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pdfMedical Office Survey on
Patient Safety and Healthcare Quality
Draft—Not for Circulation
This questionnaire may not be used or cited
without permission
This document includes a draft patient safety culture survey for medical offices. The draft
survey items are grouped according to the patient safety culture areas they are intended to
measure. The draft survey will undergo cognitive testing and is likely to be shorter before
pilot testing with providers and staff in medical offices.
This draft survey is designed to help medical offices assess provider and staff opinions about
important areas of patient safety culture. The survey was developed by Westat under contract
with the Agency for Healthcare Research and Quality (AHRQ).
This medical office survey is an expansion of AHRQ’s Hospital Survey on Patient Safety
Culture (HSOPSC), which was released in November 2004 (www.ahrq.gov/qual/hospculture).
The medical office version contains new and revised questions and safety culture areas that
more accurately apply to the medical office setting.
This questionnaire should not be used or cited by any individual or organization for any
purpose without written permission. If you have any questions about the document, please
contact:
Joann Sorra, Ph.D.
Senior Study Director
Westat
1650 Research Blvd.
Rockville, MD 20850
Phone: 301-294-3933
Fax: 301-315-5912
Email: joannsorra@westat.com
DRAFT—Medical Office Survey
on Patient Safety and Healthcare Quality
Survey Instructions
Think about the ways things are done in your medical office and provide your opinions on issues that
affect the overall safety and quality of care provided to your patients.
In this survey, the term provider refers to physicians, physician assistants, and nurse practitioners
who diagnose, treat patients, and prescribe medications. The term staff refers to all others who work
in the office.
If a question does not apply to you or you don’t know the answer, please check “Does not apply or
Don’t know.”
1. List of Patient Safety and Quality Issues
The following items describe things that can happen in medical offices that affect quality of care and
patient safety. In your best estimate, how often did the following things happen in this medical office
OVER THE PAST 12 MONTHS?
Once or
twice a
year
Not
during
past 12
months
Does Not
Apply or
Don’t Know
Daily
Weekly
Several
times a
year
1
2
3
4
5
99
2. The next available appointment to see a
provider in our office for a nonacute problem
1
was several weeks away ..............................................
2
3
4
5
99
3. After office hours a patient was unable to talk to
a provider about an urgent medical problem ..
1
2
3
4
5
99
4. A message from a patient was not responded to
in a timely manner ......................................................... 1
2
3
4
5
99
5. A patient’s chart/medical record was not
available when needed ................................................. 1
2
3
4
5
99
6. Clinical information in a patient’s chart/medical
record was missing ....................................................... 1
2
3
4
5
99
7. Incorrect clinical information was recorded in a
patient’s chart/medical record ....................................... 1
2
3
4
5
99
8. An inappropriate or wrong medication was
prescribed for a patient ................................................. 1
2
3
4
5
99
9. The wrong medication dose was prescribed for
a patient ........................................................................ 1
2
3
4
5
99
10. A patient’s medication list was not updated
during his or her visit ..................................................... 1
2
3
4
5
99
a. Access & Patient Flow
1. A patient was unable to get an appointment
within 48 hours for an acute problem ......................
b. Messages/Triage
c. Charts/Medical Records
d. Medication
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1. List of Patient Safety and Quality Issues, continued
Weekly
Several
times a
year
Once or
twice a
year
Not
during
past 12
months
Does Not
Apply or
Don’t Know
11. The results from a lab or imaging test were not
available when needed ................................................. 1
2
3
4
5
99
12. A patient was not notified of a normal lab or
imaging test ................................................................
1
2
3
4
5
99
13. A critical abnormal result from a lab or imaging
test was not followed up promptly, resulting in a
1
delay in important care ..................................................
