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J Patient Saf. 2012 Mar;8(1):15-21. doi: 10.1097/PTS.0b013e31823d047a.

Better medical office safety culture is not associated with better scores on quality measures.

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  • 1Case Western Reserve University, Cleveland, Ohio 44106, USA.



A strong safety culture is an essential element of safe medical practice. Few studies, however, have studied the link between safety culture and clinical quality outcomes. In this study, we examined the association between safety culture and quality measures in primary care offices.


A total of 24 primary care offices in Cleveland, Ohio.


The Medical Office Survey on Patient Safety was administered to clinicians and support staff to rate 12 dimensions of safety culture and a single overall patient safety rating. An average of the 12 safety culture dimension scores was calculated to produce an aggregated patient safety score. Using linear correlation, we calculated the association between the 2 summary safety measures (overall patient safety rating and aggregated patient safety score) and 2 composite quality measures, a chronic disease score, and a prevention score.


The survey response rate was 79% (387/492). There was considerable variation in both safety culture scores and quality scores from office to office. There was no association between the chronic disease score and either summary measure of safety culture. There were small but statistically significant negative associations between the prevention score and the overall patient safety rating (β = -0.087, P = 0.002) as well as the aggregated patient safety score (β = -0.004, P = 0.007).


Although safety theory predicts a positive association between safety culture and quality, we found no meaningful associations between safety culture and currently accepted measures of primary care clinical quality. Larger studies across several health care organizations are needed to determine whether these findings are reproducible. If so, it may be necessary to reconsider the dimensions of safety culture in primary care as well as the relationship between safety culture and primary care clinical quality.

[PubMed - indexed for MEDLINE]
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