Form #4 Example Screen Shots of Web Site Information Collection

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications

AHRQ
Medical Office Survey on Patient Safety Culture
Survey Data File Specifications

Version 2

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications

AHRQ Medical Office Survey on Patient Safety Culture
Data Submission Specifications
These specifications are for preparing your respondent-level data from the Medical Office Survey
on Patient Safety Culture. The instructions below tell you how to prepare your Excel data file for
submission to the Medical Office Survey on Patient Safety Culture Comparative Database.
INSTRUCTIONS (Excel File Only):
Step 1: Include a header row with the variable name for each column.
Step 2: Submit individual survey response data using the response values indicated in this
document (beginning on page 4).
Step 3: Check your data before submitting for the following things:
•

SKIP PATTERN
There is one skip pattern in this survey. If a respondent answers 1 = Yes, to question EA,
“Are you an owner, a managing partner, or in a leadership position with responsibility
for making financial decisions for your medical office?”, then questions E1 – E4 should
be blank.

•

OUT-OF-RANGE VALUES
You should clean your data before submitting to the database to ensure that there are
no out-of-range values and that the data submitted are free from error. Make sure all
response values match the response value for the question.

•

REVERSE CODED ITEMS
Do not submit reverse coded data on the survey’s negatively worded items—simply
submit each individual’s unmodified responses to the survey items.
For example, survey item C3, “In this office, we often feel rushed when taking care of
patients” is negatively worded. Regardless, the data should be submitted so that
1=Strongly disagree and 5=Strongly agree, as originally indicated in the survey, as
follows:
1=Strongly Disagree
2=Disagree
3=Neither
4=Agree
5=Strongly Agree
9=Does Not Apply or Don’t Know

MOR-1015

2

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
•

STAFF POSITIONS
If your medical office modified or added a new staff position (H3) category, you
MUST RECODE your specific staff positions back to the survey’s original staff
position category. If you added staff positions that do not match any of the survey’s
original staff positions, re-code your specific staff positions as “OTHER” (H3 = “g”),
before submitting your data.

•

OTHER, PLEASE SPECIFY TEXT
Do not include Other-Please Specify data (questions B5, H3, and Section I). While you
may find it useful to review this text, it should not be submitted to the Database.

•

SPANISH VERSION OF THE SURVEY
Please indicate which respondents (if any) completed a Spanish version of the safety
culture survey, if you have this information available. You should do so by adding an ‘S’
to the Individual Unique Record ID, e.g. 001S.

•

OTHER LANGUAGE VERSION OF THE SURVEY
Please indicate which respondents (if any) completed the safety culture survey in a language
that was not English or Spanish, if you have this information available. You should do so by
adding an ‘N’ to the Individual Unique Record ID (UNIQUEID), e.g. 001N.

MOR-1015

3

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
SURVEY DATA FILE LAYOUT – EXCEL:
Record Identifier
Site ID
Individual Unique Record ID

Variable
Name

Column
Position
Column
SITEID
A
Column
UNIQUEID
B

Response Values
5 digits or less
4 digits or less

SECTION A: List of Patient Safety and Quality Issues
Survey Question

Variable
Name

Column
Position

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

A1

Column
C

2. The wrong chart/medical
record was used for a
patient

A2

Column
D

3. A patient’s chart/medical
record was not available
when needed

A3

Column
E

4. Medical information was
filed, scanned, or entered
into the wrong patient’s
chart/medical record

A4

Column
F

MOR-1015

Response Values
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =

Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Don’t Know
Missing
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Don’t Know
Missing
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Don’t Know
Missing
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Don’t Know
Missing

4

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
Survey Question

Variable
Name

Column
Position

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

A5

Column
G

6. A pharmacy contacted
our office to clarify or
correct a prescription

A6

Column
H

7. A patient’s medication
list was not updated
during his or her visit

A7

Column
I

8. The results from a lab or
imaging test were not
available when needed

A8

Column
J

9. A critical abnormal
result from a lab or
imaging test was not
followed up within 1
business day

A9

Column
K

MOR-1015

Response Values
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =

Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Don’t Know
Missing
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Don’t Know
Missing
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Don’t Know
Missing
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Don’t Know
Missing
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Don’t Know
Missing

5

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
SECTION B: Information Exchange With Other Settings
Survey Question

Variable
Name

Column
Position

1. Outside lab/imaging
centers?

B1

Column
L

2. Other medical offices/
outside physicians?

B2

Column
M

3. Pharmacies?

B3

Column
N

4. Hospitals?

B4

Column
O

5. Other? (Specify):

B5

Column
P

Response Values
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =
1=
2=
3=
4=
5=
6=
9=
blank =

