Nine Years, One Mission: Building Florida's Patient Safety Infrastructure
How nine years of partnership between Beterra Health and the Florida Hospital Association built the state's first, and only, statewide patient safety culture infrastructure.
Florida's first and only statewide patient safety culture benchmark established
13% second victim rate identified statewide — a national first
100+ hospitals · #1 AHCA data contributor in Florida
79%
Avg. response rate (2024)
vs. 52% national average
+27pp
Above national response avg.
Three facilities hit 100%
75,687
Survey participants in 2024
65 facilities statewide
100+
Hospitals & health systems
#1 AHCA data contributor in FL
In 2016, safety culture in Florida hospitals was largely unmeasured — and that was the problem.
Not for lack of evidence that it mattered. The research had been clear for years: how staff communicate about errors, whether leadership responds to near misses without blame, how well teams function under pressure — these aren't soft management concerns. They are among the strongest predictors of whether patients are harmed.
Yet most Florida hospitals had no systematic way to measure safety culture, no meaningful peer comparison, and no infrastructure to act on what they found. The Florida Hospital Association, representing more than 200 hospitals statewide, recognized the gap. With regulatory pressure building — including eventual mandates from AHCA requiring public submission of safety culture data — FHA needed more than a survey vendor. It needed a partner willing to build something that had never existed.
79%
vs. 52% national
Average response rate across the FHA–Beterra program (2024)
27 points above the national benchmark, with three facilities achieving 100%. Beterra's own analysis found weak correlation between response rate and safety culture scores — meaning this is not a participation bias story. Florida hospitals are genuinely more engaged.
FHA–Beterra Partnership · Active Since 2016
"Measurement without action is just data collection. Every part of this program was designed around the question of what happens after the results are received."
The Challenge
Systematic Measurement at Scale — Before It Was Required
Florida became the first state in the nation to require safety culture measurement. That made establishing the foundation not only operationally important but historically significant. FHA needed a partner to build three things that did not exist:
A Statewide Benchmark
Florida hospitals could only compare themselves to national AHRQ data — useful, but telling a Tampa hospital how it compares to rural Montana. A Florida peer benchmark was essential.
AHCA Compliance Infrastructure
When AHCA mandated public submission of safety culture data, individual hospitals needed end-to-end support without maintaining internal analytics capacity at each facility.
A Culture of Action
Most survey vendors deliver reports. FHA needed a partner whose entire program was designed around what happens after results are received — unit-level action planning, leadership accountability, improvement tracking.
The Partnership
Year by Year: How the Program Grew
From a modest survey administration contract with 11 hospitals to a statewide quality and safety infrastructure serving 100+ hospitals and health systems. The evolution tracks one continuous thread of trust, capability, and measurable impact.
11 hospitals. Florida's first statewide benchmark.
4,362 survey responses across 146 unit-level micro-cultures. Overall response rate 60% — five points behind the national average, with the entire gap ahead still to close.
25 hospitals. Year-over-year trend analysis introduced.
14,967 survey responses. Florida hospitals can now track their own trajectory, not just a single snapshot. 11 of 16 returning facilities improve their Overall Percent Positive Response. FHA statewide benchmark: 65.7%.
Net Promoter Score added. Safety culture meets engagement.
8,920 total responses. Beterra's Journey to Zero Harm framework connects safety culture to patient outcomes, staff safety, and patient experience as a unified system.
13% second victim rate surfaced statewide — a first of its kind.
11,113 responses achieved despite COVID-19. 11 of 14 facilities meet or exceed the 60% response target. A finding stops hospital leaders cold: nearly 1,400 staff identify as second victims, experiencing anxiety, depression, or serious doubt about continuing their career.
65 facilities. 75,687 participants. 79% avg. response rate.
27 points above the 52% national average, with three facilities hitting 100%. Florida's Overall Percent Positive Response: 72.8%, exceeding the 71% national average. Approx. 9,760 second victims identified statewide.
100+ hospitals. AHCA's most significant data contributor.
Beterra serves as FHA's technical advisor for AHCA compliance — having worked directly with the agency to validate submission software and data pipelines — and is the most significant data contributor to AHCA's statewide public safety culture reporting program.
What Beterra Built
More Than a Platform — A Statewide Infrastructure
The evolution of this partnership mirrors Beterra's evolution as a company. What began as a survey administration contract became, over nine years, something that didn't exist before.
Florida's First and Only Statewide Safety Culture Benchmark
Before this partnership, Florida hospitals could only compare themselves to the national AHRQ database. The FHA–Beterra benchmark provides a Florida peer comparison across all 12 HSOPS composites, segmented by bed size, care setting, and role type — updated annually since 2016. That data asset exists nowhere else.
- Peer comparison across Florida hospitals and health systems
- Segmented by bed size, care setting, and role type
- Updated annually since 2016 across 12 HSOPS composites
AHCA Compliance — Built In, Not Bolted On
Beterra worked directly with AHCA to validate data pipelines and submission software. Today Beterra is the most significant data contributor to AHCA's statewide reporting program. For FHA member hospitals, AHCA compliance isn't a separate workstream — it's built into the survey process itself.
