In order to characterize outpatient safety, this study of small- and medium-sized ambulatory clinics surveyed administrators about organizational safety and staff about communication and existing safety processes. Administrators reported a lack of safety systems, consistent with prior discussion of ambulatory settings. As with earlier research in hospitals, frontline staff describe difficulty speaking up about errors. Staff responses suggested that insufficient time to manage their workload leads to safety problems, echoing a recent focus group study of physicians. Respondents also reported weaknesses in outpatient referral processes. Overall, staff and administrators in ambulatory practices continue to identify gaps in care that contribute to adverse events, highlighting opportunities to improve safety in primary care settings. A recent AHRQ WebM&M interview and perspective discuss patient safety in ambulatory care.