Comparative Results from the AHRQ Nursing Home Survey on Patient Safety Culture Track A, Session 108 Deborah Carpenter R

1. 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

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

3. 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

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

5. 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 Patient Safety Culture Dimensions

6. 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—insafety 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 NHSOPS Comparative Database

7. 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% 2011 NHSOPS Comparative Database

8. 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% Job Titles

9. 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 Work Areas & Patient Contact

10. Nursing Home Strengths

11. Nursing Home Areas for Improvement

12. Overall Rating on Resident Safety

13. Willingness to Recommend to Friends

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

15. 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%

16. 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%)

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 technical assistance

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