Quality improvement in a publicly provided long-term care system: the case of Norway

Team dynamics within quality improvement teams: a scoping review

Purpose

This scoping review examines what is known about the processes of quality improvement (QI) teams, particularly related to how teams impact outcomes. The aim is to provide research-informed guidance for QI leaders and to inform future research questions.

Data sources

Databases searched included: MedLINE, EMBASE, CINAHL, Web of Science and SCOPUS.

Study selection

Eligible publications were written in English, published between 1999 and 2016. Articles were included in the review if they examined processes of the QI team, were related to healthcare QI and were primary research studies. Studies were excluded if they had insufficient detail regarding QI team processes.

Data extraction

Descriptive detail extracted included: authors, geographical region and health sector. The Integrated (Health Care) Team Effectiveness Model was used to synthesize findings of studies along domains of team effectiveness: task design, team process, psychosocial traits and organizational context.

Results of data synthesis

Over two stages of searching, 4813 citations were reviewed. Of those, 48 full-text articles are included in the synthesis. This review demonstrates that QI teams are not immune from dysfunction. Further, a dysfunctional QI team is not likely to influence practice. However, a functional QI team alone is unlikely to create change. A positive QI team dynamic may be a necessary but insufficient condition for implementing QI strategies.

Conclusions

Areas for further research include: interactions between QI teams and clinical microsystems, understanding the role of interprofessional representation on QI teams and exploring interactions between QI team task, composition and process.

Aspects of corporate wellness programs: comparisons of customer satisfaction

Purpose

With the passage of the Affordable Health Care Act in the USA, many companies are investing in corporate wellness programs as a way to reduce healthcare costs and increase productivity of their workforces. Increasing healthcare expenditures and the pandemic of obesity and chronic diseases are driving forces to the development and implementation of workplace wellness programs across the globe. Companies expect to experience a return on their investment through lower healthcare costs and increased productivity. The paper aims to discuss these issues.

Design/methodology/approach

In this study, 109 business professionals were surveyed (primarily almost equally divided between Russian and Americans citizens) to examine their health-promoting and health risk behaviors. Demographics were compared in an effort to identify the key differences in order to pinpoint development opportunities to increase efficiencies among target populations.

Findings

According to the results, nationality was related to certain differences in health-promoting behaviors, participation rates and frequency of wellness programs offered by employers. No differences were found among different age groups. The results indicated that not even a single wellness program design is appropriate for all companies or even one company across all locations.

Research limitations/implications

Although there were no general conclusions have been drawn nor have the influencing factors for the different behaviors of the various target groups been adequately examined in this exploratory study, there were baselines developed for future research.

Originality/value

Few empirical studies exists that measure the perceived value of corporate wellness programs, especially among different cultural settings. In effect, wellness programs need to be developed specifically for the target population, with considerations to perceived value differences.

The match between institutional elderly care management research and management challenges - a systematic literature review

BACKGROUND

Elderly care practice and its management together with policy and research play a crucial role in responding to increasing challenges in institutional care for elderly people. Successful dialogue between these is necessary. The purpose of this systematic literature review is to compare how institutional elderly care management research meets the care challenges currently emphasized in international long-term care policy documents.

METHODS

This paper was based on a systematic literature review. After screening 1971 abstracts using inclusion/exclusion criteria, 58 refereed articles published between 2000 and 2010 remained for analysis. The articles were analyzed using theory-based content analysis by comparing the results to the framework based on analysis of international long-term care management policy documents.

RESULTS

The current challenges of long-term care management identified from policy documents were Integrated Care Management, Productivity Management, Quality Management, Workforce Management and ICT Management. The research on institutional elderly care management responded somewhat to the challenges mentioned in policy documents. However, some of the challenges were studied broadly and some were paid only minor attention. Further, only few studies focused on the core items of challenges addressed in policy documents.

CONCLUSIONS

Institutional care management research needs to focus more on challenges in integrated care, productivity, ICT and division of labor. Managers, researchers and policy-makers should assume more active collaborative roles in processes of research, policymaking and policy implementation. In addition managers' and policymakers' scientific literacy needs to be enhanced.

Perceived service quality, perceived value, overall satisfaction and happiness of outlook for long-term care institution residents

OBJECTIVE

To investigate the psychometric properties and relationships of perceived service quality, perceived value and overall satisfaction for residents with respect to their long-term care institutions.

DESIGN

The five-point Likert scale questionnaire administered through facetoface interviews.

SETTING

Fourteen long-term care institutions located in central and southern Taiwan stratified according to services and accommodation population.

PARTICIPANTS

One hundred and eighty long-term institutional care residents.

MAIN OUTCOME MEASURES

Perceived service quality (the SERVPERF model), perceived value and overall satisfaction (models based on the literature on perceived value and satisfaction).

RESULTS

Student's t-test on institutional location shows a significant difference between overall satisfaction for central and southern institution long-term care recipients. The correlation test revealed that the higher a resident's level of education, the higher the scores for perceived value. The factor loading results of confirmation factor analysis show acceptable levels of reliability and index-of-model fits for perceived service, perceived value and overall satisfaction. In addition, the results suggest that an additional construct, a positive attitude (happiness of outlook) towards long-term care institutions, is also an important factor in residents' overall satisfaction.

