Health topic

2010 P re lim in a ry Co m p a ra tive Re s u lts : Me d ic a l Offic e S u rve y o n P a tie n t S a fe ty Cu ltu re Prepared for: U.S. Department of Health and Human Services Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850 http://www.ahrq.gov

Contract No. HHSA 290200710037 Managed and prepared by: Westat, Rockville, MD

AHRQ Publication No. 11-0015-EF November 2010

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

ii

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without specific permission of copyright holders.

Suggested Citation:

2010 Preliminary Comparative Results: Medical Office Survey on Patient Safety Culture. (Prepared by Westat, Rockville, MD, under Contract No. HHSA 290200710037). Rockville, MD: Agency for Healthcare Research and Quality; November 2010. AHRQ Publication No. 11- 0015-EF.

No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.

iii

Contents Purpose and Use of This Document 1 Report Overview 1 Survey Development 1 Survey Administration 2 Description of the 470 Medical Offices 3 Description of Medical Office Respondents 6 Composite-Level and Item-Level Comparative Results 7

Calculating Item Percent Positive Scores 7 Calculating Composite Percent Positive Scores 8

Comparative Results Using Percentiles 18 Composite-Level and Item-Level Results by Staff Position 25

Tables Table 1. Overall and Average Response Statistics for 470 Medical Offices 3 Table 2. Distribution of Medical Offices by Number of Providers and Staff 3 Table 3. Distribution of Medical Offices by Type of Specialty 4 Table 4. Number of Medical Offices by Specialty 4 Table 5. Distribution of Medical Offices by Number of Locations 5 Table 6. Distribution of Medical Offices by Majority Ownership 5 Table 7. Implementation Status of Electronic Tools 5 Table 8. Number of Patient Visits and Providers at the Medical Office 6 Table 9. Distribution of Respondents by Staff Category 6 Table 10. Distribution of Respondents by Tenure 7 Table 11. Distribution of Respondents by Hours Worked per Week 7 Table 12. Example of How To Calculate Item and Composite Percent Positive Scores 8 Table 13. Interpretation of Percentile Scores 18 Table 14. Sample Percentile Statistics 19 Table 15. Composite-Level Minimum, Maximum, and Percentile Results 19 Table 16. Item-Level Minimum, Maximum, and Percentile Results 20 Table 17. Overall Rating on Quality Minimum, Maximum, and Percentile Results 24 Table 18. Overall Rating on Patient Safety Minimum, Maximum, and Percentile Results 25 Table 19. Composite-Level Results by Staff Position 25 Table 20. Item-Level Results by Staff Position 26 Table 21. Overall Rating on Quality Results by Staff Position 30 Table 22. Overall Rating on Patient Safety Results by Staff Position 31

Charts Chart 1. Composite-Level Comparative Results From 470 Medical Offices 10 Chart 2. Item-Level Comparative Results From 470 Medical Offices 11 Chart 3. Comparative Results for Overall Ratings on Quality From 470 Medical Offices 17 Chart 4. Comparative Results for Overall Rating on Patient Safety From 470 Medical Offices 18

1

Purpose and Use of This Document Comparative results are provided for the items and patient safety culture dimensions on the AHRQ Medical Office Survey on Patient Safety Culture to allow medical offices to compare their survey results against the results from 470 medical offices. This number includes 292 Practice Based Research Network (PBRN) medical offices that administered the survey in 2009 and 182 medical offices that participated in a pilot test of the survey in the United States in late 2007.

The results presented here are from limited numbers of staff and medical offices and will provide only a general indication of how your medical office compares with other medical offices in the United States. The data summarized here were not derived from a statistically selected sample of U.S. medical offices.

At this time, there is no central repository for medical offices to submit data for comparative purposes. However, similar to the AHRQ Hospital Survey on Patient Safety Culture Comparative Database (www.ahrq.gov/qual/patientsafetyculture), AHRQ plans to support a U.S. comparative database for the medical office survey that will provide more extensive comparative data. More details will be forthcoming from AHRQ about when data submission will begin and when updated comparative results will be available.

Report Overview • Comparative results are provided for the survey items and patient safety culture

dimensions based on data from 10,567 staff from 470 medical offices. • The data were obtained from two survey administrations: 6,463 staff from 292 PBRN

medical offices surveyed in 2009 and 4,174 staff from 182 pilot test medical offices surveyed in late 2007.

• Basic descriptive data are provided about the respondents and medical offices. • A description of how composite scores on the Medical Office Survey on Patient Safety

Culture were calculated is also provided.

Survey Development The Medical Office Survey on Patient Safety Culture is an expansion of the Agency for Healthcare Research and Quality’s (AHRQ) Hospital Survey on Patient Safety Culture, which was pilot tested and made available to the public in November 2004 (http://www.ahrq.gov/qual/patientsafetyculture/hospsurvindex.htm). The Medical Office Survey on Patient Safety Culture was specifically designed to measure the culture of patient safety in medical offices from the perspectives of providers and staff.

Safety culture can be defined as the set of values, beliefs, and norms about what is important, how to behave, and what attitudes are appropriate when it comes to patient safety in a workgroup or organization. The Medical Office Survey on Patient Safety Culture is intended to help a medical office assess the extent to which its organization’s culture emphasizes the importance of patient safety, facilitates teamwork and open discussion about mistakes, and creates an atmosphere of continuous learning and improvement.

2

The survey design team reviewed the literature on patient safety problems and issues in medical offices, interviewed more than two dozen experts and researchers on patient safety in medical offices, asked many medical office providers and staff to identify appropriate survey topics, and drafted sets of survey dimensions and items for review by experts. The draft survey was pretested with medical office providers and staff to ensure that the questions were easy to understand and answer and that the items were relevant. The pilot test survey was then administered in 2007 in a total of 182 medical offices, the data were analyzed to examine the survey’s psychometric properties (reliability and factor structure), and the length was shortened by dropping items.

