title: Measuring safety culture in the ambulatory setting: the safety attitudes questionnaire--ambulatory version.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Division of General Medicine, The University of Texas Health Science Center at Houston Medical School, Houston, TX, USA.
authors.forename: Isitri
authors.initials: I
authors.lastname: Modak
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Sexton
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Lux
authors.forename: Robert L
authors.initials: RL
authors.lastname: Helmreich
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D015279:Organizational Culture; D010348:Patient Care Team; D012017:Referral and Consultation; D017751:Safety Management; D013315:Stress, Psychological / Q000175:diagnosis; D011795:Surveys and Questionnaires; D013781:Texas; D017132:Workplace