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CDA 08-008 – HSR Study

CDA 08-008
Investigating Safety Climate and Outcomes in VA Nursing Homes
Christine W. Hartmann, PhD
VA Bedford HealthCare System, Bedford, MA
Bedford, MA
Funding Period: July 2009 - June 2014
One fundamental aspect to improving care is creating a culture that both reduces the likelihood of individual errors and limits their consequences when they do occur. This project provided a better understanding of resident safety climate-staff members' beliefs and attitudes about resident safety-in VA Community Living Centers (CLCs), which serve a large and vulnerable population.

The objectives included (1) adapting a patient safety climate instrument previously used in VA hospitals for use in CLCs; (2) conducting a preliminary study of resident safety climate in five CLCs.

Objective 1:The CLC Employee Survey of Attitudes about Resident Safety (CESARS) was developed using the following steps: (1) review of the safety climate literature, (2) construction of preliminary survey domains and items, (3) implementation of a modified Delphi approach via online surveys and an in-person meeting with a panel of 13 experts providing iterative input on the survey, (4) 2 rounds of cognitive interviews with CLC staff members. The preliminary instrument had 65 items. Objective 2: The CESARS was piloted at a national conference. Psychometric analyses of the pilot data resulted in revisions to the CESARS. The revised CESARS had 48 items. The revised CESARS was administered at 5 CLCs using a Web-based survey tool. All CLC staff at each site were targeted. Psychometric analyses showed a final, 31-item CESARS was reliable and valid. Data from the survey allowed for characterization of safety climate across the sites. Descriptive statistics were used to characterize variability in safety climate within and among CLCs and among management categories and workgroups and differences between frontline worker management perceptions of safety climate. A toolkit was developed for distribution to all participating CLCs, to aid them in determining and addressing specific safety climate areas.

Not yet available.

The CESARS survey was shown to be reliable and valid. Study results have been published in Medical Care Research and Review and in Research in Gerontological Nursing. In addition to providing preliminary information on safety climate in CLCs, data were also fed back to sites via the safety climate improvement toolkit designed in this study to help sites target specific, relevant, and actionable areas for unit-level improvements in safety climate. The data from the administration of the CESARS served as pilot data for an ongoing funded RRP that is investigating the relationship between CLC safety climate and pressure ulcer care. The CESARS work will be extended in an IIR investigating safety climate in CLCs nationally.

External Links for this Project

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Journal Articles

  1. Palmer JA, Meterko M, Zhao S, Berlowitz D, Mobley E, Hartmann CW. Nursing home employee perceptions of culture change. Research in gerontological nursing. 2013 Jul 1; 6(3):152-60. [view]
  2. Hartmann CW, Meterko M, Zhao S, Palmer JA, Berlowitz D. Validation of a novel safety climate instrument in VHA nursing homes. Medical care research and review : MCRR. 2013 Aug 1; 70(4):400-17. [view]
Conference Presentations

  1. Hartmann CW, Meterko M, Zhao S, Palmer J, Berlowitz DR. A New Instrument for Assessing Safety Climate in VA Nursing Homes: You Can’t Improve What You Can’t Measure. Poster session presented at: Gerontological Society of America Annual Scientific Meeting; 2012 Nov 4; Charlotte, NC. [view]
  2. Palmer J, Meterko M, Zhao S, Berlowitz DR, Hartmann CW. Comfort Levels with Culture Change: A Survey of VA Nursing Home Staff. Poster session presented at: Gerontological Society of America Annual Scientific Meeting; 2012 Nov 4; Charlotte, NC. [view]
  3. Hartmann CW, Meterko M, Zhao S, Palmer J, Berlowitz DR. Community Living Center employees' perceptions of resident safety climate: Validation of a novel instrument and results from a national survey. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 16; National Harbor, MD. [view]
  4. Hartmann CW, Meterko M, Zhao S, Pakmer JA, Berlowitz DR. Cultural Transformation in Select Veterans Affairs Community Living Centers. Symposium participation. Presented at: Pioneer Network Annual Meeting; 2012 Aug 5; Jacksonville, FL. [view]
  5. Hartmann CW, Palmer JA, Berlowitz DR. Development of a New Resident Safety Climate Survey for VA Community Living Centers (Nursing Homes). Poster session presented at: Gerontological Society of America Annual Scientific Meeting; 2011 Nov 19; New Orleans, LA. [view]
  6. Hartmann CW, Palmer J, Berlowitz DR. Resident safety climate in Community Living Centers: A new survey and implementation toolkit. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 18; National Harbor, MD. [view]

DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Prevention
Keywords: Patient outcomes, Safety
MeSH Terms: none

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