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

Read More

Access further information on this document at Health Care Management Review

This article was published outside of RAND. The full text of the article can be found at the link above.

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.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/research-integrity.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.