2
3
4
5
99
14. Medical supplies were not available when
needed during a patient visit ......................................... 1
2
3
4
5
99
15. Medical equipment was not working properly or
was in need of repair or replacement ........................... 1
2
3
4
5
99
16. A patient’s diagnosis was missed, resulting in
an inappropriate delay in essential care ....................... 1
2
3
4
5
99
17. An adequate history was not obtained for a
patient, leading to a delay in important care ................. 1
2
3
4
5
99
18. A patient’s physical exam was not thorough
enough for the presenting problem, leading to a
1
delay in diagnosis .........................................................
2
3
4
5
99
19. A treatment or procedure was inappropriately
prescribed for a patient ................................................. 1
2
3
4
5
99
20. A provider’s limited knowledge or training
resulted, or nearly resulted, in a medical
1
problem for a patient .....................................................
2
3
4
5
99
Daily
e. Diagnostics & Tests
f. Medical Supplies & Equipment
g. Diagnosis and Treatment
2. Patient Care Coordination With Other Settings
Coordination of patient care involves accurate, complete, and timely information exchange and
communication about patients. How would you rate the coordination of patient care between this
medical office and:
Good
Good
Good
Good
Good
coordination coordination coordination coordination coordination
with
with
with
with
with
none
a few
some
most
all
Does Not
Apply or
Don’t Know
1. Other medical offices? ..............
1
2
3
4
5
99
2. Outside laboratories? ...............
1
2
3
4
5
99
3. Outside imaging centers? ........
1
2
3
4
5
99
4. Other ambulatory testing
facilities (cardiac,
1
pulmonary, etc.) ................................
2
3
4
5
99
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2. Patient Care Coordination With Other Settings, continued
Good
Good
Good
Good
Good
coordination coordination coordination coordination coordination
with
with
with
with
with
none
a few
some
most
all
Does Not
Apply or
Don’t Know
5. Pharmacies? .............................
1
2
3
4
5
99
6. Hospitals? ..............................
1
2
3
4
5
99
7. Nursing homes? .....................
1
2
3
4
5
99
8. Patients?. ................................
1
2
3
4
5
99
3. Organizational Learning
How much do you agree or disagree with the
following statements?
Neither
Agree
nor
Strongly
Disagree Disagree Disagree
Agree
Does Not
Strongly Apply or
Agree Don’t Know
1. We are actively doing things to improve the
quality of patient care ..................................................... 1
2
3
4
5
99
2. Mistakes have led to positive changes here ................ 1
2
3
4
5
99
3. After we make changes to improve the patient
care process, we evaluate whether the changes
1
have been effective ........................................................
2
3
4
5
99
4. When there is a problem in our office, we see if
we need to change the way we do things ................
1
2
3
4
5
99
5. This office is good at changing office processes
to ensure that the same mistakes don’t happen
again .........................................................................
1
2
3
4
5
99
1. We support one another in this medical office .............
1
2
3
4
5
99
2. When a lot of work needs to be done quickly, we
work as a team to get the work done ...........................
1
2
3
4
5
99
3. In this office, we treat each other with respect .............
1
2
3
4
5
99
4. When someone in this office gets really busy,
others help out ..............................................................
2
3
4
5
99
5. This office emphasizes teamwork in taking care
of patients .....................................................................
1
2
3
4
5
99
1
2
3
4
5
99
4. Teamwork
1
6. In this office, we work together effectively....................
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5. Collegiality (Teamwork Among Providers)
Adapted from Curoe, A, Kralewski, J, & Kaissi, A. 2003. Assessing the cultures of medical group practices.
J Am Board Fam Pract, 16, 394-398
How much do you agree or disagree with the
following statements?
Neither
Agree
Strongly
nor
Disagree Disagree Disagree
Agree
Does Not
Strongly Apply or
Agree Don’t Know
1. There is a close collegial relationship among the
providers in this medical office. ................................
1
2
3
4
5
99
2. In this office, there is a great deal of informal
consulting among the providers ................................
