1. Results from the AHRQ Medical Office Survey on Patient Safety Culture 2012 User Comparative Database 2012 AHRQ Annual Conference September 10, 2012 Theresa Famolaro, MPS, Westat

2. Acknowledgements  Westat staff  Joann Sorra  Naomi Dyer  Scott Smith  Helen Liu  Matt Ragan  AHRQ staff  Christine Crofton  James Battles  Technical Expert Panel Members

3. Objectives  Provide background on the development of the AHRQ Medical Office Survey on Patient Safety Culture  Describe the AHRQ Medical Office Survey on Patient Safety Culture Comparative Database  Present the overall results from the AHRQ Medical Office Survey on Patient Safety Culture 2012 User Comparative Database Report  Review results by medical office and respondent characteristics

4. Medical Office Survey on Patient Safety Culture 4 Background  Part of a larger suite of surveys sponsored by the Agency for Healthcare Research and Quality’s (AHRQ)  Hospital,  Medical Office  Nursing Home  Pharmacy (to be released in October)  Specifically designed to measure the culture of patient safety in outpatient medical offices  Assesses staff and provider attitudes and beliefs about patient safety  Assesses many areas that are different than the other surveys  Pilot tested in two survey administrations:  2007; 182 medical offices, 4,174 office staff  2009; 292 PBRN medical offices, 6,463 office staff  Pilot test report at http://www.ahrq.gov/qual/mosurvey10/moresults10.pdf

5. Medical Office Survey on Patient Safety Culture 5 MOSOPS Patient Safety Culture Composites 10 composites of organizational culture: 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 7.Communication About Error 8.Communication Openness 9.Office Processes and Standardization 10.Work Pressure and Pace Other questions:  Nine questions on Patient Safety and Quality Issues  Five questions on Information Exchange With Other Settings  Ratings on Areas of Quality  Overall Rating on Patient Safety

6. Medical Office Survey on Patient Safety Culture 6 Definition of a Medical Office  A medical office is an outpatient facility in a specific location  A medical office located in a building containing multiple medical offices is considered a separate medical office  A provider in a single medical office with other providers should share administrative and clinical support staff

7. Medical Office Survey on Patient Safety Culture 7 Medical Office Comparative Database  23,679 medical office respondents from 934 medical offices  Submission to the database is voluntary  Individual Medical Office Feedback Report is a benefit for participation  290 Medical Offices from the pilot study are retained in the 2012 Database  Pilot PBRN data collected November 2009

8. Medical Office Survey on Patient Safety Culture 8 Call for Data Submission  Data submission occurred September 15 – Oct 31 2011  Participation requirements –Medical offices located in the United States or U.S. territory –Each medical office had at least five completed surveys –Survey administered in its entirety without significant modifications or deletions –Medical offices signed an AHRQ Data Use Agreement  Submission was online and included a Web-based tutorial

9. Medical Office Survey on Patient Safety Culture 9 Survey Administration Statistics  Surveys were collected by –Paper Only (35%) –Web Only (63%) –Both paper and Web (2%)  The average medical office response rate was 71% –Paper Only (80% response rate) –Web only (66% response rate) –Both Web and Paper (87% response rate)  Average of 25 completed surveys per medical office

10. Medical Office Survey on Patient Safety Culture 10 Medical Offices by Number of Providers Number of ProvidersN% 1344% 211112% 311012% 4-938241% 10-13879% 14-19637% More than 1913915% Note: Percentages may not add to exactly 100 percent due to rounding; n = 926,

11. Medical Office Survey on Patient Safety Culture 11 Medical Offices by Single vs. Multi-Specialty Single vs. Multi-SpecialtyN% Single specialty64169% Multi-specialty with primary care only859% Multi-specialty with primary care and specialty care 18820% Multi-specialty with specialty care only182% Note: Percentages may not add to exactly 100 percent due to rounding; n = 932,.

12. Medical Office Survey on Patient Safety Culture 12 Implementation Status of Electronic Tools Electronic Tools % Not Implemented % Implementation in Process % Fully Implemented Appointment scheduling 4%8%88% Ordering of medications 30%18%52% Ordering of tests, imaging, or procedures 34%18%48% Access to patients’ test or imaging results 16%15%69% Medical/health records 25%13%62% Note: Percentages may not add to exactly 100 percent due to rounding.

13. Medical Office Survey on Patient Safety Culture 13 Medical Offices by Majority Ownership Majority OwnershipN% Provider(s) and/or physician(s)9210% University or academic medical institution 536% Hospital or health system67873% Community health system586% Government (Federal, State, local)344% Other142% Note: Percentages may not add to exactly 100 percent due to rounding; n = 929,.

14. Medical Office Survey on Patient Safety Culture 14 Respondents by Staff Position Staff PositionN% Administrative or clerical staff6,37828% Other clinical staff or clinical support staff5,55724% Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN) 4,20318% Physician (M.D. or D.O.)2,94313% Management1,6217% Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Nurse Midwife, Advanced Practice Nurse, etc. 1,0615% Other1,2005% Note: Percentages may not add to exactly 100 percent due to rounding; n = 22,963.

