Variability in staff perceptions of patient safety culture in Norwegian nursing homes—a longitudinal cross-sectional study

Abstract

Background: Patients in nursing homes are at risk of adverse events, representing a highly vulnerable group that is chronically weak and cognitively or physically reduced. To prevent adverse events, knowledge of patient safety culture can act as a basis for nursing homes' own organizational improvement initiatives. There is scarcity of longitudinal studies exploring the sustainability or variability of safety culture in nursing homes. This study therefore describes the variability in staff perceptions of patient safety culture over time in a cross-sectional sample of Norwegian nursing homes, and tests the influence of nursing homes' own organizational initiatives. Methods: The study applied a cross-sectional and prospective longitudinal design collecting data on staff perceptions of patient safety culture in nine Norwegian nursing homes based on the Norwegian version of the Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument. Data collection took place through a baseline survey (June-September 2013) and through a follow-up survey (March-April 2015). Data were analyzed by descriptive statistics, t-test, and hierarchical regression analysis. Results: The response rate was 70% at baseline and 69% at follow-up. Variability, measured by changes in the average percentage of positive responses per safety culture dimension, showed a high degree of stability for the nine nursing homes in total with more variability across each single nursing home. When comparing mean scores for the total patient safety culture score, only one of the nursing homes improved significantly from the baseline to the follow-up. After adjusting for the facility level (single nursing home), nursing homes' own organizational initiatives explained 29.5% of the variance in the total patient safety culture score (F [4, 263] = 27.53, p < 0.001). Conclusion: Our results demonstrate that patient safety culture is relatively stable in the Norwegian sample of nursing homes over a 20-month period. Our findings indicate that organizational initiatives tailored to local needs are predictors for the total patient safety culture score. Furthermore, there is a need for an extensive and sustained level of effort as only one nursing home (NH6) showed a significant improvement in the total patient safety culture score.

The role of transformational leadership, job demands and job resources for patient safety culture in Norwegian nursing homes: a cross-sectional study

“…However, the heterogeneity of the included units (small and large units and municipalities, urban and rural) are representative for the variability present between nursing homes across the country. Furthermore, the response rate was similar to other Norwegian nursing home studies [48,49], indicating a general challenge in obtaining high response rates in this setting. The small sample size did not allow for sub-group analyses with different professions, age groups, years of experience or between departments within each nursing home.…”

Linking transformational leadership, patient safety culture and work engagement in home care services

“…The Cronbach's alpha value of this total score was .88. Previous studies have demonstrated an acceptable fit of a 10‐factor model of the scale in Norwegian settings (Cappelen et al, , ). The 10 factors are “teamwork,” “staffing,” “compliance with procedures,” “training and skills,” “nonpunitive responses to mistakes,” “handoffs,” “feedback and communication about incidents,” “communication and openness,” “supervisor expectations and actions promoting patient safety” and “organizational learning” (Cappelen et al, ).…”

“…The research on leadership in relation to patient safety in the home care context is scarce. Patient safety research in home care services is limited, as most of the literature on safety culture centres on hospitals and acute care settings (Gartshore, Waring, & Timmons, ) in addition to some recent studies from Norwegian nursing homes (Cappelen, Aase, Storm, Hetland, & Harris, ; Cappelen, Harris, & Aase, ). One study has explored perceptions of the patient safety culture in Norwegian home care services (Olsen & Bjerkan, ).…”

Variation between nursing homes in drug use and in drug-related problems

“…The large difference in DRP levels found between otherwise comparable NHs most probably reflect different institutional prescription cultures, with higher prescription rates at NH-level irrespective of the patient's clinical indications [29] or different organizational initiatives for patient safety at the NH [33]. To improve the quality of drug use in the NH setting, staff should be educated in geriatric pharmacotherapy and on alternative non-pharmacological interventions [9,10].…”