1
2
3
4
5
99
2
3
4
5
99
1. Different providers in this office expect staff to
follow different processes to do the same things .........
2
3
4
5
99
2. This office has standardized processes to get
most tasks done ...........................................................
1
2
3
4
5
99
3. This office has formal processes for getting most
things done. ................................................................
1
2
3
4
5
99
4. This office has quality-control processes in place
to prevent and catch mistakes ........................................ 1
2
3
4
5
99
5. This office has formal processes for documenting
patient care ................................................................
1
2
3
4
5
99
1
2
3
4
5
99
1
2
3
4
5
99
2. Staff get the training they need in this office ................
1
2
3
4
5
99
3. Staff in this office are able to cover tasks of
absent coworkers .........................................................
2
3
4
5
99
4. Staff in this office are asked to do tasks they
have not been trained to do .....................................
2
3
4
5
99
5. New staff in this office do not get adequate onthe-job training .......................................................
2
3
4
5
99
3. There is a great deal of sharing of clinical
information among the providers in this office ..............
1
6. Office Systems and Standardization
1
6. This office is disorganized ............................................
7. Staff Training
1. Staff in this office are well trained for their tasks ........
1
1
1
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8. Work Pressure and Pace
How much do you agree or disagree with the
following statements?
Neither
Agree
Strongly
nor
Disagree Disagree Disagree
Agree
Strongly
Agree
Does Not
Apply or
Don’t
Know
1. We have enough staff to handle our patient load........... 1
2
3
4
5
99
2. The amount of time we schedule for office visits
compromises the care patients receive ...................... 1
2
3
4
5
99
3. This office has too many patients to be able to
handle everything effectively .......................................... 1
2
3
4
5
99
4. In this office, patient care is never compromised
when we are rushed ................................................ 1
2
3
4
5
99
5. We have too many patients for the number of
providers in this office .............................................. 1
2
3
4
5
99
9. Owner/Managing Partner Support for Patient Safety
Are you an owner or managing partner of this office? Yes (SKIP TO NEXT SECTION)
No
How much do you agree or disagree with the
following statements?
1. The owners/managing partners of this office
emphasize the importance of preventing
mistakes that affect patients.................................
Neither
Agree
nor
Strongly
Disagree Disagree Disagree
Agree
Strongly
Agree
Does Not
Apply or
Don’t
Know
1
2
3
4
5
99
2. The actions of owners/managing partners show
that providing patients with the best possible care
1
is a top priority. .......................................................
2
3
4
5
99
3. The owners/managing partners of this office
seem interested in improving patient care
1
practices only after a patient is harmed ......................
2
3
4
5
99
4. The owners/managing partners tolerate lessthan-optimal patient care .......................................... 1
2
3
4
5
99
5. The owners/managing partners of this office are
not making enough of an investment in quality of
1
care .......................................................................
2
3
4
5
99
6. The owners/managing partners overlook patient
care mistakes that happen over and over. .................. 1
2
3
4
5
99
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10. Overall Perceptions of Patient Safety and Quality
How much do you agree or disagree with the
following statements?
Neither
Agree
Strongly
nor
Disagree Disagree Disagree
Agree
Strongly
Agree
Does Not
Apply or
Don’t
Know
1. Mistakes happen more than they should in this
office. .............................................................................. 1
2
3
4
5
99
2. The quality of patient care is never sacrificed to
get more work done........................................................ 1
2
3
4
5
99
3. Our office processes are good at preventing
mistakes that could harm patients.................................
1
2
3
4
5
99
4. It is just by chance that we don’t make more
mistakes that affect our patients.................................
