Patient safety is a critical component of health care quality. As medical offices continually strive to improve, there is growing recognition of the importance of establishing a culture of patient safety. Achieving a culture of patient safety requires an understanding of the values, beliefs, and norms about what is important in a medical office and which attitudes and behaviors related to patient safety are supported, rewarded, and expected.
Survey Content
Recognizing the need for a measurement tool to assess the culture of patient safety in medical offices, the Agency for Healthcare Research and Quality (AHRQ) funded the development of the Medical Office Survey on Patient Safety Culture. This work is an extension of research used to develop the Hospital Survey on Patient Safety Culture.
Developers reviewed research pertaining to safety, patient safety, health care quality, ambulatory medicine, medical errors, error reporting, safety climate and culture, and organizational climate and culture. In addition, they reviewed existing medical office surveys. The researchers also consulted more than two dozen experts in the field of medical office practice and patient safety and many medical office providers and staff for help in identifying key topics and issues. Based on these activities, the researchers identified a potential list of composites to include in the survey.
The survey was pilot tested and revised, and AHRQ released it in 2009. It was designed to assess medical office staff opinions about patient safety issues, medical error, and event reporting. The survey includes 38 items that measure 10 composites of patient safety culture. In addition to the composite items, 14 items measure how often medical offices have problems exchanging information with other settings and other patient safety and quality issues. Each of the 10 patient safety culture composites is listed and defined in Table 1-1.
The survey also includes questions that ask respondents to rate their medical office in five areas of health care quality (patient centered, effective, timely, efficient, and equitable) and to provide an overall patient safety rating. In addition, respondents are asked to provide limited background demographic information.
The survey's toolkit materials are available at the AHRQ Web site (http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/index.html) and include the survey, survey items and dimensions, user's guide, feedback report template, information about a Data Entry and Analysis Tool, and a Medical Office Patient Safety Improvement Resource List. The toolkit provides medical offices with the basic knowledge and tools needed to conduct a patient safety culture assessment and suggestions for using the data.
The Medical Office Survey on Patient Safety Culture is available in Spanish on the AHRQ Web site. The Spanish translation is designed for U.S. Spanish-speaking respondents from different countries. Information for translators and translation guidelines are available for download at the AHRQ Web site (http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/transguide.html).
Data Limitations
The survey results presented in this report represent the largest known compilation of medical office patient safety culture survey data currently available and therefore provide a useful reference for comparison. However, several limitations to these data should be kept in mind.
First, the medical offices that submitted data to the database are not a statistically selected sample of all U.S. medical offices, since only medical offices that administered the survey on their own and were willing to submit their data for inclusion in the database are represented. To provide a basic comparison of the database medical offices with these medical office population estimates, Table 1-2 shows the geographic distribution of the medical offices in the AHRQ Medical Office Survey on Patient Safety Culture database.ii This distribution is compared with the distribution of physicians' offices based on the 2007 U.S. Economic Census and the National Ambulatory Medical Care Survey (NAMCS) estimates of the number of office-based medical practices in 2005-2006.
The table shows that the 935 AHRQ database medical offices represent less than 1 percent of the estimated population of medical offices. In addition, database medical offices overrepresent the South and Midwest regions and underrepresent medical offices in the West and Northeast.
Second, medical offices that administered the survey were not required to undergo any training and administered the survey in different ways. Some medical offices used a paper-only survey, others used Web-only surveys, and others used a combination of these two methods to collect the data. It is possible that these different modes could lead to differences in survey responses; further research is needed to determine whether and how different modes affect the results.
Finally, the data medical offices submitted have been cleaned for blank records (where responses to all survey items were missing or "Don't know" with the exception of demographic items) and straight-lining (where responses to all survey items in a section were the same even though at least one item was negatively worded). Otherwise, data are presented as submitted. No additional attempts were made to verify or audit the accuracy of the data submitted.
ii. Geographic distribution is based on Census Bureau regions (go to https://www.census.gov/geo/maps-data/maps/docs/reg_div.txt).
