Attachment E - Sample Individual MO Feedback Report

Attachment E - Sample Individual MO Feedback Report.pdf

Medical Office Survey on Patient Safety Culture Comparative Database

Attachment E - Sample Individual MO Feedback Report

OMB: 0935-0196

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Medical Office Survey on Patient Safety Culture
Individual Medical Office Feedback Report

Sample Medical Office
Anytown, USA

May-10

Produced by Westat
Rockville, MD
safetyculturesurveys@ahrq.hhs.gov

Sponsored by the Agency for Healthcare Research and Quality (AHRQ) under
Contract No. HHSA 290 2007 10037 with Westat

Demographic Data about Respondents for Sample Medical
Office
May-10

Your Medical Office Completed Survey Data Collection

Survey Administration Statistics
Number of completed surveys
(response rate numerator)
Number of surveys administered
(response rate denominator)

88
100
88%

Response rate

1. Tenure With This Medical Office Location:
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
Total
Missing

2. Hours Worked per Week in This Medical Office
Location:
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
Total
Missing

3. Staff Position
Physician
Physician Assistant, Nurse Practitioner, Clinical Nurse
Specialist, Nurse Midwife, Advanced Practice Nurse, etc
Management
Administrative or clerical staff
Nurse (RN), Licensed Vocational Nurse (LVN), Licensed
Practical Nurse (LPN)
Other clinical staff or clinical support staff
Other position
Total
Missing

N
0
16
20
33
15
4
88
0

%
0
18%
23%
38%
17%
5%
100%

N
1
3
2
3
71
8
88
0

%
1%
3%
2%
3%
81%
9%
100%

N
3

%
3%

0

0

7
27

8%
31%

9

10%

25
16
87
1

29%
18%
100%

2

Composite-Level Results for Sample Medical Office
Patient Safety Culture Composites

% Positive Response

81%

1. Teamwork

87%

2. Patient Care Tracking/Follow-up

83%

3. Organizational Learning

4.

Overall Perceptions of Patient
Safety and Quality

88%
69%

5. Staff Training
Owner/Managing Partner/
6. Leadership Support for
Patient Safety

72%

7. Communication About Error

66%

8. Communication Openness

67%

79%

9. Patient Safety and Quality Issues

10.

Office Processes and
Standardization

11.

Information Exchange With Other
Settings

74%

67%

66%

12. Work Pressure and Pace

0%

20%

40%

60%

80%

100%

Note: Composite scores are not calculated when any item in the composite has fewer than 3 respondents.

3

Item-Level Results for Sample Medical Office
Number of responses = 88

Neutral

Positive

1. Teamwork
1. When someone in this office gets really busy, others
help out. (C1)

75%

2. In this office, there is a good working relationship
between staff and providers. (C2)

4. This office emphasizes teamwork in taking care of
patients. (C13)

2. Patient Care Tracking/Follow-up
1. This office reminds patients when they need to
schedule an appointment for preventive or routine care.
(D3)

83%

75%

Positive

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

(NA/DK/MI = 2%)

11%6%

(NA/DK/MI = 0%)

16% 8%

(NA/DK/MI = 3%)

Neutral

Negative

(NA/DK/MI = 32%)

88%

3. Our office follows up when we do not receive a report
we are expecting from an outside provider. (D6)

10%

90%

78%

Positive

86%

81%

(NA/DK/MI = 55%)

10%

(NA/DK/MI = 42%)

16% 6%

(NA/DK/MI = 42%)

Neutral
81%

(NA/DK/MI = 3%)

8%

92%

2. This office documents how well our chronic-care
patients follow their treatment plans. (D5)

4. This office follows up with patients who need
monitoring. (D9)

14% 11%

90%

3. In this office, we treat each other with respect. (C5)

Negative

Negative
14%

11%

(NA/DK/MI = 17%)

(NA/DK/MI = 18%)

18%

(NA/DK/MI = 17%)

Notes: 1) “R” = a negatively worded item; 2) Chart totals exclude missing & NA/DK & may not sum to 100% due to rounding;
3) NA/DK/MI = % of respondents answering NA/DK or with missing data; 4) Item data not displayed for fewer than 3
respondents; 5) % not displayed for 5% or less.
4

Item-Level Results for Sample Medical Office
Number of responses = 88
4. Overall Perceptions of Patient Safety
and Quality
1. Our office processes are good at preventing mistakes
that could affect patients. (F2)

Neutral

Positive

Negative

a

89%

10%

(NA/DK/MI = 17%)

2. Mistakes happen more than they should in this office.
(F3R)

89%

7%

(NA/DK/MI = 17%)

3. It is just by chance that we don’t make more mistakes
that affect our patients. (F4R)

86%

12%

(NA/DK/MI = 17%)

4. In this office, getting more work done is more
important than quality of care. (F6R)

88%

10%

(NA/DK/MI = 17%)

Positive

5. Staff Training
1. This office trains staff when new processes are put
into place. (C4)

Neutral

71%

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

69%

3. Staff in this office are asked to do tasks they haven’t
been trained to do. (C10R)

68%

6. Owner/Managing Partner/Leadership
Support for Patient Safety
1. They aren’t investing enough resources to improve the
quality of care in this office. (E1R)
2. They overlook patient care mistakes that happen over
and over. (E2R)
3. They place a high priority on improving patient care
processes. (E3)
4. They make decisions too often based on what is best
for the office rather than what is best for patients. (E4R)

Negative
20%

10%

(NA/DK/MI = 7%)

25%

6%

(NA/DK/MI = 6%)

a

Positive

(NA/DK/MI = 8%)

28%

Neutral

57%

29%

84%

14%

11%

81%

65%

Negative

14%

26%

9%

(NA/DK/MI = 26%)

(NA/DK/MI = 30%)

(NA/DK/MI = 17%)

(NA/DK/MI = 22%)

Notes: 1) “R” = a negatively worded item; 2) Chart totals exclude missing & NA/DK & may not sum to 100% due to rounding;
3) NA/DK/MI = % of respondents answering NA/DK or with missing data; 4) Item data not displayed for fewer than 3
respondents; 5) % not displayed for 5% or less.