1
2
3
4
5
99
5. This office makes mistakes that negatively affect
patients. .......................................................................... 1
2
3
4
5
99
6. This office adheres to a common set of care
standards. ....................................................................... 1
2
3
4
5
99
11. Patient Care Tracking/Follow-up
Rarely
Sometimes
Most of
the time
Always
Does Not
Apply or
Don’t
Know
1. Our office follows up when a report of findings
from a provider is not received as expected. ................. 1
2
3
4
5
99
2. This office notifies patients of normal lab or
imaging results. .............................................................. 1
2
3
4
5
99
3. We support our chronic-care patients by tracking
how well they adhere to their treatment plans................ 1
2
3
4
5
99
4. This office reminds patients when they need to
come in for routine preventive care ................................ 1
2
3
4
5
99
5. This office follows up with patients who need
monitoring ....................................................................... 1
2
3
4
5
99
1. Staff are encouraged to express alternative
viewpoints in this office.................................................
2
3
4
5
99
2. Providers in this office are open to staff ideas
about how to improve office processes. .......................
2
3
4
5
99
3. Staff are afraid to ask questions when something
does not seem right. .....................................................
1
2
3
4
5
99
1
2
3
4
5
99
How often do the following things happen in this
medical office?
Never
12. Communication Openness
1
1
4. It is difficult to voice disagreement in this office ...........
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12. Communication Openness, continued
Rarely
Sometimes
Most of
the time
Always
Does Not
Apply or
Don’t
Know
5. Staff speak up if they see something that may
negatively affect patient care........................................
2
3
4
5
99
6. Providers show that they do not want to be
bothered by staff questions ..........................................
2
3
4
5
99
1. In this office, we discuss ways to prevent errors
from happening again...................................................
1
2
3
4
5
99
2. Staff are willing to report mistakes they observe
in this office ................................................................
1
2
3
4
5
99
3. Providers are willing to report mistakes they
observe in this office .....................................................
2
3
4
5
99
4. Staff feel like their mistakes are held against
them..............................................................................
2
3
4
5
99
5. Providers feel like their mistakes are held against
them..............................................................................
2
3
4
5
99
6. Providers and staff talk openly about office
problems. ......................................................................
2
3
4
5
99
7. We openly discuss problems in the office that
affect patients. ..............................................................
2
3
4
5
99
8. In this office, we do not discuss cases where
patients have been harmed ..........................................
1
2
3
4
5
99
1. We actively consider the preferences of patients,
or their caregivers, regarding treatment ......................... 1
2
3
4
5
99
2. Providers in this office actively engage patients,
or their caregivers, in making care decisions. .............. 1
2
3
4
5
99
3. We treat patients, or their caregivers, as partners
in care.................................................................
1
2
3
4
5
99
4. In this office, we encourage patients, or their
caregivers, to tell us if they have concerns
1
about the care being provided. .......................................
2
3
4
5
99
5. When patients’ care instructions are complicated,
we provide written instructions before they leave
1
the office. ........................................................................
2
3
4
5
99
6. Before patients or their caregivers leave this
office, we check to make sure they understand
1
what they need to do. .....................................................
2
3
4
5
99
How often do the following things happen in this
medical office?
Never
1
1
13. Communication about Error
1
1
1
1
1
14. Patient-Centered Care
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15A. Overall Rating on Healthcare Quality
Healthcare quality can be defined as care that is:
• Safe
Avoids harming patients
• Effective
Is based on scientific knowledge
• Patient-centered
Is responsive to patient preferences and needs
• Timely
Minimizes waits and harmful delays
• Efficient
Is not wasteful
• Equitable
Does not discriminate against individuals because of gender, race, ethnicity,
socioeconomic status, etc
Considering the definition above, please give your medical office an overall grade on the quality of
healthcare patients receive at your office.
Poor
▼
Fair
▼
Good
▼
Very good
▼
Excellent
▼
15B. Overall Rating on Patient Safety
Patient safety is a part of healthcare quality. It is the avoidance of patient harm resulting from the way
healthcare is provided. Patient safety means having office systems and clinical processes in place to
prevent, catch, and correct mistakes that have the potential to harm patients.
Overall, how would you rate your medical office at preventing, catching, and correcting mistakes that
have the potential to affect patients?
