Banaszak-Holl Jane, Reichert Heidi, Todd Greene M, Mody Lona, Wald Heidi L, Crnich Christopher, McNamara Sara E, Meddings Jennifer
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Institute of Gerontology, University of Michigan Medical School, Ann Arbor, Michigan.
J Am Geriatr Soc. 2017 Oct;65(10):2244-2250. doi: 10.1111/jgs.15030. Epub 2017 Aug 28.
To identify facility- and individual-level predictors of nursing home safety culture.
Cross-sectional survey of individuals within facilities.
Nursing homes participating in the national Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infections Project.
Responding nursing home staff (N = 14,177) from 170 (81%) of 210 participating facilities.
Staff responses to the Nursing Home Survey on Patient Safety Culture (NHSOPS), focused on five domains (teamwork, training and skills, communication openness, supervisor expectations, organizational learning) and individual respondent characteristics (occupation, tenure, hours worked), were merged with data on facility characteristics (from the Certification and Survey Provider Enhanced Reporting): ownership, chain membership, percentage residents on Medicare, bed size. Data were analyzed using multivariate hierarchical models.
Nursing assistants rated all domains worse than administrators did (P < .001), with the largest differences for communication openness (24.3 points), teamwork (17.4 points), and supervisor expectations (16.1 points). Clinical staff rated all domains worse than administrators. Nonprofit ownership was associated with worse training and skills (by 6.0 points, P =.04) and communication openness (7.3 points, P =.004), and nonprofit and chain ownership were associated with worse supervisor expectations (5.2 points, P =.001 and 3.2 points, P =.03, respectively) and organizational learning (5.6 points, P =.009 and 4.2 points, P = .03). The percentage of variation in safety culture attributable to facility characteristics was less than 22%, with ownership having the strongest effect.
Perceptions of safety culture vary widely among nursing home staff, with administrators consistently perceiving better safety culture than clinical staff who spend more time with residents. Reporting safety culture scores according to occupation may be more important than facility-level scores alone to describe and assess barriers, facilitators, and changes in safety culture.
确定疗养院安全文化在机构层面和个人层面的预测因素。
对机构内个体进行横断面调查。
参与国家医疗保健研究与质量机构长期护理安全计划：医疗相关感染/导尿管相关尿路感染项目的疗养院。
来自210家参与机构中170家（81%）机构的做出回应的疗养院工作人员（N = 14,177）。
工作人员对疗养院患者安全文化调查（NHSOPS）的回答，重点关注五个领域（团队合作、培训与技能、沟通开放性、上级期望、组织学习）以及个体受访者特征（职业、任期、工作时长），并与机构特征数据（来自认证和调查提供者强化报告）合并：所有权、连锁会员关系、医疗保险参保居民百分比、床位规模。使用多变量分层模型对数据进行分析。
护理助理对所有领域的评分均低于管理人员（P < .001），沟通开放性（相差24.3分）、团队合作（相差17.4分）和上级期望（相差16.1分）方面的差异最大。临床工作人员对所有领域的评分也低于管理人员。非营利性所有权与较差的培训与技能（相差6.0分，P = .04）和沟通开放性（相差7.3分，P = .004）相关，非营利性和连锁所有权与较差的上级期望（分别相差5.2分，P = .001和3.2分，P = .03）以及组织学习（分别相差5.6分，P = .009和4.2分，P = .03）相关。安全文化中可归因于机构特征的变异百分比小于22%，其中所有权的影响最为显著。
疗养院工作人员对安全文化的认知差异很大，管理人员始终认为安全文化状况优于与居民相处时间更多的临床工作人员。按职业报告安全文化得分对于描述和评估安全文化中的障碍、促进因素及变化可能比仅报告机构层面得分更为重要。
