Physician perspectives on quality and error in the outpatient setting.
BACKGROUND
Little is known about the influence of the primary care workplace on patient care. Assessing physician opinion through focus groups can elucidate factors related to safety and error in this setting.


METHODS
During phase 1 of the Minimizing Error, Maximizing Outcome (MEMO) Study, 9 focus groups were conducted with 32 family physicians and general internists from 5 areas in the upper Midwest and New York City.


RESULTS
The physicians described challenging settings with rapidly changing conditions. Patients are medically and psychosocially complex and often underinsured. Communication is complicated by multiple languages, time pressure, and inadequate information systems. Complex processes of care have missing elements including medication lists and test results. Physicians are pressed to be more productive, and key administrative decisions are made without their input. Targeted areas to improve safety and reduce error included teamwork, aligned leadership values, diversity, collegiality, and respect.


CONCLUSIONS
Primary care physicians clearly described positive and negative workplace factors related to safety and error. The themes suggest that systems of care and their dynamic nature warrant attention. Enhancing positive and ameliorating negative cultures and processes of care could bring real benefits to patients, physicians, and ambulatory office settings.
Manwell
Linda Baier
LB
Section of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA. lmanwell@wisc.edu
Williams
Eric S
ES
Babbott
Stewart
S
Rabatin
Joseph S
JS
Linzer
Mark
M
D000553:Ambulatory Care / Q000592:standards*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D010045:Outpatients; D010821:Physicians, Family / Q000523:psychology*; D011320:Primary Health Care; D011785:Quality Assurance, Health Care; D014481:United States