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Safety culture of nursing homes: Opinions of top managers

Castle, Nicholas G.; Wagner, Laura M.; Ferguson, Jamie C.; Handler, Steven M.

doi: 10.1097/HMR.0b013e3182080d5f

Background: Examining the perception of patient safety culture (PSC) of top managers in health care settings is important because their orientation to PSC can have a large influence on the facility.

Purposes: In this research, the perception of PSC of nursing home administrators (NHAs) and directors of nursing (DONs) is examined.

Methodology/Approach: Primary data were collected to examine the opinions of NHAs and DONs regarding PSC. Information was collected from a large nationally representative sample of 4,000 nursing homes. The Nursing Home Survey on Patient Safety Culture survey instrument was used as a measure of PSC. This has 12 domains and 38 items. Bias indexes, intraclass correlation coefficients, and Pearson's product-moment correlation coefficients of the differences between NHA and DON item scores were examined.

Findings: Using a 0-100 scale, most scores fell into the 55-80 range. Higher scores represent a higher (more favorable) PSC. Agreement between the NHAs and DONs was excellent in 10 items, good in 15 items, moderate in 4 items, and poor in 8 items. Of the four largest differences in scores, the NHA scores were higher than the DON scores for 1 item, and DON scores were higher than the NHA scores for 3 items.

Implications: The overall perception from both NHAs and DONs appear to represent a somewhat "positive" outlook from these top managers on their institution's PSC. However, NHAs in general report higher scores than DONs do. The areas of divergence between these top managers are further discussed, with a view toward directing future patient safety investigations and initiatives in nursing homes.

Nicholas G. Castle, PhD, is Professor, Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pennsylvania. E-mail:

Laura M. Wagner, PhD, RN, is Gerontological Nursing Research Scientist, Kunin-Lunenfeld Applied Research Unit, Baycrest Geriatric Healthcare System, Toronto, Ontario, Canada. E-mail:

Jamie C. Ferguson, MHA, is Project Director, Graduate School of Public Health, University of Pittsburgh, PA. E-mail:

Steven M. Handler, MD, MS, CMD, is Assistant Professor, Department of Biomedical Informatics, University of Pittsburgh School of Medicine, and Division of Geriatric Medicine Medical Director, LTC Health Information Technology, UPMC Senior Communities Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System (VAPHS), Pittsburgh, Pennsylvania. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.