Jane Banaszak-Holl1,2, Heidi Reichert3, M Todd Greene3,4, Lona Mody5,6, Heidi L Wald7, Christopher Crnich8,9, Sara E McNamara5, Jennifer Meddings3,4,10,11. 1. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan. 2. Institute of Gerontology, University of Michigan Medical School, Ann Arbor, Michigan. 3. Division of General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan. 4. Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan. 5. Division of Geriatric and Palliative Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan. 6. Geriatric Research, Education, and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan. 7. Division of Health Care Policy and Research, School of Medicine, University of Colorado, Aurora, Colorado. 8. School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin. 9. William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin. 10. Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, Medical School, University of Michigan, Ann Arbor, Michigan. 11. School of Medicine, University of Colorado, Aurora, Colorado.
Abstract
OBJECTIVES: To identify facility- and individual-level predictors of nursing home safety culture. DESIGN: Cross-sectional survey of individuals within facilities. SETTING: Nursing homes participating in the national Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infections Project. PARTICIPANTS: Responding nursing home staff (N = 14,177) from 170 (81%) of 210 participating facilities. MEASUREMENTS: Staff responses to the Nursing Home Survey on Patient Safety Culture (NHSOPS), focused on five domains (teamwork, training and skills, communication openness, supervisor expectations, organizational learning) and individual respondent characteristics (occupation, tenure, hours worked), were merged with data on facility characteristics (from the Certification and Survey Provider Enhanced Reporting): ownership, chain membership, percentage residents on Medicare, bed size. Data were analyzed using multivariate hierarchical models. RESULTS: Nursing assistants rated all domains worse than administrators did (P < .001), with the largest differences for communication openness (24.3 points), teamwork (17.4 points), and supervisor expectations (16.1 points). Clinical staff rated all domains worse than administrators. Nonprofit ownership was associated with worse training and skills (by 6.0 points, P =.04) and communication openness (7.3 points, P =.004), and nonprofit and chain ownership were associated with worse supervisor expectations (5.2 points, P =.001 and 3.2 points, P =.03, respectively) and organizational learning (5.6 points, P =.009 and 4.2 points, P = .03). The percentage of variation in safety culture attributable to facility characteristics was less than 22%, with ownership having the strongest effect. CONCLUSION: Perceptions of safety culture vary widely among nursing home staff, with administrators consistently perceiving better safety culture than clinical staff who spend more time with residents. Reporting safety culture scores according to occupation may be more important than facility-level scores alone to describe and assess barriers, facilitators, and changes in safety culture.
OBJECTIVES: To identify facility- and individual-level predictors of nursing home safety culture. DESIGN: Cross-sectional survey of individuals within facilities. SETTING: Nursing homes participating in the national Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infections Project. PARTICIPANTS: Responding nursing home staff (N = 14,177) from 170 (81%) of 210 participating facilities. MEASUREMENTS: Staff responses to the Nursing Home Survey on Patient Safety Culture (NHSOPS), focused on five domains (teamwork, training and skills, communication openness, supervisor expectations, organizational learning) and individual respondent characteristics (occupation, tenure, hours worked), were merged with data on facility characteristics (from the Certification and Survey Provider Enhanced Reporting): ownership, chain membership, percentage residents on Medicare, bed size. Data were analyzed using multivariate hierarchical models. RESULTS: Nursing assistants rated all domains worse than administrators did (P < .001), with the largest differences for communication openness (24.3 points), teamwork (17.4 points), and supervisor expectations (16.1 points). Clinical staff rated all domains worse than administrators. Nonprofit ownership was associated with worse training and skills (by 6.0 points, P =.04) and communication openness (7.3 points, P =.004), and nonprofit and chain ownership were associated with worse supervisor expectations (5.2 points, P =.001 and 3.2 points, P =.03, respectively) and organizational learning (5.6 points, P =.009 and 4.2 points, P = .03). The percentage of variation in safety culture attributable to facility characteristics was less than 22%, with ownership having the strongest effect. CONCLUSION: Perceptions of safety culture vary widely among nursing home staff, with administrators consistently perceiving better safety culture than clinical staff who spend more time with residents. Reporting safety culture scores according to occupation may be more important than facility-level scores alone to describe and assess barriers, facilitators, and changes in safety culture.
Authors: Lona Mody; M Todd Greene; Jennifer Meddings; Sarah L Krein; Sara E McNamara; Barbara W Trautner; David Ratz; Nimalie D Stone; Lillian Min; Steven J Schweon; Andrew J Rolle; Russell N Olmsted; Dale R Burwen; James Battles; Barbara Edson; Sanjay Saint Journal: JAMA Intern Med Date: 2017-08-01 Impact factor: 21.873
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