The final survey includes 52 survey items that measure the following 12 areas of organizational culture pertaining to patient safety:

1. Communication About Error 2. Communication Openness 3. Information Exchange With Other Settings 4. Office Processes and Standardization 5. Organizational Learning 6. Overall Perceptions of Patient Safety and Quality 7. Owner/Managing Partner/Leadership Support for Patient Safety 8. Patient Care Tracking/Followup 9. Patient Safety and Quality Issues 10. Staff Training 11. Teamwork 12. Work Pressure and Pace

The survey uses 6-point frequency scales (“Daily” to “Not in the past 12 months”), 5-point frequency scales (“Never” to “Always”), or 5-point scales of agreement (“Strongly disagree” to “Strongly agree”). Most items include a “Does not apply or Don’t know” option.

The survey also includes overall ratings questions that ask respondents to rate their medical office in five areas of health care quality (patient centered, effective, timely, efficient, equitable) and to provide an overall rating on patient safety.

Survey Administration In 2007, a pilot administration was conducted with 182 medical offices and 4,174 staff across 21 States. The pilot survey was designed to contain a diverse sample of medical offices, although participation was voluntary and therefore may not statistically represent all medical offices in the United States. In 2009, 11 PBRNs collected data from 292 medical offices and 6,463 staff across 17 States.

The data from the 182 pilot test medical offices were combined with the data from the 292 PBRN medical offices, yielding a total of 474 medical offices. Four medical offices were dropped because they had participated in both data collections, resulting in a final combined dataset of 470 medical offices.

3

Description of the 470 Medical Offices Completed responses from the 470 medical offices came from 33 States. However, the medical offices that voluntarily participated in these data collection efforts may not be representative of all medical offices in the United States. Overall response results for the participating medical offices are summarized in Table 1.

In all tables, column percent totals may not add to exactly 100 percent because of rounding.

Table 1. Overall and Average Response Statistics for 470 Medical Offices Overall Response Rate Information Statistic

Number of respondents 10,567 Number of surveys administered 14,558 Overall response rate 73%

Average Response Rate Information Statistic Average number of respondents per medical office (range: 5 to 192) 22 Average number of surveys administered per medical office (range: 5 to 376) 31 Overall average medical office response rate (range: 21% to 100%) 78%

Medical office characteristics were obtained from a designated point of contact in each medical office. Tables 2 through 4 show the distribution of medical offices by total number of providers and staff, type of specialty, and number of medical offices by specialty.

The vast majority of medical offices (77%) had 40 or fewer providers and staff.

Table 2. Distribution of Medical Offices by Number of Providers and Staff

Total Number of Providers and Staff All Medical Offices

Number Percent 5–10 84 18% 11–20 140 30% 21–30 90 19% 31–40 47 10% 41–50 40 9% 51–60 22 5% 61–70 11 2% More than 70 36 8% Total 470 100%

4

As shown in Table 3, more than half of medical offices (56%) were single specialty.

Table 3. Distribution of Medical Offices by Type of Specialty

Type of Specialty All Medical Offices

Number Percent Single specialty 263 56% Multispecialty with primary care only (e.g., family medicine, internal medicine, pediatrics, OB/GYN, general practice)

114 24%

Multispecialty with primary care and specialty care 81 17% Multispecialty with specialty care only 11 2% Total 469 100% Missing 1 0

The 470 medical offices represent a wide range of specialties, with most categorized as family practice/family medicine (291 offices)(Table 4).

Table 4. Number of Medical Offices by Specialty

Specialty Number of

Medical Offices Specialty Number of

Medical Offices Allergy/immunology 15 Neurology 11 Anesthesiology 2 Nuclear medicine 2 Cardiology 22 OB/GYN or GYN 63 Child and adolescent psychiatry 6 Ophthalmology 15 Dermatology 11 Orthopedics 23 Diagnostic radiology 8 Otolaryngology 12 Emergency medicine 7 Pathology –

anatomic/clinical 1

Endocrinology/metabolism 22 Pediatrics 95 Family practice/family medicine 291 Physical medicine and

rehabilitation 9

Forensic pathology 1 Psychiatry 26 Gastroenterology 11 Public health and

rehabilitation 2

General practice 16 Pulmonary medicine 9 General preventive medicine 7 Radiology 6 General surgery 21 Rheumatology 11 Geriatrics 14 Surgery (all) 11 Hematology/oncology 12 Urology 12 Internal medicine 102 Vascular medicine 3 Medical genetics 2 Other specialty 47 Nephrology 9

Note: The total number of medical offices will not necessarily sum to 470 as some medical offices may categorize themselves as more than one type of specialty.

5

Table 5 shows the distribution of medical offices by number of locations. Approximately two- thirds of medical offices (67%) had a single location, while the rest (33%) had multiple locations. Medical offices with more than one location had an average of 9 locations (ranging from 2 to 40 locations). Of the 152 medical offices with multiple locations, 48 indicated they were the primary/parent location and 104 indicated they were a satellite location.

Table 5. Distribution of Medical Offices by Number of Locations

Number of Locations

All Medical Offices

Number Percent One location 310 67% Multiple locations 152 33% Total 462 100% Missing 8

Table 6 shows that almost half of medical offices (47%) were owned by a hospital or health system.

Table 6. Distribution of Medical Offices by Majority Ownership

Majority Ownership All Medical Offices

Number Percent Providers and/or Physicians 134 29% Managed care or health maintenance organization 3 1% University or medical school or academic medical institution 75 16% Hospital or health system 220 47% Federal, State, or local government, community board, etc. 23 5% Other 10 2% Total 465 100% Missing 5

Table 7 presents the implementation status of five common electronic tools in the medical offices. The vast majority of medical offices (82%) had fully implemented electronic appointment scheduling, while only 37% of medical offices had fully implemented electronic ordering of tests, imaging, or procedures.