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
Missing
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
Missing
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
Missing
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
Missing
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
Missing

TEXT FOR OTHER, SPECIFY [B5os]- DO NOT SUBMIT TO DATABASE

MOR-1015

6

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
SECTION C: Working in Your Medical Office
Survey Question

Variable
Name

Column
Position

1. When someone in this
office gets really busy,
others help out

C1

Column
Q

2. In this office, there is a
good working
relationship between
staff and providers

C2

Column
R

3. In this office, we often
feel rushed when taking
care of patients

C3

Column
S

4. This office trains staff
when new processes are
put into place

C4

Column
T

5. In this office, we treat
each other with respect

C5

Column
U

6. We have too many
patients for the number
of providers in this
office

C6

Column
V

MOR-1015

Response Values
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing

7

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
Survey Question

Variable
Name

Column
Position

7. This office makes sure
staff get the on-the-job
training they need

C7

Column
W

8. This office is more
disorganized than it
should be

C8

Column
X

9. We have good
procedures for checking
that work in this office
was done correctly

C9

Column
Y

10. Staff in this office are
asked to do tasks they
haven’t been trained to
do

C10

Column
Z

11. We have enough staff to
handle our patient load

C11

Column
AA

12. We have problems with
workflow in this office

C12

Column
AB

MOR-1015

Response Values
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing

8

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
Survey Question

Variable
Name

Column
Position

13. This office emphasizes
teamwork in taking care
of patients

C13

Column
AC

14. This office has too many
patients to be able to
handle everything
effectively

C14

Column
AD

15. Staff in this office follow
standardized processes
to get tasks done

C15

Column
AE

Response Values
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing

SECTION D: Communication and Follow-up
Survey Question

Variable
Name

Column
Position

1. Providers in this office
are open to staff ideas
about how to improve
office processes

D1

Column
AF

2. Staff are encouraged to
express alternative
viewpoints in this office

D2

Column
AG

3. This office reminds
patients when they need
to schedule an
appointment for
preventive or routine
care

D3

Column
AH

MOR-1015

Response Values
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =

Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing
Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing
Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing

9

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
Survey Question

Variable
Name

Column
Position

4. Staff are afraid to ask
questions when
something does not seem
right

D4

Column
AI

5. This office documents
how well our chroniccare patients follow their
treatment plans

D5

Column
AJ

6. Our office follows up
when we do not receive
a report we are expecting
from an outside provider

D6

Column
AK

7. Staff feel like their
mistakes are held against
them.

D7

Column
AL

8. Providers and staff talk
openly about office
problems.

D8

Column
AM

9. This office follows up
with patients who need
monitoring

D9

Column
AN

MOR-1015

Response Values
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =

Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing
Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing
Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing
Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing
Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing
Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing

10

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
Survey Question

Variable
Name

Column
Position

10. It is difficult to voice
disagreement in this
office

D10

Column
AO

11. In this office, we discuss
ways to prevent errors
from happening again

D11

Column
AP

12. Staff are willing to
report mistakes they
observe in this office

D12

Column
AQ

Response Values
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =

Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing
Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing
Never
Rarely
Sometimes
Most of the time
Always
Does Not Apply or Don’t Know
Missing

SECTION E: Owner/Managing Partner/Leadership Support
Survey Question

Variable
Name

Column
Position

Response Values

A. Are you an owner, a
managing partner, or in a
1 = Yes
leadership position with
Column
EA
2 = No
responsibility for making
AR
blank = Missing
financial decisions for
your medical office?
If question EA (Column AR) = 1 (Yes) then skip to section F.
1 = Strongly Disagree
2 = Disagree
1. They aren’t investing
3 = Neither Agree nor Disagree
enough resources to
Column
4 = Agree
E1
improve the quality of
AS
5 = Strongly Agree
care in this office
9 = Does Not Apply or Don’t Know
blank = Missing or properly skipped
1 = Strongly Disagree
2 = Disagree
3 = Neither Agree nor Disagree
2. They overlook patient
Column
4 = Agree
care mistakes that
E2
AT
5 = Strongly Agree
happen over and over
9 = Does Not Apply or Don’t Know
blank = Missing or properly skipped

MOR-1015

11

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
Survey Question

Variable
Name

Column
Position

3. They place a high
priority on improving
patient care processes

E3

Column
AU

4. They make decisions too
often based on what is
best for the office rather
than what is best for
patients

E4

Column
AV

Response Values
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing or properly skipped
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing or properly skipped

