Safety Culture in French Nursing Homes: A Randomised Controlled Study to Evaluate the Effectiveness of a Risk Management Intervention Associated with Care

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2022 Dec 1

PMID 36454806

Authors

Delphine Teigne

Guillaume Mabileau

Marion Lucas

Leila Moret

Noemie Terrien

Affiliations

Soon will be listed here.

Abstract

Background: French Nursing Homes (NHs) are in the early stages of implementing their Risk Management (RM) approach. A regional structure, which was mandated to provide independent support in RM, designed a training package.

Objective: To study the impact of the RM training package on safety culture (SC) in NHs and drivers for improvement in SC scores.

Method And Analysis: This randomised controlled study targeted French NHs. Inclusion criteria were voluntary participation, no external support provided on the topic of adverse incidents upstream of the project, and the commitment of top management to its implementation. The 61 NHs were randomly allocated to one of two groups: the first benefited from a training package; support was given to the second after the impact measurement. Seven dimensions of SC were measured, at an 18-month interval, using the validated Nursing Home Survey on Patient Safety Culture questionnaire (22 items), which was administered to all of the professionals working in NHs. Eleven variables were captured, relating to the structural profile of the NH, the choices of top management in terms of healthcare safety, and the implementation of the system. Further modelling identified predictive factors for changes in SC scores.

Results: 95% of NHs completed both rounds of the questionnaire. The dimension Feedback and communication about incidents (SC = 85.4% before the intervention) significantly improved (+2.8%; p = 0.044). Improvement in the dimension Overall perceptions of resident safety-organizational learning was close to significant (+3.1%; p = 0.075). Drivers for improvement in scores were a pre-existing quality improvement approach, and a steering group that showed RM leadership.

Conclusions: The system appears to have improved several dimensions of SC. Our findings are all the more important given the current crisis in the healthcare sector.

Trial Registration: Retrospectively registered as NCT02908373 (September 21, 2016).

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References

Lin S, Tseng W, Hsu M, Chiang H, Tseng H . A psychometric evaluation of the Chinese version of the nursing home survey on patient safety culture. J Clin Nurs. 2017; 26(23-24):4664-4674. DOI: 10.1111/jocn.13815. View

Khoshakhlagh A, Yazdanirad S, Motalebi Kashani M, Khatooni E, Hatamnegad Y, Kabir S . A Bayesian network based study on determining the relationship between job stress and safety climate factors in occurrence of accidents. BMC Public Health. 2021; 21(1):2222. PMC: 8650553. DOI: 10.1186/s12889-021-12298-z. View

Teigne D, Mabileau G, Moret L, Terrien N . What is the level of safety culture in French nursing homes? The EHPAGE study. BMC Health Serv Res. 2021; 21(1):1332. PMC: 8666034. DOI: 10.1186/s12913-021-07336-w. View

Smith S, Greene M, Mody L, Banaszak-Holl J, Petersen L, Meddings J . Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative. BMJ Qual Saf. 2017; 27(6):464-473. PMC: 5869141. DOI: 10.1136/bmjqs-2017-006610. View

Halligan M, Zecevic A . Safety culture in healthcare: a review of concepts, dimensions, measures and progress. BMJ Qual Saf. 2011; 20(4):338-43. DOI: 10.1136/bmjqs.2010.040964. View

Boussat B, Seigneurin A, Giai J, Kamalanavin K, Labarere J, Francois P . Involvement in Root Cause Analysis and Patient Safety Culture Among Hospital Care Providers. J Patient Saf. 2017; 17(8):e1194-e1201. DOI: 10.1097/PTS.0000000000000456. View

Hartmann C, Mills W, Pimentel C, Palmer J, Allen R, Zhao S . Impact of Intervention to Improve Nursing Home Resident-Staff Interactions and Engagement. Gerontologist. 2018; 58(4):e291-e301. PMC: 6455946. DOI: 10.1093/geront/gny039. View

Titlestad I, Haugstvedt A, Igland J, Graue M . Patient safety culture in nursing homes - a cross-sectional study among nurses and nursing aides caring for residents with diabetes. BMC Nurs. 2018; 17:36. PMC: 6081853. DOI: 10.1186/s12912-018-0305-z. View

Johannessen T, Ree E, Stromme T, Aase I, Bal R, Wiig S . Designing and pilot testing of a leadership intervention to improve quality and safety in nursing homes and home care (the SAFE-LEAD intervention). BMJ Open. 2019; 9(6):e027790. PMC: 6597165. DOI: 10.1136/bmjopen-2018-027790. View

10.

