Retirement and nursing homes are charged for travel from the home to doctors’ surgeries; residents want more contact to the outside world and excursions. The statement from the operator and the supervisory authority only referred to the visits in accordance with the Styrian Nursing Home Act (Pflegeheimgesetz), which documented no need for change. Recommendations by the NPM are rarely completely rejected by the home because they appear to be insufficiently justified. The failure to implement the recommendations is not because the NPM is requesting the impossible or does not leave the homes any leeway either. Written reactions speak rather of the strain of meeting all of the expectations under the given conditions. For example, a Tyrolean home informed the NPM that enabling residents to go outside as requested by Commission 1 could not be implemented due to staff shortages and the requested evening programme could not be introduced, not even occasionally. The results of international studies confirm the positive effects of experiencing nature and being outside on the health and behaviour of persons suffering from dementia. Evidence shows that bright daylight has a normalising effect on the sleep-wake rhythm. The use of well-designed gardens and pleasant outside areas should therefore be systematically integrated in the care concept. 2.1.2 Complaints of staff shortages from home management and personnel Instruments for quality assurance Care is always complex and process-oriented. The experience of the NPM shows that the quality of care depends on many factors. The qualification and training of the staff, individual knowledge and skills, human and social competence, advanced and further education and the willingness for further personal development all play an important role. The necessary organisational framework includes real (and not merely propagated) role models, a staffing ratio that is proportionate with the actual tasks and challenges, the participation of employees as well as target-oriented interdisciplinary cooperation with other healthcare professions. The culture of error is also of critical importance. The longer suboptimal decisions are made and the later deficits are detected and rectified, the higher will be the damage suffered by those in need of care and indeed the staff as well. A change of consciousness is necessary for a successful culture of error in care facilities – for managers in particular, but also for all employees. Everyone needs to understand that errors are there so that they can learn from them. As long as the attitude of individuals to this topic does not change, errors will be covered up, kept secret, blamed on others. Establishing a positive culture of error The Federal Act on Healthcare and Nursing Professions (Gesundheits- und Krankenpflegegesetz) also recognises prevention, health promotion and advice as a core competence of the higher civil service. In all areas of care the legislator therefore requires – on the basis of medical-nursing knowledge 26