Abstract
Objectives
To examine perceptions of patient safety culture (PSC) among assisted living (AL)
administrators and direct care workers (DCWs), and their associations with state regulations.
Design
We conducted a survey using the PSC instrument developed by the Agency for Healthcare
Research & Quality. Secondary data on ALs and residents were derived from the Medicare
Master Beneficiary Summary Files. Other data sources were the Area Health Resource
Files, a previously compiled national AL directory, and the US census. Data on state
AL regulations were available from a prior study.
Setting and Participants
Participants included administrators and DCWs working in assisted living communities
serving Medicare beneficiary residents.
Methods
We employed exploratory factor analysis, examined Pearson correlations, and obtained
standardized Cronbach alphas to test the PSC instrument. We estimated linear regression
models with the dependent variable being the proportion of positive PSC assessments,
for each PSC domain, with SEs clustered at the AL level.
Results
Surveys were completed by 714 administrators and DCWs in 257 ALs. The PSC instrument
tested reliable and valid for AL communities. Administrators’ and DCWs’ perceptions
of PSC differed significantly across almost all domains. A 1-unit increase in state
regulatory specificity for DCW staffing was associated with a 4.13–percentage point
(P < .05) increase in the PSC staffing domain. Associations with regulatory specificity
in staff training were also found for other PSC domains.
Conclusions and Implications
PSC is an important metric for assessing organizational performance. DCWs have significantly
worse perceptions of PSC than do administrators, suggesting it is crucial to understand
the source of these differing perceptions. Because state regulations relate to PSC,
achieving a comprehensive focus on patient safety in AL may require regulatory action,
particularly increasing specificity with regard to staffing and training.
Keywords
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Article info
Publication history
Published online: October 17, 2022
Footnotes
The authors declare no conflicts of interest.
This study was supported by a grant from the Agency for Healthcare Research & Quality (R01HS026893 to H.T.-G.). The funders had no role in the study design, data collection and analysis, decision to publish, or in the preparation of the manuscript.
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