5

Item-Level Results for Sample Medical Office
Number of responses = 88
Positive

7. Communication About Error
1. Staff feel like their mistakes are held against them.
(D7R)
2. Providers and staff talk openly about office problems.
(D8)
3. In this office, we discuss ways to prevent errors from
happening again. (D11)
4. Staff are willing to report mistakes they observe in this
office. (D12)
8. Communication Openness
1. Providers in this office are open to staff ideas about
how to improve office processes. (D1)

Neutral

64%

54%

Negative

25%

11%

26%

68%

20%

21%

78%

Positive
65%

11%

20%

Neutral

(NA/DK/MI = 14%)

(NA/DK/MI = 14%)

(NA/DK/MI = 5%)

(NA/DK/MI = 9%)
Negative

29%

6%

(NA/DK/MI = 23%)

2. Staff are encouraged to express alternative viewpoints
in this office. (D2)

68%

24%

8%

(NA/DK/MI = 14%)

3. Staff are afraid to ask questions when something does
not seem right. (D4R)

68%

25%

6%

(NA/DK/MI = 10%)

4. It is difficult to voice disagreement in this office.
(D10R)

67%

28%

(NA/DK/MI = 8%)

Notes: 1) “R” = a negatively worded item; 2) Chart totals exclude missing & NA/DK & may not sum to 100% due to rounding;
3) NA/DK/MI = % of respondents answering NA/DK or with missing data; 4) Item data not displayed for fewer than 3
respondents; 5) % not displayed for 5% or less.

6

Item-Level Results for Sample Medical Office
Number of responses = 88
9. Patient Safety and Quality Issues
Access to Care
1. A patient was unable to get an appointment within 48
hours for an acute/serious problem. (A1)

Positive

Negative

53%

19%

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

(NA/DK/MI = 51%)

28%

(NA/DK/MI = 39%)

96%
a

Charts/Medical Records
3. A patient's chart/medical record was not available
when needed. (A3)
4. Medical information was filed, scanned, or entered into
the wrong patient's chart/medical record. (A4)
Medical Equipment
5. Medical equipment was not working properly or was in
need of repair or replacement. (A5)
Medication
6. A pharmacy contacted our office to clarify or correct a
prescription. (A6)

(NA/DK/MI = 33%)

86%

10%

(NA/DK/MI = 34%)

87%

8%

(NA/DK/MI = 57%)

61%

7. A patient's medication list was not updated during his
or her visit. (A7)
Diagnostics & Tests
8. The results from a lab or imaging test were not
available when needed. (A8)

15% 7%

78%

30%

83%

25%

6%

96%

Positive

(NA/DK/MI = 63%)

(NA/DK/MI = 66%)

13%

69%

9. A critical abnormal result from a lab or imaging test
was not followed up within 1 business day. (A9)

10. Office Processes and Standardization
1. This office is more disorganized than it should be.
(C8R)

9%

(NA/DK/MI = 59%)

(NA/DK/MI = 73%)

Neutral

Negative

72%

18%

11%

(NA/DK/MI = 3%)

2. We have good procedures for checking that work in
this office was done correctly. (C9)

70%

19%

11%

(NA/DK/MI = 5%)

3. We have problems with workflow in this office. (C12R)

71%

14%

4. Staff in this office follow standardized processes to get
tasks done. (C15)

84%

14%

12%

(NA/DK/MI = 5%)

(NA/DK/MI = 3%)

Notes: 1) “R” = a negatively worded item; 2) Chart totals exclude missing & NA/DK & may not sum to 100% due to rounding;
3) NA/DK/MI = % of respondents answering NA/DK or with missing data; 4) Item data not displayed for fewer than 3
respondents; 5) % not displayed for 5% or less.

7

Item-Level Results for Sample Medical Office
Number of responses = 88
11. Information Exchange With Other Settings
Over the past 12 months, how often has your medical
office had problems exchanging accurate, complete, and
timely information with:
1. Outside labs/imaging centers? (B1)

2. Other medical offices/Outside physicians? (B2)

Positive
61%

Positive

2. We have too many patients for the number of
providers in this office. (C6R)

23%

16%

(NA/DK/MI = 65%)

27%

79%

22%

71%

Positive

74%

4. This office has too many patients to be able to handle
everything effectively. (C14R)

73%

(NA/DK/MI = 58%)

(NA/DK/MI = 92%)

Negative

26%

23%

3. We have enough staff to handle our patient load.
(C11)

14%

Neutral

(NA/DK/MI = 44%)

(NA/DK/MI = 67%)

14%

14%

63%

52%

12%

17%

65%

5. Other? (Specify) (B5)
(Not included in composite results)

12. Work Pressure and Pace
1. In this office, we often feel rushed when taking care of
patients. (C3R)

Negative

Neutral

61%

3. Pharmacies? (B3)

4. Hospitals? (B4)

Neutral

11%

25%

(NA/DK/MI = 15%)

12% 14%

20%

(NA/DK/MI = 9%)

7%

(NA/DK/MI = 2%)

(NA/DK/MI = 7%)

Notes: 1) “R” = a negatively worded item; 2) Chart totals exclude missing & NA/DK & may not sum to 100% due to rounding;
3) NA/DK/MI = % of respondents answering NA/DK or with missing data; 4) Item data not displayed for fewer than 3
respondents; 5) % not displayed for 5% or less.
8

Overall Ratings of Quality
Responses for Sample Medical Office
Item Survey Items
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.

100%
80%
60%
38%

40%
20%

44%

14%

5%

NA/DK/MI = 1%
0%

0%
Excellent

G1b.

Very
Good

Good

Fair

Poor

2%

0%

Fair

Poor

7%

3%

Fair

Poor

Effective
Is based on scientific
knowledge.

100%
80%

59%

60%
40%
20%

27%
12%

NA/DK/MI = 7%

0%
Excellent

G1c.

Very
Good

Good

Timely
Minimizes waits and
potentially harmful delays.