Table 7. Implementation Status of Electronic Tools

Electronic Tools

Implementation Status Fully

Implemented In Progress Not

Implemented Electronic appointment scheduling 82% 13% 5% Electronic ordering of medications 41% 30% 29% Electronic ordering of tests, imaging, or procedures 37% 26% 37% Electronic access to your patients’ test or imaging results 59% 29% 12% Electronic medical/health records (EMR/EHR) 51% 21% 28%

6

Table 8 presents the average number of patient visits per week per provider across all medical offices.i

Table 8. Number of Patient Visits and Providers at the Medical Office

On average, the total number of patient visits per total number of providers was 69 (ranging from 1 to 450).

Number of Patient Visits and Providers at the Medical Office

Medical Office Statistics

Average Minimum Maximum Total number of patient visits/total number of providers 69 1 450

Description of Medical Office Respondents Tables 9 through 11 display distributions of the 10,567 medical office respondents by:

• Staff category, • Tenure in the medical office, and • Hours worked per week in the medical office.

According to the data on respondent characteristics shown in these tables:

• Twenty-eight percent of respondents were administrative or clerical staff, 21% were other clinical staff or clinical support staff, and 19% were physicians.

• About 60% of respondents had worked in their medical office for at least 3 years. • About 78% of respondents worked in their medical office at least 33 hours per week.

Table 9. Distribution of Respondents by Staff Category

Staff Category

All Medical Offices

Number Percent Administrative or clerical staff 2,860 28% Other clinical staff or clinical support staff 2,155 21% Physician (M.D. or D.O.) 1,941 19% Nurse (RN), licensed vocational nurse (LVN), licensed practical nurse (LPN) 1,564 15% Management 749 7% Physician assistant, nurse practitioner, clinical nurse specialist, nurse midwife, advanced practice nurse, etc.

486 5%

Other position 435 4% TOTAL 10,190 100% Missing 377 Overall total 10,567

i The PBRN medical offices were asked to report two pieces of information: total number of patient visits in a typical week and total number of providers working in the medical office in a typical week. The pilot test medical offices were simply asked to report the average number of patient visits per week across all providers.

7

Table 10. Distribution of Respondents by Tenure

Tenure in Medical Office All Medical Offices

Number Percent Less than 2 months 282 3% 2 months to less than 1 year 1,268 12% 1 year to less than 3 years 2,461 24% 3 years to less than 6 years 2,085 20% 6 years to less than 11 years 2,082 20% 11 years or more 2,108 20% Total 10,286 100% Missing 281 Overall total 10,567

Table 11. Distribution of Respondents by Hours Worked per Week

Hours Worked per Week in the Medical Office All Medical Offices

Number Percent 1 to 4 hours 118 1% 5 to 16 hours 492 5% 17 to 24 hours 706 7% 25 to 32 hours 996 10% 33 to 40 hours 5,245 51% 41 hours or more 2,735 27% Total 10,292 100% Missing 275 Overall total 10,567

Composite-Level and Item-Level Comparative Results You can obtain a summary view of how your medical office compares to other medical offices by examining the composite-level and item-level percent positive scores displayed in Charts 1 through 4.

Calculating Item Percent Positive Scores To compare your medical office results to the comparative results from the Medical Office Survey on Patient Safety Culture, it is helpful to understand how the medical office percent positive scores are calculated.

For positively worded items, percent positive is the total percentage of respondents who answered positively. This total is the combined percentage of “Strongly agree” and “Agree” responses or “Always” and “Most of the time” responses, depending on the response categories used for the item.

For Section B (Information Exchange With Other Settings), percent positive is based on the combined percentage of “Problems once or twice in the past 12 months” and “No problems in the past 12 months.”

8

For negatively worded items, percent positive is the total percentage of respondents who answered negatively. This total is the combined percentage of “Strongly disagree” and ”Disagree” responses or “Never” and “Rarely” responses, since a negative answer on these items indicates a positive response.

For Section A (List of Patient Safety and Quality Issues), all items are negatively worded, so the combined percentage of “Once or twice in the past 12 months” and “Not in the past 12 months” represents positive responses.

Calculating Composite Percent Positive Scores A composite score summarizes how respondents answered groups of items that all measure the same thing. Composite scores on the 12 patient safety culture survey dimensions tell you the average percentage of respondents who answered positively when looking at the survey items that measure each safety culture dimension. Composite scores allow a summary comparison because you compare against only 12 safety culture dimensions rather than 52 separate survey items.

To calculate each medical office’s composite score on a particular safety culture dimension, calculate the average percent positive response of the items included in the composite. Table 12 shows an example of computing a composite score for Office Processes and Standardization. The composite has four items. Two are positively worded (items C9 and C15) and two are negatively worded (items C8 and C12). Keep in mind that DISAGREEING with a negatively worded item indicates a POSITIVE response.

Table 12. Example of How To Calculate Item and Composite Percent Positive Scores

Office Processes and Standardization

For positively worded items, the

# of “Strongly agree” or “Agree”

responses

For negatively worded items, the #

of “Strongly disagree” or “Disagree”

responses

Total # of responses to the item*

Percent positive

response on item

Item C9-positively worded: “We have good procedures for checking that work in this office was done correctly”

24 NA* 52 24/52=46%

Item C15-positively worded: “Staff in this office follow standardized processes to get tasks done”

26 NA* 50 26/50=52%

Item C8-negatively worded: “This office is more disorganized than it should be”

NA* 22 48 22/48=46%

Item C12-negatively worded: “We have problems with workflow in this office”

NA* 28 50 28/50= 56%

Average percent positive response across the 4 items = 50%

* Excluding not applicable/don’t know and missing responses

9

In this example, there were four items, with percent positive response scores of 46, 52, 46, and 56. Averaging these item-level percent positive scores ([46 + 52 + 46 + 56]/4 = 50) results in a composite score of .50 or 50% on Office Processes and Standardization. That is, an average of 50% of the respondents responded positively to the survey items in this composite.

