Advancing the Big Five of user-oriented care and accounting for its variations

Linking supportive leadership to satisfaction with care: proposing and testing a service-profit chain inspired model in the context of elderly care

PURPOSE

As marketization has gained ground in elderly care, satisfaction with care has come to play a crucial role in designing for high-quality care. Inspired by the service-profit chain (SPC) model, the authors aimed to gain a deeper understanding of the intricate interplay between supportive leadership practices, organizational climate, job satisfaction and service quality by predicting satisfaction with care.

DESIGN/METHODOLOGY/APPROACH

A Swedish sample of frontline elderly care staff (n = 1,342) participated in a cross-sectional questionnaire study. Mediation analyses were conducted to test the proposed model.

FINDINGS

As predicted, engaging in supportive leadership practices was directly and positively associated with satisfaction with care. In addition, as predicted, this relationship was partially mediated by organizational climate and job satisfaction. Moreover, job satisfaction predicted satisfaction with care with service quality explaining a statistically significant part of this relationship.

PRACTICAL IMPLICATIONS

Managers in elderly care services may improve satisfaction with care in multiple ways but primarily by showing that they care about the staff and ensuring that they are satisfied with their working conditions. Employee job satisfaction seems to be particularly crucial for satisfaction with care, beyond what can be accounted for by care service quality.

ORIGINALITY/VALUE

The authors proposed a novel service-outcome model. Adding to the original SPC model, the model in this study suggested and validated previously unexplored relationships including a direct path between leadership practices and satisfaction with service and a multiple-mediator model explaining this relationship. Also, new measures of organizational climate and supportive leadership were developed for which satisfactory reliability estimates were obtained.

A client-centered approach in home care for older persons - an integrative review

OBJECTIVE

To describe and synthesize client-centered care and service in home care for older persons.

METHODS

The study was an integrative review using the guidelines for literature reviews by the Joanna Briggs Institute. The research process followed the Whittemore and Knafl framework and PRISMA toolkit in the selection of eligible articles. The CINAHL, Medline, Scopus, Web of Science and Social Sciences abstracts were searched for articles published between January 2007 and May 2020 according to previously designed search strategies. In total, 24 articles were deemed relevant for an analysis using a thematic analysis.

RESULTS

The analysis resulted in four themes with sub-themes which revealed that client-centered care and service in home care consist of: 1) Clients' involvement in their own care; self-care, decision-making, satisfactory daily life, 2) Family members' and care partners' participation in care; family members' and care partners' commitment to care, family members' and care partners' competence in care, 3) Communication and co-operation; communication models, empowerment, partnership, and 4) Evidence-based service competence; delivery and organization of services, implementation of services, versatile clinical skills, quality outcomes and personnel wellbeing.

CONCLUSIONS

According to the results, achieving client-centered care and service in home care requires the realization of all of the above aspects. The practice of nursing must better identify all dimensions of client-centered care and take these into account in the delivery of home care services. KEY POINTS Client-centeredness is a fundamental value and the basis of nursing and care in home care provided for older persons This paper: deepens and structures the concept of client-centered care in the context of home care. assists professionals to understand the factors behind client-centered care within the home care environment. provides deeper understanding of the roles of the older person, family members, and the service system in developing client-centered services in home care for older persons.

Understanding client satisfaction in elderly care: new insights from social resource theory

Social resource theory suggests that social interaction can be conceived as resource transaction or exchange with behaviours falling within six fundamental resource categories (i.e. love, status, information, money, goods, and services) organised along two underlying dimensions: particularism-universalism and concreteness-abstractness. With the purpose of extending knowledge about quality of care, this study adopts a novel approach in that it describes and categorises care behaviours using social resource theory instead of using single instances of care behaviour. The categorisation is further used to predict client satisfaction in care services targeting older people. Daily interactions between care staff and older persons were observed in two different residential care facilities using a structured non-participant observation design. The data were analysed using principal component analysis, correlation, and regression analysis. The results confirmed the hypothesis that satisfaction with care services is predicted by resource transactions that are high on the underlying dimensions of particularism and abstractness. Thus, the resource categories of love and status (resource categories high on particularism and abstractness) were shown to be strong predictors of client satisfaction. The use of social resource theory is a novel and appropriate approach to examine person-centred care and satisfaction with care. Also, in addition to addressing potential problems in previous self-report studies on care staff behaviour, the observational technique was highly practical to this service area where dealing with clients not always able to provide feedback directly.