15. Medical Office Survey on Patient Safety Culture 15 Medical Office SOPS Composites

16. Medical Office Survey on Patient Safety Culture 16 Medical Office SOPS Composites

17. Medical Office Survey on Patient Safety Culture 17 Most Positive Items  Teamwork –In this office, there is a good working relationship between staff and providers (88%) –When someone in this office gets really busy, others help out (84%)  Patient Care Tracking/Follow-up –This office follows up with patients who need monitoring (89%) –Our office follows up when we do not receive a report we are expecting from an outside provider (84%)

18. Medical Office Survey on Patient Safety Culture 18 Least Positive Items  Work Pressure and Pace  In this office, we often feel rushed when taking care of patients (31%)  We have enough staff to handle our patient load (47%)  We have too many patients for the number of providers in this office (48%)  Office Processes and Standardization –We have problems with workflow in this office (49%)  Owner/Managing Partner/Leadership Support for Patient Safety –They aren’t investing enough resources to improve the quality of care in this office (49%)

19. Medical Office Survey on Patient Safety Culture 19 Patient Safety and Quality Issues  Nine ratings of things happening in your medical office over the past 12 months  Example items include: –Use of a wrong chart/medical record on a patient –One day follow-up of an abnormal result from a lab or imaging test –Ability of patient to get an appointment within 48 hours for an acute/serious problem –Availability of lab or imaging test results –Contact by pharmacy to clarify or correct a prescription

20. Medical Office Survey on Patient Safety Culture 20 Patient Safety and Quality Issues Percent of Respondents The wrong chart/medical record was used for a patient. 96% Positive

21. Medical Office Survey on Patient Safety Culture 21 Percent of Respondents A critical abnormal test from a lab or imaging test was not followed up within 1 business day. 92% Positive Patient Safety and Quality Issues

22. Medical Office Survey on Patient Safety Culture 22 Percent of Respondents A patient was unable to get an appointment within 48 hours for an acute/serious problem. 77% Positive Patient Safety and Quality Issues

23. Medical Office Survey on Patient Safety Culture 23 Percent of Respondents The results from a lab or imaging test were not available when needed. 73% Positive Patient Safety and Quality Issues

24. Medical Office Survey on Patient Safety Culture 24 Percent of Respondents A pharmacy contacted our office to clarify or correct a prescription. 51% Positive Patient Safety and Quality Issues

25. Medical Office Survey on Patient Safety Culture 25 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:  Outside labs/imaging centers?  Other medical offices/ outside physicians?  Pharmacies?  Hospitals?  Other?

26. Medical Office Survey on Patient Safety Culture 26 Most Positive - Hospitals Percent of Respondents 81% Positive

27. Medical Office Survey on Patient Safety Culture 27 Least Positive - Pharmacies Percent of Respondents 75% Positive

28. Medical Office Survey on Patient Safety Culture 28 Overall Ratings on Quality  Overall, how would you rate your medical office on each of the following areas of health care quality?  Percent positive is the combined response of Excellent and Very good –Equitable 81% (51% Excellent, 30% Very good) –Effective 69% (27% Excellent, 42% Very good) –Patient Centered 68% (29% Excellent, 39% Very good) –Efficient 57% (20% Excellent, 37% Very good) –Timely 50% (17% Excellent, 33% Very good)

29. Medical Office Survey on Patient Safety Culture 29 Overall Rating on Patient Safety Percent of Respondents 65% Positive 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?

30. Medical Office Survey on Patient Safety Culture 30 Average Overall Rating on Quality and Patient Safety Percent of Respondents 65% Positive The average of the five overall ratings on quality and the overall rating on patient safety across all 2012 database medical offices

31. Medical Office Survey on Patient Safety Culture 31 Results by Medical Office Characteristics  Smaller medical offices had better results  Average % positive across all 10 survey composites  Smaller medical offices (2 providers) (75%) vs. larger (14-19 providers) (66%)  Average Overall Rating on Quality and Patient Safety  Smaller medical offices (2 providers) (74%) vs. larger (14-19 providers) (57%)  Small correlation between size and composite results  Average % positive across 10 survey composites related to size (r = -0.08,to - 0.10, p < 0.05).

32. Medical Office Survey on Patient Safety Culture 32 Results by Medical Office Characteristics Single specialty scored higher than multi-specialty  Slightly higher on all 10 survey composites  Owner/Managing Partner/Leadership Support for Patient Safety  Single specialty (69%) vs. Multi-specialty (61%) Ownership impacts patient safety culture results  Average % positive across all 10 survey composites  Community health centers and Provider and/or Physician owned (72%) vs. Federal, State, or local govt. (61%)  Overall Rating on Patient Safety (Excellent, Very Good)  Provider and/or Physician owned (67%) vs. Federal, State, or local govt.(48%)

33. Medical Office Survey on Patient Safety Culture 33 Results by Staff Characteristics  Management scored higher than other staff positions  Management scored highest in 8 out of 10 survey composites  Average % positive across all 10 survey composites  Management (80%) vs. Admin/Clerical staff (68%)  Communication About Error –Management (80%) vs. Admin/Clerical staff (62%)  Communication Openness  Physicians (80%) vs. Admin/Clerical Staff (58%)  Management scored similar to physicians (79%)

34. Medical Office Survey on Patient Safety Culture 34 AHRQ Supporting Materials  Medical Office Survey Toolkit  Survey in English and Spanish  Survey User’s Guide  Medical Office Data Entry and Analysis Tool  Medical Office Survey Feedback Report Template  Medical Office Patient Safety Resource List  Arranged by patient safety culture composite  Tools and resources for improvement  Medical Office Data Submission Timeline  Dates forthcoming in 2013  Download all materials at: http://www.ahrq.gov/qual/patientsafetyculture/mosurvindex.htm

35. Medical Office Survey on Patient Safety Culture 35 Thank you Questions? TheresaFamolaro@westat.com