Alberta Clinics 2024
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About the Health Quality Alberta
Health Quality Alberta is a provincial agency that brings together patients, families, and our partners from across healthcare and academia to inspire improvement in patient safety, person-centred care, and health service quality. We assess and study the healthcare system, identify effective practices, and engage with Albertans to gather information about their experiences. Our responsibilities are outlined in the Health Quality Council of Alberta Act.
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Survey content
Overview
Patient safety culture (PSC) is the extent to
which these beliefs, values, and norms support and promote patient
safety.
Informed culture – relevant safety information is collected, analyzed and actively disseminated
Reporting culture – an atmosphere where people have the confidence and feel safe to report safety concerns without fear of blame, and they trust that concerns will be acted upon
Learning culture – preventable patient safety incidents are seen as opportunities for learning and changes are made as a result
Just culture – the importance of fairly balancing and understanding system failure with professional accountability
Flexible culture – people are capable of adapting effectively to changing demands
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Survey on patient safety culture includes:
- Section 1: Topics on patient safety culture
- Section 2: Patient safety and quality issues
- Section 3: Information exchange with other setting
- Section 4: Health care quality
- Section 5: Overall rating on patient safety
Surveys on patient safety culture™ and SOPS® are trademarks of AHRQ.
Surveys on patient safety culture™. Agency for healthcare research and quality, Rockville, MD USA. https://www.ahrq.gov/sops/index.html
Survey administration statistics
This section presents descriptive information on the number of clinics and survey respondents included in the 2024 survey on patient safety culture, as well as information about response rates.
2023 - 6 clinics participated in the PSC pilot
2024 - 19 clinics participated in the first official PSC year
| ————— | 2023 | 2024 |
|---|---|---|
| Completed surveys | 104 | 274 |
| Number of surveys sent | 173 | 617 |
| Response rate | 60.1% | 46.9% |
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Non-clinical = Administrative or clerical staff, Management, Practice facilitator, Other position.
Clinical = Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Physician (MD or DO), Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Nurse Midwife, Advanced Practice Nurse, etc., Pharmacist, Mental health therapist, Social worker, Dietician, Behavioural health consultant.
1. Topics on patient safety culture
Section 1 includes 38 questions that make up 10 patient safety topics. Topics are defined below:
| Topic | Definition |
|---|---|
| Communication About Error | Staff are willing to report mistakes they observe and do not feel like their mistakes are held against them and providers and staff talk openly about clinic problems and how to prevent errors from happening. |
| Communication openness | Providers in the clinic are open to staff ideas about how to improve clinic processes and staff are encouraged to express alternative viewpoints and do not find it difficult to voice disagreement. |
| Clinic processes and standardization | The clinic is organized, has an effective workflow, has standardized processes for completing tasks, and has good procedures for checking the accuracy of work performed. |
| Organizational learning | The clinic has a learning culture that facilitates making changes in clinic processes to improve the quality of patient care and evaluates changes for effectiveness. |
| Overall perceptions of patient safety and quality | The quality of patient care is more important than getting more work done, clinic processes are good at preventing mistakes, and mistakes do not happen more than they should. |
| Owner/managing partner/leadership support for patient safety | Clinic leadership actively supports quality and patient safety, places a high priority on improving patient care processes, does not overlook mistakes, and makes decisions based on what is best for patients. |
| Patient care tracking/follow-up | The clinic reminds patients about appointments, documents how well patients follow treatment plans, follows up with patients who need monitoring, and follows up when reports from an outside provider are not received. |
| Staff training | The clinic provides staff with effective on-the-job training, trains staff on new processes, and does not assign staff tasks they have not been trained to perform. |
| Teamwork | The clinic has a culture of teamwork, mutual respect, and close working relationships among staff and providers. |
| Work pressure and pace | There are enough staff and providers to handle the patient load and the clinic work pace is not hectic. |
2. Safety and quality issues
Section 2 includes 9 questions on patient safety and quality issues:
In your best estimate, how often did the following things happen in your primary care clinic OVER THE PAST 12 MONTHS?
| Questions | Options |
|---|---|
| The wrong chart/medical record was used for a patient. | Daily |
| Medical equipment was not working properly or was in need of repair or replacement. | Weekly |
| Medical information was filed, scanned or entered into the wrong patient’s chart/medical record. | Monthly |
| A critical abnormal result from lab or imaging test was not followed up within one business day. | Several times in the past 12 months |
| A patient’s chart/medical record was not available when needed. | *Once or twice in the past 12 months |
| The results from a lab or imaging test were not available when needed. | *Not in the past 12 months |
| A patient’s medication list was not updated during his or her visit. | |
| A patient was unable to get an appointment within 48 hours for an acute/serious problem. | |
| A pharmacy contacted our office to clarify or correct a prescription. | (* = positive response for safety and quality issues) |
3. Information exchange
Section 3 includes 4 questions on information exchange with other settings:
OVER THE PAST 12 MONTHS, how often has your primary care clinic had problems exchanging accurate, complete, and timely information with:
| Sites | Options |
|---|---|
| Hospitals | Problems daily |
| Pharmacies | Problems weekly |
| Outside labs imaging centers | Problems monthly |
| Other medical offices/outside physicians | Problems several times in the past 12 months |
| *Problems once or twice in the past 12 months | |
| *No problems in the past 12 months | |
| (* = positive response for information exchange with other settings) |
4. Quality
Section 4 includes 5 questions on areas of health care quality:
Overall, how would you rate your medical office on each of the following areas of health care quality?