The charts on the following pages display the composite-level and item-level comparative results from the 470 medical offices. Chart 1 shows the average percent positive response for each of the survey’s patient safety culture composites, in order from most positive to least positive. Chart 2 provides the average percent positive response for the survey items. Chart 3 shows the average distribution of responses for the Overall Ratings on Quality, and Chart 4 shows the average distribution of responses for the Overall Rating on Patient Safety.

Use a difference of 5 percentage points as a rule when comparing medical office results to the results shown. Medical office percentages should be at least 5 points higher than the comparative results to be considered “better” (e.g., 75% vs. 70%) and should be at least 5 points lower to be considered “lower” than the comparative results (e.g., 60% vs. 65%). A 5 percentage point difference is likely to be statistically significant for most medical offices given the number of responses per medical office and is also a meaningful difference to consider.

This information provides only relative comparisons. Although your medical office’s results may be better than the comparative results, you may still believe there is room for improvement in an absolute sense.

10

Chart 1. Composite-Level Comparative Results From 470 Medical Offices

Patient Safety Culture Composites % Positive Response

82%

77%

74%

74%

72%

67%

67%

65%

60%

59%

54%

46%

1. Teamwork

2. Patient Care Tracking/Followup

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. Patient Safety and Quality Issues

10. Office Processes and Standardization

11. Information Exchange With Other Settings

12. Work Pressure and Pace

0 20 40 60 80 100

1

11

Chart 2. Item-Level Comparative Results from 470 Medical Offices Item Survey Items By Patient Safety Culture

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.

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 2. This office documents how well our chronic- care 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 4. This office follows up with patients who need monitoring.

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

Average % Positive Response

80%

87%

83%

80%

77%

78%

65%

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

86%

82%

75%

67%

Note: The item’s survey location is shown to the left.

12

Chart 2. Item-Level Comparative Results from 470 Medical Offices, continued Item Survey Items By Patient Safety Culture

4. Overall Perceptions of Patient Safety and Quality

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.

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

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.

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

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.

E2R 2. They overlook patient care mistakes that happen over and over.

E3 3. They place a high priority on improving patient care processes.

E4R 4. They make decisions too often based on what is best for the office rather than what is best for patients.

Average % Positive Response

78%

79%

69%

71%

75%

51%

61%

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

70%

74%

79%

73%

Note: The item’s survey location is shown to the left. An “R” indicates a negatively worded item, where the percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never” or “Rarely” (depending on the response category used for the item).

13

Chart 2. Item-Level Comparative Results from 470 Medical Offices, continued Item Survey Items By Patient Safety Culture

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.

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.

Average % Positive Response

57%

59%

78%

72%

69%

68%

70%

53%

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

Note: The item’s survey location is shown to the left. An “R” indicates a negatively worded item, where the percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never” or “Rarely” (depending on the response category used for the item).

14

Chart 2. Item-Level Comparative Results from 470 Medical Offices, continued Item Survey Items By Patient Safety Culture

9. Patient Safety and Quality Issues

In your best estimate, how often did the following things happen in your medical office over the past 12 months?

Access to Care

A1 1. A patient was unable to get an appointment within 48 hours for an acute/serious problem.

Patient Identification

A2 2. The wrong chart/medical record was used for a patient.

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.

Medical Equipment

A5 5. Medical equipment was not working properly or was in need of repair or replacement.

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.

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.

Average % Positive Response

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

22%

73%

69%

86%

63%

39%

79%

44%

70%

Note: The percent positive response is based on those who answered “Not in the past 12 months” or “Once or twice in the past 12 months.”

15

Chart 2. Item-Level Comparative Results from 470 Medical Offices, continued Item Survey Items By Patient Safety Culture Area

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.

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

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

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)

Average % Positive Response

55%

50%

52%

58%

70%

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

60%

47%

58%

74%

Note: The item’s survey location is shown to the left. An “R” indicates a negatively worded item, where the percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never” or “Rarely” (depending on the response category used for the item). The percent positive response for items B1 through B5 is based on those who answered “Not in the past 12 months” or “Once or twice in the past 12 months.”

16

Chart 2. Item-Level Comparative Results from 470 Medical Offices, continued Item Survey Items By Patient Safety Culture

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.

Average % Positive Response

28%

46%

49%

59%

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

Note: The item’s survey location is shown to the left. An “R” indicates a negatively worded item, where the percent positive response is based on those who responded “Strongly disagree” or “Disagree,” or “Never” or “Rarely” (depending on the response category used for the item).

17

Chart 3. Comparative Results for Overall Ratings on Quality From 470 Medical Offices

Note: Some percentages add to more than 100 due to rounding.

Item Survey Items By Patient Safety Culture Area

G1a. Patient Centered

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

G1b. Effective

Is based on scientific knowledge.

G1c. Timely

Minimizes waits and potentially harmful delays.

G1d. Efficient

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

G1e. Equitable

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

Overall, how would you rate your medical office on each of the following areas of health care quality?

25% 42%

27% 5% 1%

0% 20% 40% 60% 80%

100%

Excellent Very Good

Good Fair Poor

25% 46%

25% 4% 0%

0%

20%

40%

60%

80%

100%

Excellent Very Good

Good Fair Poor

15%

35% 32% 15%

4% 0%

20%

40%

60%

80%

100%

Excellent Very Good Good Fair Poor

16%

39% 33%

10% 2%

0%

20%

40%

60%

80%

100%

Excellent Very Good Good Fair Poor

52%

31% 14%

3% 1% 0%

20%

40%

60%

80%

100%

Excellent Very Good Good Fair Poor

18

Chart 4. Comparative Results for Overall Rating on Patient Safety From 470 Medical Offices

Comparative Results Using Percentiles In addition to comparing percent positive scores from your medical office with the average percent positive scores from other medical offices, you may find it useful to examine additional comparative statistics: minimum and maximum scores and percentiles.

