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

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

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

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

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

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

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%

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%

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

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

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

Overall Rating on Resident Safety

Willingness to Recommend to Friends

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 - 1-49 beds (88%) vs. 100-199 beds (74%) - Nonprofit/gov (80%) vs. Profit (72%)

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%

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%)

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

For Assistance or Questions DatabasesOnSafetyCulture@ahrq.hhs.gov SafetyCultureSurveys@ahrq.hhs.gov