Medical Office Survey on Patient Safety Culture

Purpose and Use of This Document

Comparative results are provided for the items and patient safety culture dimensions on the AHRQ Medical Office Survey on Patient Safety Culture to allow medical offices to compare their survey results against the results from 470 medical offices. This number includes 292 Practice Based Research Network (PBRN) medical offices that administered the survey in 2009 and 182 medical offices that participated in a pilot test of the survey in the United States in late 2007.

The results presented here are from limited numbers of staff and medical offices and will provide only a general indication of how your medical office compares with other medical offices in the United States. The data summarized here were not derived from a statistically selected sample of U.S. medical offices. 

At this time, there is no central repository for medical offices to submit data for comparative purposes. However, similar to the AHRQ Hospital Survey on Patient Safety Culture Comparative Database (https://archive.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html), AHRQ plans to support a U.S. comparative database for the medical office survey that will provide more extensive comparative data. More details will be forthcoming from AHRQ about when data submission will begin and when updated comparative results will be available.

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Report Overview 

• Comparative results are provided for the survey items and patient safety culture dimensions based on data from 10,567 staff from 470 medical offices.
• The data were obtained from two survey administrations: 6,463 staff from 292 PBRN medical offices surveyed in 2009 and 4,174 staff from 182 pilot test medical offices surveyed in late 2007.
• Basic descriptive data are provided about the respondents and medical offices.
• A description of how composite scores on the Medical Office Survey on Patient Safety Culture were calculated is also provided.

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Survey Development

The Medical Office Survey on Patient Safety Culture is an expansion of the Agency for Healthcare Research and Quality's (AHRQ) Hospital Survey on Patient Safety Culture, which was pilot tested and made available to the public in November 2004 (https://archive.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/index.html). The Medical Office Survey on Patient Safety Culture was specifically designed to measure the culture of patient safety in medical offices from the perspectives of providers and staff.

Safety culture can be defined as the set of values, beliefs, and norms about what is important, how to behave, and what attitudes are appropriate when it comes to patient safety in a workgroup or organization. The Medical Office Survey on Patient Safety Culture is intended to help a medical office assess the extent to which its organization's culture emphasizes the importance of patient safety, facilitates teamwork and open discussion about mistakes, and creates an atmosphere of continuous learning and improvement.

The survey design team reviewed the literature on patient safety problems and issues in medical offices, interviewed more than two dozen experts and researchers on patient safety in medical offices, asked many medical office providers and staff to identify appropriate survey topics, and drafted sets of survey dimensions and items for review by experts. The draft survey was pretested with medical office providers and staff to ensure that the questions were easy to understand and answer and that the items were relevant. The pilot test survey was then administered in 2007 in a total of 182 medical offices, the data were analyzed to examine the survey's psychometric properties (reliability and factor structure), and the length was shortened by dropping items.

The final survey includes 52 survey items that measure the following 12 areas of organizational culture pertaining to patient safety:

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

The survey uses 6-point frequency scales ("Daily" to "Not in the past 12 months"), 5-point frequency scales ("Never" to "Always"), or 5-point scales of agreement ("Strongly disagree" to "Strongly agree"). Most items include a "Does not apply or Don't know" option. 

The survey also includes overall ratings questions that ask respondents to rate their medical office in five areas of health care quality (patient centered, effective, timely, efficient, equitable) and to provide an overall rating on patient safety.

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Survey Administration

In 2007, a pilot administration was conducted with 182 medical offices and 4,174 staff across 21 States. The pilot survey was designed to contain a diverse sample of medical offices, although participation was voluntary and therefore may not statistically represent all medical offices in the United States. In 2009, 11 PBRNs collected data from 292 medical offices and 6,463 staff across 17 States.

The data from the 182 pilot test medical offices were combined with the data from the 292 PBRN medical offices, yielding a total of 474 medical offices. Four medical offices were dropped because they had participated in both data collections, resulting in a final combined dataset of 470 medical offices.

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