Relationships among patient safety culture, processes of care, and resident falls in nursing homes

Studies have shown that patient safety culture, defined as the outcome of a concerted organizational effort to move towards safety, is poorly developed in nursing homes (NHs) and therefore, residents of nursing homes may be at risk of harm. Using the Revised Version of Donabedian's Structure-Process-Outcome (SPO) Model, this study examines the relationships among top management's ratings of NH patient safety culture, safe processes of care, and resident outcomes. Using directors of nursing and NH administrators' responses from a nationally representative sample of 3559 NHs on the Agency for Healthcare Research and Quality 2008 Nursing Home Survey on Patient Safety Culture, the Online Survey Certification and Reporting Database, and the Minimum Data Set, we examine if the patient safety culture of NHs is related to processes of care (restraint use and catheterization) and patient safety outcomes (falls). Using hierarchical generalized linear models, we find that higher ratings of patient safety culture were significantly related to lower prevalence of physical restraints (est. = -.003; p<.001) and resident falls (est= -.001; p<.05). Furthermore, poorer processes of care (catheterization and restraint use) were related to negative patient safety outcomes when controlling for structural characteristics and patient safety culture (est.= 0.109, p<.001; est.= 0.573, p<.001; respectively). These findings hopefully will contribute to the development of a patient safety culture in NHs and promote improvements in health care that can be measured by processes of care and resident outcomes.