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Sorensen J, Kadowaki L, Kervin L, Hamilton C, Berndt A, Dhadda S, Irfan A, Leong E, Mithani A. Quality improvement collaborative approach to COVID-19 pandemic preparedness in long-term care homes: a mixed-methods implementation study. BMJ Open Qual 2024; 13:e002589. [PMID: 38589056 PMCID: PMC11015329 DOI: 10.1136/bmjoq-2023-002589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The devastating impact of the COVID-19 pandemic on long-term care (LTC) homes underscores the importance of effective pandemic preparedness and response. This mixed-methods, implementation science study investigated how a virtual-based quality improvement (QI) collaborative approach can improve uptake of pandemic-related promising practices and shared learning across six LTC homes in British Columbia, Canada in 2021 during the COVID-19 pandemic health emergency. METHODS QI teams consisting of residents, family/informal caregivers, care providers and leadership in LTC homes are supported by QI facilitation and shared learning through virtual communication platforms. QI projects address gaps in outbreak preparation, prevention and response; planning for care; staffing; and family presence. Thematically analysed semi-structured qualitative interviews and a validated questionnaire on organisational readiness investigated participants' perceptions of challenges, success factors and benefits of participating in the virtual QI collaborative approach. RESULTS Nine themes were identified through interview analysis, including two related to challenges (ie, making time for QI and hands tied by external forces), four regarding factors for successes (ie, team buy-in, working together as a team, bringing together diverse perspectives and facilitators keep us on track) and three on the benefits of the QI collaborative approach (ie, seeing improvements, staff empowerment and appetite for change). Continuous QI facilitation and coaching for QI teams was feasible and sustainable virtually via video conferencing (Zoom). The QI team members showed limited engagement on the virtual communication platform (Slack), which was predominantly used by the implementation science team and QI facilitators to coordinate the study and QI projects, respectively. CONCLUSIONS The virtual-based QI collaborative approach to pandemic preparedness supported LTC homes to rapidly and successfully form multidisciplinary QI teams, learn about QI methods and conduct timely QI projects to implement promising practice for improved COVID-19 pandemic response.
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Affiliation(s)
- Janice Sorensen
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Laura Kadowaki
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Simon Fraser University Gerontology Research Centre, Vancouver, British Columbia, Canada
| | - Lucy Kervin
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Simon Fraser University Gerontology Research Centre, Vancouver, British Columbia, Canada
| | - Clayon Hamilton
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Annette Berndt
- Long-Term Care and Assisted Living Research Partners Group, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Simran Dhadda
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Abeera Irfan
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Emma Leong
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Akber Mithani
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
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Interventions to enhance safety culture for nursing professionals in long-term care: a systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023. [DOI: 10.1016/j.ijnsa.2023.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Sarakbi D, Mensah-Abrampah N, Kleine-Bingham M, Syed SB. Aiming for quality: a global compass for national learning systems. Health Res Policy Syst 2021; 19:102. [PMID: 34281534 PMCID: PMC8287697 DOI: 10.1186/s12961-021-00746-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 06/23/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Transforming a health system into a learning one is increasingly recognized as necessary to support the implementation of a national strategic direction on quality with a focus on frontline experience. The approach to a learning system that bridges the gap between practice and policy requires active exploration. METHODS This scoping review adapted the methodological framework for scoping studies from Arksey and O'Malley. The central research question focused on common themes for learning to improve the quality of health services at all levels of the national health system, from government policy to point-of-care delivery. RESULTS A total of 3507 records were screened, resulting in 101 articles on strategic learning across the health system: health professional level (19%), health organizational level (15%), subnational/national level (26%), multiple levels (35%), and global level (6%). Thirty-five of these articles focused on learning systems at multiple levels of the health system. A national learning system requires attention at the organizational, subnational, and national levels guided by the needs of patients, families, and the community. The compass of the national learning system is centred on four cross-cutting themes across the health system: alignment of priorities, systemwide collaboration, transparency and accountability, and knowledge sharing of real-world evidence generated at the point of care. CONCLUSION This paper proposes an approach for building a national learning system to improve the quality of health services. Future research is needed to validate the application of these guiding principles and make improvements based on the findings.
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Affiliation(s)
- Diana Sarakbi
- Health Quality Programs, Queen's University, Kingston, Canada.