| Areas | Options |
|---|---|
| Equitable: Provides the same quality of care to all individuals regardless of gender, race, ethnicity, socioeconomic status, language, etc. | Excellent |
| Effective: Is based on scientific knowledge | Very good |
| Patient centred: Is responsive to individual patient preferences, needs, and values | Good |
| Timely: Minimized waits and potentially harmful delays | Fair |
| Efficient: Ensures cost effective care (avoids waste, overuse, and misuse of services) | Poor |
5. Overall rating
Section 5 includes 1 question on the overall rating on patient safety:
| Overall | Options |
|---|---|
| Overall, how would you rate the systems and clinical processes your medical office has in place to prevent, catch, and correct problems that have the potential to affect patients | Excellent |
| Very good | |
| Good | |
| Fair | |
| Poor |
Go to Section 5: Overall rating on patient safety
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Section 1: Topics on patient safety culture
Patient safety culture measures - average per cent positive response
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Highlights 2024
Note: Per cent positive response is based on those who responded “Strongly Agree”, “Agree”, “Most of the time” or “Always” to POSITIVELY framed questions OR those who responded “Strongly disagree”, “Disagree”, “Never” or “Rarely” to NEGATIVELY framed questions. The per cent positive displayed might not equal the sum of the response option percentages due to rounding. Percentages might not add to 100 per cent due to rounding.
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Patient safety culture composite measures - average per cent positive response
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Note: Higher percentage is a better outcome for both positively and negatively framed questions. Per cent positive response is based on those who responded “Strongly Agree”, “Agree”, “Most of the time” or “Always” to POSITIVELY framed questions OR those who responded “Strongly disagree”, “Disagree”, “Never” or “Rarely” to NEGATIVELY framed questions.
- Items are ordered from highest to lowest scoring topic
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Section 1:Topics on patient safety culture 2024 results
Patient safety culture measures - average per cent positive response
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Highlights 2024
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In your best estimate, how often did the following things happen in your primary care clinic OVER THE PAST 12 MONTHS?
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Note: In the graph above, per cent “Positive” is based on those who responded “Not in the past 12 months”, “Once or twice in the past 12 months” or “Several times in the past 12 months”. “Other” is based on those who responded “Does not know/Does not apply”, “Monthly”, “Weekly”, or “Daily”. The per cent positive displayed might not equal the sum of the response option percentages due to rounding. Percentages might not add to 100 per cent due to rounding.
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In your best estimate, how often did the following things happen in your primary care clinic OVER THE PAST 12 MONTHS?
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Section 3: Information exchange with other settings
Average per cent response on information exchange with other settings
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Highlights 2024
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OVER THE PAST 12 MONTHS, how often has your primary care clinic had problems exchanging accurate, complete, and timely information with…?
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Note: In the graph above, Per cent “Positive” is based on those who responded “No problems in the past 12 months”, “Problems once or twice in the past 12 months” or “Problems several times in the past 12 months”.”Other” is based on those who responded “Does not know/Does not apply”, “Problems monthly”, “Problems weekly”, or “Problems daily”. The per cent positive displayed might not equal the sum of the response option percentages due to rounding. percentages might not add to 100 per cent due to rounding.
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OVER THE PAST 12 MONTHS, how often has your primary care clinic had problems exchanging accurate, complete, and timely information with?
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Highlights 2024
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Overall, how would you rate your medical office on each of the following areas of health care quality?
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Note: In the graph above, per cent “Positive” is based on those who responded “Excellent” or “Very good”. The per cent positive displayed might not equal the sum of the response option percentages due to rounding. Percentages might not add to 100 per cent due to rounding.
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Overall, how would you rate your medical office on each of the following areas of health care quality?
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Resource guide
Patient Safety Culture Resource Guide provides practical resources primary care clinics can use to improve patient safety culture and patient safety.
Survey resources
You’ve received survey results with valuable feedback… now what? This guide provides healthcare leaders and quality improvement professionals with seven steps to review survey data, identify areas for improvement, and create a quality improvement plan. Go to Improvement guide for using survey results
Methods & background
This section provides additional detail regarding data cleaning, calculations of various statistics presented in this report, and data limitations.
