Assisted living direct care workers have significantly worse perceptions of patient safety culture than their administrators, requiring a renewed focus on quality in the industry, according to the results of a new study published in JAMDA, the official journal of AMDA–The Society for Post-Acute and Long-Term Care Medicine.
In fact, the researchers said, achieving a comprehensive focus on resident safety in assisted living may require state regulatory action, particularly in the areas of staffing and training.
The researchers surveyed 714 administrators and direct care workers in 257 assisted living communities to assess perceptions of patient safety culture, a key measure of organizational performance. They noted that a push to measure and improve organizational safety culture was made in the wake of a 2000 Institute of Medicine report that documented that medical errors and safety mistakes in hospitals were largely due to systemic rather than individual staff issues.
According to the Department of Health and Human Services’ Agency for Healthcare Research & Quality, a good patient safety culture reflects beliefs, attitudes, values and norms of work behavior shared among staff. All but one study published about on patient safety culture in long-term care, according to the authors, was conducted in nursing homes and showed an association with better patient/resident care, including lower rates of restraint use, pressure ulcers and falls.
Administrators, staff wide apart on perceptions
In this latest research, investigators found that administrator and caregiver perceptions of patient safety culture in assisted living communities differed significantly across almost all domains, except compliance with procedures.
Only one-fourth of responses in each group (administrator and caregiver) negatively rated compliance within their communities, suggesting that a large portion of assisted living staff members may not fully adhere to the community standards and procedures for resident care where they work, according to the researchers, who called the finding “troubling.”
Caregiver assessments of patient safety culture were significantly lower than those of administrators — by 7.47 percentage points overall — with the largest differences seen in the areas of communication openness, nonpunitive response, management support and teamwork.
The researchers also noted an association between the concentration of residents with Alzheimer’s disease and related dementias and a decrease in the patient safety culture assessment of staff members. Respondents working in larger assisted living communities were more likely to rate communication openness and overall safety perception lower than those working in smaller communities.
The authors concluded that the assessments were “sufficiently sensitive to detect differences between assisted living communities, suggesting both the need and the opportunity for improvement in safety culture.”
Achieving a comprehensive focus on patient safety in assisted living may require state regulatory action, particularly in the areas of staffing and training, they added. Greater regulation of staff training, the authors wrote, increased the positive assessment of staffing, as well as the domains of supervisor expectations, management support and organizational learning.
“Increasing the specificity of assisted living regulations that already exist may be a good first step in promoting safer care practices for assisted living residents, and a better working environment for assisted living staff,” they concluded. “Renewed attention on quality is much needed in this industry, and it may be wise for its leaders, community operators and other stakeholders to start with initiatives focusing on [patient safety culture].”
The survey was conducted between November 2019 and April 2021 by researchers at the University of Rochester and the University of North Carolina, Chapel Hill, NC.