The minimum and maximum percent positive scores are presented for each composite. These scores provide information about the range of percent positive scores from the pilot test medical offices and are actual scores from the lowest and highest scoring offices. When comparing against the minimum and maximum scores, keep in mind that these scores may represent offices that are extreme outliers.

The 25th, 50th, and 75th percentile scores are displayed for the survey composites. Percentiles provide information about the distribution of the medical office scores. To calculate percentile scores, percent positive scores from the 470 medical offices were rank ordered from low to high. A specific percentile score shows the percentage of medical offices that scored at or below a particular score. For example, the 75th percentile is the percent positive score where 75 percent of the medical offices scored the same or lower, and 25 percent of the medical offices scored higher. Interpret the percentile scores as shown in Table 13.

Table 13. Interpretation of Percentile Scores Percentile Score Interpretation

25th percentile Lower scoring medical offices

25% of the medical offices scored the same or lower 75% of the medical offices scored higher

50th percentile Middle-scoring medical offices

50% of the medical offices scored the same or lower 50% of the medical offices scored higher

75th percentile Higher scoring medical offices

75% of the medical offices scored the same or lower 25% of the medical offices scored higher

20

44

27

8 1

0

20

40

60

80

100

Excellent Very Good Good Fair Poor

P er

ce nt

19

For example, for a survey composite in Table 14, the 25th percentile score is 49 percent positive, and the 50th percentile score is 62 percent positive. If your medical office’s score on the composite is 55 percent positive, it falls above the 25th percentile but below the 50th percentile, meaning that your medical office scored higher than at least 25 percent of the other medical offices. If your medical office’s score on the composite is 65 percent positive, it falls above the 50th percentile, meaning your medical office scored higher than at least 50 percent of the other medical offices.

Table 14. Sample Percentile Statistics

Survey Composite

Composite Percent Positive Response

Minimum 25th

Percentile 50th Percentile 75th

Percentile Maximum Composite 1 8% 49% 62% 85% 96%

If your medical office’s score is 55%, your score falls here.

If your medical office’s score is 65%, your score falls here.

For each patient safety culture composite, Table 15 shows the average percent positive scores, minimum score, 25th percentile, 50th percentile, 75th percentile, and maximum score for the 470 medical offices.

Table 15. Composite-Level Minimum, Maximum, and Percentile Results

Patient Safety Culture Composites

Average %

Positive

% Positive Response

Min 25th %ile

Median/ 50th %ile

75th %ile Max

1 Teamwork 82% 25% 75% 84% 92% 100% 2 Patient Care Tracking/Followup 77% 31% 69% 78% 86% 100% 3 Organizational Learning 74% 23% 67% 75% 84% 100% 4 Overall Perceptions of Patient

Safety and Quality 74% 18% 65% 75% 85% 100%

5 Staff Training 72% 15% 61% 73% 83% 100% 6 Owner/Managing

Partner/Leadership Support for Patient Safety

67% 15% 56% 68% 79% 100%

7 Communication About Error 67% 17% 57% 67% 75% 100% 8 Communication Openness 65% 21% 54% 64% 77% 100% 9 Patient Safety and Quality Issues 60% 22% 52% 61% 69% 95% 10 Office Processes and

Standardization 59% 13% 47% 60% 71% 100%

11 Information Exchange With Other Settings

54% 8% 42% 54% 66% 100%

12 Work Pressure and Pace 46% 0% 31% 46% 60% 95%

20

Table 16 shows the average percent positive scores, minimum score, 25th percentile, 50th percentile, 75th percentile, and maximum score for the 470 medical offices on each survey item sorted by patient safety culture composite.

Tables 17 and 18 show the average percent positive scores, minimum score, 25th percentile, 50th percentile, 75th percentile, and maximum score for the overall ratings on quality and overall ratings on patient safety, respectively.

Table 16. Item-Level Minimum, Maximum, and Percentile Results

Survey Items by Composite

Average %

Positive

% Positive Response

Min 25th %ile

Median/ 50th %ile

75th %ile Max

1. Teamwork C1 1. When someone in this office gets

really busy, others help out. 83% 25% 75% 85% 92% 100%

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

87% 20% 80% 90% 100% 100%

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

80% 0% 70% 82% 93% 100%

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

80% 17% 71% 82% 90% 100%

2. Patient Care Tracking/Followup D3 1. This office reminds patients when

they need to schedule an appointment for preventive or routine care.

78% 18% 67% 80% 91% 100%

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

65% 17% 50% 67% 80% 100%

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

77% 18% 67% 80% 89% 100%

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

86% 40% 79% 88% 100% 100%

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.

82% 20% 73% 82% 93% 100%

F5 2. This office is good at changing office processes to make sure the same problems don’t happen again.

75% 8% 64% 75% 86% 100%

F7 3. After this office makes changes to improve the patient care process, we check to see if the changes worked.

67% 11% 57% 68% 80% 100%

21

Table 16. Item-Level Minimum, Maximum, and Percentile Results, continued

Survey Items by Composite Average

% Positive

% Positive Response

Min 25th %ile

Median/ 50th %ile

75th %ile Max

4. Overall Perceptions of Patient Safety and Quality F2 1. Our office processes are good at

preventing mistakes that could affect patients.

79% 11% 69% 81% 90% 100%

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

70% 11% 60% 71% 83% 100%

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

74% 11% 64% 76% 88% 100%

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

73% 17% 60% 75% 87% 100%

5. Staff Training C4 1. This office trains staff when new

processes are put into place. 75% 13% 64% 78% 88% 100%

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

71% 17% 60% 72% 85% 100%

C10 R

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

69% 14% 57% 70% 80% 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.

51% 0% 33% 50% 67% 100%

E2R 2. They overlook patient care mistakes that happen over and over.

