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Sion KYJ, Heerings M, Blok M, Scheffelaar A, Huijg JM, Westerhof G, Pot AM, Luijkx K, Hamers JPH. How Stories Can Contribute Toward Quality Improvement in Long-Term Care. THE GERONTOLOGIST 2024; 64:gnad084. [PMID: 37392446 PMCID: PMC10943509 DOI: 10.1093/geront/gnad084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Indexed: 07/03/2023] Open
Abstract
It is important to evaluate how residents, their significant others, and professional caregivers experience life in a nursing home to improve quality of care based on their needs and wishes. Narratives are a promising method to assess this experienced quality of care as they enable a rich understanding, reflection, and learning. In the Netherlands, narratives are becoming a more substantial element within the quality improvement cycle of nursing homes. The added value of using narrative methods is that they provide space to share experiences, identify dilemmas in care provision, and provide rich information for quality improvements. The use of narratives in practice, however, can also be challenging as this requires effective guidance on how to learn from this data, incorporation of the narrative method in the organizational structure, and national recognition that narrative data can also be used for accountability. In this article, 5 Dutch research institutes reflect on the importance, value, and challenges of using narratives in nursing homes.
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Affiliation(s)
- Katya Y J Sion
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
- Living-Lab in Ageing and Long-Term Care, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Marjolijn Heerings
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Marije Blok
- Leyden Academy on Vitality and Ageing, Leiden, Zuid-Holland, The Netherlands
- Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Aukelien Scheffelaar
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
| | - Johanna M Huijg
- Leyden Academy on Vitality and Ageing, Leiden, Zuid-Holland, The Netherlands
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Gerben Westerhof
- Department Psychology, Health and Technology, University of Twente, Enschede, Overijssel, The Netherlands
| | - Anne Margriet Pot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Optentia, North-West University, Vanderbijlpark, Gauteng, South Africa
| | - Katrien Luijkx
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
- Living-Lab in Ageing and Long-Term Care, Maastricht University, Maastricht, Limburg, The Netherlands
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Scheffelaar A, Janssen M, Luijkx K. Learning as a way of achieving quality improvement in long-term care: A qualitative evaluation of The Story as a Quality Instrument. Nurse Educ Pract 2023; 70:103659. [PMID: 37201265 DOI: 10.1016/j.nepr.2023.103659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023]
Abstract
AIM/OBJECTIVE This study aimed to evaluate the use of the narrative quality instrument 'The Story as a Quality Instrument' (or SQI) for learning as a way of achieving quality improvement. BACKGROUND Learning is a widespread aim in long-term care. If professionals share detailed information about their views on the quality of care, they can see it from each other's perspective and create a new joint perspective that may generate a broader meaning in total. One useful source for learning and improvement is the narratives of older adults. These narratives enable reflection and learning, which encourages action. In care organizations, there is a drive to find methods that can be used to facilitate learning and encourage quality improvement. DESIGN A qualitative evaluation design. METHODS Data collection was performed in 2021-2022 at six field sites of four large care organizations providing long-term care to older adults in the Netherlands. At each field site, SQI was applied: an action plan was formulated in a quality meeting and, 8-12 weeks later, the progress was evaluated in a follow-up meeting. The data collected was participants' responses during focus groups: the verbatim transcripts of both meetings and the observation reports of the researchers. 46 participants took part in the quality meetings and 34 participants were present at the follow-up meetings. The data was analyzed using thematic analysis. RESULTS The results are mechanisms that help learning, participant responses, and practical challenges and conditions. Four mechanisms became visible that encourage learning among participants for achieving quality improvements: in-depth discussions, exchange of perspectives, abstraction, and concretization. The participants listed several outcomes regarding individual learning such as change of attitude, viewing older adults more holistically and the realization that possibilities for working on quality improvement could be just a small and part of everyday work. Participants learned from each other as they came to understand each other's perspectives. The added value lay in getting insights into the individual perceptions of clients, the concrete areas for improvement as an outcome, and getting a picture of the perspectives of diverse people and functions represented. Time was found to be the main challenge when applying SQI. CONCLUSIONS SQI is deemed promising for practice, as it allows care professionals to learn in their workplace in a structured way from narratives of older adults in order to improve the quality of care.
