work Pressure, and Pace.
11. Teamwork.

In addition, the community pharmacy survey also includes several single item measures that assess:

1. Documenting mistakes.
2. Overall rating.
3. Background characteristics (tenure, hours worked per week, and job position).

The SOPS Community Pharmacy Survey has a total of 43 items and it takes approximately 10 minutes to complete. Most of the items use Agree/Disagree or Never/Always response categories so it is easy to answer. There is room for written comments at the end of the survey.

The survey was designed to measure the culture of patient safety in community pharmacies in a single location. This includes pharmacies such as:

• Independent pharmacies.
• Supermarket pharmacies.
• Mass merchants/discount retailer pharmacies.
• Chain drugstores (local, regional, national).
• Integrated health system pharmacies (non-hospital unit based).

The survey was designed for community pharmacies. You may decide, however, that it is appropriate to administer it in other types of pharmacies, such as pharmacies in an integrated health care system or a hospital, or pharmacies that supply medications only to hospices or nursing homes. Alternatively, it may be that the Hospital Survey best suits the needs of hospital-based pharmacies. We recommend that you closely review the content of both surveys before deciding.

������Ƶestablished the SOPS Community Pharmacy Database as a central repository for survey data from the SOPS Community Pharmacy Survey. ������Ƶproduced a database report in 2019 which aggregates data from dozens of community pharmacies that have voluntarily submitted their data to the Database. Note that the SOPS Database stopped accepting data from the SOPS Community Pharmacy Survey after the 2019 database report was released. There are no future plans for the SOPS Database to collect data from this survey.

The SOPS Ambulatory Surgery Center Survey includes a total of 35 items. There are 27 items grouped into 8 composite measures.

The composite measures in the ambulatory surgery center survey are:

1. Communication About Patient Information.
2. Communication Openness.
3. Staffing, Work Pressure, and Pace.
4. Teamwork.
5. Staff Training.
6. Organizational Learning—Continuous Improvement.
7. Response to Mistakes.
8. Management Support for Patient Safety.

In addition, the ambulatory surgery center survey also includes several single item measures that assess:

1. How often ASCs document near-misses.
2. An overall rating on patient safety for their ASC.
3. A screener item asking whether the respondent is in the room during surgeries, procedures, or treatments and three subsequent items measuring how often doctors and staff communicate before and after surgeries.
4. Communication before and after surgery.
5. Background characteristics (job position and hours worked).

The survey has a total of 35 items and it takes approximately 15 minutes to complete. Most of the items use Agree/Disagree or Never/Always response categories so it is easy to answer. There is room for written comments at the end of the survey.

Ambulatory Surgery Centers (ASCs) are facilities that have been certified and approved to participate in the Centers for Medicare & Medicaid Services’ ASC program. ASCs provide surgical services to patients who are not expected to need an inpatient stay following surgery. ASCs can be freestanding or affiliated with a hospital or large medical center.

The survey was designed for ASCs, which are facilities that have been certified and approved to participate in the Centers for Medicare & Medicaid Services' ASC program. However, an ASC can be affiliated with a hospital and the SOPS Hospital Survey may best suit the needs of hospital outpatient departments. We recommend that you closely review the content of both surveys before deciding.

������Ƶestablished the SOPS Ambulatory Surgery Center Database as a central repository for survey data from the SOPS Ambulatory Surgery Center Survey. ������Ƶhas produced a database report, which aggregates data from hundreds of ASCs that have voluntarily submitted their data to the Database. The Database serves as an important resource for patient safety culture improvement.

Information about eligibility requirements, registration procedures, and benefits of participating in the Database is available.