100%
80%
60%

44%
32%

40%
20%

NA/DK/MI = 1%

14%

0%
Excellent

Very
Good

Good

Notes: 1) NA/DK/MI = % of respondents who answered Does Not Apply or Don't Know, or missing data; 2) Item data
not displayed for fewer than 3 respondents does not include NA/DK/MI.
9

Overall Ratings of Quality
Responses for Sample Medical Office
Item Survey Items
Overall, how would you rate your medical office on each of the following areas of health care
quality?
G1d.

Efficient
Ensures cost-effective care 100%
(avoids waste, overuse, and 80%
misuse of services).
60%

42%

40%
20%

34%

16%

NA/DK/MI = 1%
7%

0%

0%

G1e.

Equitable
Provides the same quality of
care to all individuals
regardless of gender, race,
ethnicity, socioeconomic
status, language, etc.

Excellent

Very
Good

Good

30%

30%

30%

Fair

Poor

100%
80%
60%
40%
20%

7%

2%

NA/DK/MI = 3%

0%
Excellent

Very
Good

Good

Fair

Poor

Notes: 1) NA/DK/MI = % of respondents who answered Does Not Apply or Don't Know, or missing data; 2) Item data
not displayed for fewer than 3 respondents does not include NA/DK/MI.
10

Overall Rating on Patient Safety
Sample Medical Office
(Survey item G2)

Percent of Respondents

100%

80%

60%
49%
40%
32%

20%

15%
3%

1%

0%

Excellent

Very Good

Good

Fair

Poor

Overall Rating on Patient Safety

NA/DK/MI = 0%
Notes: 1) NA/DK/MI refers to the percentage of respondents that answered Does Not Apply or Don’t Know or did not respond to the item; 2)
Item data does not display for fewer than three respondents; 3) % do not include NA/DK/MI.

11

Composite-Level and Item-level Comparative Results

Composite-Level Comparative Results for Sample Medical Office
All PBRN Medical
Offices
% Positive

Patient Safety Culture Composites % Positive Response

82%
81%

1. Teamwork

2.

77%
87%

Patient Care Tracking/
Follow-up

74%
83%

3. Organizational Learning

4.

74%

Overall Perceptions of Patient
Safety and Quality

72%
69%

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

67%
72%

7. Communication About Error

67%
66%

8. Communication Openness

65%
67%

10.

MAX
100%

31%

100%

23%

100%

18%

100%

15%

100%

15%

100%

17%

100%

21%

100%

22%

95%

13%

100%

8%

100%

0%

95%

88%

5. Staff Training

9.

MIN
25%

Patient Safety and Quality
Issues

60%

Office Processes and
Standardization

59%

79%

74%
54%

Information Exchange With
11.
Other Settings

67%
46%

12. Work Pressure and Pace

66%

Database Medical Offices
Your Medical Office

0%

20%

40%

60%

80%

100%

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Composite
scores are not calculated when any item in the composite has fewer than three respondents.

13

Responses for Sample Medical Office

Item

Survey Items By
Patient Safety Culture Area

Survey Item % Positive Response

All PBRN
Medical Offices
% Positive
MIN
MAX

1. Teamwork
C1

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

C2

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

C5

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

C13

4. This office emphasizes teamwork in taking
care of patients.

D3

87%
90%
80%
83%
80%
75%

2. Patient Care Tracking/Follow-up
1. This office reminds patients when they need to
schedule an appointment for preventive or
routine care.

D5

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

D6

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

D9

83%
75%

78%
92%
65%
88%
77%

100%

20%

100%

0%

100%

17%

100%

18%

100%

17%

100%

18%

100%

40%

100%

90%
86%

4. This office follows up with patients who need
monitoring.
Database Medical Offices

25%

78%

0%

20%

40%

60% 80% 100%

Your Medical Office

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) “R” indicates a negatively
worded item; 3) Item data not displayed for fewer than 3 respondents.

14

Responses for Sample Medical Office

Item

Survey Items By
Patient Safety Culture Area

Survey Item % Positive Response

All PBRN
Medical Offices
% Positive
MIN
MAX

3. Organizational Learning
F1

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

F5

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

F7

82%
81%
75%
86%

3. After this office makes changes to improve the
patient care process, we check to see if the
changes worked.
4. Overall Perceptions of Patient Safety
and Quality

20%

100%

8%

100%

11%

100%

11%

100%

11%

100%

11%

100%

17%

100%

67%
81%

79%

F2

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

F3R

2. Mistakes happen more than they should in this
office.

F4R

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

74%

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

73%

F6R

89%
70%
89%

86%

88%

Database Medical Offices

0%

20%

40% 60% 80% 100%

Your Medical Office

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) “R” indicates a negatively
worded item; 3) Item data not displayed for fewer than 3 respondents.

15

Responses for Sample Medical Office

Item

Survey Items By
Patient Safety Culture Area

Survey Item % Positive Response

All PBRN
Medical Offices
% Positive
MIN
MAX

5. Staff Training
75%

C4

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

C7

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

69%

C10R

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

68%

71%
71%

69%

13%

100%

17%

100%

14%

100%

0%

100%

0%

100%

0%

100%

0%

100%

6. Owner/Managing Partner/Leadership
Support for Patient Safety
E1R

1. They aren’t investing enough resources to
improve the quality of care in this office.
2. They overlook patient care mistakes that
happen over and over.

79%

E2R

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

78%

E3

E4R

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

51%
57%

84%

81%
61%
65%

0%

20%

40% 60% 80% 100%

Your Medical Office

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) “R” indicates a negatively
worded item; 3) Item data not displayed for fewer than 3 respondents.

16

Responses for Sample Medical Office

Item

Survey Items By
Patient Safety Culture Area

Survey Item % Positive Response

All PBRN
Medical Offices
% Positive
MIN
MAX

7. Communication About Error
D7R

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

D8

2. Providers and staff talk openly about office
problems.

D11

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

D12

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

57%
64%
59%
54%
78%
68%
72%
78%

0%

100%

0%

100%

17%

100%

17%

100%

13%

100%

0%

100%

20%

100%

0%

100%

8. Communication Openness
D1

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

D2

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

D4R

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

D10R

4. It is difficult to voice disagreement in this
office.

69%
65%
68%
68%
70%
68%
53%
67%

Database Medical Offices

0%

20%

40%

60% 80% 100%

Your Medical Office

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) “R” indicates a negatively
worded item; 3) Item data not displayed for fewer than 3 respondents.

