The Medical Office Survey on Patient Safety Culture is an expansion of AHRQ's Hospital Survey on Patient Safety Culture to the medical office setting. The medical office survey is designed to measure the culture of patient safety in medical offices from the perspective of providers and staff. The Medical Office Survey on Patient Safety Culture 2014 User Comparative Database Report consists of data from 935 medical offices and 27,103 medical office staff respondents who completed the survey between November 2011 and November 2013.
This comparative database report was developed as a tool for the following purposes:
- Comparison—To allow medical offices to compare their patient safety culture survey results with other medical offices.
- Assessment and Learning—To provide data to medical offices to facilitate internal assessment and learning in the patient safety improvement process.
- Supplemental Information—To provide supplemental information to help medical offices identify their strengths and areas with potential for improvement in patient safety culture.
Survey Content
The medical office survey includes 38 items that measure 10 composites of organizational culture pertaining to patient safety:
- Communication About Error.
- Communication Openness.
- Office Processes and Standardization.
- Organizational Learning.
- Overall Perceptions of Patient Safety and Quality.
- Owner/Managing Partner/Leadership Support for Patient Safety.
- Patient Care Tracking/Followup.
- Staff Training.
- Teamwork.
- Work Pressure and Pace.
The survey also includes questions that ask respondents about problems exchanging information with other settings and about access to care. In addition, respondents are asked to rate their medical office in five areas of health care quality (patient centered, effective, timely, efficient, and equitable) and to provide an overall rating on patient safety.
Survey Administration Statistics
- A total of 935 medical offices submitted data for the 2014 report.
- The average medical office response rate was 64 percent, with an average of 29 completed surveys per medical office.
Characteristics of Participating Medical Offices
- Database medical offices vary in number of providers and specialties.
- Most medical offices (83 percent) had fully implemented electronic medical/health records.
- More than two-thirds (69 percent) of medical offices were owned by a hospital or health system.
Characteristics of Respondents
- There were 27,103 medical office respondents.
- The top three staff positions of respondents were:
- Other clinical staff or clinical support staff (34 percent).
- Administrative or clerical staff (20 percent).
- Registered nurse (RN), licensed vocational nurse (LVN), or licensed practical nurse (LPN) (15 percent).
- Nearly one-fourth of staff (24 percent) had worked at their medical office for 11 years or more.
- Most respondents (61 percent) worked between 33 and 40 hours per week.
Areas of Strength for Most Medical Offices
The two areas of strength or composites with the highest average percent positive responses werei:
- Teamwork (average 86 percent positive)—the extent to which the office has a culture of teamwork, mutual respect, and close working relationships among staff and providers.
- Patient Care Tracking/Follow-up (average 86 percent positive)—the extent to which the office reminds patients about appointments, documents how well patients follow treatment plans, follows up with patients who need monitoring, and follows up when reports from an outside provider are not received.
Areas With Potential for Improvement for Most Medical Offices
- Work Pressure and Pace (average 50 percent positive)—the extent to which there are enough staff and providers to handle the office patient load, and the office work pace is not hectic. This composite had the lowest average percent positive response.
- Communication Openness (average 68 percent positive)—the extent to which providers in the office are open to staff ideas about how to improve office processes, and staff are encouraged to express alternative viewpoints and do not find it difficult to voice disagreement.
Results by Medical Office Characteristics
Number of Providers
- Medical offices with one provider had the highest average percent positive scores on all 10 patient safety culture composites; the greater the number of providers, the lower the average percent positive score across composites.
- Percent positive scores for all five Overall Ratings on Quality (those responding "Excellent" or "Very good") were typically higher for medical offices with fewer providers.
- Medical offices with one provider had the highest percentage of respondents who gave their medical office an Overall Rating on Patient Safety of "Excellent" or "Very good" (75 percent); medical offices with 20 or more providers had the lowest (53 percent).
Single vs. Multi-Specialty
- Single specialty medical offices were more positive than Multi-specialty medical offices on all 10 patient safety culture composites.
- Single specialty medical offices had higher percent positive scores for all five Overall Ratings on Quality (those responding "Excellent" or "Very good").
- Single specialty medical offices had a higher percentage of respondents who gave their medical office an Overall Rating on Patient Safety of "Excellent" or "Very good" (70 percent) than Multi-specialty medical offices (65 percent).
Single Specialty
- Medical offices that only specialized in Pediatrics had the highest average percent positive score on all 10 patient safety culture composites (79 percent); Hematology had the lowest (68 percent).
