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The Relationship Between Safety Culture and Voluntary Event Reporting in a Large Regional Ambulatory Care Group

Miller, Nina MD, MPH*; Bhowmik, Shelly MD, MPH*; Ezinwa, Margarete MD, MPH*; Yang, Ting PhD, MHS; Schrock, Susan MD; Bitzel, Daniel MS, LSWA; McGuire, Maura Joyce MD‡§

doi: 10.1097/PTS.0000000000000337
Original Article: PDF Only

Objectives The safety culture in the workplace may affect event reporting. We evaluated the relationship of safety culture and voluntary event reporting within a large network of ambulatory practices, most of which provided primary care.

Methods This study was an observational, retrospective cohort study. Patient safety event reporting rates for 35 ambulatory practices were collected using a standard tool (UHC Patient Safety Net [PSN]) and normalized based on the number of patient visits in each practice. The overall and domain-specific safety culture of each practice was measured with a validated instrument (Safety Attitudes Questionnaire [SAQ]), distributed to 828 employees in 2013. We compared safety culture scores and the average event reporting rates during a 4-month window before and after the survey distribution. Poisson regression analyses were performed to determine the relationship between PSN reporting rates and SAQ results.

Results The SAQ response rate was 87%. Practices varied widely in rates of reporting events, from 0.00 to 6.99 reports per 1000 total patient visits per month. Regression analyses indicated a positive association between PSN reporting rates and SAQ scores for the domains of overall culture (incidence rate ratio [IRR], 1.019; P = 0.004) and 4 safety culture domains: teamwork climate (IRR, 1.016; P = 0.019), safety climate (IRR, 1.018; P = 0.004), working conditions (IRR, 1.017; P = 0.006), and perceptions of local management (IRR, 1.016; P = 0.040).

Conclusions Our work provides new evidence to show that in the ambulatory setting more events and near misses are reported when there is a strong culture of safety.

From the *Johns Hopkins Bloomberg School of Public Health; †Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine; ‡Johns Hopkins Community Physicians; and §Division of General Internal Medicine, Johns Hopkins Department of Medicine, Baltimore, Maryland.

Correspondence: Maura Joyce McGuire, MD, 3100 Wyman Park Dr, Baltimore, MD 21211 (e-mail:

The authors disclose no conflict of interest.

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