Relationship between nursing home safety culture and Joint Commission accreditation

Safety culture interventions in hospitals have been found to be associated with improved safety practices and outcomes. Studies in nursing homes generally report a poorly developed safety culture. Voluntary accreditation provides a structure for organizing care processes and is known to stimulate continuous quality improvement and thereby has the potential to stimulate improvements in organizational safety culture. The impact of Joint Commission accreditation on patient safety culture perceptions among senior managers in nursing homes in the United States was assessed.

A random sample of 6,000 nursing homes was selected from all 50 states. The Nursing Home Survey on Resident Safety Culture was sent to these facilities, and nursing home administrators and directors of nursing were instructed to complete the survey. Scores were computed using the instrument agreement scale, in which the percentage of positive responses represented the summary score. Students' paired sample t-tests were used to compare differences in scores between respondents from accredited nursing homes and those from nonaccredited nursing homes. Multivariate analyses were then used to examine the association between accreditation and each resident safety culture (RSC) subscale, controlling for facility and market characteristics.

The analytic response rate for the sample was 67%. After facility and market characteristics were controlled for, senior managers in accredited nursing homes rated 8 of the 11 RSC domains significantly higher.

Joint Commission accreditation appeared to be associated with a more favorable RSC in nursing homes. Assessing a nursing home's RSC is an organization's first step toward improving the culture of safety. These findings support the need for further discussion and facilitation of voluntary accreditation in nursing homes.