Safety culture of nursing homes: opinions of top managers.

BACKGROUND: Examining the perception of patient safety culture (PSC) of top managers in health care settings is important because their orientation to PSC can have a large influence on the facility. PURPOSES: In this research, the perception of PSC of nursing home administrators (NHAs) and directors of nursing (DONs) is examined. METHODOLOGY/APPROACH: Primary data were collected to examine the opinions of NHAs and DONs regarding PSC. Information was collected from a large nationally representative sample of 4,000 nursing homes. The Nursing Home Survey on Patient Safety Culture survey instrument was used as a measure of PSC. This has 12 domains and 38 items. Bias indexes, intraclass correlation coefficients, and Pearson's product-moment correlation coefficients of the differences between NHA and DON item scores were examined. FINDINGS: Using a 0-100 scale, most scores fell into the 55-80 range. Higher scores represent a higher (more favorable) PSC. Agreement between the NHAs and DONs was excellent in 10 items, good in 15 items, moderate in 4 items, and poor in 8 items. Of the four largest differences in scores, the NHA scores were higher than the DON scores for 1 item, and DON scores were higher than the NHA scores for 3 items. IMPLICATIONS: The overall perception from both NHAs and DONs appear to represent a somewhat "positive" outlook from these top managers on their institution's PSC. However, NHAs in general report higher scores than DONs do. The areas of divergence between these top managers are further discussed, with a view toward directing future patient safety investigations and initiatives in nursing homes.

Nursing home deficiency citations for safety.

Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the organization) associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents.

What is nursing home quality and how is it measured?

PURPOSE: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. DESIGN AND METHODS: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO) model is used to frame the discussion. Current quality indicators and quality initiatives are discussed, including those included in the Facility Quality Indicator Profile Report, Nursing Home Compare, deficiency citations included as part of Medicare/Medicaid certification, and the Advancing Excellence Campaign. RESULTS: Current quality indicators are presented as a mix of structural, process, and outcome measures, each of which has noted advantages and disadvantages. We speculate on steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes, including report cards, pay for performance, market-based incentives, and policy developments in the certification process. Areas for future research are identified throughout the review. IMPLICATIONS: We conclude that improvements in nursing home quality have likely occurred, but improvements are still needed.

Assessing resident safety culture in nursing homes: using the nursing home survey on resident safety.

OBJECTIVES: To examine the overall responses of nursing home staff to a newly developed nursing home specific survey instrument to assess patient safety culture (PSC) and to examine whether nursing home staff (including administrator/manager, licensed nurse, nurse aide, direct care staff, and support staff) differ in their PSC ratings. METHODS: Data were collected in late 2007 through early 2008 using a survey administered to staff in each of 40 nursing homes. In 4 of these nursing homes, the responses of different staff were identified. The Nursing Home Survey on Patient Safety Culture was used to assess the 12 domains of the PSC and identify differences in PSC perceptions between staff. RESULTS: For the 40 nursing homes in the sample, the overall facility response rate was 72%. For the 4 nursing homes of interest, the overall facility response rate was 68.9%. The aggregate Nursing Home Survey on Patient Safety Culture scores, using all staff types for all survey items, show that most respondents report a poor PSC. However, administrators/managers had more positive scores than the other staff types (P < 0.05) across most domains. CONCLUSIONS: Staff in nursing homes generally agree that PSC is poor. This may have a significant impact on quality of care and quality of life for residents.

Humanism in nursing homes: the impact of top management.

We provide a review of ways in which top managers of nursing homes can provide or impact the humanistic component of care provided in their facilities. We describe the nursing home top management team; the role of top managers in nursing homes; the role of top managers as leaders in the nursing home; the literature examining the impact of top managers in nursing homes; and, examine developments in the nursing home industry that are influencing (or could potentially influence) the humanistic components of care. We conclude with suggestions for top managers, nursing home owners, and policy makers to create more caring humanistic environments. Suggestions include resident-directed care initiatives and culture change.