Employees’ perceptions of patient safety culture in Norwegian nursing homes and home care services

Abstract

Background Most health care services are provided in the primary health care sector, and an increasing number of elderly is in need of these services. Nonetheless, the research on patient safety culture in home care services and nursing homes remains scarce. This study describes staff perceptions of patient safety culture in Norwegian home care services and nursing homes, and assesses how various patient safety culture dimensions contribute to explaining overall perceptions of patient safety. Methods Cross-sectional surveys were conducted among healthcare professionals in Norwegian home care services ( N = 139) and nursing homes ( N = 165) in 2018, response rates being 67.5% and 65%, respectively. A Norwegian version of the international recognized Nursing Home Survey on Patient Safety Culture was used. Descriptive statistics and t-tests were used to explore staff perceptions of patient safety culture. We used multiple regression analyses to explore the degree to which patient safety culture dimensions could explain overall perceptions of patient safety. Results The number of patient safety dimensions having an average score of more than 60% positive responses was seven out of 10 in nursing homes, and nine out of 10 in home care. Staffing had the lowest scores in both health care services. Home care services scored significantly higher than nursing homes on teamwork (eta squared = .053), while nursing homes scored somewhat higher on handover (eta squared = .027). In home care, total explained variance of overall perceptions of patient safety was 45%, with teamwork, staffing, and handoffs as significant predictors. The explained variance in nursing homes was 42.7%, with staffing and communication openness as significant predictors. Conclusions There are differences in perceptions of patient safety culture between nursing homes and home care services. Staffing is important for patient safety perceptions in both health care services. In home care, teamwork seems to be a significant contributing factor to patient safety, and building sound teams with mutual trust and collaboration should therefore be an essential part of managers’ work with patient safety. In nursing homes, the main focus when building a good patient safety culture should be on open communication, ensuring that staff’s ideas and suggestions are valued.

Elder abuse and neglect: an overlooked patient safety issue. A focus group study of nursing home leaders’ perceptions of elder abuse and neglect

“…A recent Norwegian study found that communication, openness and staffing were significant predictors of staff's overall perception of patient safety in nursing homes, yet the nursing home staff scored low on these dimensions [56]. This finding aligns with our study, which revealed that care managers find it difficult to distinguish between prioritising and patient neglect.…”

“…Leaders' abilities to promote a safety culture for both the resident and staff are linked to their leadership skills, knowledge of the resident's needs and their capacity to implement effective safety care practices [6,31,32]. Care managers' lack of awareness in identifying and following up on abuse will necessarily affect the safety culture in the organisation and, in the end, clinical outcomes such as quality and safe care for the residents [6,10,56].…”

Patient safety culture and obstacles to adverse event reporting in nursing homes

“…and 'compliance with procedures' dimensions are the priority areas to be improved in nursing homes, as they had the lowest scores and the lowest PRRs. A similar situation was found in other countries, such as the USA (Smith et al, 2018), Belgium (Desmedt et al, 2018) and Norway (Ree & Wiig, 2019). The majority of staff are reported to be under-educated, lack experience and are only temporarily employed, which was confirmed in a similar study (Yang et al, 2019).…”

Predictors of Patient Safety Activities among Registered Nurses and Nurse Aides in Long-term Care Facilities

“…An effective reporting system identi es safe behaviors that should be adapted to prevent errors, encompassing the individuals' adherence to their safety responsibilities, promises to maintain patient safety, efforts to acquire the latest knowledge on patient safety, and their learnings based on errors to achieve safety goals [47]. Further, noting the nding that administering a patient safety education program to nursing home staff led to a reduction of potential safety incidents (e.g., falls and pressure ulcers) by increasing the staff's awareness of PSC [48], establishing a standardized educational system for nursing home staff is crucial. Thus, teamwork and personnel management founded on open communication, trust, and cooperation within the organization are warranted [49].…”

“…Particularly, nurses play an important role in identifying and managing risk to ensure patient safety at nursing homes [30,31]. The main patient safety activities in LTC facilities include prevention of falls, pressure ulcers, infection, medication safety, inspection of equipment, re safety, and education for residents [32,33]. Previous studies have investigated employees' perceptions of PSC in nursing homes [4,5,[34][35][36][37], but research on the relationship between the perceptions of PSC and patient safety activities of nursing staff is inadequate.…”