Nursing Home Administrators' Opinions of the Resident Safety Culture in Nursing Homes

Published in: Health Care Management Review, v. 32, no. 1, Jan/Mar. 2007, p. 66-76

Posted on RAND.org on January 15, 2007

by Nicholas G. Castle, Steven Handler, John Engberg, Kristen Sonon

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BACKGROUND: In recent years, we have seen substantial interest in patient safety initiatives in health care. However, most studies in this area have examined hospital settings; few studies have examined nursing homes. PURPOSES: First, the resident safety culture of nursing homes from a top management perspective is compared with existing data from hospitals. Second, how the safety culture of nursing homes varies according to facility characteristics and market characteristics is examined. METHODOLOGY/APPROACH: Data came from a nationally representative sample of nursing homes (N = 2,840 completed surveys and a response rate of 71%). Administrators of these nursing homes completed The Hospital Survey on Patient Safety Culture (HSOPSC) instrument, a previously validated survey with 12 subscales used to assess safety culture. The nursing home scores from this instrument were compared with the hospital scores. Multivariate regression was used to examine the association between nine nursing home facility characteristics and three market characteristics and each of the subscales. FINDINGS: Nine of the ten HSOPSC subscale scores from the nursing home sample were considerably lower than the hospital scores, indicating a less well-developed safety culture. The significant facility and market characteristics from the regression analyses resemble many of those found when the same characteristics are used in examinations of quality. PRACTICE IMPLICATIONS: We have witnessed many patient safety initiatives in hospitals. These may be a harbinger of things to come for nursing homes. Thus, we argue that nursing homes in the near future would benefit by addressing the resident safety culture. This may also have the beneficial effect of improving the image of the industry.

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