Items and Dimensions

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

In this document, the items in the Medical Office Survey on Patient Safety Culture are grouped according to the safety culture dimensions they are intended to measure. The item's survey location is shown to the left of each item. Negatively worded items are indicated. Reliability statistics (Cronbach's alpha) based on the pilot test data from 202 medical offices and over 4,200 staff are provided for the dimensions.

1. List of Patient Safety and Quality Issues
(Daily, Weekly, Monthly, Several times in the past 12 months, Not in the past 12 months, Does Not Apply or Don't Know)

The following items describe things that can happen in medical offices that affect patient safety and quality of care. In your best estimate, how often did the following things happen in your medical office OVER THE PAST 12 MONTHS?

Access to Care
A1. A patient was unable to get an appointment within 48 hours for an acute/serious problem.

Patient Identification
A2. The wrong chart/medical record was used for a patient.

Charts/Medical Records
A3. A patient's chart/medical record was not available when needed.
A4. Medical information was filed, scanned, or entered into the wrong patient's chart/medical record.

Medical Equipment
A5. Medical equipment was not working properly or was in need of repair or replacement.

Medication
A6. A pharmacy contacted our office to clarify or correct a prescription.
A7. A patient's medication list was not updated during his or her visit.

Diagnostics & Tests
A8. The results from a lab or imaging test were not available when needed.
A9. A critical abnormal result from a lab or imaging test was not followed up within 1 business day.

Reliability of this dimension—Cronbach's alpha (9 items) = .86

2. Information Exchange With Other Settings
(Problems daily, Problems weekly, Problems monthly, Problems several times in the past 12 months, Problems once or twice in the past 12 months, No problems in the past 12 months, Does Not Apply or Don't Know)

Over the past 12 months, how often has your medical office had problems exchanging accurate, complete, and timely information with:

B1. Outside labs/imaging centers?
B2. Other medical offices/outside physicians?
B3. Pharmacies?
B4. Hospitals?
B5. Other? (Specify): ________________

Reliability of this dimension—Cronbach's alpha (4 items, excluding "Other, specify") = .90

3. Teamwork
(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

C1. When someone in this office gets really busy, others help out.
C2. In this office, there is a good working relationship between staff and providers.
C5. In this office, we treat each other with respect.
C13. This office emphasizes teamwork in taking care of patients.

Reliability of this dimension—Cronbach's alpha (4 items) = .83

4. Work Pressure and Pace
(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

C3. In this office, we often feel rushed when taking care of patients. (negatively worded)
C6. We have too many patients for the number of providers in this office. (negatively worded)
C11. We have enough staff to handle our patient load.
C14. This office has too many patients to be able to handle everything effectively. (negatively worded)

Reliability of this dimension—Cronbach's alpha (4 items) = .76

5. Staff Training
(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

C4. This office trains staff when new processes are put into place.
C7. This office makes sure staff get the on-the-job training they need.
C10. Staff in this office are asked to do tasks they haven't been trained to do. (negatively worded)

Reliability of this dimension—Cronbach's alpha (3 items) = .80

6, Office Processes and Standardization
(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

C8. This office is more disorganized than it should be. (negatively worded)
C9. We have good procedures for checking that work in this office was done correctly.
C12. We have problems with workflow in this office. (negatively worded)
C15. Staff in this office follow standardized processes to get tasks done.

Reliability of this dimension—Cronbach's alpha (4 items) = .77

7. Communication Openness
(Never, Rarely, Sometimes, Most of the time, Always, Does Not Apply or Don't Know)

How often do the following things happen in your medical office?

D1. Providers in this office are open to staff ideas about how to improve office processes.
D2. Staff are encouraged to express alternative viewpoints in this office.
D4. Staff are afraid to ask questions when something does not seem right. (negatively worded)
D10. It is difficult to voice disagreement in this office. (negatively worded)

Reliability of this dimension—Cronbach's alpha (4 items) = .81

8. Patient Care Tracking/Follow-up
(Never, Rarely, Sometimes, Most of the time, Always, Does Not Apply or Don't Know)

How often do the following things happen in your medical office?

D3. This office reminds patients when they need to schedule an appointment for preventive or routine care.
D5. This office documents how well our chronic-care patients follow their treatment plans.
D6. Our office follows up when we do not receive a report we are expecting from an outside provider.
D9. This office follows up with patients who need monitoring.

Reliability of this dimension—Cronbach's alpha (4 items) = .78

9. Communication About Error
(Never, Rarely, Sometimes, Most of the time, Always, Does Not Apply or Don't Know)

How often do the following things happen in your medical office?

D7. Staff feel like their mistakes are held against them. (negatively worded)
D8. Providers and staff talk openly about office problems.
D11. In this office, we discuss ways to prevent errors from happening again.
D12. Staff are willing to report mistakes they observe in this office.

Reliability of this dimension—Cronbach's alpha (4 items) = .75

10. Owner/Managing Partner/Leadership Support for Patient Safety

A. Are you an owner, a managing partner, or in a leadership position with responsibility for making financial decisions for your medical office?

Yes (SKIP TO SECTION F)
No (ANSWER ITEMS 1-4 BELOW)

(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements about the owners/managing partners/leadership of your medical office?

E1. They aren't investing enough resources to improve the quality of care in this office. (negatively worded)
E2. They overlook patient care mistakes that happen over and over. (negatively worded)
E3. They place a high priority on improving patient care processes.
E4. They make decisions too often based on what is best for the office rather than what is best for patients. (negatively worded)

Reliability of this dimension—Cronbach's alpha (4 items) = .76

11. Organizational Learning
(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

F1. When there is a problem in our office, we see if we need to change the way we do things.
F5. This office is good at changing office processes to make sure the same problems don't happen again.
F7. After this office makes changes to improve the patient care process, we check to see if the changes worked.

Reliability of this dimension—Cronbach's alpha (3 items) = .82

12. Overall Perceptions of Patient Safety and Quality
(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

F2. Our office processes are good at preventing mistakes that could affect patients.
F3. Mistakes happen more than they should in this office. (negatively worded)
F4. It is just by chance that we don't make more mistakes that affect our patients. (negatively worded)
F6. In this office, getting more work done is more important than quality of care. (negatively worded)

Reliability of this dimension—Cronbach's alpha (4 items) = .79

13. Overall Ratings on Quality and Patient Safety
(Poor, Fair, Good, Very good, Excellent)

G1. Overall, how would you rate your medical office on each of the following areas of health care quality?
G1A. Patient-centered Is responsive to individual patient preferences, needs, and values.
G1B. Effective Is based on scientific knowledge.
G1C. Timely Minimizes waits and potentially harmful delays
G1D. Efficient Ensures cost-effective care (avoids waste, overuse, and misuse of services).
G1E. Equitable Provides the same quality of care to all individuals regardless of gender, race, ethnicity, socioeconomic status, language, etc.
Reliability of this dimension—Cronbach's alpha (5 items) = .87

G2. Overall, how would you rate the systems and clinical processes your medical office has in place to prevent, catch, and correct problems that have the potential to affect patients?

Poor, Fair, Good, Very good, Excellent

Note: Negatively worded questions should be reverse coded when calculating percent "positive" response, means, and composites.

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Current as of December 2008
Internet Citation: Items and Dimensions: 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/medoffitems.html