Executive Summary

2011 User Comparative Database Report

The Nursing Home Survey on Patient Safety Culture, released in 2008, is an expansion of the Hospital Survey on Patient Safety Culture from the Agency for Healthcare Research and Quality (AHRQ). The nursing home survey is specifically designed to measure the culture of resident safety in nursing homes from a staff perspective. The Nursing Home Survey on Patient Safety Culture: 2011 User Comparative Database Report consists of data from 226 nursing homes and 16,155 nursing home staff respondents who completed the survey.

This comparative database report was developed as a tool for the following purposes:

  • Comparison—To allow nursing homes to compare their patient safety culture survey results with those of other nursing homes
  • Assessment and Learning—To provide data to nursing homes to facilitate internal assessment and learning in the patient safety improvement process.
  • Supplemental Information—To provide supplemental information to help nursing homes identify their strengths and areas with potential for improvement in patient safety culture.

Survey Content

The nursing home survey is designed to assess nursing home staff opinions about resident safety issues, medical errors, and event reporting. The survey includes 42 items that measure 12 areas, or composites, of patient safety culture:

  1. Communication openness.
  2. Compliance with procedures.
  3. Feedback and 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. Supervisor expectations and actions promoting resident safety.
  11. Teamwork.
  12. Training and skills.

The survey also includes two questions that ask respondents whether they would tell friends that this is a safe nursing home for their family (also called "willingness to recommend") and to provide an overall rating on resident safety for their nursing home.

Survey Administration Statistics

  • The average nursing home response rate was 67 percent, with an average of 71 completed surveys per nursing home.
  • Most nursing homes (83 percent) administered paper surveys. On average, nursing homes administering a paper survey had higher response rates (70 percent) compared with response rates from Web (49 percent) or mixed-mode surveys (56 percent).
  • All nursing homes but one administered the survey to all staff or a sample of all staff.

Characteristics of Participating Nursing Homes

  • The nursing homes represent a range of bed sizes and geographic regions.
  • Just under half the nursing homes are for profit (48 percent).
  • Overall, the characteristics of the 226 database nursing homes are similar to the distribution of U.S. nursing homes in the Centers for Medicare & Medicaid's Nursing Home Compare database.

Characteristics of Respondents

  • There were 16,155 nursing home staff respondents from 226 nursing homes.
  • The top three job titles of respondents were:
    • Nursing Assistant/Aide (35 percent).
    • Support Staff (18 percent).
    • Licensed Nurse (17 percent).
  • The top three work areas of respondents were:
    • Skilled Nursing (21 percent).
    • Other (20 percent).
    • Alzheimer's/Dementia (7 percent).
  • Most respondents (71 percent) indicated that they had direct interaction with residents.

Areas of Strength for Most Nursing homes

Results are expressed in terms of percent positive response. Percent positive is the percentage of positive responses (e.g., Agree, Strongly agree) to positively worded items (e.g., "Staff support one another in this nursing home") or negative responses (e.g., Disagree, Strongly disagree) to negatively worded items (e.g., "Staff use shortcuts to get their work done faster").

Overall Perceptions of Resident Safety (average 86 percent positive response)— This composite is defined as the extent to which residents are well cared for and safe. This composite had the highest average percent positive response.

Feedback and Communication About Incidents (average 84 percent positive response)— This composite is defined as the extent to which staff discuss ways to keep residents safe, tell someone if they see something that might harm a resident, and talk about ways to keep incidents from happening again. This composite had the second highest average percent positive response.

Areas With Potential for Improvement for Most Nursing homes

Nonpunitive Response to Mistakes (average 51 percent positive response)— This composite is defined as the extent to which staff are not blamed when a resident is harmed, are treated fairly when they make mistakes, and feel safe reporting their mistakes. This composite had the lowest average percent positive response.

Staffing (average 52 percent positive response)— This composite is defined as the extent to which there are enough staff to handle the workload, meet residents' needs during shift changes, and keep residents safe because there is not much staff turnover. This composite had the second lowest average percent positive response.