17

Responses for Sample Medical Office

Has this been a problem
in the past 12 months?
Item

Survey Items By
Patient Safety Culture Area

Survey Item % Positive Response

All PBRN
Medical Offices
% Positive
MIN
MAX

9. Patient Safety and Quality Issues
Access to Care
A1

69%

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

53%

0%

100%

14%

100%

0%

100%

10%

100%

14%

100%

0%

100%

0%

100%

0%

100%

17%

100%

Patient Identification
A2

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

86%
96%

Charts/Medical Records
A3

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

A4

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

63%
78%

70%
86%

Medical Equipment
A5

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

73%
87%

Medication
A6

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

A7

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

22%
61%
44%
83%

Diagnostics & Tests
A8

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

A9

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

39%
69%
79%
96%

Database Medical Offices

0%

20%

40%

60%

80% 100%

Your Medical Office

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) “R” indicates a negatively
worded item; 3) Item data not displayed for fewer than 3 respondents.

18

Responses for Sample Medical Office

Item

Survey Items By
Patient Safety Culture Area

Survey Item % Positive Response

All PBRN
Medical Offices
% Positive
MIN
MAX

10. Office Processes and Standardization
C8R

1. This office is more disorganized than it should
be.

C9

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

58%
72%
60%
70%
47%

C12R 3. We have problems with workflow in this office.

C15

71%
74%

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

84%

0%

100%

0%

100%

0%

100%

20%

100%

0%

100%

0%

100%

0%

100%

0%

100%

0%

100%

11. Information Exchange With Other
Settings
Over the past 12 months, how often has your
medical office had problems exchanging
accurate, complete, and timely information with:
B1

1. Outside labs/imaging centers?

B2

2. Other medical offices/Outside physicians?

B3

3. Pharmacies?

B4

4. Hospitals?

B5

5. Other? (Specify)

55%
61%
50%
61%
52%
79%
58%
65%
70%
71%

Database Medical Offices

0%

20%

40% 60% 80% 100%

Your Medical Office

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) “R” indicates a negatively
worded item; 3) Item data not displayed for fewer than 3 respondents.

19

Responses for Sample Medical Office

Item

Survey Items By
Patient Safety Culture Area

Survey Item % Positive Response

All PBRN
Medical Offices
% Positive
MIN
MAX

12. Work Pressure and Pace
C3R

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

C6R

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

C11

3. We have enough staff to handle our patient
load.

C14R

4. This office has too many patients to be able to
handle everything effectively.
Database Medical Offices

28%
63%
46%
52%
49%
74%
59%
73%

0%

20%

40%

60% 80%

0%

100%

0%

100%

0%

100%

0%

100%

100%

Your Medical Office

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) “R” indicates a negatively
worded item; 3) Item data not displayed for fewer than 3 respondents.

20

Overall Ratings of Quality
Responses for Sample Medical Office
Item Survey Items
Overall, how would you rate your medical office on each of the following areas of health care quality?

80%

1%

0%

5%

5%

25%

20%

14%

40%

42%

60%

44%

Is responsive to individual patient preferences,
needs, and values.

100%

27%

Patient Centered

38%

G1a.

0%
Excellent

Good

Fair

Poor

Effective
100%

0%

0%

4%

20%

2%

25%

40%

12%

60%

25%

46%

80%

27%

Is based on scientific knowledge.

59%

G1b.

Very Good

0%
Excellent

G1c.

Very Good

Good

Fair

Poor

Timely
Minimizes waits and potentially harmful delays. 100%

4%

3%

15%

32%

32%

7%

15%

20%

14%

40%

35%

60%

44%

80%

0%
Excellent

Very Good

Good

Fair

Poor

Database Medical Offices
Your Medical Office

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Item data not displayed for
21
fewer than 3 respondents.

Overall Ratings of Quality
Responses for Sample Medical Office
Item Survey Items
Overall, how would you rate your medical office on each of the following areas of health care quality?
Efficient
100%

2%

0%

10%

7%

16%

20%

16%

40%

39%

60%

34%

80%

33%

Ensures cost-effective care (avoids waste,
overuse, and misuse of services).

42%

G1d.

0%
Excellent

Good

Fair

Poor

100%

2%

1%

7%

20%

3%

30%
14%

31%

40%

30%

Provides the same quality of care to all
80%
individuals regardless of gender, race, ethnicity,
60%
socioeconomic status, language, etc.

52%

Equitable

30%

G1e.

Very Good

0%
Excellent

Very Good

Good

Fair

Poor

Database Medical Offices
Your Medical Office

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Item data not displayed for
22
fewer than 3 respondents.

Overall Rating on Patient Safety Comparative Results for
Sample Medical Office
(Survey item G2)
100%

Percent of Respondents

80%

60%
49%
44%
Database Medical Offices

40%

Your Medical Office

32%
27%
20%

20%
15%
8%
3%

1% 1%

0%

Excellent

Very Good

Good

Fair

Poor

Overall Rating on Patient Safety

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Item data does
not display for fewer than three respondents.

23

Composite-Level and Item-level Comparative Results
by Staff Position

Composite Level Average % Positive Response by Respondent Staff Position (Page 1 of 2) -- Sample Medical Office
Staff Position

Patient Safety Culture Composites

Database: # Respondents
Your Medical Office: # Respondents

1. Teamwork
2. Patient Care Tracking/Follow-up
3. Organizational Learning
4. Overall Perceptions of Patient Safety and
Quality
5. Staff Training
6. Owner/Managing Partner/Leadership
Support for Patient Safety

Dataset

6,425
71
Database
Your Office
Database
Your Office
Database
Your Office
Database
Your Office
Database
Your Office
Database
Your Office

Physician
(MD or DO)

PA, NP, CNS,
N. Midwife,
APN

1,251

61

3

0

87%
-62%
-75%
-70%
-77%
-66%
--

82%
-78%
-54%
-57%
-66%
-61%
--

Mgmt

Admin or
clerical staff

RN/LVN/
LPN

Other clinical
staff or clinical
support staff

159

2,265

1,132

1,557

7

27

9

25

87%
82%
72%
91%
85%
81%
77%
100%
77%
81%
68%
84%

75%
88%
80%
98%
70%
88%
67%
93%
63%
68%
65%
68%

79%
50%
74%
86%
69%
56%
70%
72%
67%
63%
61%
65%

78%
81%
80%
83%
72%
80%
70%
84%
65%
65%
64%
71%

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" & missing are not
shown. 3) Composite scores are not calculated when a staff position has fewer than 5 respondents or if an item in the composite has fewer than 3
respondents.

