Chapter 1. Introduction
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.
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 and supervised 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 dimensions 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, 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 the Microsoft® Excel® Data Entry and Analysis Tool, and the 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.
Since its release, the medical office survey has been implemented in hundreds of medical offices across the United States. Medical offices administering the survey have expressed interest in comparing their results with other medical offices as an additional source of information to help them identify areas of strength and areas for improvement. In response to these requests, AHRQ funded the Medical Office Survey on Patient Safety Culture Comparative Database to enable medical offices to compare their most recent survey results with other medical offices and to eventually examine trends in patient safety culture over time. Medical offices interested in submitting to the database should go to the AHRQ Web site for more information (http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/2011/index.html).
The survey results presented in this report represent the largest 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, medical offices that administered the survey were not required to undergo any training and administered the survey in different ways. Some medical offices used an outside company or vendor to handle the survey data collection tasks. Other medical offices administered the survey themselves. It is possible that these different collection methods could lead to differences in survey response; further research is needed to determine whether and how different collection methods affect the results.
Second, the data medical offices submitted have been cleaned for out-of-range values (e.g., invalid response values due to data entry errors) and blank records (where responses to all survey items were missing). In addition, some logic checks were made. Otherwise, data are presented as submitted. No additional attempts were made to verify or audit the accuracy of the data submitted.
Finally, 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 voluntarily administered the survey and were willing to submit their data for inclusion in the database are represented.
Medical offices are typically characterized as either those with one or two physicians or group medical practices consisting of three or more physicians. According to the U.S. Census Bureau 2007 Economic Census (2007 NAICS code 6211 "Offices of physicians"), there were 220,131 physicians' offices in the United States (http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml).
A 2008 report from the National Center for Health Statistics presents estimates of the number and characteristics of medical practices with which physicians are associated. These data, from the 2005-2006 National Ambulatory Medical Care Surveys (NAMCS), estimate that during 2005-2006 there were 163,700 medical practices in the United States. This is considerably lower than the 220,131 physicians' offices in the U.S. Census Bureau 2007 Economic Census.
To provide a basic comparison of the database medical offices with these medical office population estimates, Table 1-2 shows the geographic distribution (http://www.census.gov/econ/industry/geo/g6211.htm) of the AHRQ Medical Office Survey on Patient Safety Culture database. This distribution is compared with the distribution of physicians' offices based on the 2007 U.S. Economic Census and the NAMCS estimates of the number of office-based medical practices in 2005-2006. The table shows that the 934 AHRQ database medical offices represent less than 1 percent of the estimated population of medical offices. In addition, database medical offices overrepresent the Midwest region and underrepresent medical offices in the West and Northeast.
Additional comparisons of the AHRQ database medical offices with other characteristics of the population of medical offices are not available. Subsequent chapters of this report only present information about the characteristics of AHRQ database medical offices.