Assessing person-centred care: An item response theory approach

BACKGROUND AND OBJECTIVES

Given recent advances in psychometric assessment, there is a need for assessment studies using modern test theory in the field of person-centred care, mainly due to the dominant use of analytical strategies based on classical test theory. The main objective of the present study was thus to examine whether selected items from commonly used instruments of person-centred care were able to differentiate between respondents with a reasonably even level of measurement precision across different regions of the construct range using item response theory (IRT).

RESEARCH DESIGN AND METHODS

A Swedish sample of care staff in elderly care (N = 1342) completed a survey including a selection of items from three previously validated measures of person-centred care.

RESULTS

All questionnaire items were submitted to IRT analyses to examine the extent to which the items produced information on the underlying construct. The items exhibited different levels of information. However, in general, for those items exhibiting some information, the pattern of information across the trait range was similar for most of them, that is, the items discriminated better in the lower levels of person-centredness.

DISCUSSION AND IMPLICATIONS

Item response theory analyses are instrumental in creating shorter measurement instruments that may perform nearly as well as the original longer instruments. Given time and other resource constraints in questionnaire administration, there is a gain in only including the most informative items which efficiently and evenly tap the underlying construct along its entire range and in the context of person-centred care assessment this study was an initial step towards this goal. Thus, a set of ten items with satisfactory levels of psychometric quality, that is relatively high information levels across a relatively broad range of the underlying construct, is proposed.

Striking a balance: Health care providers' experiences with home-based, patient-centered care for older people-A meta-synthesis of qualitative studies

OBJECTIVE

The aim of this article was to synthesize research findings about health care providers' experiences of patient-centered care in the home setting.

METHODS

This is a meta-synthesis of qualitative findings using the analytical method of meta-ethnography developed by Noblit and Hare. We performed a systematic literature search in seven databases and assessed potential studies against eligibility criteria and quality. Subsequently, 10 primary studies were included for analysis.

RESULTS

The core theme "being a balance artist" emerged from the synthesis, incorporating the participants' experiences when faced with conflicting and competing responsibilities and needs. Two subthemes-"balancing the older clients' needs against organizational demands" and "balancing the older clients' needs against professional standards"-further elaborated on this core theme.

CONCLUSION

Health care providers' experiences indicate that organizational factors play a crucial role in shaping the conditions for patient-centered care for older people in the home setting.

PRACTICE IMPLICATIONS

To motivate and facilitate health care providers to move to a more patient-centered practice, it is important to expand the values of patient-centered care beyond the clinical encounter into the organization.

Home care services for older persons. The views of older persons and family members: A realistic evaluation

AIMS AND OBJECTIVES

The aim of the present study was to evaluate client-centred care in older persons' home care services from the perspective of older persons and family members. The following research questions were addressed: How do home care older persons and family members perceive client-centered care in their home care services? What kind of social mechanisms are realized when home care services are implemented?

BACKGROUND

Several older persons are dependent on home care services for their continued living at home. The fundamental value and best practice of home care is the client-centred care in services.

METHOD

The research method was realistic evaluation. Six families with six older person clients of home care and seven family members were interviewed. In the present study, the interview contained three themes (1) content and services of the home care, (2) activities and practices of the home care and (3) development of client centredness in home care. Research data were analysed with deductive content analysis.

