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

Acknowledgements

·Westat staff

Joann Sorra Naomi Dyer Scott Smith

Helen Liu

Matt Ragan

· AHRQ staff Christine Crofton James Battles

· Technical Expert Panel Members

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

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

Medical Office Survey on Patient Safety Culture 5

MOSOPS Patient Safety Culture Composites

10 composites of organizational culture:1. Teamwork2. Patient Care Tracking/Follow-up3. Organizational Learning4. Overall Perceptions of Patient Safety and Quality5. Staff Training6. Owner/Managing Partner/Leadership Support for Patient Safety7. Communication About Error8. Communication Openness9. Office Processes and Standardization10. 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

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

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

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

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

Medical Office Survey on Patient Safety Culture 10

Medical Offices by Number of Providers

Number of Providers N %

1 34 4%

2 111 12%

3 110 12%

4-9 382 41%

10-13 87 9%

14-19 63 7%

More than 19 139 15%

Note: Percentages may not add to exactly 100 percent due to rounding; n = 926,

Medical Office Survey on Patient Safety Culture 11

Medical Offices by Single vs. Multi-Specialty

Single vs. Multi-Specialty N %

Single specialty 641 69%

Multi-specialty with primary care only 85 9%

Multi-specialty with primary care and specialty care

188 20%

Multi-specialty with specialty care only 18 2%

Note: Percentages may not add to exactly 100 percent due to rounding; n = 932,.

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.

Medical Office Survey on Patient Safety Culture 13

Medical Offices by Majority Ownership

Majority Ownership N %

Provider(s) and/or physician(s) 92 10%

University or academic medical institution

53 6%

Hospital or health system 678 73%

Community health system 58 6%

Government (Federal, State, local) 34 4%

Other 14 2%

Note: Percentages may not add to exactly 100 percent due to rounding; n = 929,.

Medical Office Survey on Patient Safety Culture 14

Respondents by Staff Position

Staff Position N %Administrative or clerical staff 6,378 28%

Other clinical staff or clinical support staff 5,557 24%

Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN)

4,203 18%

Physician (M.D. or D.O.) 2,943 13%

Management 1,621 7%

Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Nurse Midwife, Advanced Practice Nurse, etc.

1,061 5%

Other 1,200 5%

Note: Percentages may not add to exactly 100 percent due to rounding; n = 22,963.

Medical Office Survey on Patient Safety Culture 15

Staff Training

Overall Perceptions of Patient Safety and Quality

Organizational Learning

Patient Care Tracking/Follow-up

Teamwork

0% 20% 40% 60% 80% 100%

73%

76%

77%

82%

84%

% Positive Response

Medical Office SOPS Composites

Medical Office Survey on Patient Safety Culture 16

Work Pressure and Pace

Office Processes and Standardization

Communication Openness

Communication About Error

Owner Managing Partner/Leadership Support for Patient Safety

0% 20% 40% 60% 80% 100%

46%

64%

64%

66%

67%

% Positive Response

Medical Office SOPS Composites

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%)

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%)

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

Medical Office Survey on Patient Safety Culture 20

Patient Safety and Quality Issues

Not in the past 12 months

Once or twice in the past

12 months

Several times in the past

12 months

Monthly Weekly Daily0%

20%

40%

60%

80%

100%

52%

37%

7%2% 1% 0%P

erce

nt o

f Res

pond

ents

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

96% Positive

Medical Office Survey on Patient Safety Culture 21

Not in the past 12 months

Once or twice in the past

12 months

Several times in the past

12 months

Monthly Weekly Daily0%

20%

40%

60%

80%

100%

60%

24%

8%4% 3% 1%P

erce

nt o

f Res

pond

ents

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

Medical Office Survey on Patient Safety Culture 22

Not in the past 12 months

Once or twice in the past

12 months

Several times in the past

12 months

Monthly Weekly Daily0%

20%

40%

60%

80%

100%

47%

21%

9% 6% 8% 7%

Per

cent

of R

espo

nden

ts

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

77% Positive

Patient Safety and Quality Issues

Medical Office Survey on Patient Safety Culture 23

Not in the past 12 months

Once or twice in the past

12 months

Several times in the past

12 months

Monthly Weekly Daily0%

20%

40%

60%

80%

100%

20%

29%24%

13% 11%3%P

erce

nt o

f Res

pond

ents

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

73% Positive

Patient Safety and Quality Issues

Medical Office Survey on Patient Safety Culture 24

Not in the past 12 months

Once or twice in the past

12 months

Several times in the past

12 months

Monthly Weekly Daily0%

20%

40%

60%

80%

100%

7%

20%24%

14%22%

12%

Per

cent

of R

espo

nden

ts

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

51% Positive

Patient Safety and Quality Issues

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?

Medical Office Survey on Patient Safety Culture 26

Most Positive - Hospitals

No prob-lems in the past

12 months

Problems once or twice in the past

12 months

Problems several times in the past

12 months

Problems monthly

Problems weekly

Problems daily

0%

20%

40%

60%

80%

100%

34%30%

17%10%

6%2%

Per

cent

of R

espo

nden

ts

81% Positive

Medical Office Survey on Patient Safety Culture 27

Least Positive - Pharmacies

No prob-lems in the past

12 months

Problems once or twice in the past

12 months

Problems several times in the past

12 months

Problems monthly

Problems weekly

Problems daily

0%

20%

40%

60%

80%

100%

32%26%

17%10% 10%

5%

Per

cent

of R

espo

nden

ts

75% Positive

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)

Medical Office Survey on Patient Safety Culture 29

Overall Rating on Patient Safety

Excellent Very good Good Fair Poor0%

20%

40%

60%

80%

100%

22%

43%

27%

7%1%

Per

cent

of R

espo

nden

ts 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?

Medical Office Survey on Patient Safety Culture 30

Average Overall Rating on Quality and Patient Safety

Excellent Very good Good Fair Poor0%

20%

40%

60%

80%

100%

28%

37%

26%

7%2%

Per

cent

of R

espo

nden

ts 65% Positive

The average of the five overall ratings on quality and the overall rating on patient safety across all 2012 database medical offices

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).

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%)

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%)

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

Medical Office Survey on Patient Safety Culture 35

Thank you

Questions?

TheresaFamolaro@westat.com