Ulibarrena M, Sainz de Vicuna L, Garcia-Alonso I, Lledo P, Gutierrez M, Ulibarrena-Garcia A . Evolution of Culture on Patient Safety in the Clinical Setting of a Spanish Mutual Insurance Company: Observational Study between 2009 and 2017 Based on AHRQ Survey. Int J Environ Res Public Health. 2021; 18(18). PMC: 8467676. DOI: 10.3390/ijerph18189437. View

11.

Amalberti R, Vincent C, Nicklin W, Braithwaite J . Coping with more people with more illness. Part 1: the nature of the challenge and the implications for safety and quality. Int J Qual Health Care. 2018; 31(2):154-158. DOI: 10.1093/intqhc/mzy235. View

12.

Marshall M, Pfeifer N, de Silva D, Wei L, Anderson J, Cruickshank L . An evaluation of a safety improvement intervention in care homes in England: a participatory qualitative study. J R Soc Med. 2018; 111(11):414-421. PMC: 6243438. DOI: 10.1177/0141076818803457. View

13.

Teigne D, Mabileau G, Anthoine E, Lucas M, Leclere B, Moret L . Transcultural adaptation and psychometric study of the French version of the nursing home survey on patient safety culture questionnaire. BMC Health Serv Res. 2019; 19(1):490. PMC: 6631961. DOI: 10.1186/s12913-019-4333-5. View

14.

Basson T, Montoya A, Neily J, Harmon L, Watts B . Improving Patient Safety Culture: A Report of a Multifaceted Intervention. J Patient Saf. 2018; 17(8):e1097-e1104. DOI: 10.1097/PTS.0000000000000470. View

15.

Cappelen K, Aase K, Storm M, Hetland J, Harris A . Psychometric properties of the Nursing Home Survey on Patient Safety Culture in Norwegian nursing homes. BMC Health Serv Res. 2016; 16:446. PMC: 5002111. DOI: 10.1186/s12913-016-1706-x. View

16.

Xie J, Ding S, Zhong Z, Zeng S, Qin C, Yi Q . A safety culture training program enhanced the perceptions of patient safety culture of nurse managers. Nurse Educ Pract. 2017; 27:128-133. DOI: 10.1016/j.nepr.2017.08.003. View

17.

Shortell S, GILLIES R, Anderson D, Erickson K, Mitchell J . Remaking health care in America. Hosp Health Netw. 1996; 70(6):43-4, 46, 48. View

18.

Teigne D, Mouret D, Lucas M, Gaultier A, Moret L, Leclere B . [Incidence of adverse events associated with technical care and support in French nursing homes: the EHPAGE project]. Geriatr Psychol Neuropsychiatr Vieil. 2019; 17(3):243-253. DOI: 10.1684/pnv.2018.0775. View

19.

Teigne D, Lucas M, Leclere B, Moret L, Terrien N . Overview of the risk areas associated with care in nursing homes. Geriatr Psychol Neuropsychiatr Vieil. 2017; 15(2):117-126. DOI: 10.1684/pnv.2017.0662. View

20.

Banaszak-Holl J, Reichert H, Greene M, Mody L, Wald H, Crnich C . Do Safety Culture Scores in Nursing Homes Depend on Job Role and Ownership? Results from a National Survey. J Am Geriatr Soc. 2017; 65(10):2244-2250. PMC: 5835315. DOI: 10.1111/jgs.15030. View