For further information about this feedback report, contact: Joseph M. Bestic, NHA, BA

1. Nursing Home (NH) Survey on Patient Safety Culture (SOPSC) Arizona Aggregate Baseline Results November 19, 2009 For further information about this feedback report, contact: Joseph M. Bestic, NHA, BA Director, Nursing Home Health Services Advisory Group, Inc. (HSAG) 1600 E. Northern Avenue, Suite 100 Phoenix, AZ 85020 602.745.6205 jbestic@azqio.sdps.org

2. Background on the Nursing Home Survey • An expansion of the Agency for Healthcare Research and Quality’s (AHRQ) Hospital Survey on Patient Safety Culture www.ahrq.gov/qual/hospculture • Specifically designed to measure the culture of resident safety in nursing homes from a staff perspective • Assesses staff attitudes and beliefs about resident safety • Assess many areas similar to the hospital survey, but items are different • Pilot tested in 2007 in 40 U.S. nursing homes with 3,698 respondents; final survey released on AHRQ Web site in 2008 • Conducted in 2009 in 19 AZ nursing homes with 809 respondents. • Average number of returned surveys per facility: 45

3. Assesses 12 Areas of Resident Safety Survey areas: • Overall Perceptions of Resident Safety • Feedback and Communication About Incidents • Supervisor/Manager Expectations and Actions Promoting Patient Safety • Organizational Learning • Management Support for Resident Safety • Training and Skills • Compliance With Procedures • Teamwork • Handoffs • Communication Openness • Nonpunitive Response to Mistakes • Staffing Two overall rating questions: • Whether staff would tell friends this is a safe nursing home for their family • Overall rating on resident safety

4. Demographic Data About Respondents

5. Demographic Data About Respondents

6. Nursing Home Recommendation

7. Overall Rating on Resident Safety

8. Interpreting the Results • Positively and negatively worded items are used in the survey • A positive response to an item is when respondents answer: • “Strongly Agree/Agree” or “Always/Most of the time” with a positively worded item • “Strongly Disagree/Disagree” or “Never/Rarely” with a negatively worded item

9. Interpreting the Results EXAMPLE OF POSITIVE RESPONSES ON COMPLIANCE WITH PROCEDURES: (This item is negatively worded so disagreeing is “positive”) (This item is negatively worded so disagreeing is “positive”)

10. % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree Overall Perceptions of Resident Safety • Residents are well cared for in this nursing home. (D1) • This nursing home does a good job keeping residents safe. (D6) • This nursing home is a safe place for residents. (D8) NOTE: The item ‘s survey location is in parentheses.

11. % Never/ % Sometimes % Most of the Rarely Time/Always Feedback and Communication About Incidents • When staff report something that could harm a resident, someone takes care of it. (B4) • In this nursing home, we talk about ways to keep incidents from happening again. (B5) • Staff tell someone if they see something that might harm a resident. (B6) 4. In this nursing home, we discuss ways to keep residents safe from harm. (B8) NOTE: The item ‘s survey location is in parentheses.

12. % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree Supervisor Expectations and Actions Promoting Resident Safety • My supervisor listens to staff ideas and suggestions about resident safety. (C1) • My supervisor says a good word to staff who follow the right procedures. (C2) • My supervisor pays attention to resident safety problems in this nursing home. (C3) NOTE: The item ‘s survey location is in parentheses.

13. % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree Organizational Learning • This nursing home lets the same mistakes happen again and again. R (D3) • It is easy to make changes to improve resident safety in this nursing home. (D4) • This nursing home is always doing things to improve resident safety. (D5) • When this nursing home makes changes to improve resident safety, it checks to see if the changes worked. (D10) NOTE: R indicates a negatively worded item; the item ‘s survey location is in parentheses.

14. % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree Management Support for Resident Safety • Management asks staff how the nursing home can improve resident safety. (D2) • Management listens to staff ideas and suggestions to improve resident safety. (D7) • Management often walks around the nursing home to check on resident care. (D9) NOTE: The item ‘s survey location is in parentheses.

15. % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree Training and Skills • Staff get the training they need in this nursing home. (A7) • Staff have enough training on how to handle difficult residents. (A11) • Staff understand the training they get in this nursing home. (A13) NOTE: The item ‘s survey location is in parentheses.

16. % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree Compliance with Procedures • Staff follow standard procedures to care for residents. (A4) • Staff use shortcuts to get their work done faster. R (A6) • To make work easier, staff often ignore procedures. R (A14) NOTE: 1) R indicates a negatively worded item; 2) The item ‘s survey location is in parentheses.

17. % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree Teamwork • Staff in this nursing home treat each other with respect. (A1) • Staff support one another in this nursing home. (A2) • Staff feel like they are part of a team. (A5) • When someone gets really busy in this nursing home, other staff help out. (A9) NOTE: The item ‘s survey location is in parentheses.

18. % Never/ % Sometimes % Most of the Rarely Time/Always Handoffs • Staff are told what they need to know before taking care of a resident for the first time. (B1) • Staff are told right away when there is a change in a resident’s care plan. (B2) • We have all the information we need when residents are transferred from the hospital. (B3) • Staff are given all the information they need to care for residents. (B10) NOTE: The item ‘s survey location is in parentheses.

19. % Never/ % Sometimes % Most of the Rarely Time/Always Communication Openness • Staff ideas and suggestions are valued in this nursing home. (B7) • Staff opinions are ignored in this nursing home. R (B9) • It is easy for staff to speak up about problems in this nursing home. (B11) NOTE: 1) R indicates a negatively worded item; 2) The item ‘s survey location is in parentheses.

20. % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree Nonpunitive Response to Mistakes • Staff are blamed when a resident is harmed. R (A10) • Staff are afraid to report their mistakes. R (A12) • Staff are treated fairly when they make mistakes. (A15) • Staff feel safe reporting their mistakes. (A18) NOTE: R indicates a negatively worded item; the item ‘s survey location is in parentheses.

21. % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree Staffing • We have enough staff to handle the workload. (A3) • Staff have to hurry because they have too much work to do.R (A8) • Residents’ needs are met during shift changes. (A16) • It is hard to keep residents safe here because so many staff quit their jobs.R (A17) NOTE: 1) R indicates a negatively worded item; 2) The item ‘s survey location is in parentheses.

22. Verbatim Survey Comments • 145 Comments over 19 AZ nursing homes. • Recurring negative themes/comments: -Lack of fair treatment – (3) -Lack of professionalism – (1) -No comments – (9) -Lack of management support – (8) -Lack of teamwork – (15) -Did not like the AHRQ NH SOPSC – (1)

23. Verbatim Survey Comments • Recurring negative themes/comments -Lack of communication – (5) -Lack of equipment/supplies – (10) -Neglectful care by others – (8) -Work overload – (3) -Lack of training – (4) -Budget issues – (5) -Staffing issues – (12) -Lack of appreciation – (5)

24. Verbatim Survey Comments Recurring positive themes/comments -Staff overall satisfied – (30) -Staff care – (3) -Management cares – (9) -Good teamwork – (7) -Safety is a priority here – (4) -Good wages – (1) -Good communication – (1) -Good training – (1)

25. Comparison With 40 Pilot Study Nursing Homes

26. Assistance For additional assistance in improving patient safety culture, please visit http://teamstepps.ahrq.gov or contact: Joe Bestic, NHA, BA HSAG Director, Nursing Home 602.745.6205 jbestic@azqio.sdps.org This material was prepared by Health Services Advisory Group, Inc. the Medicare Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services (CMS) an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. AZ-9SOW-6.2-111609-01.