SECTION F: Your Medical Office
Survey Question

Variable
Name

Column
Position

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

F1

Column
AW

2. Our office processes are
good at preventing
mistakes that could
affect patients

F2

Column
AX

3. Mistakes happen more
than they should in this
office

F3

Column
AY

4. It is just by chance that
we don’t make more
mistakes that affect our
patients

F4

Column
AZ

MOR-1015

Response Values
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing

12

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
Survey Question

Variable
Name

Column
Position

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

F5

Column
BA

6. In this office, getting
more work done is more
important than quality of
care

F6

Column
BB

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

F7

Column
BC

Variable
Name

Column
Position

Response Values
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =
1=
2=
3=
4=
5=
9=
blank =

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Does Not Apply or Don’t Know
Missing

SECTION G: Overall Ratings
Survey Question
1a. Is responsive to
individual patient
preferences, needs, and
values

G1a

Column
BD

1b. Is based on scientific
knowledge

G1b

Column
BE

1c. Minimizes waits and
potentially harmful
delays

G1c

Column
BF

MOR-1015

Response Values
1=
2=
3=
4=
5=
blank =
1=
2=
3=
4=
5=
blank =
1=
2=
3=
4=
5=
blank =

Poor
Fair
Good
Very good
Excellent
Missing
Poor
Fair
Good
Very good
Excellent
Missing
Poor
Fair
Good
Very good
Excellent
Missing

13

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
Survey Question
1d. Ensures cost-effective
care (avoids waste,
overuse, and misuse of
services)
1e. Provides the same
quality of care to all
individuals regardless of
gender, race, ethnicity,
socioeconomic status,
language, etc.
2. 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?

Variable
Name

Column
Position

G1d

Column
BG

G1e

Column
BH

G2

Column
BI

Response Values
1=
2=
3=
4=
5=
blank =
1=
2=
3=
4=
5=
blank =

Poor
Fair
Good
Very good
Excellent
Missing
Poor
Fair
Good
Very good
Excellent
Missing

1=
2=
3=
4=
5=
blank =

Poor
Fair
Good
Very good
Excellent
Missing

SECTION H: Background Questions
Survey Question
1. How long have you
worked in this medical
office location?

2. Typically, how many
hours per week do you
work in this medical
office location?

MOR-1015

Variable
Name

Column
Position

H1

Column
BJ

H2

Column
BK

Response Values
a=
b=
c=
d=
e=
f =
blank =
a=
b=
c=
d=
e=
f =
blank =

Less than 2 months
2 months to less than 1 year
1 year to less than 3 years
3 years to less than 6 years
6 years to less than 11 years
11 years or more
Missing
1 to 4 hours per week
5 to 16 hours per week
17 to 24 hours per week
25 to 32 hours per week
33 to 40 hours per week
41 hours per week or more
Missing

14

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
Survey Question

3. What is your position in
this office? Check ONE
category that best
applies to your job.

Variable
Name

H3

Column
Position

Response Values

Column
BL

a = Physician (MD or DO)
b = Physician Assistant, Nurse Practitioner,
Clinical Nurse Specialist, Nurse
Midwife, Advanced Practice Nurse, etc.
c = Management
d = Administrative or clerical staff
e = Nurse (RN), Licensed Vocational Nurse
(LVN), Licensed Practical Nurse (LPN)
f = Other clinical staff or clinical support
staff
g = Other position
blank = Missing

TEXT FOR OTHER, SPECIFY [H3gos]* - DO NOT SUBMIT TO DATABASE
TEXT FOR YOUR COMMENTS [Section I]* - DO NOT SUBMIT TO DATABASE

MOR-1015

15

AHRQ Medical Office Survey on Patient Safety Culture Data File Specifications
Two examples of SECTION E: Owner/Managing Partner/Leadership Support questions are
displayed below. Columns C - AQ are omitted for display purposes.
Example 1: Are you an owner, a managing partner, or in a leadership position with
responsibility for making financial decisions for your medical office?
1=Yes
2=No
SiteID
1

UniqueID
0001

…
…

EA E1
1

E2

E3

E4

F1
2

Columns E1 through E4
are left blank because
EA is 1 (Yes).

Example 2: Are you an owner, a managing partner, or in a leadership position with
responsibility for making financial decisions for your medical office?
1=Yes
2=No
SiteID
2

UniqueID
0002

…
…

EA E1
2
3

E2
4

E3
5

E4
2

F1
3

Columns E1 through E4
are filled in because EA
was 2 (No).

MOR-1015

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