Chapter 5. Overall Results

2012 User Comparative Database Report: Medical Office Survey on Patient Safety Culture

This chapter presents the overall survey results for the database, showing the average percentage of positive responses across the database medical offices on each of the survey's items and composites. Reporting the average across medical offices ensures that each medical office receives an equal weight that contributes to the overall average.

Reporting the data at the medical office level in this way is important because culture is considered to be a group characteristic and is not considered to be a solely individual characteristic. An alternative method would be to report a straight percentage of positive responses across all respondents, but this method would give greater weight to respondents from larger medical offices.
 

Highlights

  • Two composites were identified as areas of strength for the medical offices:
    • Teamwork—the average percent positive response (84 percent) was the highest.
    • Patient Care Tracking/Follow-up—the average percent positive response (82 percent) was the second highest.
  • One composite was identified as an area for improvement for the medical offices:
    • Work Pressure and Pace—the average percent positive response (46 percent) was the lowest.
  • Most respondents within medical offices (65 percent) gave their medical office an Average Overall Quality and Patient Safety rating of "Excellent" (28 percent) or "Very good" (37 percent).

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Composite and Item-Level Charts

This section provides the overall item and composite-level results. The methods for calculating the percent positive scores at the item and composite levels are described in the Notes section of this document.

Composite-Level Results

 

Chart 5-1 shows the average percent positive response for each of the 10 patient safety culture composites across the database medical offices. The patient safety culture composites are shown in order from the highest average percent positive response to the lowest.

Areas of Strength
  • Teamwork—the office has a culture of teamwork, mutual respect, and close working relationships among staff and providers. This patient safety culture composite had the highest average percent positive response (84 percent), indicating it is an area of strength across the database medical offices.
  • Patient Care Tracking/Follow-up—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. This patient safety culture composite had the second highest average percent positive response (82 percent).
Area With Potential for Improvement
  • Work Pressure and Pace—there are enough staff and providers to handle the patient load, and the office work pace is not hectic. This patient safety culture composite had the lowest average percent positive response (46 percent), indicating it is an area with potential for improvement across the database medical offices.

Item-Level Results

 

Chart 5-2 shows the average percent positive response for each of the 38 survey composite items. The items are grouped by the patient safety culture composite they are intended to measure. Within each composite, the items are presented in the order in which they appear in the survey. Chart 5-3 shows the item-level average ratings on a list of patient safety and quality issues, and Chart 5-4 shows the item-level average ratings on information exchange with other settings.

Area of Strength for the Patient Safety Culture Composite Items
  • The survey item with the highest average percent positive response (89 percent) was from the patient safety culture composite Patient Care Tracking/Follow-up: "This office follows up with patients who need monitoring."
Area With Potential for Improvement for the Patient Safety Culture Composite Items
  • The survey item with the lowest average percent positive response (31 percent) was from the patient safety culture composite Work Pressure and Pace: "In this office, we often feel rushed when taking care of patients." (That is, an average of only 31 percent of respondents in each medical office Strongly disagreed or Disagreed with this negatively worded item.)
Area of Strength for Noncomposite Items
  • The survey item with the highest average percent positive response (96 percent) was: "The wrong chart/medical record was used for a patient." (That is, an average of 96 percent of respondents in each medical office indicated that the frequency of this event occurring was several times or less in the past 12 months.)
Area With Potential for Improvement for Noncomposite Items
  • The survey item with the lowest average percent positive response (51 percent) was "A pharmacy contacted our office to clarify or correct a prescription."

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Overall Ratings

 

Chart 5-5 shows the results from the five items on quality, and Chart 5-6 shows an Overall Rating on Patient Safety. On average across medical offices, the area of greatest strength was providing equitable care to patients, with 81 percent of medical office staff giving their medical office a rating of "Excellent" (51 percent) or "Very good" (30 percent).

The area with most potential for improvement was providing timely health care to patients, with only 50 percent of medical office staff giving their medical office a rating of "Excellent" (17 percent) or "Very good" (33 percent). Most respondents were positive on the overall rating on patient safety, with 65 percent giving their medical office a rating of "Excellent" (22 percent) or "Very good" (43 percent).

Average Overall Rating on Quality and Patient Safety

 

Chart 5-7 shows the average overall rating on quality and patient safety, which is the average of the five quality items and the overall rating on patient safety across all 2012 database medical offices. Consistent with the items in Chart 5-5, most respondents were positive, with 65 percent giving their medical office a rating of "Excellent" (28 percent) or "Very good" (37 percent).

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Additional Correlational Analyses

 

This section presents correlational analyses that examined the relationship between medical office size and health information technology (IT) with the AHRQ Medical Office Survey on Patient Safety Culture scores. Table 5-1 shows the correlation results for health IT implementation and patient safety culture composite results.

Correlations (r) are a type of statistic that conveys the extent to which two variables have a linear relationship. Correlations range from a low of 0 to a high of 1.00 and can be either positive or negative. The closer the correlation is to 1 (or -1.00), the greater the degree of association between the variables. A correlation is considered statistically significant (not due to chance) when the p value is less than .05 (p <.05).

Medical Office Size

We first examined the relationship between medical office size and patient safety culture. Medical office size was measured by the number of providers working in the medical office during a typical week. Patient safety culture was measured with the 10 composite scores, the Overall Rating on Patient Safety Item (those giving their medical office an "Excellent" or "Very good"), and an average score across the 10 composites.

We found that:

  • Smaller medical offices tended to have slightly higher patient safety culture scores.
    • Six of the 10 composites were significantly related to medical office size, with correlations ranging from -0.06 to -0.10. However, the sizes of the relationships are relatively small.
    • The correlation between the average patient safety composite score and medical office size was relatively small (r = -0.08, p < 0.05).
  • Smaller medical offices tended to have a slightly higher percentage of staff giving their medical office an "Excellent" or "Very good" Overall Rating on Patient Safety (r = -0.09, p < 0.05).

Health Information Technology Implementation

We also examined the extent to which medical office implementation of health IT systems (e.g., electronic medical reports or ordering of tests) was related to patient safety culture scores. We performed partial correlations, controlling for medical office size due to the relationship we found between size and patient safety culture. As shown in Table 5-1, we found that:

  • Health IT implementation was related to higher patient safety culture scores for:
    • Electronic Medical/Health Records (EMR/EHRs). Implementation of EMR/EHRs was related to higher patient safety culture scores for 7 of the 10 composites (correlations ranging from 0.07 to 0.12). The correlation between the average patient safety composite score and EMR/EHR implementation was 0.09 (p < 0.05).
    • Electronic Ordering of Tests (EOT). Implementation of EOT was related to higher patient safety culture scores for 3 of the 10 composites (correlations ranging from 0.08 to 0.14). The correlation between the average patient safety composite score and EOT implementation was 0.07 (p <0.05).
    • Electronic Ordering of Medications (EOM). Implementation of EOM was related to higher patient safety culture scores for 3 of the 10 composites (correlations ranging from 0.07 to 0.09). The correlation between the average patient safety composite score and EOM implementation was 0.07 (p <0.05).
  • Health IT implementation was related to lower patient safety culture scores for:
    • Electronic Access to Patients' Tests or Imaging Results (ETI). Implementation of ETI was related to lower patient safety culture scores for 2 of the 10 composites (correlations ranging from -0.11 to -0.13).

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Page last reviewed May 2012
Internet Citation: Chapter 5. Overall Results: 2012 User Comparative Database Report: Medical Office Survey on Patient Safety Culture. May 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/2012/mosurv12chap5.html