79% 0% 71% 80% 92% 100%

E3 3. They place a high priority on improving patient care processes.

78% 0% 70% 80% 90% 100%

E4R 4. They make decisions too often based on what is best for the office rather than what is best for patients.

61% 0% 47% 60% 75% 100%

7. Communication About Error

D7 R

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

57% 0% 41% 57% 71% 100%

D8 2. Providers and staff talk openly about office problems.

59% 0% 46% 57% 71% 100%

D11 3. In this office, we discuss ways to prevent errors from happening again.

78% 17% 69% 80% 89% 100%

D12 4. Staff are willing to report mistakes they observe in this office.

72% 17% 63% 72% 82% 100%

22

Table 16. Item-Level Minimum, Maximum, and Percentile Results, continued

Survey Items by Composite

Average %

Positive

% Positive Response

Min 25th %ile

Median/ 50th %ile

75th %ile Max

8. Communication Openness D1 1. Providers in this office are open to

staff ideas about how to improve office processes.

69% 13% 57% 70% 82% 100%

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

68% 0% 55% 68% 80% 100%

D4 R

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

70% 20% 59% 71% 83% 100%

D10 R

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

53% 0% 40% 50% 67% 100%

9. Patient Safety and Quality Issues Access to Care A1 1. A patient was unable to get an

appointment within 48 hours for an acute/serious problem.

69% 0% 53% 75% 88% 100%

Patient Identification A2 2. The wrong chart/medical record

was used for a patient. 86% 14% 78% 89% 100% 100%

Charts/Medical Records A3 3. A patient's chart/medical record

was not available when needed. 63% 0% 43% 70% 87% 100%

A4 4. Medical information was filed, scanned, or entered into the wrong patient's chart/medical record.

70% 10% 55% 71% 86% 100%

Medical Equipment A5 5. Medical equipment was not

working properly or was in need of repair or replacement.

73% 14% 60% 73% 88% 100%

Medication A6 6. A pharmacy contacted our office

to clarify or correct a prescription. 22% 0% 9% 18% 30% 100%

A7 7. A patient's medication list was not updated during his or her visit.

44% 0% 27% 43% 60% 100%

Diagnostics and Tests A8 8. The results from a lab or imaging

test were not available when needed.

39% 0% 25% 38% 51% 100%

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

79% 17% 67% 82% 96% 100%

Note: For the A items (Patient Safety and Quality Issues), the percent positive response is based on those who answered “Not in the past 12 months” or “Once or twice in the past 12 months.”

23

Table 16. Item-level Minimum, Maximum and Percentile Results, continued

Survey Items by Composite Average

% Positive

% Positive Response

Min 25th %ile

Median/ 50th %ile

75th %ile Max

10. Office Processes and Standardization C8 R

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

58% 0% 43% 59% 72% 100%

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

60% 0% 45% 60% 72% 100%

C12 R

3. We have problems with workflow in this office.

47% 0% 31% 44% 62% 100%

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

74% 20% 63% 75% 86% 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? 55% 0% 40% 56% 67% 100% B2 2. Other medical offices/outside

physicians? 50% 0% 38% 50% 63% 100%

B3 3. Pharmacies? 52% 0% 39% 50% 69% 100% B4 4. Hospitals? 58% 0% 45% 59% 72% 100% B5 5. Other? (Specify) 70% 0% 50% 67% 100% 100% 12. Work Pressure and Pace C3 R

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

28% 0% 15% 25% 40% 100%

C6 R

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

46% 0% 25% 44% 67% 100%

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

49% 0% 29% 47% 67% 100%

C14 R

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

59% 0% 43% 59% 78% 100%

24

Table 17. Overall Rating on Quality Minimum, Maximum, and Percentile Results

Survey Items by Composite Average %

% Positive Response

Min 25th %ile

Median/ 50th %ile

75th %ile Max

G1a. Patient Centered Is responsive to individual patient preferences, needs, and values. Excellent 25% 0% 13% 22% 33% 100% Very Good 42% 0% 33% 42% 50% 89% Good 27% 0% 17% 27% 38% 71% Fair 5% 0% 0% 2% 8% 38% Poor 1% 0% 0% 0% 0% 13% G1b. Effective Is based on scientific knowledge. Excellent 25% 0% 13% 22% 33% 100% Very Good 46% 0% 36% 45% 55% 100% Good 25% 0% 14% 25% 35% 86% Fair 4% 0% 0% 0% 6% 29% Poor 0% 0% 0% 0% 0% 29% G1c. Timely Minimizes waits and potentially harmful delays. Excellent 15% 0% 5% 11% 20% 86% Very Good 35% 0% 22% 33% 44% 83% Good 32% 0% 22% 33% 41% 75% Fair 15% 0% 5% 13% 22% 75% Poor 4% 0% 0% 0% 6% 80% G1d. Efficient Ensures cost-effective care (avoids waste, overuse, and misuse of services). Excellent 16% 0% 6% 14% 22% 100% Very Good 39% 0% 27% 38% 50% 100% Good 33% 0% 23% 33% 43% 83% Fair 10% 0% 0% 9% 15% 38% Poor 2% 0% 0% 0% 3% 32% G1e. Equitable Provides the same quality of care to all individuals regardless of gender, race, ethnicity, socioeconomic status, language, etc. Excellent 52% 0% 39% 50% 63% 100% Very Good 31% 0% 21% 31% 40% 80% Good 14% 0% 5% 13% 20% 50% Fair 3% 0% 0% 0% 6% 33% Poor 1% 0% 0% 0% 0% 20%

25

Table 18. Overall Rating on Patient Safety Minimum, Maximum, and Percentile Results

G2a. Overall Rating on Patient Safety Average %

% Positive Response

Min 25th %ile

Median/ 50th %ile

75th %ile Max

Excellent 20% 0% 10% 17% 27% 80% Very Good 44% 0% 33% 43% 54% 88% Good 27% 0% 18% 27% 37% 88% Fair 8% 0% 0% 6% 13% 47% Poor 1% 0% 0% 0% 0% 40%

Composite-Level and Item-Level Results by Staff Position Tables 19 through 22 show the average percent positive scores for the survey composites and items across medical offices, broken down by staff position. These tables allow comparison of the survey results of various staff positions in the medical office. In the following four tables, the precise number of medical offices and respondents corresponding to each data cell varies, due to omission of survey items by some medical offices, individual nonresponse, and missing data.