25

Composite Level Average % Positive Response by Respondent Staff Position (Page 2 of 2) -- Sample Medical Office
Staff Position

Patient Safety Culture Composites

Database: # Respondents
Your Medical Office: # Respondents

7. Communication About Error
8. Communication Openness
9. Patient Safety and Quality Issues
10. Office Processes and Standardization
11. Information Exchange With Other
Settings
12. Work Pressure and Pace
Average Across Composites

Dataset

6,425
71
Database
Your Office
Database
Your Office
Database
Your Office
Database
Your Office
Database
Your Office
Database
Your Office
Database
Your Office

Physician
(MD or DO)

PA, NP, CNS,
N. Midwife,
APN

1,251
3

Mgmt

Admin or
clerical staff

RN/LVN/
LPN

Other clinical
staff or clinical
support staff

61

159

2,265

1,132

1,557

0

7

27

9

25

71%
-76%
-54%
-54%
-43%
-45%
--

60%
-68%
-55%
-49%
-36%
-38%
--

67%
55%
64%
62%
55%
-58%
79%
36%
56%
40%
88%

57%
61%
53%
62%
58%
75%
55%
75%
53%
73%
40%
63%

62%
56%
54%
72%
58%
74%
53%
50%
56%
65%
33%
58%

61%
75%
55%
60%
60%
83%
57%
79%
58%
66%
41%
66%

65%
--

59%
--

66%
78%

61%
76%

61%
64%

63%
74%

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" & missing are not
shown. 3) Composite scores are not calculated when a staff position has fewer than 5 respondents or if an item in the composite has fewer than 3
respondents.

26

Item Level Average % Positive Response by Respondent Staff Position (Page 1 of 7) -- Sample Medical Office
Staff Position

Item Survey Items by Composite

Database: # Respondents
Your Medical Office: # Respondents
1.

Teamwork

C1

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

Dataset

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

6,425

1,251

71

3

Database
Your Office

C2

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

C5

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

C13

4. This office emphasizes teamwork in taking care of
patients.

2.

Patient Care Tracking/Follow-up

D3

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

D5

D6

D9

2. This office documents how well our chronic-care patients
follow their treatment plans.
3. Our office follows up when we do not receive a report we
are expecting from an outside provider.
4. This office follows up with patients who need monitoring.

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical
staff or clinical
support staff

61

159

2,265

1,132

1,557

0

7

27

9

25

86%

81%

90%

77%

79%

77%

--

--

86%

81%

44%

76%

91%

87%

89%

80%

87%

85%

--

--

86%

93%

67%

88%

Database

92%

85%

82%

70%

76%

73%

Your Office

--

--

86%

96%

33%

84%

Database

80%

76%

86%

75%

75%

76%

Your Office

--

--

71%

81%

56%

76%

Database

64%

71%

66%

81%

78%

83%

Your Office

--

--

100%

100%

100%

85%

Database

50%

68%

65%

75%

59%

73%

Your Office

--

--

80%

100%

67%

78%

Database

56%

76%

79%

81%

76%

81%

Your Office

--

--

100%

100%

88%

90%

Database

78%

94%

82%

85%

82%

85%

Your Office

--

--

83%

90%

89%

79%

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not shown; 3) “R” = a
negatively worded item; 4) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

27

Item Level Average % Positive Response by Respondent Staff Position (Page 2 of 7) -- Sample Medical Office
Staff Position

Item

Survey Items by Composite

Database: # Respondents
Your Medical Office: # Respondents
3.

Organizational Learning

F1

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

F5

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

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

6,425
71

1,251
3

Database

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical
staff or clinical
support staff

61

159

2,265

1,132

1,557

0

7

27

9

25

88%

65%

90%

73%

78%

76%

Your Office

--

--

86%

88%

67%

65%

Database

70%

52%

85%

69%

66%

73%

Your Office

--

--

71%

100%

56%

80%

Database

66%

47%

79%

66%

64%

67%

Your Office

--

--

86%

75%

44%

95%

73%

58%

78%

73%

77%

77%

--

--

100%

100%

67%

75%

Database

63%

60%

74%

60%

72%

68%

Your Office

--

--

100%

92%

67%

90%

73%

57%

74%

65%

72%

70%

--

--

100%

88%

67%

90%

Database

68%

53%

82%

69%

58%

64%

Your Office

--

--

100%

92%

89%

80%

Dataset

F7

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

4.

Overall Perceptions of Patient Safety and Quality

F2

Database
1. Our office processes are good at preventing mistakes that
could affect patients.
Your Office

F3
R

2. Mistakes happen more than they should in this office.

F4
R

Database
3. It is just by chance that we don’t make more mistakes that
affect our patients.
Your Office

F6
R

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

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not shown; 3) “R” = a
negatively worded item; 4) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

28

Item Level Average % Positive Response by Respondent Staff Position (Page 3 of 7) -- Sample Medical Office
Staff Position

Item

Survey Items by Composite
Database: # Respondents
Your Medical Office: # Respondents

5.

