Items and Dimensions

Nursing Home Survey on Patient Safety Culture

In this document, the items in the Nursing Home Survey on Patient Safety Culture are grouped according to the safety culture dimensions they are intended to measure. The item's survey location is shown to the left of each item. Negatively worded items are indicated. Reliability statistics based on the pilot test data from 40 nursing homes and over 3,600 nursing home staff are provided for the dimensions.

1. Teamwork

(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

A1.   Staff in this nursing home treat each other with respect.
A2.   Staff support one another in this nursing home.
A5.   Staff feel like they are part of a team.
A9.   When someone gets really busy in this nursing home, other staff help out.

Reliability of this dimension—Cronbach's alpha (4 items) = .86

2. Staffing

(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

A3.   We have enough staff to handle the workload.
A8.   Staff have to hurry because they have too much work to do. (negatively worded)
A16.   Residents' needs are met during shift changes.
A17.   It is hard to keep residents safe here because so many staff quit their jobs. (negatively worded)

Reliability of this dimension—Cronbach's alpha (4 items) = .71

3. Compliance With Procedures

(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

A4.   Staff follow standard procedures to care for residents.
A6.   Staff use shortcuts to get their work done faster. (negatively worded).
A14.   To make work easier, staff often ignore procedures. (negatively worded)

Reliability of this dimension—Cronbach's alpha (3 items) = .73

4. Training & Skills

(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

A7.   Staff get the training they need in this nursing home.
A11.   Staff have enough training on how to handle difficult residents.
A13.   Staff understand the training they get in this nursing home.

Reliability of this dimension—Cronbach's alpha (3 items) = .76

5. Nonpunitive Response to Mistakes

(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

A10.   Staff are blamed when a resident is harmed. (negatively worded).
A12.   Staff are afraid to report their mistakes. (negatively worded).
A15.   Staff are treated fairly when they make mistakes.
A18.   Staff feel safe reporting their mistakes.

Reliability of this dimension—Cronbach's alpha (4 items) = .74

6. Handoffs

(Never, Rarely, Sometimes, Most of the time, Always, Does Not Apply or Don't Know)

How often do the following things happen in your nursing home?

B1.   Staff are told what they need to know before taking care of a resident for the first time.
B2.   Staff are told right away when there is a change in a resident's care plan.
B3.   We have all the information we need when residents are transferred from the hospital.
B10.   Staff are given all the information they need to care for residents.

Reliability of this dimension—Cronbach's alpha (4 items) = .86

7. Feedback & Communication About Incidents

(Never, Rarely, Sometimes, Most of the time, Always, Does Not Apply or Don't Know)

How often do the following things happen in your nursing home?

B4.   When staff report something that could harm a resident, someone takes care of it.
B5.   In this nursing home, we talk about ways to keep incidents from happening again.
B6.   Staff tell someone if they see something that might harm a resident.
B8.   In this nursing home, we discuss ways to keep residents safe from harm.

Reliability of this dimension—Cronbach's alpha (4 items) = .85

8. Communication Openness

(Never, Rarely, Sometimes, Most of the time, Always, Does Not Apply or Don't Know)

How often do the following things happen in your nursing home?

B7.   Staff ideas and suggestions are valued in this nursing home.
B9.   Staff opinions are ignored in this nursing home. (negatively worded)
B11. It is easy for staff to speak up about problems in this nursing home.

Reliability of this dimension—Cronbach's alpha (3 items) = .84

9. Supervisor Expectations & Actions Promoting Resident Safety**

(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

C1.   My supervisor listens to staff ideas and suggestions about resident safety.
C2.   My supervisor says a good word to staff who follow the right procedures.
C3.   My supervisor pays attention to resident safety problems in this nursing home.

Reliability of this dimension—Cronbach's alpha (3 items) = .81

10. Overall Perceptions of Resident Safety

(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

D1.   Residents are well cared for in this nursing home.
D6.   This nursing home does a good job keeping residents safe.
D8.   This nursing home is a safe place for residents.

Reliability of this dimension—Cronbach's alpha (3 items) = .86

11. Management Support for Resident Safety

(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

D2.   Management asks staff how the nursing home can improve resident safety.
D7.   Management listens to staff ideas and suggestions to improve resident safety.
D9.   Management often walks around the nursing home to check on resident care.

Reliability of this dimension—Cronbach's alpha (3 items) = .83

12. Organizational Learning

(Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree, Does Not Apply or Don't Know)

How much do you agree or disagree with the following statements?

D3.   This nursing home lets the same mistakes happen again and again. (negatively worded)
D4.   It is easy to make changes to improve resident safety in this nursing home.
D5.   This nursing home is always doing things to improve resident safety.
D10.   When this nursing home makes changes to improve resident safety, it checks to see if the changes worked.

Reliability of this dimension—Cronbach's alpha (4 items) = .81

13. Overall Ratings

(Yes, Maybe, No)
E1.   I would tell friends that this is a safe nursing home for their family.

(Poor, Fair, Good, Very good, Excellent)
E2.   Please give this nursing home an overall rating on resident safety.

Note: Negatively worded questions should be reverse coded when calculating percent "positive" response, means, and composites.

**Partially adapted from Zohar D. A group-level model of safety climate: Testing the effect of group climate on microaccidents in manufacturing jobs. Journal of Applied Psychology 2000;85(4):587-96.

Current as of February 2011
Internet Citation: Items and Dimensions: Nursing Home Survey on Patient Safety Culture. February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/nursing-home/resources/nhdimensions.html