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Affiliation(s)
- Aukelien Scheffelaar
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands.
| | - Meriam Janssen
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
| | - Katrien Luijkx
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands
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van de Bovenkamp H, van Pijkeren N, Ree E, Aase I, Johannessen T, Vollaard H, Wallenburg I, Bal R, Wiig S. Creativity at the margins: A cross-country case study on how Dutch and Norwegian peripheries address challenges to quality work in care for older persons. Health Policy 2023; 127:66-73. [PMID: 36543693 DOI: 10.1016/j.healthpol.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripheral areas are often overlooked in health-care research but they in fact deserve specific attention. Such areas struggle to maintain access to good quality health-care services due to their geographical context. At the same time, new interventions or promising innovations often emerge in places where creativity is urgently needed. In this paper, we explore this creativity at the margins in older persons care organizations in peripheral areas, which other healthcare providers and policymakers can learn from. METHODS This exploratory study is based on two large research projects on the quality of care for older persons in Norway and the Netherlands. We performed secondary analysis of interviews with quality managers and other quality workers and used additional document analysis and expert interviews to deepen our analysis. RESULTS The results show that older persons care organizations working in peripheral areas must deal with a number of challenges caused by their geographical context, e.g. geographical distances (between services and to the geographical center), workforce shortages, and landscape characteristics. We found that organizations use different strategies to tackle these challenges, such as scaling up, brightening up and opening up. These strategies, conceptualized as creativity at the margins, impact quality work in different ways, for example by enabling more person-centered care. CONCLUSION We conclude that both policymakers and research should overcome their peripheral blindness by learning from and supporting creativity at the margins in future policies and research.
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Affiliation(s)
- Hester van de Bovenkamp
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands.
| | - Nienke van Pijkeren
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Eline Ree
- Faculty of Health Sciences, University of Stavanger, Norway
| | - Ingunn Aase
- Faculty of Health Sciences, University of Stavanger, Norway
| | | | - Hans Vollaard
- Utrecht School of Governance, Utrecht University, The Netherlands
| | - Iris Wallenburg
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Siri Wiig
- Faculty of Health Sciences, University of Stavanger, Norway
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Management Strategy of Alzheimer’s Patients under the Medical-Care Integration Model Based on Big Data Evaluation. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9896935. [PMID: 36267839 PMCID: PMC9578817 DOI: 10.1155/2022/9896935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
Abstract
In the context of the era of big data, the management of Alzheimer's patients has aroused widespread concern in the society. What should the elderly and people with dementia do and how the society should accommodate these special groups have aroused heated discussions in the society. The goal of the medical-nursing integration model is to realize the integrated model of medical care-nursing-rehabilitation-old care, and to better satisfy the needs by providing medical services, rehabilitation care, and health management. The medical needs of the elderly can help the elderly maintain a healthy state; the elderly care needs can be better met through elderly care services, and the burden on families and society can be reduced. With the advancement of the medical-care integration model, new solutions have been provided for the management of senile dementia patients. Therefore, under the medical-care integration model, this paper managed Alzheimer's patients based on the big data algorithm based on association rules and compared it with the management of Alzheimer's patients under the traditional model, and drew the following conclusions: compared with the management satisfaction of Alzheimer's patients under the traditional model, family members and patients' total satisfaction with nursing management under the medical-care integration model was greatly improved; compared with the management of Alzheimer's patients under the traditional model, the incidence of adverse events in the management of Alzheimer's patients under the medical-care integration model was greatly reduced, which was reduced to 17.6%; under the medical-care integration model, the anxiety and depression scores of the elderly patients with dementia decreased rapidly; under the medical-care integration model, the living ability of senile dementia patients has been greatly improved; the use of the medical-care integration model to manage senile dementia patients has greatly improved the sleep quality, mental quality, and quality of life of senile dementia patients.