Staff Training

C4

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

C7

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

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

6,425
71

1,251

61

3

Database

83%
-75%

Dataset

Your Office
Database

1,132

1,557

0

7

27

9

25

66%
-63%

80%
71%
77%

66%
68%
66%

69%
67%
66%

70%
68%
65%

--

--

86%

77%

44%

54%

68%

74%

57%

66%

62%

--

--

86%

58%

78%

72%

Database

48%

47%

45%

49%

41%

47%

Your Office

--

--

60%

44%

67%

60%

82%

83%

76%

75%

77%

73%

E1
R

1. They aren’t investing enough resources to improve the
quality of care in this office.

E2
R

2. They overlook patient care mistakes that happen over and Database
over.
Your Office

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

2,265

73%

Owner/Managing Partner/Leadership Support for Patient
Safety

E4
R

159

Database

6.

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

RN/LVN/ LPN

Other clinical
staff or clinical
support staff

Your Office

C10 3. Staff in this office are asked to do tasks they haven’t been
R
trained to do.
Your Office

E3

Mgmt

Admin or
clerical staff

--

--

100%

69%

63%

90%

Database

78%

73%

85%

79%

75%

79%

Your Office

--

--

100%

83%

88%

70%

Database

59%

40%

63%

59%

51%

56%

Your Office

--

--

75%

75%

44%

63%

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not shown; 3) “R” = a
negatively worded item; 4) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

29

Item Level Average % Positive Response by Respondent Staff Position (Page 4 of 7) -- Sample Medical Office
Staff Position

Item

Survey Items by Composite
Database: # Respondents
Your Medical Office: # Respondents

7.

Communication about Error

D7
R

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

D8

2. Providers and staff talk openly about office problems.

D11

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

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

6,425
71

1,251

61

3

Database

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical
staff or clinical
support staff

159

2,265

1,132

1,557

0

7

27

9

25

Database

65%
-69%

42%
-58%

51%
50%
61%

45%
44%
45%

51%
67%
50%

47%
86%
50%

Your Office

--

--

57%

44%

38%

57%

Database

77%

73%

87%

72%

77%

78%

Your Office

--

--

71%

72%

44%

72%

Database

71%

68%

68%

65%

69%

68%

Your Office

--

--

43%

83%

75%

84%

Database

83%

80%

60%

53%

55%

58%

Your Office

--

--

50%

46%

67%

65%

Database

77%

73%

77%

56%

55%

56%

Your Office

--

--

83%

56%

56%

62%

71%

64%

66%

62%

64%

65%

--

--

71%

75%

78%

57%

Database

72%

50%

53%

41%

42%

41%

Your Office

--

--

43%

71%

89%

56%

Dataset

Your Office

D12

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

8.

Communication Openness

D1

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

D2

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

D4
R

Database
3. Staff are afraid to ask questions when something does not
seem right.
Your Office

D10
4. It is difficult to voice disagreement in this office.
R

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not shown; 3) “R” = a
negatively worded item; 4) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

30

Item Level Average % Positive Response by Respondent Staff Position (Page 5 of 7) -- Sample Medical Office
Staff Position

Survey Items by Composite

Item

9.
A1

A2

A3

A4

1,251

61

3

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical
staff or clinical
support staff

159

2,265

1,132

1,557

0

7

27

9

25

65%
--

42%
--

55%
67%

65%
47%

63%
33%

67%
70%

84%
--

83%
--

84%
100%

82%
100%

85%
100%

85%
87%

Database

59%
-64%

50%
-58%

55%
83%
63%

59%
68%
69%

62%
75%
72%

61%
92%
76%

Your Office

--

--

80%

84%

78%

92%

Dataset

6,425
Database: # Respondents
71
Your Medical Office: # Respondents
Patient Safety and Quality Issues
Access to Care
Database
1. A patient was unable to get an appointment within 48
hours for an acute/serious problem.
Your Office
Patient Identification
Database
2. The wrong chart/medical record was used for a patient.
Your Office
Charts/Medical Records
Database
3. A patient's chart/medical record was not available when
needed.
Your Office
4. Medical information was filed, scanned, or entered into
the wrong patient's chart/medical record.

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

Medical Equipment
A5

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

Database

64%

66%

69%

71%

62%

67%

Your Office

--

--

100%

100%

88%

89%

Medication
A6

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

Database

22%

29%

15%

14%

22%

19%

Your Office

--

--

--

63%

67%

40%

A7

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

Database
Your Office

30%
--

34%
--

35%
--

45%
50%

41%
100%

47%
86%

Your Office

32%
--

42%
--

42%
75%

44%
82%

37%
29%

45%
89%

Database

71%

69%

81%

68%

80%

80%

Your Office

--

--

100%

80%

100%

100%

Diagnostics & Tests
A8

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

A9

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

Database

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not shown; 3) “R” = a
negatively worded item; 4) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

31

Item Level Average % Positive Response by Respondent Staff Position (Page 6 of 7) -- Sample Medical Office
Staff Position

Item Survey Items by Composite

Database: # Respondents
Your Medical Office: # Respondents
10.

Office Processes and Standardization

C8
R

1. This office is more disorganized than it should be.

C9

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

C12
3. We have problems with workflow in this office.
R
C15

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

11.

Information Exchange With Other Settings

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical
staff or clinical
support staff

6,425
71

1,251
3

61

159

2,265

1,132

1,557

0

7

27

9

25

Database

54%

51%

60%

53%

52%

55%

Your Office
Database

-56%

-51%

57%
60%

70%
56%

44%
51%

88%
58%

Your Office

--

--

86%

63%

33%

75%

Database
Your Office
Database

37%
-71%
--

35%
-59%
--

42%
86%
71%
86%

44%
76%
70%
89%

40%
56%
70%
67%

43%
72%
72%
80%

57%
50%
52%
71%
55%
100%
62%
40%
81%
--

60%
57%
56%
64%
56%
67%
63%
75%
74%
100%

Dataset

Your Office

Over the past 12 months, how often has your medical office had problems exchanging accurate, complete, and timely information with:
B1

1. Outside labs/imaging centers?

B2

2. Other medical offices/Outside physicians?

B3

3. Pharmacies?

B4

4. Hospitals?

B5

5. Other?

Database
Your Office
Database
Your Office
Database
Your Office
Database
Your Office
Database
Your Office

43%
-34%
-50%
-45%
-77%
--

37%
-38%
-46%
-36%
----

41%
50%
35%
50%
42%
75%
41%
50%
---

55%
70%
53%
67%
42%
80%
59%
73%
73%
--

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not shown; 3) “R” = a
negatively worded item; 4) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

32

Item Level Average % Positive Response by Respondent Staff Position (Page 7 of 7) -- Sample Medical Office
Staff Position

Item Survey Items by Composite

Database: # Respondents
Your Medical Office: # Respondents
12.
C3
R

Work Pressure and Pace
1. In this office, we often feel rushed when taking care of
patients.

