Measuring Safety Culture in the Ambulatory Setting

The Safety Attitudes Questionnaire-Ambulatory Version

The goal of this research was to compare attitudes toward patient safety among providers of outpatient care.The study used a modified version of the safety attitudes questionnaire (SAQ) and adapted it for use in this group of providers. The modified version is termed the SAQ-A. The majority of health care is delivered in outpatient settings, yet little research has been done on provider attitudes toward ambulatory patient safety.

The author's analyzed 190 surveys (46% of all mailed, 67% of all returned) gathered from providers at an academic, urban practice in Texas. Most of the respondents (58%) were physicians and 70 percent were female. Analysis revealed that only 18 percent of physicians had positive perceptions of management (versus 32% of nurses, 33% of assistants and 70% of managers). Stress recognition also varied considerably among respondent types, with nurses having the highest rates of acknowledging effects of stress (45%) and medical assistants the lowest (20%). Only 39 percent of physicians had a positive attitude toward safety climate, and slightly less than half of physicians and nurses were satisfied with their jobs. Sixty-six percent of all providers agreed that "abnormal test results are frequently lost or overlooked."

The authors conclude that their adapted version of the SAQ may be useful for ambulatory practices that want to compare and contrast attitudes among different units within the practice to measure changes before and after initiatives to improve safety. Additionally, these same practices may want to measure primary care provider attitudes about teamwork, safety culture, or other related issues. Since the SAQ-A was used in only one setting in Texas, it may need to be adapted for other settings and practices. Lastly, small sample size made comparisons among types of providers difficult. The authors emphasize that it remains unknown whether ambulatory safety attitudes correlate with other measures of safety or with behavior change. Further research must be done to answer these questions.