Results by Nursing Home Characteristics

Bed Size

  • Small nursing homes (49 or fewer beds) had the highest average percent positive response on 10 of the 12 patient safety culture composites.
  • Small nursing homes (49 or fewer beds) had the highest percentage of respondents who indicated they would tell their friends that this is a safe nursing home for their family (88 percent for 49 or fewer beds versus 74 percent for 100-199 beds).
  • Small nursing homes (49 or fewer beds) had the highest percentage of respondents who gave their nursing home an overall rating on resident safety of "Excellent" or "Very Good" (77 percent for 49 or fewer beds versus 59 percent for 100-199 beds and 200 beds or more).

Ownership

  • Nonprofit/government nursing homes had a higher average percent positive response than for profit nursing homes on all 12 patient safety culture composites.
  • Nonprofit/government nursing homes had a higher percentage of respondents who indicated they would tell their friends that this is a safe nursing home for their family (80 percent) than for profit nursing homes (72 percent).
  • Nonprofit/government nursing homes had a higher percentage of respondents who gave their nursing home an overall rating on resident safety of "Excellent" or "Very Good" (66 percent) than for profit nursing homes (57 percent).

Results by Respondent Characteristics

Job Title

  • Administrators/Managers and Physicians had the highest average percent positive response across the patient safety culture composites (79 percent positive); Nursing Assistants/Aides had the lowest (63 percent positive).
  • Administrators/Managers and Physicians had the highest percentage of respondents who indicated they would tell their friends that this is a safe nursing home for their family (93 percent); Nursing Assistants/Aides had the lowest (72 percent).
  • Administrators/Managers had the highest percentage of respondents who gave their nursing home an overall rating on resident safety of "Excellent" or "Very Good" (81 percent); Other Providers had the lowest (56 percent).

Work Area

  • Results for the patient safety culture composites and willingness to recommend were quite similar across work areas.
  • Respondents who indicated they worked in Many different areas in this nursing home/No specific area or unit had the highest percentage of respondents who gave their nursing home an overall rating on resident safety of "Excellent" or "Very Good" (63 percent); Alzheimer's/Dementia Unit and Rehab Unit had the lowest (58 percent).

Interaction With Residents

  • Respondents without direct interaction with residents were more positive on 11 of the 12 patient safety composites than those with direct interaction with residents. The average response across all 12 composites was 73 percent positive for respondents without direct interaction with residents and 66 percent positive for respondents with direct interaction with residents.
  • Respondents without direct interaction with residents had a higher percentage of respondents who indicated they would tell their friends that this is a safe nursing home for their family (81 percent) than respondents with direct interaction with residents (75 percent).
  • Respondents without direct interaction with residents had a higher percentage of respondents who gave their nursing home an overall rating on resident safety of "Excellent" or "Very Good" (69 percent) than respondents with direct interaction with residents (60 percent).

Shift Worked Most Often

  • Respondents working day shifts had the highest average percent positive response on 11 of the 12 patient safety culture composites. The average percent positive response across all 12 composites was 69 percent positive for respondents working day shifts versus 62 percent positive for respondents working nights.
  • Respondents working day shifts had the highest percentage who indicated they would tell their friends that this is a safe nursing home for their family (79 percent for respondents working days versus 74 percent for respondents working evenings and 70 percent for respondents working nights).
  • Respondents working day shifts had the highest percentage who gave their nursing home an overall rating on resident safety of "Excellent" or "Very Good" (65 percent for respondents working days versus 60 percent for respondents working evenings and 51 percent for respondents working nights).

Action Planning for Improvement

The delivery of survey results is not the end point in the survey process; it is just the beginning. Often, the perceived failure of surveys to create lasting change is actually due to faulty or nonexistent action planning or survey followup.

Seven steps of action planning are provided to give nursing homes guidance on next steps to take to turn their survey results into actual patient safety culture improvement:

  1. Understand your survey results.
  2. Communicate and discuss the survey results.
  3. Develop focused action plans.
  4. Communicate action plans and deliverables.
  5. Implement action plans.
  6. Track progress and evaluate impact.
  7. Share what works.
Page last reviewed August 2011
Internet Citation: Executive Summary: 2011 User Comparative Database Report. August 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/nursing-home/2011/nhsurv11summ.html