C6
R

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

C11 3. We have enough staff to handle our patient load.
C14 4. This office has too many patients to be able to handle
everything effectively.
R

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical
staff or clinical
support staff

6,425
71

1,251

61

159

2,265

3

1,132

1,557

0

7

27

9

25

Database
Your Office
Database
Your Office
Database
Your Office

19%
-48%
-52%
--

11%
-37%
-47%
--

20%
71%
40%
80%
44%
100%

26%
74%
38%
45%
42%
63%

19%
67%
31%
33%
36%
78%

28%
56%
38%
57%
45%
76%

Database

60%

56%

56%

52%

44%

53%

Your Office

--

--

100%

71%

56%

76%

Dataset

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not shown; 3) “R” = a
negatively worded item; 4) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

33

Overall Ratings on Quality Percent Response by Respondent Staff Position (Page 1 of 5) -- Sample Medical Office
Staff Position

Database: # Respondents
Your Medical Office: # Respondents

Dataset

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

6,425

1,251

71

3

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical staff
or clinical support
staff

61

159

2,265

1,132

1,557

0

7

27

9

25

G1a. Patient Centered
Is responsive to individual patient preferences, needs, and values.
Database

23%

7%

18%

18%

18%

21%

Your Office

--

--

14%

8%

0%

20%

Database

43%

51%

48%

38%

43%

37%

Your Office

--

--

29%

46%

44%

28%

Database

25%

34%

28%

34%

32%

35%

Your Office

--

--

57%

42%

44%

44%

Database

8%

8%

6%

9%

6%

6%

Your Office

--

--

0%

4%

11%

8%

Database

1%

0%

0%

1%

1%

0%

Your Office

--

--

0%

0%

0%

0%

Excellent

Very Good

Good

Fair

Poor
Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not
shown; 3) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

34

Overall Ratings on Quality Percent Response by Respondent Staff Position (Page 2 of 5) -- Sample Medical Office
Staff Position

Database: # Respondents
Your Medical Office: # Respondents

Dataset

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

6,425

1,251

71

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical staff
or clinical support
staff

61

159

2,265

1,132

1,557

3

0

7

27

9

25

Database

30%

12%

19%

18%

20%

20%

Your Office

--

--

14%

14%

0%

20%

Database

47%

52%

55%

41%

47%

43%

Your Office

--

--

57%

52%

56%

60%

Database

20%

30%

24%

35%

27%

32%

Your Office

--

--

29%

24%

44%

20%

Database

2%

5%

2%

6%

5%

5%

Your Office

--

--

0%

10%

0%

0%

Database

0%

2%

0%

1%

0%

0%

Your Office

--

--

0%

0%

0%

0%

G1b. Effective
Is based on scientific knowledge.
Excellent

Very Good

Good

Fair

Poor

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not
shown; 3) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

35

Overall Ratings on Quality Percent Response by Respondent Staff Position (Page 3 of 5) -- Sample Medical Office
Staff Position

Database: # Respondents
Your Medical Office: # Respondents

Dataset

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

6,425

1,251

71

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical staff
or clinical support
staff

61

159

2,265

1,132

1,557

3

0

7

27

9

25

Database

14%

5%

9%

10%

8%

10%

Your Office

--

--

14%

15%

33%

12%

Database

34%

33%

37%

29%

35%

33%

Your Office

--

--

43%

27%

11%

60%

Database

31%

35%

37%

35%

34%

34%

Your Office

--

--

29%

46%

44%

16%

Database

17%

24%

14%

19%

18%

18%

Your Office

--

--

14%

12%

11%

0%

Database

4%

2%

3%

7%

6%

5%

Your Office

--

--

0%

0%

0%

12%

G1c. Timely
Minimizes waits and potentially harmful delays.
Excellent

Very Good

Good

Fair

Poor

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not
shown; 3) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

36

Overall Ratings on Quality Percent Response by Respondent Staff Position (Page 4 of 5) -- Sample Medical Office
Staff Position

Database: # Respondents
Your Medical Office: # Respondents

Dataset

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

6,425

1,251

71

3

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical staff
or clinical support
staff

61

159

2,265

1,132

1,557

0

7

27

9

25

G1d. Efficient
Ensures cost-effective care (avoids waste, overuse, and misuse of services).
Excellent

Very Good

Good

Fair

Poor

Database

13%

12%

9%

13%

9%

13%

Your Office

--

--

0%

21%

0%

20%

Database

36%

29%

41%

33%

38%

34%

Your Office

--

--

71%

42%

33%

44%

Database

35%

40%

38%

38%

37%

37%

Your Office

--

--

29%

29%

56%

24%

Database

13%

13%

10%

13%

13%

12%

Your Office

--

--

0%

8%

11%

12%

Database

3%

6%

2%

3%

3%

4%

Your Office

--

--

0%

0%

0%

0%

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not
shown; 3) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

37

Overall Ratings on Quality Percent Response by Respondent Staff Position (Page 5 of 5) -- Sample Medical Office
Staff Position

Database: # Respondents
Your Medical Office: # Respondents

Dataset

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

6,425

1,251

71

3

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical staff
or clinical support
staff

61

159

2,265

1,132

1,557

0

7

27

9

25

G1e. Equitable
Provides the same quality of care to all individuals regardless of gender, race, ethnicity, socioeconomic status, language, etc.
Excellent

Very Good

Good

Fair

Poor

Database

55%

48%

51%

41%

43%

46%

Your Office

--

--

43%

32%

22%

24%

Database

32%

34%

33%

33%

37%

30%

Your Office

--

--

29%

28%

44%

24%

Database

11%

15%

12%

20%

17%

19%

Your Office

--

--

29%

32%

33%

36%

Database

2%

2%

3%

5%

3%

4%

Your Office

--

--

0%

8%

0%

12%

Database

0%

2%

1%

2%

1%

2%

Your Office

--

--

0%

0%

0%

4%

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are not
shown; 3) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

