Encouraging Safety in Nursing Homes: Organizational Factors

The term “safety culture” refers to an organization’s commitment to an environment in which adverse events can be discussed openly and productively. In health care settings, fostering a safety culture results in a healthier environment for patients. In hospitals, for example, staff members have improved patient safety by openly discussing errors, bringing up potential improvements to workflow, and pointing out other issues. A non-punitive response to staff error encourages more honest reporting of errors, which leads to improved work process. In contrast to hospitals and many other health care settings, relatively little is known about safety culture in nursing homes.

A recent study of four nursing homes in the Detroit area (Arnetz, et. al., 2011) examined the relationship of organizational factors to safety culture, and points to a few factors that can improve safety culture. The authors drew on previous nursing home research to specify specific elements of safety culture that are relevant for nursing homes. Previous research indicates that staff unease regarding reporting errors or potential safety concerns is a significant problem in the nursing home industry, and that a non-punitive environment makes it more likely for staff to report adverse events. Because of this, the researchers wanted to identify organizational factors that encourage the open reporting of errors and communication about safety concerns.

Previous research has also found inconsistent compliance with safety guidelines within the nursing home industry, and suggested several contributing factors for non-compliance, including staff shortages and staff time constraints. As a result, for this study, the researchers designed a questionnaire that included “scales” for non-punitive responses to mistakes and compliance.

The researchers also used previous nursing home findings to identify aspects of organizational climate that might relate to safety culture. Of these, workplace efficiency and staff cohesion were seen to have a positive relationship with non-punitive response to mistakes; clarity of workplace goals were seen to positively relate to communication about adverse incidents; and efficiency, staff cohesion, and low work stress related to compliance.

The article asserts that future studies involving larger samples will be necessary before conclusions can be drawn, but this study is a first step to identifying how nursing homes can establish a safety culture. The findings suggest that potentially changeable organizational characteristics—such as clear workplace goals and manageable levels of stress—can contribute to patient safety.



Arnetz, J.E.; Zhdanova, L.S.; Elsouhag, D.E.; Licthenberg, P.; Luborsky, M.R.; and Arnetz, B.B. (2011). “Organizational Climate Determinants of Resident Safety Culture in Nursing Homes.” The Gerontologist [forthcoming; doi:10:1093/geront/gnr053].

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