Poor
▼
Fair
▼
Good
▼
Very good
▼
Excellent
▼
16. BACKGROUND QUESTIONS
1. How long have you worked in this medical office location?
a.
b.
c.
Less than 2 months
2 months to less than 1 year
1 year to less than 3 years
d. 3 years to less than 6 years
e. 6 years to less than 11 years
f. 11 years or more
2. Typically, how many hours per week do you work in this medical office location?
a.
b.
c.
1 to 4 hours per week
5 to 16 hours per week
17 to 24 hours per week
d.
e.
f.
25 to 32 hours per week
33 to 40 hours per week
41 hours per week or more
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3. What is your position in this office? Check ONE category that best applies to your job.
a. Physician
b. Resident / Physician in training
c. Physician Assistant, Nurse Practitioner, Nurse Clinician, Advanced Practice Nurse,
Nurse Midwife, etc.
d.
Administrative, management, or clerical staff
Office Manager
Office Administrator
Business Manager
Nurse Manager
Insurance Processor
Database Manager Billing Staff
e.
Referral Staff
Front Desk
Receptionist
Scheduler (appointments, surgery, etc.)
Other administrative, management, or
clerical staff position
Clinical staff or clinical support staff
Registered Nurse
LVN/LPN
Medical Assistant
Therapist (all types)
Technician (all types)
Dietician/Nutritionist
Audiologist
Other clinical or clinical support staff
f. Other position; please specify: _________________________________
4. If you are a physician or resident, please indicate your primary specialty:
a. Primary care (family medicine, internal medicine, pediatrics, OB/GYN, general practice)
b. Other specialty
17. Your Comments
Please feel free to write any comments about how things are done in your medical office that
affect patient safety or quality of care.
Thank you for your participation in this survey.
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Medical Office Background Questions
FOR OFFICE MANAGER ONLY
NOTE: The office manager completes the following questions BEFORE data collection begins at the office
Name of Office Point-of-Contact:_____________________________
Name of Office:__________________________________________
Office Mailing address: ____________________________________
_______________________________________________________
Phone: ____________________
Fax: _______________________
Email: _____________________
1. Does your medical practice have:
a. Multiple locations? → Total number of locations:_______ (GO TO NEXT QUESTION Q2)
b. One location?
(SKIP TO Q3)
2. Is this office location the:
a. Primary/parent location?
b. Satellite location?
3. How many of the following types of staff are employed at this medical office location?
•
Include all full-time, part-time, and contract staff who work in this medical office location.
Number of
Individuals
Number
of FTEs
Physician ………………………………………………………….
___
____
Resident/Physician in Training ……………………………….
____
____
PA, NP, Nurse Midwife, Advanced Practice Nurse ………..
____
____
Administrative, Management, or Clerical Staff …………….
____
____
____
____
Other Positions …………………………………………………..
____
____
TOTAL NUMBER OF OFFICE STAFF (100%)
____
____
Office Manager
Office Administrator
Business Manager
Nurse Manager
Insurance Processor
Billing Staff
Referral Staff
Front Desk
Receptionist
Scheduler (appt., surgery, etc.)
Other administrative,
management, or clerical staff
Clinical Support Staff …………………………………………...
Registered Nurse
LVN/LPN
Medical Assistant
Therapist (all types)
Technician (all types)
Dietician/Nutritionist
Audiologist
Other clinical support staff
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4. Which of the following best describes the type of practice at this office location?
