Analysis of patient safety culture and patient safety performance in medical group practice organizations

In conjunction with growing interest and public pressure, research into patient safety in the health care system has grown over the past seven years. Initial work focused on describing the magnitude of medical error and patient safety problems within hospitals. Current research explores ways to improve patient safety within health care organizations and the successes of interventions intended to increase patient safety. Recognition is growing that ambulatory care organizations must also be considered within the spectrum of patient safety improvement. A popular focus within the area of patient safety improvement interventions is patient safety culture. Patient safety culture is a subset of organizational culture that describes the organization's orientation to patient safety concerns reflected in organizational practices and employee behavior.;This dissertation describes an investigation of patient safety culture and performance within medical group practice organizations in Missouri. First, a conceptual framework is introduced that orients the numerous patient safety improvement strategies according to organizational ergonomic theory. Within this framework, research on patient safety interventions is reviewed and analyzed and increasing patient safety culture is identified as one of several organization-level strategies implemented to improve patient safety. Next, a new survey for assessing patient safety culture in ambulatory care organizations is reported. Finally, using the newly-developed survey, patient safety culture and performance are analyzed in a study of Missouri's medical group practice organizations. Conclusions from this investigation and future directions for research in the area of ambulatory care patient safety culture and performance are delineated.