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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1060 — Community Living Center Employees’ Perceptions of Resident Safety Climate: Validation of A Novel Instrument and Results from A National Survey

Hartmann CW, Center for Health Quality, Outcomes, and Economic Research (CHQOER); Meterko M, Center for Organizational Leadership and Management Research (COLMR); Zhao SPalmer JA, and Berlowitz D, CHQOER;

A climate of safety—shared values, beliefs, and norms of behavior regarding safety among frontline staff, managers, and leadership—is recognized as a key to reducing adverse events in hospitals. However, we know little about safety climate in Community Living Centers (CLCs). This study explores perceptions of safety climate in a national sample of CLC employees using a VA-specific instrument.

A preliminary version of the CLC Employee Survey of Attitudes about Resident Safety (CESARS) was developed by an expert panel (including CLC and Central Office partners) using a modified Delphi approach. We next conducted two rounds of cognitive interviews and then administered the revised survey at a national CLC employee conference. A Multi-trait analysis (MTA) of these pre-pilot data produced a revised CESARS consisting of 40 items representing 10 separate dimensions, plus 8 demographic items. This version was subsequently administered by Web in 5 geographically diverse CLCs in 4 VISNs, and MTA was applied to these pilot data.

We had an overall response rate of 43% (n = 300) across the 5 sites (range 26%-66%). Chronbach alphas for the 8 multi-item scales ranged from 0.71 to 0.95. The percent item internal consistency and discriminant validity were 96% and 98%, respectively. Based on a 9-point scale where higher scores indicated a stronger safety climate, staff felt extremely responsible for keeping residents safe (mean = 8.3) and very comfortable speaking up if they noticed a resident in an unsafe situation (mean = 8.0). However, perceptions of safety-related teamwork (mean = 6.5) and of coworker receptivity to expressed concerns about resident safety (mean = 6.7) were weaker. Additionally, staff did not feel publicly rewarded or praised for keeping residents safe (mean = 4.3) and had not seen senior leadership on the units (mean = 4.8).

The CESARS instrument demonstrated strong psychometric properties. There was considerable variation in the perception of CLC staff across the dimensions of safety climate, indicating some aspects of safety climate are strong, while others can be improved.

Facility-specific results were distributed to participating sites along with an extensive toolkit for improving safety climate. This study capitalized on a strong relationship between research, CLC operational partners, and front-line staff.

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