- Health Quality Programs, Queen's University, Cataraqui Building, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada.
| | | | | | - Shams B Syed
- Integrated Health Services, World Health Organization, Geneva, Switzerland
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Carpenter JG, Ersek M. Developing and implementing a novel program to prepare nursing home-based geriatric nurse practitioners in primary palliative care. J Am Assoc Nurse Pract 2021; 34:142-152. [PMID: 33625167 PMCID: PMC9637018 DOI: 10.1097/jxx.0000000000000565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Current palliative care workforce projections indicate that the growing palliative care needs of older adults in US nursing homes cannot be met by specialists, leaving them vulnerable and at risk for poor end-of-life outcomes. The purpose of this article is to describe the development, implementation, and initial evaluation of a program to support primary care nursing home nurse practitioners (NPs) in palliative care. The program aimed to improve geriatric NPs' knowledge and skills related to palliative care and to provide a structured protocol for integrating palliative care encounters into NPs' practice. It comprised three phases consisting of asynchronous online learning modules, a 1-day face-to-face communication skills and patient simulation workshop, and ongoing monthly virtual meetings to support NP clinical practice. Over a 1-year period, the program was developed and implemented with 12 practicing NPs in a national organization. Through an online survey and face-to-face feedback, NPs reported satisfaction with the curriculum and expressed it as valuable to their clinical practice. Future work will focus on sustaining implementation of the program, measuring patient level outcomes, and refining the curriculum based on NP feedback.
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Affiliation(s)
- Joan G Carpenter
- Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Mary Ersek
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Kamal AH, Bossley H, Blum R, Berman AJ, von Gunten C, Von Roenn J. Evaluation of a Virtual Learning Collaborative to Integrate Palliative Care Into Routine Oncology Practice. JCO Oncol Pract 2020; 16:e1371-e1377. [DOI: 10.1200/jop.19.00254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: The integration of palliative care into usual oncology care is a best practice, but implementation can be challenging. METHODS: We convened a virtual learning collaborative (VLC) of oncology practices with a focus on integrating palliative care. The entire program was virtual, with teams meeting via online Webinar and conference call and accessing content via an online portal. Because of the need to pause and retool after the first 5 months, the VLC evolved into 2 phases, with feedback after the first phase informing the second. We primarily evaluated the reaction of participants and project team members after the completion of the VLC using 2 quantitative surveys (after each phase) and semistructured interviews with participants. RESULTS: A total of 24 oncology practices entered the VLC. Evaluation after each of 2 phases was conducted. For the first evaluation, 67% of respondents agreed a quality improvement coach was helpful to complete the program; 61% agreed a palliative care expert was helpful. The most common reasons for withdrawal involved organizational and VLC factors. Organizational factors included: time constraints, personnel changes (turnover), loss of the champion, and lack of team engagement. Twenty-two active participants and 8 former participants completed the second survey. Of those, 79% agreed the experience with the VLC was valuable, and 74% agreed the virtual delivery mode was useful. We identified 3 themes to drive future improvements related to structure, engagement, and content. CONCLUSION: VLCs are a potential mechanism to disseminate information and facilitate learning in oncology. Further study of program characteristics that promote acceptance of VLCs are needed.
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Niñerola A, Sánchez-Rebull MV, Hernández-Lara AB. Quality improvement in healthcare: Six Sigma systematic review. Health Policy 2020; 124:438-445. [DOI: 10.1016/j.healthpol.2020.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 12/26/2022]
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Katz PR. An International Perspective on Improving Physician Care in Nursing Homes. J Am Med Dir Assoc 2020; 21:295-296. [DOI: 10.1016/j.jamda.2020.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 10/25/2022]
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Carpenter J, Miller SC, Kolanowski AM, Karel MJ, Periyakoil VS, Lowery J, Levy C, Sales AE, Ersek M. Partnership to Enhance Resident Outcomes for Community Living Center Residents With Dementia: Description of the Protocol and Preliminary Findings. J Gerontol Nurs 2019; 45:21-30. [PMID: 30789986 DOI: 10.3928/00989134-20190211-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/09/2019] [Indexed: 11/20/2022]
Abstract
The goal of this quality improvement project is to improve care planning around preferences for life-sustaining treatments (LST) and daily care to promote quality of life, autonomy, and safety for U.S. Department of Veterans Affairs (VA) Community Living Center (CLC) (i.e., nursing home) residents with dementia. The care planning process occurs through partnerships between staff and family surrogate decision makers. This process is separate from but supports implementation of the LST Decision Initiative-developed by the VA National Center for Ethics in Health Care-which seeks to increase the number, quality, and documentation of goals of care conversations (GOCC) with Veterans who have life-limiting illnesses. The current authors will engage four to six VA CLCs in the Mid-Atlantic states, provide teams with audit and feedback reports, and establish learning collaboratives to address implementation concerns and support action planning. The expected outcomes are an increase in CLC residents with dementia who have documented GOCC and LST plans. [Journal of Gerontological Nursing, 45(3), 21-30.].