(SELECT ONE)
a. Single specialty group practice → (Indicate specialty below)
b. Multispecialty group practice → (Check all specialties below that apply)
1. Child & Adolescent Psychiatry
17. Otolaryngology
2 Colon & Rectal Surgery
18. Pathology - Anatomic / Clinical
3. Dermatology
19. Pediatric Cardiology
4. Diagnostic Radiology
20. Pediatrics
5. Emergency Medicine
21. Physical Medicine & Rehabilitation
6 Family Practice / Family Medicine
22. Plastic Surgery
7. Forensic Pathology
23. Psychiatry
8. Gastroenterology
24. Public Health & Rehabilitation
9. General Practice
25. Pulmonary Disease
10. General Preventive Medicine
26. Radiation Oncology
11. General Surgery
27. Radiology
12. Internal Medicine
28. Thoracic Surgery
13. Medical Genetics
29. Transplant Surgery
14. Neurological Surgery
30. Urology
15. Neurology
31. Vascular Medicine
16. Nuclear Medicine
32. Other specialty (Please specify):
5. Which best describes the majority ownership of this medical office/practice?
a. Provider(s) and/or Physician(s)
b. HMO (Health Maintenance Organization)
c. University or Medical School or Academic Medical Institution
d. Hospital
e. Community Health Center
f. Government (Federal / State / Local)
g. Health Corporation
h. Other, please specify: _________________________________
6a. Does your medical office currently use some type of formal system to document or
record errors, incidents, accidents, and/or adverse events that occur with patients?
a. No, we do not document these events (SKIP TO Q7)
b. Yes, on both paper (hard copy files) and electronically (computer files)
c. Yes, on paper (in hard copy files)
d. Yes, electronically (in computer files)
6b. IF YES, please briefly describe the types of errors, incidents, accidents, and/or adverse
events that your medical office documents:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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7. Do you have meetings attended by at least one provider, the office manager, and most
other staff?
a.
b.
Yes (GO TO NEXT QUESTION Q8)
No (SKIP TO Q9)
8. How often do the meetings occur?
a.
b.
c.
d.
Daily
Weekly
Monthly
Every 2 months
e.
f.
g.
h.
3 to 5 times a year
Twice a year
Once a year
Less than once a year
9. To what extent has this medical office implemented each of the following electronic
tools?
Not
implemented &
no plans
to implement in
the next 12
months
▼
Not
implemented
but
implementation
planned in the
next 12 months
▼
Implementation
in process
▼
Fully
implemented
▼
a) Electronic appointment
scheduling
1
2
3
4
b) Electronic billing of services
1
2
3
4
c) Electronic ordering of
medications (with pharmacies
capable of processing
electronic orders)
1
2
3
4
d) Electronic ordering of tests,
imaging, or procedures (with
test/imaging centers capable
of processing electronic
orders)
1
2
3
4
e) Electronic access to your
patients' test or imaging
results
1
2
3
4
f) Electronic patient medical
records
1
2
3
4
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Patient Demographics
10a. In your best estimate, what percentage of patient revenue at this medical office comes
from each of the following sources?
Medicare ……………………………………….. _____%
Medicaid or other state-sponsored insurance _____%
Private insurance, health plans, or HMO……. _____%
Self-pay . ………………………… … … … …. _____%
TOTAL = 100%
10b. In your best estimate, what percentage of your patients are uninsured? ________%
11. In your best estimate, approximately what percentage of patients at this medical office
are in the following age groups?
Pediatric/Adolescent (age 17 or under) ………. _____%
Adult (18-64 yrs old).…………………………….._____%
Geriatric (age 65 or older)……….…….. ……… _____%
TOTAL = 100%
12. In your best estimate, what percentage of patients seen at this medical
office in the past 12 months speak a language other than English as
their primary language? _______%
13. What is the average number of patient visits per week in this office (across
all providers)? ________________patient visits per week
MEDICAL OFFICE SURVEY ON PATIENT SAFETY & HEALTHCARE QUALITY, DRAFT 2-2-07 DO NOT DISTRIBUTE
4
| File Type | application/pdf |
| File Title | Microsoft Word - Amb patient safety culture survey draft 2-5-07.doc |
| Author | Sorra_j |
| File Modified | 2007-02-07 |
| File Created | 2007-02-05 |