- Medical offices that only specialized in Pediatrics had the highest Overall Rating on Patient Safety (those responding "Excellent" or "Very good") (76 percent); Hematology and Internal Medicine had the lowest (64 percent).
Ownership
- Hospital or health system owned medical offices had the highest average percent positive response across the composites (75 percent); University/Medical School/Academic Medical Institution had the lowest (69 percent).
- Hospital or health system ownedmedical offices had the highest percent positive scores (those responding "Excellent" or "Very good") for all five Overall Ratings on Quality.
- Hospital or health system owned medical offices had the highest Overall Rating on Patient Safety (those responding "Excellent" or "Very good") (71 percent); University/Medical School/Academic medical institution owned medical offices had the lowest (59 percent).
Geographic Region
- South Atlantic medical offices had the highest average percent positive response across patient safety culture composites (77 percent); New England/Mid-Atlantic had the lowest (67 percent).
- South Atlantic medical offices had the highest percent positive scores for all five Overall Ratings on Quality (those responding "Excellent" or "Very good").
- South Atlantic medical offices had the highest percentage of respondents who gave their medical office an Overall Rating on Patient Safety of "Excellent" or "Very good" (75 percent). New England/Mid-Atlantic medical offices had the lowest (55 percent).
Results by Respondent Characteristics
Staff Position
- Management had the highest average percent positive response across the composites (84 percent); Nurses (RN/LVN/LPN) had the lowest (71 percent).
- Management had the highest percent positive scores for all five Overall Ratings on Quality (those responding "Excellent" or "Very Good").
- Management had the highest percentage who gave their medical office an Overall Rating on Patient Safety of "Excellent" or "Very good" (83 percent); Nurses (RN/LVN/LPN) had the lowest (64 percent).
Tenure in Medical Office
- Respondents with less than 1 year in their current medical office had the highest average percent positive response across the composites (78 percent); respondents with 1 year to less than 6 years (72 percent) had the lowest.
- Respondents with less than 1 year or more than 11 years in their current medical office had the highest percent positive scores for all five Overall Ratings on Quality (those responding "Excellent" or "Very Good").
- Respondents with less than 1 year in their current medical office had the highest percentage of respondents who gave their medical office an Overall Rating on Patient Safety of "Excellent" or "Very good" (70 percent); respondents with 11 years or more in their current medical office had the second highest (69 percent).
Action Planning for Improvement
The delivery of survey results is not the end point in the survey process; it is just the beginning. Often, the perceived failure of surveys to create lasting change is actually due to faulty or nonexistent action planning or survey followup.
Seven steps of action planning are provided to give medical offices guidance on next steps to take to turn their survey results into actual patient safety culture improvement:
- Understand your survey results.
- Communicate and discuss the survey results.
- Develop focused action plans.
- Communicate action plans and deliverables.
- Implement action plans.
- Track progress and evaluate impact.
- Share what works.
Purpose and Use of This Report
In response to requests from medical offices interested in comparing results with those of other medical offices on the Medical Office Survey on Patient Safety Culture, the Agency for Healthcare Research and Quality established the Medical Office Survey on Patient Safety Culture Comparative Database. The first medical office survey comparative database report was released in 2012 and consisted of results from 934 medical offices and 23,679 staff respondents.
The Medical Office Survey on Patient Safety Culture 2014 User Comparative Database Report consists of data from 935 medical offices and 27,103 staff respondents.
This comparative database report was developed as a tool for the following purposes:
- Comparison—To allow medical offices to compare their patient safety culture survey results with other medical offices.
- Assessment and Learning—To provide data to medical offices to facilitate internal assessment and learning in the patient safety improvement process.
- Supplemental Information—To provide supplemental information to help medical offices identify their strengths and areas of potential improvement in patient safety culture.
This report presents statistics (averages, standard deviations, minimum and maximum scores, and percentiles) on the patient safety culture composites and items from the survey.
Appendixes A and B present overall results by medical office characteristics (number of providers, single vs. multi-specialty, specialty, ownership, and region) and respondent characteristics (staff position and tenure in medical office).
i. Percent positive is the percentage of positive responses (e.g., Agree, Strongly agree) to positively worded items (e.g., "Staff in this office follow standardized processes to get tasks done") or negative responses (e.g., Disagree, Strongly disagree) to negatively worded items (e.g., "This office is more disorganized than it should be").