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Quality Clinical Care in Nursing Facilities. J Am Med Dir Assoc 2019; 19:833-839. [PMID: 30268289 DOI: 10.1016/j.jamda.2018.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 01/29/2023]
Abstract
Despite improvements in selected nursing facility (NF) quality measures such as reduction in antipsychotic use; local, state, and national initiatives; and regulatory incentives, the quality of clinical care delivered in this setting remains inconsistent. Herein, recommendations for overcoming barriers to achieving consistent, high-quality clinical outcomes in long-term (LTC) and post-acute care are provided to address inadequate workforce, suboptimal culture and interprofessional teamwork, insufficiently evidence-based processes of care, and poor adoption and fidelity of technology and integrated clinical decision support. With high staff attrition rates in NFs, mechanisms to measure and close knowledge gaps as well as opportunities for practice simulations should be available to educate and ensure adoption of clinical quality standards on clinician hiring and on an ongoing basis. Multipronged, integrated approaches are needed to further the quest for sustainment of high clinical quality in NF care. In addition to setting a tone for attainment of clinical quality, leadership should champion adoption of practice standards, quality initiatives, and evidence-based guidelines. Maintaining an optimal ratio of hours per resident per day of nurses and nurse aides can improve quality outcomes and staff satisfaction. Clinicians must consistently and effectively apply care processes that include recognition, problem definition, diagnosis, goal identification, intervention, and monitoring resident progress. In order to do so they must have rapid, easy access to necessary tools, including evidence-based standards, algorithms, care plans, during the care delivery process. Embedding such tools into workflow of electronic health records has the potential to improve quality outcomes. On a national and international level, quality standards should be developed by interprofessional LTC experts committed to applying the highest levels of clinical evidence to improve the care of older persons. The standards should be realistic and practical, and basic principles of implementation science must be used to achieve the desired outcomes.
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Mills WL, Pimentel CB, Palmer JA, Snow AL, Wewiorski NJ, Allen RS, Hartmann CW. Applying a Theory-Driven Framework to Guide Quality Improvement Efforts in Nursing Homes: The LOCK Model. THE GERONTOLOGIST 2018; 58:598-605. [PMID: 28651351 PMCID: PMC6281338 DOI: 10.1093/geront/gnx023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 06/13/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. Design and development The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. Results The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. Implications The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.
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Affiliation(s)
- Whitney L Mills
- Center for Innovation in Quality, Effectiveness and Safety, Michael E.
DeBakey VA Medical Center, Houston, Texas
- Department of Medicine, Section of Health Services Research, Baylor College
of Medicine, Houston, Texas
| | - Camilla B Pimentel
- Department of Quantitative Health Sciences, University of Massachusetts
Medical School, Worcester
| | - Jennifer A Palmer
- Center for Healthcare Organization and Implementation Research, Edith Nourse
Rogers Memorial VA Hospital, Bedford, Massachusetts
| | - A Lynn Snow
- Alabama Research Institute on Aging, University of Alabama, Tuscaloosa
- Department of Psychology, University of Alabama, Tuscaloosa
- Tuscaloosa Veterans Affairs Medical Center, Alabama
| | - Nancy J Wewiorski
- Center for Healthcare Organization and Implementation Research, Edith Nourse
Rogers Memorial VA Hospital, Bedford, Massachusetts
| | - Rebecca S Allen
- Alabama Research Institute on Aging, University of Alabama, Tuscaloosa
- Department of Psychology, University of Alabama, Tuscaloosa
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, Edith Nourse
Rogers Memorial VA Hospital, Bedford, Massachusetts
- Department of Health Law, Policy and Management, School of Public Health,
Boston University, Massachusetts
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Burke RE, Cumbler E, Coleman EA, Levy C. Post-acute care reform: Implications and opportunities for hospitalists. J Hosp Med 2017; 12:46-51. [PMID: 28125831 DOI: 10.1002/jhm.2673] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nearly all practicing hospitalists have firsthand experience discharging patients to post-acute care (PAC), which is provided by inpatient rehabilitation facilities, skilled nursing facilities, or home healthcare providers. Many may not know that PAC is poised to undergo transformative change, spurred by recent legislation resulting in a range of reforms. These reforms have the potential to fundamentally reshape the relationship between hospitals and PAC providers. They have important implications for hospitalists and will open up opportunities for hospitalists to improve healthcare value. In this article, the authors explore the reasons for PAC reform and the scope of the reforms. Then they describe the implications for hospitalists and hospitalists' opportunities to Choose Wisely and improve healthcare value for the rapidly growing number of vulnerable older adults transitioning to PAC after hospital discharge.
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Affiliation(s)
- Robert E Burke
- Research Section, Denver VA Medical Center, Denver, CO, USA
- Hospital Medicine Section, Denver VA Medical Center, Denver, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ethan Cumbler
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Eric A Coleman
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cari Levy
- Research Section, Denver VA Medical Center, Denver, CO, USA
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO, USA
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