Table 19. Composite-Level Results by Staff Position

Patient Safety Culture Composites

Staff Position

Physician (M.D. or

D.O.)

PA, NP, CNS, N, Midwife,

APN Mgmt

Admin or

Clerical Staff

RN/ LVN/ LPN

Other Clinical Staff or Clinical Support

Staff # Medical Offices 127 12 24 222 125 157 # Respondents 1,251 61 159 2,265 1,132 1,557 1. Teamwork 87% 82% 87% 75% 79% 78% 2. Patient Care Tracking/Followup 62% 78% 72% 80% 74% 80% 3. Organizational Learning 75% 54% 85% 70% 69% 72% 4. Overall Perceptions of Patient

Safety and Quality 70% 57% 77% 67% 70% 70%

5. Staff Training 77% 66% 77% 63% 67% 65% 6. Owner/Managing Partner/

Leadership Support for Patient Safety

66% 61% 68% 65% 61% 64%

7. Communication About Error 71% 60% 67% 57% 62% 61% 8. Communication Openness 76% 68% 64% 53% 54% 55% 9. Patient Safety and Quality Issues 54% 55% 55% 58% 58% 60% 10. Office Processes and

Standardization 54% 49% 58% 55% 53% 57%

11. Information Exchange With Other Settings

43% 36% 36% 53% 56% 58%

12. Work Pressure and Pace 45% 38% 40% 40% 33% 41%

Note: Respondents who selected “Other” and missing are not shown; results are not calculated when a staff position has fewer than five respondents or an item in the composite has fewer than three respondents.

26

Table 20. Item-Level Results by Staff Position

Survey Items by Composite

Staff Position

Physician (M.D. or

D.O.)

PA, NP, CNS, N, Midwife,

APN Mgmt

Admin or Clerical

Staff

RN/ LVN/ LPN

Other Clinical Staff or Clinical Support

Staff # Medical Offices 127 12 24 222 125 157 # Respondents 1,251 61 159 2,265 1,132 1,557 1. Teamwork C1 1. When someone in this office

gets really busy, others help out. 86% 81% 90% 77% 79% 77%

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

91% 87% 89% 80% 87% 85%

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

92% 85% 82% 70% 76% 73%

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

80% 76% 86% 75% 75% 76%

2. Patient Care Tracking/Followup D3 1. This office reminds patients

when they need to schedule an appointment for preventive or routine care.

64% 71% 66% 81% 78% 83%

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

50% 68% 65% 75% 59% 73%

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

56% 76% 79% 81% 76% 81%

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

78% 94% 82% 85% 82% 85%

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.

88% 65% 90% 73% 78% 76%

F5 2. This office is good at changing office processes to make sure the same problems don’t happen again.

70% 52% 85% 69% 66% 73%

F7 3. After this office makes changes to improve the patient care process, we check to see if the changes worked.

66% 47% 79% 66% 64% 67%

Note: Respondents who selected “Other” and missing are not shown; R indicates a negatively worded item; and results are not calculated when a staff position has fewer than five respondents or an item has fewer than three respondents.

27

Table 20. Item-Level Results by Staff Position, continued

Survey Items by Composite

Staff Position

Physician (M.D. or

D.O.)

PA, NP, CNS, N, Midwife,

APN Mgmt

Admin or Clerical

Staff

RN/ LVN/ LPN

Other Clinical Staff or Clinical Support

Staff 4. Overall Perceptions of Patient Safety and Quality F2 1. Our office processes are good

at preventing mistakes that could affect patients.

73% 58% 78% 73% 77% 77%

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

63% 60% 74% 60% 72% 68%

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

73% 57% 74% 65% 72% 70%

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

68% 53% 82% 69% 58% 64%

5. Staff Training C4 1. This office trains staff when

new processes are put into place. 83% 66% 80% 66% 69% 70%

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

75% 63% 77% 66% 66% 65%

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

73% 68% 74% 57% 66% 62%

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.

48% 47% 45% 49% 41% 47%

E2R 2. They overlook patient care mistakes that happen over and over.

82% 83% 76% 75% 77% 73%

E3 3. They place a high priority on improving patient care processes.

78% 73% 85% 79% 75% 79%

E4R 4. They make decisions too often based on what is best for the office rather than what is best for patients.

59% 40% 63% 59% 51% 56%

7. Communication About Error D7R 1. Staff feel like their mistakes are

held against them. 65% 42% 51% 45% 51% 47%

D8 2. Providers and staff talk openly about office problems.

69% 58% 61% 45% 50% 50%

D11 3. In this office, we discuss ways to prevent errors from happening again.

77% 73% 87% 72% 77% 78%

D12 4. Staff are willing to report mistakes they observe in this office.

71% 68% 68% 65% 69% 68%

28

Table 20. Item-Level Results by Staff Position, continued

Survey Items by Composite

Staff Position

Physician (M.D. or

D.O.)

PA, NP, CNS, N, Midwife,

APN Mgmt

Admin or Clerical

Staff

RN/ LVN/ LPN

Other Clinical Staff or Clinical Support

Staff 8. Communication Openness D1 1. Providers in this office are

open to staff ideas about how to improve office processes.

