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Safety and patient experience in the ambulatory setting: You can’t have one without the other

Safety is a key driver of patient experience. When patients feel secure and trust their caregivers, they feel protected. And their positive perspectives are reflected in data results.

However, when people think of safety, preventing incidents during hospitalizations and hospital-acquired infections typically come to mind. What’s often overlooked is the ambulatory setting, where some of the most important care touchpoints take place. Press Ganey’s data analysis shows how integral ambulatory safety is to the patient experience (PX). 

Optimal safety and the virtuous cycle

The optimal patient experience is achieved through safe, high-quality, patient-centered care across the continuum. Numerous analyses by Press Ganey show that, even though organizations often try to address different domains in silos, these areas are all interconnected (Figure 1).

Figure 1

In the book Zero Harm, Press Ganey leaders discuss the virtuous cycle—where engagement and safety drive experience, quality, and efficiency (Figure 2).

Figure 2

Ambulatory settings demand more attention

Efforts to address safety are often focused on the hospital setting. But much more attention needs to be placed on safety in the ambulatory setting, where most care touchpoints occur. Understanding patients’ firsthand experiences with safety in the ambulatory setting—and how that relates to their overall experience—is essential for assessing gaps in care and opportunities to better deliver treatment.

At Press Ganey, medical practice surveys include a question that asks patients how safe they felt during their care: "How well the staff protected your safety (by washing hands, wearing ID, etc.).” While analyzing data collected with this prompt, we looked at a national sample of medical practice surveys from 2021 to understand the relationship between patient experiences of safety and their overall Likelihood to Recommend (LTR) the practice. Reviewing over 12 million survey responses, we found that patients’ perceptions of safety are strongly correlated with LTR. If a patient had a top box response to the safety question, their LTR was in the 99th percentile rank, whereas if they did not have a top box to safety, the LTR fell to the 1st percentile rank (Figure 3).  

Figure 3

Safety is crucial for securing patient loyalty

If patients experienced top box for questions related to caring behaviors, they were in the 99th percentile for LTR. However, if patients experienced top box for caring behaviors but didn’t experience top box for safety, they fell to the 2nd percentile. Therefore, any loyalty built by caring providers can be eroded by negative perceptions of safety. 

Figure 4

Of note, physician perceptions of safety are also correlated with patient loyalty (Figure 5). Sites with higher physician perception of safety (based on the item “We are actively doing things to improve patient safety”) have stronger patient loyalty to the practice. That's one reason why continuously listening to providers and their perceptions of safety is vital for delivering quality care—and retaining patients. 

Figure 5

Key takeaways:

  1. If you're working to drive ambulatory LTR, breaking down silos between experience and safety is mission critical to making sure patients feel safe.  
  2. Routinely measuring patient perceptions of safety is essential in all care settings. Press Ganey has an array of questions you can add to PX surveys to see the full picture from the patient’s point of view.
  3. Once safety issues are identified, you need high reliability principles and processes in place to ensure that learning and improvement is happening. This is particularly essential in the ambulatory setting, where there's been less of a focus on patient safety. Press Ganey Strategic Consulting is rooted in data analytics and decades of expertise in improving safety across the entire continuum of care.  

Both safety and engagement in the ambulatory environment are critical to improving the patient experience. Breaking down silos is necessary for identifying how these aspects intersect with quality and efficiency—and helping you drive great PX. To learn more about any of Press Ganey’s solutions, reach out to an expert here

About the author

As Chief Safety and Transformation Officer, Dr. Gandhi, MPH, CPPS is responsible for improving patient and workforce safety, and developing innovative healthcare transformation strategies. She leads the Zero Harm movement and helps healthcare organizations recognize inequity as a type of harm for both patients and the workforce. Dr. Gandhi also leads the Press Ganey Equity Partnership, a collaborative initiative dedicated to addressing healthcare disparities and the impact of racial inequities on patients and caregivers. Before joining Press Ganey, Dr. Gandhi served as Chief Clinical and Safety Officer at the Institute for Healthcare Improvement (IHI), where she led IHI programs focused on improving patient and workforce safety.

Profile Photo of Dr. Tejal Gandhi, MPH, CPPS