- End-to-end AHCA PSCS submission handling
- No internal analytics capacity required per facility
- Direct agency partnership to validate pipelines and software
Where the Data Becomes Action
ACT gives leaders at every level what most safety culture platforms don't — Florida-specific peer benchmarking, leadership vs. frontline perception gap analysis, and structured action planning with ownership assignment and progress tracking.
- Leadership vs. frontline perception gap analysis
- Unit-level risk scoring combining culture, second victim, and engagement data
- Automated regulatory submissions to AHCA and AHRQ
Co-Designing Improvement Frameworks
Beterra's engagement with FHA's Quality Council goes well beyond presenting data. Beterra has co-designed improvement frameworks, built best-practice guidance for unit-level action planning, and supported FHA's legislative strategy with data-driven analysis when the AHCA mandate was being shaped.
- Presented benchmarking findings at quality forums
- Co-designed unit-level action planning frameworks
- Supported FHA's legislative strategy with statewide data
What the Data Surfaced
The Second Victim Finding
One of the most consequential things Beterra's work has surfaced isn't a composite score. It's a question:
"In the past year, did a patient safety event cause you to experience anxiety, depression, or doubt about whether you could continue doing your job?"
In 2020, 13% of FHA respondents said yes. In 2024, Beterra identified approximately 9,760 second victims across the Florida benchmark — roughly 12.9% of all respondents. ICU staff topped the list at nearly 20%. Caregiver support rates vary from 17% to 67% across facilities. That data doesn't appear in any CMS quality report. It exists because FHA and Beterra built the infrastructure to ask the question — and because enough hospital staff trusted the process to answer honestly.
9,760
Second victims identified statewide
2024 program data
~20%
ICU staff affected
Highest-rate care setting
17–67%
Caregiver support range
Variance across facilities
Nine Years of Measurable Impact
Response Rates: What Trust Looks Like in the Data
Survey response rates are a leading indicator of organizational trust. The FHA–Beterra program's trajectory tells a clear story: from 60% in 2016 to 79% in 2024 — 27 percentage points above the 52% national norm.
Response Rate Trajectory
FHA–Beterra Program vs. National Average
National averages are approximate; FHA figures reflect program data. 2024: FHA avg. 79% vs. national 52%.
"Measuring the culture of patient safety is critical to our work to eliminate patient harm and reduce readmissions. The Florida-specific benchmark gives our members a meaningful point of comparison — not just against national norms, but against their Florida peers."
Kim Streit, FACHE, MBA, MHS Senior Vice President, Healthcare Research & Information — Florida Hospital Association
Safety Culture Scores: What the Data Shows
Florida's Overall Percent Positive Response reached 72.8% in 2024 — 1.8 points above the national average of 71%. The state started this program 5 points behind national norms in 2016. It now leads them.
72.8%
Florida OPPR (2024)
vs. 71% national avg.
4×
Improvement rate
vs. national average
Org. Learning
Highest predictor of safety culture score
Correlation r=0.938
#1
AHCA data contributor
In Florida statewide
Key Takeaways
Nine years of partnership reveals lessons that apply to any healthcare association or state agency building safety culture infrastructure at scale.
Measurement Without Action Is Just Data Collection
Every part of the FHA–Beterra program was designed around the question of what happens after results are received. Survey infrastructure that doesn't connect to improvement planning produces reports, not change.
Peer Benchmarking Changes the Conversation
Before this partnership, Florida hospitals compared themselves to national norms that told them nothing about their Florida peers. A statewide benchmark transformed benchmarking from a compliance checkbox into a strategic improvement tool.
Response Rate Is a Leading Indicator of Trust
Beterra's own analysis found weak correlation between response rate and safety culture scores — meaning Florida's 79% avg. is not a participation bias story. Florida hospitals are genuinely more engaged because staff trust the process.
The Infrastructure Enables the Mandate
Florida became the first state in the nation to require safety culture measurement. The FHA–Beterra infrastructure made compliance operationally feasible for 100+ hospitals without requiring individual analytics capacity at each facility.
"For Beterra, the FHA partnership represents the clearest proof of what this work is for. Not delivering a survey. Not producing a report. Building the infrastructure that makes it harder for patients to get hurt — systematically, durably, across an entire state."
Beterra Health FHA Partnership · 2016–PresentPartnership Profile
Florida Hospital Association
Statewide Hospital Association · Florida
200+ Member Hospitals · Active Since 2016
9 Yrs
Partnership Length
Continuous since 2016
100+
Hospitals Served
FHA member hospitals
75,687
Participants (2024)
Statewide survey data
79%
Avg. Response Rate
vs. 52% national avg.
Florida's Only Statewide Benchmark
Built in partnership with FHA since 2016
#1 AHCA Data Contributor in FL
Direct agency pipeline validation
9,760 Second Victims Identified
2024 statewide program data
Beterra Solutions
SafeCulture Survey
AHRQ HSOPS administration, Florida-specific benchmarking, and AHCA-compliant reporting.
ACT Platform
Unit-level action planning, perception gap analysis, and automated regulatory submissions.
Florida AHCA Compliance
End-to-end AHCA PSCS submission — built into the survey process itself.
Case Study
From Survey to System — Beterra × Florida Hospital Association
Ready to build your safety culture infrastructure?
See how Beterra's statewide benchmark and AHCA compliance platform can serve your hospitals and health systems.
Talk to our team