1. Comparative Results from the AHRQ Nursing Home Survey on Patient Safety Culture
Track A, Session 108
Deborah Carpenter RN MSN PMP CPHQ
Theresa Famolaro, MPS
AHRQ 2011 Annual Conference
Leading Through Innovation & Collaboration
September 19, 2011
Bethesda, MD
Westat
1600 Research Blvd.
Rockville, MD 20850

2. Objectives Describe survey domains and development process.
Present comparative data from 200+ nursing homes.

3. Background Nursing Home Survey on Patient Safety Culture (NH-SOPS)
Sponsored by AHRQ; developed by Westat
Survey development process:
Reviewed literature & existing surveys
Interviewed nursing home staff
Identified key areas of safety culture
Developed & pretested survey items
Obtained input from researchers & stakeholders
Pilot tested in 40 nursing homes with 3,698 respondents

4. Background
AHRQ Nursing Home Survey on Patient Safety Culture released in fall 2008
Survey and support tools available at:

5. NHSOPS Patient Safety Culture Dimensions
42 items assess 12 dimensions of patient safety culture
1. Communication openness
2. Compliance with procedures
3. Feedback & communication about incidents
4. Handoffs
5. Management support for resident safety
6. Nonpunitive response to mistakes
7. Organizational learning
8. Overall perceptions of resident safety
9. Staffing
10. Supv/mgr expectations & actions promoting resident safety
11. Teamwork
12. Training and skills
Resident safety “grade” (Excellent to Poor)
Overall recommendation of nursing home to friends

6. NHSOPS Comparative Database
AHRQ funded a NHSOPS comparative database
Reports (2008 preliminary & 2011)
Purposes:
Comparison—of survey results in efforts to establish, improve and maintain a culture of resident safety
Assessment and Learning—in safety improvement process (rather than basis for determining punitive actions or external judgment of nursing home performance)
Supplemental Information—to help nursing homes identify strengths and areas with potential for safety culture improvement

7. 2011 NHSOPS Comparative Database
226 US nursing homes: 16,155 respondents
Average # respondents per nursing home = 71
Survey administration
Paper 83%
Web 12%
Both 6%
Average nursing home response rate = 67%
Paper 70%
Web 49%
Both 56%

8. Job Titles Nursing Assistant/Aide 35% (5,154) Support Staff 18%
Licensed Nurse %
Administrator/Manager %
Direct Care Staff %
Administrative Support Staff %
Other %
Physician (MD, DO) %
Other Provider %

9. Work Areas & Patient Contact
Many different areas/no specific 46%
Skilled nursing unit %
Other area or unit %
Alzheimer’s/Dementia unit %
Rehab unit %
71% had direct interaction with residents

10. Nursing Home Strengths
1. Overall Perceptions of Resident Safety
2. Feedback and Communication About Incidents
3. Supervisor Expectations & Actions Promoting
Resident Safety

11. Nursing Home Areas for Improvement
  12. Nonpunitive Response to Mistakes
11. Staffing
10. Communication Openness

12. Overall Rating on Resident Safety

13. Willingness to Recommend to Friends

14. Results by Nursing Home Characteristics
Smaller nursing homes (49 beds or fewer) scored highest on 10 out of 12 patient safety culture composites
Nonprofit/government nursing homes had higher average percent positive scores than for profit nursing homes on all 12 patient safety culture composites.
Both smaller and nonprofit/government nursing homes were willing to recommend their nursing home to friends
beds (88%) vs beds (74%)
- Nonprofit/gov (80%) vs. Profit (72%)

15. Results by Job Title
Administrators/Managers and Physicians scored highest on all patient safety culture composites.
Nursing Assistants/Aides had the lowest scores
Overall Rating on Resident Safety (% “Excellent” or
“Very good”)
- Administrators/Managers and Physicians 81%
- Nursing Assistants/Aides 56%
Willingness to Recommend this Nursing Home to Friends
- Administrators/Managers and Physicians 93%
- Nursing Assistants/Aides 72%

16. Other Respondent Characteristics
Higher scores on 11 of the 12 composites
reported for respondents that:
- Work day shifts
- Have no interaction with residents
There was a 14% difference on Overall Rating on
Resident Safety by shift
- Day shift (65%) vs. Nights (51%)

17. Future Plans for Surveys on Safety Culture
Medical Office Survey on Patient Safety Culture Data Submission is now open
(September 15 – October 15)
Pilot Test of Pharmacy Survey on Patient Safety Culture & release in Summer 2012
Free ongoing technical assistance

18. For Assistance or Questions