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Facilitated reflection meetings as a relational approach to problem-solving within long-term care facilities. J Aging Stud 2021; 59:100965. [PMID: 34794710 DOI: 10.1016/j.jaging.2021.100965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022]
Abstract
Care workers have valuable knowledge to contribute to the improvement of their work environments. Yet incorporating their perspectives into organizational decision-making within long-term care facilities (LTCFs) has been an ongoing challenge. In this article we investigate a promising practice that brought workers and management together in weekly and bimonthly facilitated reflection meetings to identify and resolve problems. Drawing on observations as well as individual and group interviews, we sought to understand whether and how this intervention worked from the perspective of participants. Our study found that one of the main achievements was creating a safe space for workers to speak honestly. They felt heard and treated with respect. In this context, they were willing to surface concerns, failures, and problems for collective deliberation and action. The inclusion of a range of occupational groups ensured that the solutions developed were sensitive to context, including organizational and occupational realities. While the outcomes of the process were impressive, this paper highlights the relational work that created trust, respect, and a spirit of collaboration. We suggest that such facilitated reflection processes may serve as an important strategy to improve the organization of work in LTCFs, one that is particularly well-suited to the dynamic and relational nature of care.
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Timmerman G, Baart A, den Bakker J. Cultivating quality awareness in corona times. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:189-204. [PMID: 33788079 PMCID: PMC8009932 DOI: 10.1007/s11019-021-10010-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 06/09/2023]
Abstract
The Covid-19 pandemic is a tragedy for those who have been hard hit worldwide. At the same time, it is also a test of concepts and practices of what good care is and requires, and how quality of care can be accounted for. In this paper, we present our Care-Ethical Model of Quality Enquiry (CEMQUE) and apply it to the case of residential care for older people in the Netherlands during the Covid-19 pandemic. Instead of thinking about care in healthcare and social welfare as a set of separate care acts, we think about care as a complex practice of relational caring, crossed by other practices. Instead of thinking about professional caregivers as functionaries obeying external rules, we think about them as practically wise professionals. Instead of thinking about developing external quality criteria and systems, we think about cultivating (self-)reflective quality awareness. Instead of abstracting from societal forces that make care possible but also limit it, we acknowledge them and find ways to deal with them. Based on these critical insights, the CEMQUE model can be helpful to describe, interrogate, evaluate, and improve existing care practices. It has four entries: (i) the care receiver considered from their humanness, (ii) the caregiver considered from their solicitude, (iii) the care facility considered from its habitability and (iv) the societal, institutional and scholarly context considered from the perspective of the good life, justice and decency. The crux is enabling all these different entries with all their different aspects to be taken into account. In Corona times this turns out to be more crucial than ever.
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Affiliation(s)
- Guus Timmerman
- Presence Foundation, Grebbeberglaan 15, 3527 VX, Utrecht, The Netherlands.