CONCLUSION

The primary goal of long-term institutional care policy in Taiwan, as in other countries, is to provide residents with practical, cost-effective but high-quality care. On the basis of the results of in-depth interviews with long-term institutional care residents, this study suggests long-term care institutions arrange more family visit days to increase the accessibility and interaction of family and residents and thereby increase the happiness of outlook of the residents.

Home care in Europe: a systematic literature review

BACKGROUND

Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade.

METHODS

A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care 'policy & regulation', 'financing', 'organisation & service delivery', and 'clients & informal carers'.

RESULTS

Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed.

CONCLUSIONS

Home care systems appeared to differ both between and within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially studies comparing countries. A comprehensive and more complete insight into the state of home care in Europe requires the gathering of information using a uniform framework and methodology.

Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly

BACKGROUND

Computerized decision support systems (CDSSs) have been shown to help health care professionals to avoid errors and improve clinical practice and efficiency in health care. Little is known about its influence on nursing practice and outcomes for residents in nursing homes.

AIM

The aim of this study was to evaluate the effects on the risk for and prevalence of pressure ulcers (PUs) and malnutrition of implementing a CDSS to improve prevention and care of PUs and also to improve nutrition in the elderly in nursing homes.

DESIGN SETTING AND PARTICIPANTS

The study used a quasi-experimental design with two intervention groups and one control group. A convenience sample of residents from 46 units in 15 nursing homes in rural areas in Norway was included. A total of 491 residents participated at baseline in 2007 and 480 residents at follow-up in 2009.

METHODS

The intervention included educational sessions in prevention of PUs and malnutrition for registered nurses (RNs) and nursing aides (NAs) in the two intervention groups. In addition, one intervention group (intervention group 1) had a CDSS integrated into the electronic healthcare record (EHR) based on two research-based risk assessment instruments: the Risk Assessment Pressure Scale (RAPS) for PU risk screening and the Mini Nutritional Assessment (MNA(®)) scale for screening nutritional status. In each participating nursing home trained RNs and NAs examined all residents who consented to participate on the RAPS and the MNA(®) scale. This examination included a skin assessment and details about PUs were collected.

RESULTS

The proportion of malnourished residents decreased significantly in intervention group 1 between the two data collection periods (2007 and 2009). No other significant effects of the CDSS on resident outcomes based on the RAPS and MNA(®) scores were found.

CONCLUSION

CDSSs used by RNs and NAs in nursing homes are still largely unexplored. A CDSS can be incorporated into the EHR to increase the meaningful use of these computerized systems in nursing home care. The effects of CDSS on healthcare provider workflow, clinical decision making and communication about preventive measures in nursing home practice still need further exploration. Based on results from our study, recommendations would be to increase both sample size and the number of RNs and NAs who participate in CDSS education programs.

The role of organizational culture on practising quality improvement in Jordanian public hospitals

Purpose

This study seeks to investigate empirically the impact of organizational culture (bureaucratic, innovative, and supportive) and quality improvement practices.

Design/methodology/approach

Data used in this study were obtained through a questionnaire by random sampling, which took place in four large public hospitals, located in Irbid Governorate, Jordan, involving 271 managers, physicians, and nurses.

Findings

Quality improvement practices were measured by 16 statements on a five‐point rating scale. Each of the three types of organizational culture was measured using five items on a five‐point rating scale.

Practical implications

The three types of culture have a significantly positive influence on quality improvement practices, and account for 62 per cent of the variation of quality improvement practices. Compared with bureaucratic and supportive cultures, innovative culture appears to play a stronger role in quality improvement practices. Contrary to expectations, the analysis shows that bureaucratic actions enhance rather than hinder quality improvement practices. Respondents with a bachelor or a higher degree and participating in a training course related to quality reported higher prevalence of each culture and a higher level of quality improvement practices.

Originality/value

Innovative culture has a crucial role in quality improvement practices compared with bureaucratic and supportive cultures.

Quality work in long-term care: the role of first-line leaders

OBJECTIVE

To explore the first-line leaders' role in quality work in long-term care in Norway, in order to determine how that work is related to such success characteristics as leadership, staff, patients, performance, information and information technology.

DESIGN

Cross-sectional telephone survey. The text was analysed using content analysis.

SETTING

Thirty-two Norwegian municipalities stratified according to region and population size.

PARTICIPANTS

Sixty-four first-line leaders in nursing homes and home-based care. Main outcome measure The clinical microsystem approach is used as a framework by defining and designing measureable variables.

RESULTS

Thirty-six leaders described how they initiated and motivated employees to be active in quality work; the remaining leaders indicated that they played a passive role. The first-line leaders played a key role in implementing national quality policies and regulations. The quantity of other success characteristics was low.

CONCLUSIONS

The municipalities delegated the responsibility of implanting national policies to the first-line leaders. Missing were key quality success criteria such as macro- and meso-perspectives for the municipality as a whole and co-operation with other leaders in the organization and fostering of relevant learning. Quality work was fragmented rather than comprehensive and systematic.