Patient safety culture in Italian nursing homes: staff perceptions and key dimensional factors

Abstract Background Nursing homes (NHs) play an essential role in the care of the elderly and vulnerable, with an increasing demand for such services. Despite their importance, research on patient safety culture (PSC) in NHs is limited, particularly in European settings. This study investigates PSC among NH staff in a northern Italian region and explores how various PSC dimensions shape overall perceptions of patient safety (PS). Methods A cross-sectional study was conducted with the staff from 25 NHs, yielding a 59% response rate. The Italian version of the Nursing Home Survey on Patient Safety Culture (NHSPSC) was validated for this study. Multilevel logistic regression and post-hoc dominance analyses assessed PSC variability across both staff and NHs, and explored how different PSC dimensions contribute to shaping overall PS perceptions. Results Analysis of 1,080 questionnaires revealed significant variability in PSC across the dimensions, with notable differences both within and between NHs. Staffing and Non-punitive Response to Mistakes had the lowest positive response rates (37.7% and 38.8%, respectively). Staff held generally positive perceptions of PS, with a satisfactory mean score of 3.3±0.9 and 74% of staff considering their NH to be safe. However, discrepancies were found between the scores of individual PSC dimensions and overall PS perceptions. Seven out of twelve dimensions significantly influenced overall PS perceptions. The most significant predictors included Organizational Learning, Management Support for PS, and Supervisor Expectations & Actions Promoting PS (p-value=0.001). The total explained variance in overall PS perceptions was 42%, with dimension dominance weights ranging from 12% to 16%. Conclusions To improve PSC within NH staff, targeted efforts should focus on prioritizing specific dimensions. Management support for PSC is essential for shaping NH staff perceptions of PS and should be considered a key focus in ongoing improvement initiatives. Key messages • Leadership support is crucial in shaping nursing home staff perceptions of patient safety and should be prioritized when implementing safety culture interventions. • Variations across PSC dimensions compared to overall patient safety perceptions highlight the need to improve the maturity of safety culture in nursing homes.