Safety culture in French nursing homes: A randomised controlled study to evaluate the effectiveness of a risk management intervention associated with care.

Abstract

French Nursing Homes (NHs) are in the early stages of implementing their Risk Management (RM) approach. A regional structure, which was mandated to provide independent support in RM, designed a training package. To study the impact of the RM training package on safety culture (SC) in NHs and drivers for improvement in SC scores. This randomised controlled study targeted French NHs. Inclusion criteria were voluntary participation, no external support provided on the topic of adverse incidents upstream of the project, and the commitment of top management to its implementation. The 61 NHs were randomly allocated to one of two groups: the first benefited from a training package; support was given to the second after the impact measurement. Seven dimensions of SC were measured, at an 18-month interval, using the validated Nursing Home Survey on Patient Safety Culture questionnaire (22 items), which was administered to all of the professionals working in NHs. Eleven variables were captured, relating to the structural profile of the NH, the choices of top management in terms of healthcare safety, and the implementation of the system. Further modelling identified predictive factors for changes in SC scores. 95% of NHs completed both rounds of the questionnaire. The dimension Feedback and communication about incidents (SC = 85.4% before the intervention) significantly improved (+2.8%; p = 0.044). Improvement in the dimension Overall perceptions of resident safety-organizational learning was close to significant (+3.1%; p = 0.075). Drivers for improvement in scores were a pre-existing quality improvement approach, and a steering group that showed RM leadership. The system appears to have improved several dimensions of SC. Our findings are all the more important given the current crisis in the healthcare sector. Retrospectively registered as NCT02908373 (September 21, 2016).