83% 80% 60% 53% 55% 58%

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

77% 73% 77% 56% 55% 56%

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

71% 64% 66% 62% 64% 65%

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

72% 50% 53% 41% 42% 41%

9. Patient Safety and Quality Issues Access to Care A1 1. A patient was unable to get

an appointment within 48 hours for an acute/serious problem.

65% 42% 55% 65% 63% 67%

Patient Identification A2 2. The wrong chart/medical

record was used for a patient. 84% 83% 84% 82% 85% 85%

Charts/Medical Records A3 3. A patient's chart/medical

record was not available when needed.

59% 50% 55% 59% 62% 61%

A4 4. Medical information was filed, scanned, or entered into the wrong patient's chart/medical record.

64% 58% 63% 69% 72% 76%

Medical Equipment A5 5. Medical equipment was not

working properly or was in need of repair or replacement.

64% 66% 69% 71% 62% 67%

Medication A6 6. A pharmacy contacted our

office to clarify or correct a prescription.

22% 29% 15% 14% 22% 19%

A7 7. A patient's medication list was not updated during his or her visit.

30% 34% 35% 45% 41% 47%

Note: For the A items (Patient Safety and Quality Issues), the percent positive response is based on those who answered “Not in the past 12 months” or “Once or twice in the past 12 months.”

29

Table 20. Item-Level Results by Staff Position, continued

Survey Items by Composite

Staff Position

Physician (M.D. or

D.O.)

PA, NP, CNS, N, Midwife,

APN Mgmt

Admin or

Clerical Staff

RN/ LVN/ LPN

Other Clinical Staff or Clinical Support

Staff Diagnostics and Tests A8 8. The results from a lab or

imaging test were not available when needed.

32% 42% 42% 44% 37% 45%

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

71% 69% 81% 68% 80% 80%

10. Office Processes and Standardization C8R 1. This office is more

disorganized than it should be. 54% 51% 60% 53% 52% 55%

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

56% 51% 60% 56% 51% 58%

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

37% 35% 42% 44% 40% 43%

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

71% 59% 71% 70% 70% 72%

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? 43% 37% 41% 55% 57% 60%

B2 2. Other medical offices/outside physicians?

34% 38% 35% 53% 52% 56%

B3 3. Pharmacies? 50% 46% 42% 42% 55% 56% B4 4. Hospitals? 45% 36% 41% 59% 62% 63% B5 5. Other? (Specify) 77% - - 73% 81% 74% 12. Work Pressure and Pace C3R 1. In this office, we often feel

rushed when taking care of patients.

19% 11% 20% 26% 19% 28%

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

48% 37% 40% 38% 31% 38%

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

52% 47% 44% 42% 36% 45%

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

60% 56% 56% 52% 44% 53%

30

Table 21. Overall Rating on Quality Results by Staff Position

Survey Items by Composite

Staff Position

Physician (M.D. or

D.O.)

PA, NP, CNS, N, Midwife,

APN Mgmt

Admin or

Clerical Staff

RN/ LVN/ LPN

Other Clinical Staff or Clinical Support

Staff # Medical Offices 127 12 24 222 125 157 # Respondents 1,251 61 159 2,265 1,132 1,557 G1a. Patient Centered Is responsive to individual patient preferences, needs, and values. Excellent 23% 7% 18% 18% 18% 21% Very Good 43% 51% 48% 38% 43% 37% Good 25% 34% 28% 34% 32% 35% Fair 8% 8% 6% 9% 6% 6% Poor 1% 0% 0% 1% 1% 0% G1b. Effective Is based on scientific knowledge. Excellent 30% 12% 19% 18% 20% 20% Very Good 47% 52% 55% 41% 47% 43% Good 20% 30% 24% 35% 27% 32% Fair 2% 5% 2% 6% 5% 5% Poor 0% 2% 0% 1% 0% 0% G1c. Timely Minimizes waits and potentially harmful delays. Excellent 14% 5% 9% 10% 8% 10% Very Good 34% 33% 37% 29% 35% 33% Good 31% 35% 37% 35% 34% 34% Fair 17% 24% 14% 19% 18% 18% Poor 4% 2% 3% 7% 6% 5% G1d. Efficient Ensures cost-effective care (avoids waste, overuse, and misuse of services). Excellent 13% 12% 9% 13% 9% 13% Very Good 36% 29% 41% 33% 38% 34% Good 35% 40% 38% 38% 37% 37% Fair 13% 13% 10% 13% 13% 12% Poor 3% 6% 2% 3% 3% 4% G1e. Equitable Provides the same quality of care to all individuals regardless of gender, race, ethnicity, socioeconomic status, language, etc. Excellent 55% 48% 51% 41% 43% 46% Very Good 32% 34% 33% 33% 37% 30% Good 11% 15% 12% 20% 17% 19% Fair 2% 2% 3% 5% 3% 4% Poor 0% 2% 1% 2% 1% 2%

Note: Respondents who selected “Other” and missing are not shown; results are not calculated when a staff position has fewer than five respondents or an item has fewer than three respondents. Percentages for each position may not add to 100 due to rounding.

31

Table 22. Overall Rating on Patient Safety Results by Staff Position

G2a. Overall Rating on Patient Safety

Staff Position

Physician (M.D. or

D.O.)

PA, NP, CNS, N, Midwife,

APN Mgmt

Admin or

Clerical Staff

RN/ LVN/ LPN

Other Clinical Staff or Clinical Support

Staff # Medical Offices 127 12 24 222 125 157 # Respondents 1,251 61 159 2,265 1,132 1,557 Excellent 16% 14% 14% 17% 16% 19% Very Good 42% 34% 52% 41% 44% 41% Good 31% 34% 26% 31% 30% 31% Fair 9% 10% 7% 10% 9% 8% Poor 1% 8% 0% 1% 1% 1%

Note: Respondents who selected “Other” and missing are not shown; results are not calculated when a staff position has fewer than five respondents or an item has fewer than three respondents. Percentages for each position may not add to 100 due to rounding.