RESULTS

Home care service should be based on analysis of older person's individual life situation. Social mechanisms such as interaction, participation, trust and adaptation are realised in implementation of home care services. The most significant outcomes of client-centred service were timely availability of services, safe care relationship and continuity of care, ability to influence on own services and appropriate price of services. Significant factors in quality of service were unhurriedness, kindness and competence of professionals.

IMPLICATION FOR PRACTICE

Social mechanisms, such as participation, trust, adaptation and interaction, should be taken in account in care relationship in home care. Client centredness and methods for evaluating it should be defined in practical work. Client-centeredness competence should also be included in all stages of professional education of home care.

Variations in user-oriented elderly care: a multilevel approach

Purpose

National Board of Health and Welfare claims that the quality of elderly care services differ considerably between municipalities in Sweden. This study aims to analyze to what extent these variations can be accounted for by the older person’s municipality affiliation (i.e. receiving elderly care in a certain municipality).

Design/methodology/approach

Addressing this issue, national survey data from 78,538 older respondents receiving elderly care services in Sweden were analyzed using multilevel modeling (MLM).

Findings

The results showed that municipality affiliation only marginally explained the variance in satisfaction with care, i.e. its variations were larger within than between municipalities. Instead, user-oriented care accounted for the variation in satisfaction with care. Specifically, the way the care workers behave toward the older person proved to be much more crucial for satisfaction with care than municipality affiliation. Moreover, random effects analyses revealed that the effects of user-oriented care on satisfaction with care varied across municipalities. Care setting (i.e. home care or nursing home) only marginally accounted for its variance.

Practical implications

Developing care quality should start and primarily be discussed at the interpersonal care level, and not, as is customary, at the municipality level.

Originality/value

The present research is the first in its kind to quantitatively investigate the sources of variation in perceived quality of Swedish elderly care using MLM.

Cost and Satisfaction Trends in Swedish Elderly Home Care

There is a widespread belief among the public and policy makers that quality of care in terms of user satisfaction can be improved with increased spending. However, recent research indicates that structural resources (e.g., budget per elderly) in elderly home care do not predict quality of care in terms of older persons’ satisfaction with care. In the present study, we analyzed the longitudinal trends in costs and perceived quality of care across 3 years using nationwide data in Swedish elderly home care. The results showed that although costs have been steadily increasing, perceived quality of interpersonal treatment in care has remained at the same level. An important implication is that future research and policy efforts to improve quality should more directly target the mechanisms generating satisfaction.

The impact of personality on person-centred care: a study of care staff in Swedish nursing homes

AIM AND OBJECTIVE

In this study, we explore how personal and situational factors relate to the provision of person-centred care (PCC) in nursing homes. Specifically, we focus on the relationship between the care staff's personality traits and provision of PCC and to what extent perceptions of the working environment influences this relationship.

BACKGROUND

The ultimate goal of elderly care is to meet the older person's needs and individual preferences (PCC). Interpersonal aspects of care and the quality of relationship between the care staff and the older person are therefore central in PCC.

DESIGN AND METHODS

A cross-sectional Swedish sample of elderly care staff (N = 322) completed an electronic survey including measures of personality (Mini-IPIP) and person-centred care (Individualized Care Inventory, ICI). A principal component analysis was conducted on the ICI-data to separate the user orientation (process quality) of PCC from the preconditions (structure quality) of PCC.

RESULTS

Among the five factors of personality, neuroticism was the strongest predictor of ICI user orientation. ICI preconditions significantly mediated this relationship, indicating the importance of a supportive working environment. In addition, stress was introduced as a potential explanation and was shown to mediate the impact of neuroticism on ICI preconditions.

CONCLUSIONS

Personality traits have a significant impact on user orientation, and the perception of a supportive and stress free working environment is an important prerequisite for achieving high-quality person-centred elderly care.

IMPLICATIONS FOR PRACTICE

Understanding how personality is linked to the way care staff interacts with the older person adds a new perspective on provision of person-centred elderly care.