| | - Andries Baart
- Presence Foundation, Grebbeberglaan 15, 3527 VX, Utrecht, The Netherlands
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan den Bakker
- Presence Foundation, Grebbeberglaan 15, 3527 VX, Utrecht, The Netherlands
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Aase I, Ree E, Johannessen T, Strømme T, Ullebust B, Holen-Rabbersvik E, Thomsen LH, Schibevaag L, van de Bovenkamp H, Wiig S. Talking about quality: how 'quality' is conceptualized in nursing homes and homecare. BMC Health Serv Res 2021; 21:104. [PMID: 33516206 PMCID: PMC7847031 DOI: 10.1186/s12913-021-06104-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The delivery of high-quality service in nursing homes and homecare requires collaboration and shared understanding among managers, employees, users and policy makers from across the healthcare system. However, conceptualizing healthcare professionals' perception of quality beyond hospital settings (e.g., its perspectives, defining attributes, quality dimensions, contextual factors, dilemmas) has rarely been done. This study therefore explores the meaning of "quality" among healthcare managers and staff in nursing homes and homecare. METHODS The study applies a cross-sectional qualitative design with focus groups and individual interviews, to capture both depth and breadth of conceptualization of quality from healthcare professionals in nursing homes and homecare. We draw our data from 65 managers and staff in nursing homes and homecare services in Norway and the Netherlands. The participants worked as managers (n = 40), registered nurses (RNs) or assistant nurses (n = 25). RESULTS The analysis identified the two categories and four sub-categories: "Professional issues: more than firefighting" (subcategories "professional pride" and "competence") and "patient-centered approach: more than covering basic needs" (subcategories "dignity" and "continuity"). Quality in nursing homes and homecare is conceptualized as an ongoing process based on having the "right competence," good cooperation across professional groups, and patient-centered care, in line with professional pride and dignity for the patients. CONCLUSION Based on the understanding of quality among the healthcare professionals in our study, quality should encompass the softer dimensions of professional pride and competence, as well as a patient-centered approach to care. These dimensions should be factors in improvement activities and in daily practice.
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Affiliation(s)
- Ingunn Aase
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Eline Ree
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Terese Johannessen
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Torunn Strømme
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | | | - Elisabeth Holen-Rabbersvik
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Health and Nursing Sciences, University of Agder, Kristiansand Municipality, Kristiansand, Norway
| | | | - Lene Schibevaag
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hester van de Bovenkamp
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Siri Wiig
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Øyri SF, Braut GS, Macrae C, Wiig S. Hospital managers' perspectives with implementing quality improvement measures and a new regulatory framework: a qualitative case study. BMJ Open 2020; 10:e042847. [PMID: 33273051 PMCID: PMC7716670 DOI: 10.1136/bmjopen-2020-042847] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 12/14/2022] Open
Abstract
A new regulatory framework to support local quality and safety efforts in hospitals was introduced to the Norwegian healthcare system in 2017. This study aimed to investigate hospital managers' perspectives on implementation efforts and the resulting work practices, to understand if, and how, the new Quality Improvement Regulation influenced quality and safety improvement activities. DESIGN This article reports one study level (the perspectives of hospital managers), as part of a multilevel case study. Data were collected by interviews and analysed according to qualitative content analysis. SETTING Three hospitals retrieved from two regional health trusts in Norway. PARTICIPANTS 20 hospital managers or quality advisers selected from different levels of hospital organisations. RESULTS Four themes were identified in response to the study aim: (1) adaptive capacity in hospital management and practice, (2) implementation efforts and challenges with quality improvement, (3) systemic changes and (4) the potential to learn. Recent structural and cultural changes to, and development of, quality improvement systems in hospitals were discovered (3). Participants however, revealed no change in their practice solely due to the new Quality Improvement Regulation (2). Findings indicated that hospital managers are legally responsible for quality improvement implementation and participants described several benefits with the new Quality Improvement Regulation (2). This related to adaptation and flexibility to local context, and clinical autonomy as an inevitable element in hospital practice (1). Trust and a safe work environment were described as key factors to achieve adverse event reporting and support learning processes (4). CONCLUSIONS This study suggests that a lack of time, competence and/or motivation, impacted hospitals' implementation of quality improvement efforts. Hospital managers' autonomy and adaptive capacity to tailor quality improvement efforts were key for the new Quality Improvement Regulation to have any relevant impact on hospital practice and for it to influence quality and safety improvement activities.
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Affiliation(s)
- Sina Furnes Øyri
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Geir Sverre Braut
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Safety, Economics and Planning, University of Stavanger, Stavanger, Norway
| | - Carl Macrae
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, Nottinghamshire, UK
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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