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Assessing the safety culture of care homes: a multimethod evaluation of the adaptation, face validity and feasibility of the Manchester Patient Safety Framework
  1. Martin Marshall1,
  2. Lesley Cruickshank2,
  3. Jenny Shand3,
  4. Sarah Perry1,
  5. James Anderson4,
  6. Li Wei5,
  7. Dianne Parker6,
  8. Debra de Silva7
  1. 1 Primary Care and Population Health, University College London, London, UK
  2. 2 Essex County Council, Chelmsford, UK
  3. 3 UCLPartners, London, UK
  4. 4 Anglia Ruskin Health Partners, London, UK
  5. 5 Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
  6. 6 Safety Culture Associates Limited, Oakwood, UK
  7. 7 Evidence Centre, London, UK
  1. Correspondence to Professor Martin Marshall, Primary Care and Population Health, University College London, Sir Ludwig Guttman Centre, 40 Liberty Bridge Road, London E201AS, UK; martin.marshall{at}


Background Understanding the cultural characteristics of healthcare organisations is widely recognised to be an important component of patient safety. A growing number of vulnerable older people are living in care homes but little attention has been paid to safety culture in this sector. In this study, we aimed to adapt the Manchester Patient Safety Framework (MaPSaF), a commonly used tool in the health sector, for use in care homes and then to test its face validity and preliminary feasibility as a tool for developing a better understanding of safety culture in the sector.

Methods As part of a wider improvement programme to reduce the prevalence of common safety incidents among residents in 90 care homes in England, we adapted MaPSaF and carried out a multimethod participatory evaluation of its face validity and feasibility for care home staff. Data were collected using participant observation, interviews, documentary analysis and a survey, and were analysed thematically.

Results MaPSaF required considerable adaptation in terms of its length, language and content in order for it to be perceived to be acceptable and useful to care home staff. The changes made reflected differences between the health and care home sectors in terms of the local context and wider policy environment, and the expectations, capacity and capabilities of the staff. Based on this preliminary study, the adapted tool, renamed ‘Culture is Key’, appears to have reasonable face validity and, with adequate facilitation, it is usable by front-line staff and useful in raising their awareness about safety issues.

Conclusions ‘Culture is Key’ is a new tool which appears to have acceptable face validity and feasibility to be used by care home staff to deepen their understanding of the safety culture of their organisations and therefore has potential to contribute to improving care for vulnerable older people.

  • Implementation science
  • Nursing homes
  • Patient safety
  • Quality improvement
  • Safety culture

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  • Twitter Follow Martin Marshall @MarshallProf

  • Contributors MM devised the original study and led on the conceptualisation and drafting of this paper. All authors contributed to the development of the ideas and the writing of the text.

  • Funding The Health Foundation (project funded as part of the Closing the Gap scheme).

  • Competing interests None declared.

  • Ethics approval Essex County Council and UCL ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This paper is based on data which is contained in the final report of the PROSPER study, which will be made publicly available in the near future by the Health Foundation. Some of the quotations are not in the final report but are available from the original transcripts or notes of the field work, available from MM.