We started our diagnostic safety initiative by convening a multidisciplinary team of representatives from diverse specialties and different practice areas encompassing both public and private care. To help prioritize the diagnostic safety-related actions to undertake first, the team conducted a survey-based initial needs assessment. We wanted to understand physician perceptions regarding safety culture related to the diagnostic process within the institution. The objective was to establish a baseline, define targeted actions, and identify key improvement opportunities based on survey responses.
The needs assessment included a modified survey adapted from the SOPS Medical Office Survey Diagnostic Safety Supplemental Item Set.2 The questions were translated to Portuguese and adapted minimally so they could be answered by physicians working in any setting (inpatient or outpatient). For instance, phrases such as "in this office/appointments" were modified to "in this service." We also included a final free-text question about what could be done to improve the institution's diagnostic process.
The original survey was developed for outpatient settings and for all clinic staff. However, we focused the survey on obtaining physician perspectives regardless of the care setting. The survey assessed the extent to which the organizational culture supports the diagnostic process, accurate diagnoses, and communication surrounding diagnoses. The survey included 12 questions (Table 1) that cover the following composite measure domains: Time Availability (3 items), Testing and Referrals (4 items), and Provider and Staff Communication Around Diagnosis (5 items).
Each item was rated using a 5-point Likert scale: strongly disagree (1), disagree (2), neither agree nor disagree (3), agree (4), and strongly agree (5), in addition to the option "not applicable/do not know."
These questions were made available through the REDcap platform. The survey was administered to all physicians affiliated with SBIBAE through institutional communication systems, including email and WhatsApp. We ensured physicians' anonymous participation.
For each item, we calculated the percentage of positive responses by summing up the "strongly agree" and "agree" responses and dividing by the total number of responses, excluding missing responses and not applicable/do not know responses. We excluded "I don't know" and "not applicable" responses from this total. While the comparison is not direct, we show the data from an AHRQ report on the results obtained from 110 medical offices in the United States with 1,126 respondents.3