38

Overall Rating on Patient Safety Comparative Results by Respondent Staff Position -- Sample Medical Office
Staff Position

Database: # Respondents
Your Medical Office: # Respondents

Dataset

Physician (MD
or DO)

PA, NP, CNS,
N. Midwife,
APN

6,425

1,251

71

Mgmt

Admin or
clerical staff

RN/LVN/ LPN

Other clinical staff
or clinical support
staff

61

159

2,265

1,132

1,557

3

0

7

27

9

25

Database

16%

14%

14%

17%

16%

19%

Your Office

--

--

0%

7%

22%

28%

Database

42%

34%

52%

41%

44%

41%

Your Office

--

--

71%

48%

22%

44%

Database

31%

34%

26%

31%

30%

31%

Your Office

--

--

29%

41%

44%

20%

Database

9%

10%

7%

10%

9%

8%

Your Office

--

--

0%

4%

11%

4%

Database

1%

8%

0%

1%

1%

1%

Your Office

--

--

0%

0%

0%

4%

Excellent

Very Good

Good

Fair

Poor

Notes: 1) 2010 Preliminary Comparative Results are based on data from 470 Medical Offices; 2) Respondents who selected "Other" and missing are
not shown; 3) Data are not only displayed for staff positions where there are fewer than 5 respondents and item data are not displayed for fewer than 3
respondents.

39

Explanation of Calculations

EXPLANATION OF CALCULATIONS
GENERAL NOTES:
The Medical Office Survey on Patient Safety is designed to measure the following:
1) Two overall patient safety outcomes:
a. Overall Ratings on Quality
b. Overall Rating on Patient Safety
2) Twelve dimensions of culture related to patient safety
SURVEY RESPONSE SCALES
The Medical Office Survey on Patient Safety asks respondents to answer items using a 5-point or 6-point
response scale. Positively and negatively worded items were used.
● Agreement (5-point response scale)
○ Strongly Agree & Agree (combined)
○ Neither
○ Disagree & Strongly Disagree (combined)
OR
● Frequency (5-point response scale)
○ Always & Most of the time (combined)
○ Sometimes
○ Rarely & Never (combined)
OR
● Frequency (6-point response scale)
○ Daily & Weekly (combined)
○ Monthly & Several times in the past 12 months (combined)
○ Once or twice in the past 12 months & Not in the past 12 months (combined)
DEFINITION OF POSITIVE, NEUTRAL & NEGATIVE (5-POINT RESPONSE SCALES)
1) Positive is the percent of responses that were rated a 4 or 5 (Agree / Strongly agree or Most of the
Time / Always) for positively worded questions, or a 1 or 2 (Strongly Disagree / Disagree or Never /
Rarely) for reverse worded questions.
2) Neutral is the percent of responses that were rated a 3 (Neither or Sometimes) for any question.
3) Negative is the percent of responses that were rated a 1 or 2 (Strongly Disagree / Disagree or
Never / Rarely ) for positively worded questions, or a 4 or 5 (Agree / Strongly agree or Most of the
Time / Always) for reverse worded questions.
DEFINITION OF POSITIVE, NEUTRAL & NEGATIVE (6-POINT RESPONSE SCALES)
1) Positive is the percent of responses that were rated a 5 or 6 (Once or twice in the past 12 months /
Not in the past 12 months) for any question.
2) Neutral is the percent of responses that were rated a 3 or 4 (Monthly / Several times in the past 12
months) for any question.
3) Negative is the percent of responses that were rated a 1 or 2 (Daily / Weekly) for any question.

41

DEFINITION OF COMPOSITE RESULTS
1) Composite results or scores measure 12 different areas of patient safety culture. They are
calculated for each medical office by averaging the percent positive response on the items within a
composite. For example, for a 3-item composite, if the item-level percent positive responses were
50 percent, 55 percent, and 60 percent, the medical office’s composite-level percent positive
response would be the average of these three percentages or 55% positive.
DEFINITION OF COMPARATIVE RESULTS
1) Item-Level Comparative Results are the comparison of your medical office results to the Item
Level Medical Office Database Comparative Results.
2) Composite Level Comparative Results are the comparison of your medical office results to the
Composite Level Medical Office Database Comparative Results.

42

INTERPRETING YOUR ITEM AND COMPOSITE-LEVEL RESULTS
SURVEY RESPONSE SCALES
Respondents use a 5-point or 6-point response scale when answering items:
● Agreement (5-point response scale)
○ Strongly Agree & Agree (combined)
○ Neither
○ Disagree & Strongly Disagree (combined)
OR
● Frequency (5-point response scale)
○ Always & Most of the time (combined)
○ Sometimes
○ Rarely & Never (combined)
OR
● Frequency (6-point response scale)
○ Daily & Weekly (combined)
○ Monthly & Several times in the past 12 months (combined)
○ Once or twice in the past 12 months & Not in the past 12 months (combined)
Most of the survey’s items include a Does Not Apply/Don’t Know response option. Does not apply/Don’t Know
and missing responses are excluded when displaying percentages of response to the survey items.
Positively and negatively worded items were used.
POSITIVELY WORDED ITEMS
This is an example of a positively worded item. For this item, the percentage who answered “Strongly
Agree/Agree” is shown in green (positive response), “Neither” in yellow, and “Strongly Disagree/Disagree”
(negative response) in red.

43

NEGATIVELY WORDED ITEMS
This is an example of a negatively worded item. The percentage who answered “Strongly Disagree/Disagree” is
shown in green (positive response), “Neither” in yellow, and “Strongly Agree/Agree” (negative response) in red.

COMPOSITE SCORES
A composite score summarizes how respondents answered groups of items that all measure the same thing.
To calculate your medical office's composite score, simply average the percent positive response on each item
that is included in the composite. Here is an example of calculating a composite score for Communication
Openness:

44


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