Journal of General Internal Medicine

, Volume 22, Issue 1, pp 1–5 | Cite as

Measuring Safety Culture in the Ambulatory Setting: The Safety Attitudes Questionnaire—Ambulatory Version

  • Isitri Modak
  • J. Bryan Sexton
  • Thomas R. Lux
  • Robert L. Helmreich
  • Eric J. ThomasEmail author
Original Article


Provider attitudes about issues pertinent to patient safety may be related to errors and adverse events. We know of no instruments that measure safety-related attitudes in the outpatient setting.


To adapt the safety attitudes questionnaire (SAQ) to the outpatient setting and compare attitudes among different types of providers in the outpatient setting.


We modified the SAQ to create a 62-item SAQ—ambulatory version (SAQ-A). Patient care staff in a multispecialty, academic practice rated their agreement with the items using a 5-point Likert scale. Cronbach’s alpha was calculated to determine reliability of scale scores. Differences in SAQ-A scores between providers were assessed using ANOVA.


Of the 409 staff, 282 (69%) returned surveys. One hundred ninety (46%) surveys were included in the analyses. Cronbach’s alpha ranged from 0.68 to 0.86 for the scales: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions, and stress recognition. Physicians had the least favorable attitudes about perceptions of management while managers had the most favorable attitudes (mean scores: 50.4 ± 22.5 vs 72.5 ± 19.6, P < 0.05; percent with positive attitudes 18% vs 70%, respectively). Nurses had the most positive stress recognition scores (mean score 66.0 ± 24.0). All providers had similar attitudes toward teamwork climate, safety climate, job satisfaction, and working conditions.


The SAQ-A is a reliable tool for eliciting provider attitudes about the ambulatory work setting. Attitudes relevant to medical error may differ among provider types and reflect behavior and clinic operations that could be improved.

Key words

adverse events errors safety attitudes ambulatory safety attitudes questionnaire 



Funding was provided by the Robert Wood Johnson Foundation, the Agency for Healthcare Research and Quality (1PO1HS1154401), and The Health Resources and Services Administration (8 D55 HP00045). Dr. Thomas was a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. Dr. Isitri Modak was a General Internal Medicine fellow in the Joint Primary Care Fellowship, a faculty development training program. Funding for the program is provided in part by the United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions. This paper was presented at the 26th Annual National Meeting for the Society of General Internal Medicine, May 2003, in Vancouver, Canada.

Potential Financial Conflicts of Interest

The author has no financial conflicts of interests.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Isitri Modak
    • 1
  • J. Bryan Sexton
    • 1
  • Thomas R. Lux
    • 1
  • Robert L. Helmreich
    • 2
  • Eric J. Thomas
    • 1
    • 3
    Email author
  1. 1.Department of Medicine, Division of General MedicineThe University of Texas Health Science Center at Houston Medical SchoolHoustonUSA
  2. 2.Department of PsychologyThe University of Texas Human Factors Research ProjectAustinUSA
  3. 3.UT Houston Medical SchoolHoustonUSA

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