# Presentation: 781228

## Medical Office Survey on Patient Safety Culture

- 			Name
- 			Title
- 			Address
- 			Phone
- 			Email

***Medical Office Survey on ******Patient Safety Culture***
***Feedback Results***
**{Site}****{City, State}****{Date}**

## Background on the Medical Office Survey

- An expansion of the Agency for Healthcare Research and Quality’s (AHRQ) *Hospital Survey on Patient Safety Culture *_www.ahrq.gov/qual/hospculture_
- Specifically designed to measure the culture of patient safety in outpatient medical offices
- Assesses staff and provider attitudes and beliefs about patient safety
- Assesses some areas that are different than the hospital survey; survey items are also different
- Pilot tested in 2007 in 182 U.S. medical offices with more than 4,000 respondents; final survey released on AHRQ Web site in 2009

## Assesses 12 Areas of Patient Safety

_**Survey areas:**_
- Teamwork
- Patient Care Tracking/Followup
- Organizational Learning
- Overall Perceptions of Patient Safety and Quality
- Staff Training
- Owner/Managing Partner/Leadership Support for Patient Safety
- Communication About Error
- Communication Openness
- Patient Safety and Quality Issues
- Office Processes and Standardization
- Information Exchange With Other Settings
- Work Pressure and Pace
_**Two overall rating questions:**_
- Health care quality (patient centered, effective, timely, efficient, equitable)
- Patient safety

## Survey Data Collection

- [Describe your medical office’s data collection methods here:]
- When survey was administered and how
- To whom the survey was administered (if not a census, how was the sample selected?)
- Response rate

## Demographic Data About Respondents

**Tenure in the medical office:**
- 	%	Less than 2 months			%  3 years to less than 6 years
- 	%	2 months to less than 1 year		%  6 years to less than 11 years
- 	%	1 year to less than 3 years 		%  11 years or more
**Hours worked per week:**
- 	%	1 to 4 hours per week		%  25 to 32 hours per week
- 	%	5 to 16 hours per week		%  33 to 40 hours per week
- 	%	17 to 24 hours per week		%  41 hours per week or more

## Demographic Data (continued)

**Staff Position:**
- Physician (MD or DO)
- Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Nurse Midwife, Advanced Practice Nurse, etc.
- Management
- Administrative or clerical staff
- Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN)
- Other clinical staff or clinical support staff
- Other position

## Main Findings: Strengths

- A number of strengths emerged from the results:
- Most respondents...
- Respondents...

## Main Findings: Areas for Improvement

- A number of areas for improvement emerged from the results:
- Most respondents....
-  Respondents.....

## Overall Rating on Patient Safety

*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.*

**Excellent**

**Very Good**

**Good**

**Fair**

**Poor**

## Overall Ratings on Quality and Patient Safety

_**Patient centered:**_** **Is responsive to patient preferences, needs, and values
_**Effective:**_** **Is based on scientific knowledge
_**Timely:**_** **Minimizes waits and potentially harmful delays
_**Efficient:**_** **Ensures cost-effective care (avoids waste, overuse, misuse of services)
_**Equitable:**_** **Provides the same quality of care to all regardless of gender, race, ethnicity, socioeconomic status, language

***Rate your medical office on each area of health care quality (G1a-e)***

- NOTE:  The item ‘s survey location is in parentheses.

## Interpreting the Results

- Positively and negatively worded items are used in the survey
- A _positive _response to an item is when respondents answer:
- “Strongly Agree/Agree” “Always/Most of the time” for a *positively* worded item
- “Strongly Disagree/Disagree,” “Never/Rarely,” or “Once, twice, or not in past 12 months” for a *negatively* worded item

## Interpreting the Results

***EXAMPLE OF POSITIVE RESPONSES ON STAFF TRAINING:***

***(This item is negatively worded so disagreeing is “positive”)***

## Teamwork

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

- NOTE:  The item ‘s survey location is in parentheses.

## Patient Care Tracking/Followup

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

- NOTE:  The item ‘s survey location is in parentheses.

## When there is a problem in our office, we see if we need to change the way we do things. (F1)

This office is good at changing office processes to make sure the same problems don’t happen again. (F5)

After this office makes changes to improve the patient care process, we check to see if the changes worked. (F7)

- This office is good at changing office processes to make sure the same problems don’t happen again. (F5)
- After this office makes changes to improve the patient care process, we check to see if the changes worked. (F7)

**Organizational Learning**

- NOTE:  The item ‘s survey location is in parentheses.

## Overall Perceptions of Patient Safety and Quality

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

- NOTE: R indicates a negatively worded item; the item ‘s survey location is in parentheses.

## This office trains staff when new processes are put into place. (C4)

This office makes sure staff get the on-the-job training they need. (C7)

Staff in this office are asked to do tasks they haven’t been trained to do.R (C10)

- This office makes sure staff get the on-the-job training they need. (C7)
- Staff in this office are asked to do tasks they haven’t been trained to do.R (C10)

**Staff Training**

- NOTE: R indicates a negatively worded item; the item ‘s survey location is in parentheses.

## Owner/Managing Partner/Leadership Support for Patient Safety

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

- NOTE: R indicates a negatively worded item; the item ‘s survey location is in parentheses.

## Communication About Error

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

- NOTE: R indicates a negatively worded item; the item ‘s survey location is in parentheses.

## Communication Openness

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

- NOTE: R indicates a negatively worded item; the item ‘s survey location is in parentheses.

## Patient Safety and Quality Issues (Page 1 of 2)

**Access to Care **
- A patient was unable to get an appointment within 48 hours for an acute/serious problem. (A1)
**Patient Identification**
- The wrong chart/medical record was used for a patient. (A2)
**Charts/Medical Records**
- A patient’s chart/medical record was not available when needed. (A3)
- Medical information was filed, scanned, or entered into the wrong patient’s chart/medical record. (A4)

***How often did the following things happen over the past 12 months?***

- NOTE:  All items are negatively worded; the item ‘s survey location is in parentheses.

## Medical Equipment 
Medical equipment was not working properly or was in need of repair or replacement. (A5)
Medication
A pharmacy contacted our office to clarify or correct a prescription. (A6)
A patient’s medication list was not updated during his/her visit. (A7)
Diagnostics and Tests
The results from a lab or imaging test were not available when needed. (A8) 
A critical abnormal result from a lab or imaging test was not followed up within 1 business day. (A9)

- Medical equipment was not working properly or was in need of repair or replacement. (A5)
**Medication**
- A pharmacy contacted our office to clarify or correct a prescription. (A6)
- A patient’s medication list was not updated during his/her visit. (A7)
**Diagnostics and Tests**
- The results from a lab or imaging test were not available when needed. (A8)
- A critical _abnormal_ result from a lab or imaging test was not followed up within 1 business day. (A9)

- NOTE:  All items are negatively worded; the item ‘s survey location is in parentheses.

***How often did the following things happen over the past 12 months?***

**Patient Safety and Quality Issues **(Page 2 of 2)

## Office Processes and Standardization

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

- NOTE: R indicates a negatively worded item; the item ‘s survey location is in parentheses.

## Information Exchange With Other Settings

- Outside labs/imaging centers?
- Other medical offices/outside physicians?
- Pharmacies?
- Hospitals?
- Other?

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

## Work Pressure and Pace

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

- NOTE: R indicates a negatively worded item; the item ‘s survey location is in parentheses.

## Comparison With 182 Pilot Study Medical Offices

**Comparison With 182 Pilot Study ****Medical Offices**