Executive Summary

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

The Medical Office Survey on Patient Safety Culture is an expansion of AHRQ's Hospital Survey on Patient Safety Culture. 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 Comparative Database consists of data from more than 900 medical offices and nearly 24,000 medical office staff respondents who completed the survey.

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.

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Survey Content

The medical office survey includes 38 items that measure 10 composites of organizational culture pertaining to patient safety:

  1. Communication About Error.
  2. Communication Openness.
  3. Office Processes and Standardization.
  4. Organizational Learning.
  5. Overall Perceptions of Patient Safety and Quality.
  6. Owner/Managing Partner/Leadership Support for Patient Safety.
  7. Patient Care Tracking/Followup.
  8. Staff Training.
  9. Teamwork.
  10. 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, it has 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 Statistics

  • The 2012 database consists of data from 23,679 medical office staff respondents from 934 participating medical offices.
  • The average medical office response rate was 71 percent, with an average of 25 completed surveys per medical office.

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Characteristics of Participating Medical Offices

  • Database medical offices vary in number of providers and specialties.
  • Nearly two-thirds (62 percent) of medical offices had fully implemented electronic medical/health records.
  • Nearly three-fourths (73 percent) of medical offices were owned by a hospital or health system.

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Characteristics of Respondents

  • The top three staff positions of respondents were:
    • Administrative or clerical staff (28 percent).
    • Other clinical staff or clinical support staff (24 percent).
    • Registered Nurse (RN), Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN) (18 percent).
  • Nearly two-thirds of respondents (63 percent) had worked at their medical office for at least 3 years.
  • Most respondents (57 percent) worked between 33 and 40 hours per week.

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Areas of Strength for Most Medical Offices

Results are expressed in terms of percent positive response. 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").

Teamwork (average 84 percent positive response)—This composite is defined as the extent to which the office has a culture of teamwork, mutual respect, and close working relationships among staff and providers. This composite had the highest average percent positive response.

Patient Care Tracking/Follow-up (average 82 percent positive response)—This composite is defined as 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. This composite had the second highest average percent positive response.

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Area With Potential for Improvement for Most Medical Offices

Work Pressure and Pace (average 46 percent positive response)—This composite is defined as 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.

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Results by Medical Office Characteristics

Number of Providers

  • Medical offices with one or two providers had the highest average percent positive on all 10 patient safety culture composites.
  • Percent positive scores (those responding "Excellent" or "Very Good") for all five Overall Ratings on Quality were higher for medical offices with fewer providers.
  • Medical offices with two providers had the highest (74 percent) percentage of respondents who gave their medical office an Average Overall Rating on Quality and Patient Safety of "Excellent" or "Very good." Medical offices with 14 to 19 providers had the lowest (57 percent).

Single vs. Multi-Specialty

  • Single specialty medical offices had a higher average percent positive response than Multi-Specialty medical offices on all 10 patient safety culture composites.
  • Single specialty medical offices had higher percent positive scores (those responding "Excellent" or "Very good") for all five Overall Ratings on Quality.
  • Single specialty medical offices had a higher percentage of respondents who gave their medical office an Average Overall Rating on Quality and Patient Safety of "Excellent" or "Very good" (68 percent) than Multi-Specialty medical offices (59 percent).

Specialty

  • No clear patterns emerged across specialties (Cardiology, Hematology, OB/GYN, Pediatrics, Primary Care) on the patient safety culture composites or the five Overall Ratings on Quality.
  • Medical offices that only specialized in Pediatrics had the highest Average Overall Rating on Quality and Patient Safety (those responding "Excellent" or "Very good") (69 percent); OB/GYN had the lowest (66 percent).

Ownership

  • Community health center and Provider and/or Physician owned medical offices had the highest average percent positive response across the composites (72 percent).
  • Federal, State, or local government medical offices had the lowest percent positive scores (those responding "Excellent" or "Very Good") for all five Overall Ratings on Quality.
  • Federal, State, or local government medical offices had the lowest Average Overall Rating on Quality and Patient Safety (those responding "Excellent" or "Very good") (51 percent).

Region

  • South Atlantic medical offices had the highest average percent positive response on all 10 patient safety culture composites.
  • South Atlantic medical offices had higher percent positive scores (those responding "Excellent" or "Very good") for all five Overall Ratings on Quality.
  • South Atlantic medical offices had the highest percentage of respondents who gave their medical office an Average Overall Rating on Quality and Patient Safety of "Excellent" or "Very good" (70 percent).

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Results by Respondent Characteristics

Staff Position

  • Management had the highest average percent positive response across the composites (80 percent).
  • Management had the highest percent positive scores (those selecting "Excellent" or "Very good") for three of the five Overall Ratings on Quality; Physicians had the highest percent positive scores for the other two ratings.
  • Management had the highest percentage who gave their medical office an Average Overall Rating on Quality and Patient Safety of "Excellent" or "Very good" (73 percent); Administrative/Clerical had the lowest (60 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.

  1. Understand your survey results.
  2. Communicate and discuss the survey results.
  3. Develop focused action plans.
  4. Communicate action plans and deliverables.
  5. Implement action plans.
  6. Track progress and evaluate impact.
  7. Share what works.

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Current as of May 2012
Internet Citation: Executive Summary: 2012 User Comparative Database Report: Medical Office Survey on Patient Safety. May 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/2012/mosurv12sum.html