Measuring safety culture in the ambulatory setting: the safety attitudes questionnaire--ambulatory version.

BACKGROUND: Provider attitudes about issues pertinent to patient safety may be related to errors and adverse events. We know of no instruments that measure safety-related attitudes in the outpatient setting. OBJECTIVE: To adapt the safety attitudes questionnaire (SAQ) to the outpatient setting and compare attitudes among different types of providers in the outpatient setting. METHODS: We modified the SAQ to create a 62-item SAQ-ambulatory version (SAQ-A). Patient care staff in a multispecialty, academic practice rated their agreement with the items using a 5-point Likert scale. Cronbach's alpha was calculated to determine reliability of scale scores. Differences in SAQ-A scores between providers were assessed using ANOVA. RESULTS: Of the 409 staff, 282 (69%) returned surveys. One hundred ninety (46%) surveys were included in the analyses. Cronbach's alpha ranged from 0.68 to 0.86 for the scales: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions, and stress recognition. Physicians had the least favorable attitudes about perceptions of management while managers had the most favorable attitudes (mean scores: 50.4 +/- 22.5 vs 72.5 +/- 19.6, P < 0.05; percent with positive attitudes 18% vs 70%, respectively). Nurses had the most positive stress recognition scores (mean score 66.0 +/- 24.0). All providers had similar attitudes toward teamwork climate, safety climate, job satisfaction, and working conditions. CONCLUSION: The SAQ-A is a reliable tool for eliciting provider attitudes about the ambulatory work setting. Attitudes relevant to medical error may differ among provider types and reflect behavior and clinic operations that could be improved.

Assessment of competencies in physicians-in-training through the delivery of a community-based health curriculum using distance learning.

Academic physicians must master the elements of curriculum development and evaluation specific to defined competencies in postgraduate medical education. Six fellows in primary care medicine, working as a peer group with a faculty mentor, designed and evaluated a distance-learning project that included resident physicians. Professionalism, interpersonal skills and systems-based medical practice skills were measured with original instruments designed by the peer group. By the process of evaluation and revision in a peer-group setting and with mentorship from program faculty, experiential learning enhanced the training of future academic physicians. This paper describes the background, process and statistical results of their work.