title: An exploration of safety climate in nursing homes.
abstract: OBJECTIVE
  Although nursing homes provide complex care requiring attention to safety, research on safety climate in nursing homes is limited. Our study assessed differences in attitudes about safety among nursing home personnel and piloted a new survey, specifically designed for the nursing home context.
  
  
  METHODS
  Drawing on previous safety climate surveys for hospitals and nursing homes, researchers developed the Survey on Resident Safety in Nursing Homes and administered it March to June 2008 to frontline caregivers and managers in 8 randomly selected Massachusetts nursing homes. Our sample consisted of 751 employees, including all full-time, direct-care staff and managers from participating facilities. First, we performed factor analysis and determined Cronbach alphas for the Survey on Resident Safety in Nursing Homes. Then, we described facilities' safety climate and variation by personnel category and among facilities by calculating the proportion of responses that were strongly positive by item, personnel category, and nursing home.
  
  
  RESULTS
  Of 432 respondents (57% response), 29% gave their nursing home an excellent rating overall. Scores varied by personnel category and home: 51% of senior managers gave an excellent safety grade versus 26% of nursing assistants; the range in top safety grades among nursing homes was 30 percentage points.
  
  
  CONCLUSIONS
  Safety climate varied substantially among this small sample of nursing homes and by personnel category; managers had more positive perceptions about safety than frontline workers. Efforts to measure safety climate in nursing homes should include the full range of staff at a facility and comparisons among staff categories to provide a full understanding for decision making and to promote targeted response to improve resident safety.
authors: Harvard School of Public Health, Boston, MA, USA. ssinger@hsph.harvard.edu
authors: Sara
authors: S
authors: Singer
authors: Barrett T
authors: BT
authors: Kitch
authors: Sowmya R
authors: SR
authors: Rao
authors: Alice
authors: A
authors: Bonner
authors: Jennifer
authors: J
authors: Gaudet
authors: David W
authors: DW
authors: Bates
authors: Terry S
authors: TS
authors: Field
authors: Jerry H
authors: JH
authors: Gurwitz
authors: Carol
authors: C
authors: Keohane
authors: Eric G
authors: EG
authors: Campbell
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D019538:Health Care Surveys; D006270:Health Facility Administrators / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008404:Massachusetts; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D015279:Organizational Culture; D061214:Patient Safety / Q000592:standards*; D010865:Pilot Projects; D011594:Psychometrics; D017751:Safety Management / Q000379:methods* / Q000592:standards; D000078329:Workforce