Appendix A. Sample Data Collection Protocol for the Medical Office Point of Contact: Paper Survey

Survey User's Guide: Medical Office Survey on Patient Safety Culture

Your Data Collection Tasks and Schedule for the Medical Office Survey on Patient Safety

Listed below are the schedule and tasks for administering the paper survey. Fill in the dates for your survey. Post this protocol in your office to remind you of the schedule.

Tasks and Schedule

Target Date Activity
One week before survey distribution

Date:
Print and post publicity materials. Post survey flyers throughout the medical office (e.g., on bulletin boards, in work areas). Promote survey throughout the data collection period.
Beginning of Week 1
(Start of Survey Data Collection)

Date:
Distribute survey packets to all staff members on the survey distribution list. Consider distributing the packets at staff meetings and encourage survey participation. Caution staff, however, not to discuss their answers if they complete their surveys during the meeting.
Beginning of Week 2

Date:
Remind staff to complete the survey. If you are not using individual identifiers to track respondents, distribute reminder cards to all staff. If you are using identifiers to track respondents, distribute reminder cards only to nonrespondents.

If your medical office is not very large and you have the time, you may find it more effective to remind staff in person to complete the survey. Thank those who have already done so.
Beginning of Week 3

Date:
Distribute a second survey packet. If you are not using individual identifiers to track respondents, distribute second survey packets to all staff. If you are using identifiers to track respondents, distribute second survey packets only to nonrespondents.
End of Week 4

Date:
Close out data collection.

Return to Contents
Proceed to Next Section

Page last reviewed December 2008
Internet Citation: Appendix A. Sample Data Collection Protocol for the Medical Office Point of Contact: Paper Survey: Survey User's Guide: Medical Office Survey on Patient Safety Culture. December 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/userguide/medofficeapa.html