Response rates
Response rates were calculated using the formula below:
\[ \begin{equation} Response Rate =\\ \frac{Number\ of\ complete,\ returned\ surveys\ –\ Incompletes}{Number\ of\ eligible\ providers\ and\ staff\ who\ received\ a\ survey} \end{equation} \] ——————————————————————————–
Calculation of per cent positive scores
Most of the survey items ask respondents to answer using five-point response categories in terms of agreement (Strongly agree, Agree, Neither Agree nor Disagree, Disagree, Strongly Disagree), or frequency (Always, Most of the Time, Sometimes, Rarely, Never). Three of the 10 SOPS composite measures consisting of 12 items use the frequency response option (Communication About Error, Communication Openness, and Patient Care Tracking/Followup), while the other seven composite measures use the agreement response option. Questions in these sections contain a “Does not apply” or “Don’t know” response option that is not included in the calculation of per cent positive scores.
The nine Patient Safety and Quality Issues items use a frequency scale ranging from “Not in the past 12 months” to “Daily”:
- Not in the past 12 months,
- Once or twice in the past 12 months,
- Several times in the past 12 months,
- Monthly,
- Weekly, and
- Daily.
The four Information Exchange with Other Settings items use similar response options ranging from “No problems in the past 12 months” to “Problems daily”:
- No problems in the past 12 months,
- Problems once or twice in the past 12 months,
- Problems several times in the past 12 months,
- Problems monthly,
- Problems weekly, and
- Problems daily.
The Overall Ratings on Quality and Patient Safety use a five-point scale ranging from “Poor” to “Excellent” (Poor, Fair, Good, Very Good, Excellent).
Composite measure item per cent positive response
The survey includes both positively worded items (e.g., “Staff support one another in this primary care clinic”) and negatively worded items (e.g., “Staff use shortcuts to get their work done faster”).
Calculating the per cent positive response from positively worded items is different from calculating the per cent positive response from negatively worded items:
For positively worded items, per cent positive response is the combined percentage of respondents within a primary care clinic who answered “Strongly agree” or “Agree,” or “Always” or “Most of the time,” depending on the response categories used for the item.For example, for the item “We have enough staff to handle our patient load,” if 50 per cent of respondents within a primary care clinic responded “Strongly agree” and 25 per cent responded “Agree,” the item per cent positive response for that primary care clinic would be 50% + 25%= 75% positive.
For negatively worded items, per cent positive response is the combined percentage of respondents within a primary care clinic who answered “Strongly disagree” or “Disagree,” or “Never” or “Rarely,” depending on the response categories used for the item, because a negative answer on a negatively worded item indicates a positive response.
For example, for the item “Mistakes happen more than they should in this office,” if 60 per cent of respondents within a primary care clinic responded “Strongly disagree” and 20 per cent responded “Disagree,” the item per cent positive response would be 60%+20% = 80% positive (i.e., 80 per cent of respondents do not believe mistakes happen more than they should in this office).
Table N1 shows an example of computing a composite measure score for Staff Training in a single primary care clinic. This composite measure has three items. Two are positively worded (items C4 and C7) and one is negatively worded (item C10). Keep in mind that DISAGREEING with a negatively worded item indicates a POSITIVE response.
Table N1. Example of computing item and composite
measure per cent positive scores
Single item per cent positive response
Per cent positive scores for the Patient Safety and Quality Issues items and the Information Exchange with Other Settings items were calculated differently. The per cent positive score for these 13 items is the sum of the three response options that represent the smallest frequency of occurrence.
For Patient Safety and Quality Issues items, the three responses are: “Not in the past 12 months,” “Once or twice in the past 12 months,” and “Several times in the past 12 months.” For Information Exchange with Other Settings items, the three responses are: “No problems in the past 12 months,” “Problems once or twice in the past 12 months,” and “Problems several times in the past 12 months.”
Per cent positive scores for the six Overall Ratings on Quality and Patient Safety items were also calculated differently based on the two most positive responses of “Excellent” or “Very good.”
Composite measure per cent positive response
The 10 SOPS Primary Care Clinic Survey composite measures are each composed of three or four survey items. We calculated composite measure scores for each primary care clinic by averaging the unrounded per cent positive response on the items within a composite measure. For example, for a three-item composite measure, if the item per cent positive responses were 45.8 per cent, 6.8 per cent, and 48.1 per cent, the primary care clinic’s composite measure per cent positive response would be the average of these three percentages, or 50.2 per cent positive, and displayed as a rounded percentage of 50 per cent.
If a primary care clinic had item data for at least 50 per cent of the items within a composite measure, the site would still receive a composite measure score. For example, for a three-item composite measure score, the number of item scores needed to calculate the composite measure is two items and for a four-item composite measure score, the number of item scores needed to calculate the composite measure is two items.
The survey results presented in this report represent a small subset of primary care clinics in Alberta. Primary care clinics voluntarily chose to participate in the pilot study; therefore, the results include those clinics that were willing to participate. As such, it likely does not reflect all clinics in Alberta.