Understanding Safety Culture in Long-Term Care A Case Study

• Published in: Journal of patient safety Vol. 10; no. 4; pp. 192 - 201
• Main Authors: Halligan, Michelle H., Zecevic, Aleksandra, Kothari, Anita R., Salmoni, Alan W., Orchard, Treena
• Format: Journal Article
• Language: English
• Published: Philadelphia, Pa Lippincott Williams & Wilkins, a business of Wolters Kluwer Health 01-12-2014; by Lippincott Williams & Wilkins; Lippincott Williams & Wilkins
• Subjects: Biological and medical sciences; Canada; Culture; Focus Groups; Humans; Long-Term Care; Medical sciences; Miscellaneous; Nursing Homes; Organizational Culture; Original Article; Patient Safety; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Canada; Iatrogenic; Accessibility; Methodology; barriers to positive safety culture; long-term care; Patient; Barrier; Method; Comprehension; Knowledge; Safety culture; Care; Case study; Improvement; Goal; safety culture maturity; Patient safety; Complication; Patient Safety Culture Improvement Tool; mixed methods design; Maturity; Long term care; Tool
• ISSN: 1549-8417; 1549-8425
• DOI: 10.1097/PTS.0b013e31829d4ae7

OBJECTIVESThis case study aimed to understand safety culture in a high-risk secured unit for cognitively impaired residents in a long-term care (LTC) facility. Specific objectives included the followingdiagnosing the present level of safety culture maturity using the Patient Safety Culture Improvement Tool (PSCIT), examining the barriers to a positive safety culture, and identifying actions for improvement.
METHODSA mixed methods design was used within a secured unit for cognitively impaired residents in a Canadian nonprofit LTC facility. Semistructured interviews, a focus group, and the Modified Stanford Patient Safety Culture Survey Instrument were used to explore this topic. Data were synthesized to situate safety maturity of the unit within the PSCIT adapted for LTC.
RESULTSResults indicated a reactive culture, where safety systems were piecemeal and developed only in response to adverse events and/or regulatory requirements. A punitive regulatory environment, inadequate resources, heavy workloads, poor interdisciplinary collaboration, and resident safety training capacity were major barriers to improving safety.
CONCLUSIONSThis study highlights the importance of understanding a unit’s safety culture and identifies the PSCIT as a useful framework for planning future improvements to safety culture maturity. Incorporating mixed methods in the study of health care safety culture provided a good model that can be recommended for future use in research and LTC practice.