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Patient safety culture assessment in the nursing home
  1. S M Handler1,2,
  2. N G Castle3,
  3. S A Studenski1,4,
  4. S Perera1,5,
  5. D B Fridsma2,
  6. D A Nace1,
  7. J T Hanlon1,6,7
  1. 1Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  4. 4GRECC, VA Pittsburgh, Pittsburgh, Pennsylvania, USA
  5. 5Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  6. 6Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  7. 7Center for Health Equity Research, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
  1. Correspondence to:
 Dr S M Handler
 Division of Geriatric Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213, USA; handlersm{at}


Objective: To assess patient safety culture (PSC) in the nursing home setting, to determine whether nursing home professionals differ in their PSC ratings, and to compare PSC scores of nursing homes with those of hospitals.

Methods: The Hospital Survey on Patient Safety Culture was modified for use in nursing homes (PSC-NH) and distributed to 151 professionals in four non-profit nursing homes. Mean scores on each PSC-NH dimension were compared across professions (doctors, pharmacists, advanced practitioners and nurses) and with published benchmark scores from 21 hospitals.

Results: Response rates were 68.9% overall and 52–100% for different professions. Most respondents (76%) were women and had worked in nursing homes for an average of 9.8 years, and at their current facility for 5.4 years. Professions agreed on 11 of 12 dimensions of the survey and differed significantly (p<0.05) only in ratings for one PSC dimension (attitudes about staffing issues), where nurses and pharmacists believed that they had enough employees to handle the workload. Nursing homes scored significantly lower (ie, worse) than hospitals (p<0.05) in five PSC dimensions (non-punitive response to error, teamwork within units, communication openness, feedback and communication about error, and organisational learning).

Conclusions: Professionals in nursing homes generally agree about safety characteristics of their facilities, and the PSC in nursing homes is significantly lower than that in hospitals. PSC assessment may be helpful in fostering comparisons across nursing home settings and professions, and identifying targets for interventions to improve patient safety.

  • HSOPSC, Hospital Survey on Patient Safety Culture
  • PSC, patient safety culture
  • PSC-NH, patient safety culture in nursing homes

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  • Funding: This study was supported in part by NIH grants 8K12 RR 023267 (Roadmap Multidisciplinary Clinical Research Career Development Award Grant), 5T32AG021885, P30-AG024827, The American Medical Directors Association Foundation/Pfizer Quality Improvement Award and by the Merck/AFAR Junior Investigator Award in Geriatric Clinical Pharmacology.

  • Competing interests: None declared.

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