Comparative Results from the AHRQ Nursing Home Survey on Patient Safety Culture

Slide Presentation from the AHRQ 2011 Annual Conference

Slide 1

Comparative Results from the AHRQ Nursing Home Survey on Patient Safety Culture

Track A, Session 108

Deborah Carpenter RN MSM 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

Slide 2

Objectives

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

Slide 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.

Slide 4

Background

• AHRQ Nursing Home Survey on Patient Safety Culture released in fall 2008.
• Survey and support tools available at: http://www.ahrq.gov/qual/patientsafetyculture/nhsurvindex.htm.

Slide 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.

Slide 6

NHSOPS Comparative Database

• AHRQ funded a NHSOPS comparative database:
  • Reports (2008 preliminary & 2011).
  • http://www.ahrq.gov/qual/nhsurvey11/.
• 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.

Slide 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%.

Slide 8

Job Titles

• Nursing Assistant/Aide 35% (5,154).
• Support Staff 18%.
• Licensed Nurse 17%.
• Administrator/Manager 10%.
• Direct Care Staff 9%.
• Administrative Support Staff 5%.
• Other 4%.
• Physician (MD, DO) 1%.
• Other Provider 1%.

Slide 9

Work Areas & Patient Contact

• Many different areas/no specific 46%.
• Skilled nursing unit 21%.
• Other area or unit 20%.
• Alzheimer's/Dementia unit 7%.
• Rehab unit 6%.

• 71% had direct interaction with residents.

Slide 10

Nursing Home Strengths

1. Overall Perceptions of Resident Safety 86%.
2. Feedback and Communication About Incidents 84%.
3. Supervisor Expectations & Actions Promoting Resident Safety 79%.

Slide 11

Nursing Home Areas for Improvement

12. Nonpunitive Response to Mistakes 51%.
11. Staffing 52%.
10. Communication Openness 56%.

Slide 12

Overall Rating on Resident Safety

Slide 13

Willingness to Recommend to Friends

Slide 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 homes to friends:
  • 1-49 beds (88%) vs. 100-199 beds (74%).
  • Nonprofit/gov (80%) vs. Profit (72%).

Slide 15

Results by Job Title

• Administrators/Manager 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/Aidea 56%.
• Willingness to Recommend this Nursing Home to Friends.
  • Administrators/Managers and Physicians 93%.
  • Nursing Assistants/Aides 72%.

Slide 16

Other Respondent Characteristics

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

Slide 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.

Slide 18

For Assistance or Questions

• DatabasesOnSafetyCulture@ahrq.hhs.gov.
• SafetyCultureSurveys@ahrq.hhs.gov.