Patient safety culture and the association with safe resident care in nursing homes.
Avedis Donabedian established the now classic model for analyzing the quality of care according to relationships between care structures, processes, and patient outcomes. Safety problems are endemic at many nursing homes, and this study used the AHRQ Nursing Home Survey on Patient Safety Culture to analyze relationships between a structure (safety culture), a process (use of physical restraints), and an outcome (incidence of falls). There was a small but statistically significant association between higher safety culture scores, lower use of restraints, and fewer falls, indicating that improving safety culture could lead to better patient outcomes. This study used only survey responses from nursing home management, who tend to have more positive perceptions of safety culture than frontline nurses.