1
|
Chui CHK, Lu S, Chan OF, Cheung JCS, Guo Y, Liu Y, Lum TYS. Universities as Intermediary Organizations: Catalyzing the Construction of an Age-Friendly City in Hong Kong. Innov Aging 2023; 7:igad016. [PMID: 37038553 PMCID: PMC10082544 DOI: 10.1093/geroni/igad016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Indexed: 02/23/2023] Open
Abstract
Background and Objectives The construction of an Age-Friendly City (AFC) requires active contribution from relevant interest groups including older adults, nonprofit organizations, and policy-makers. However, given that relevant interest groups may have limited resources, knowledge, and skills, as well as unique contextual factors, they often require help from intermediary organizations-actors that aim to build interest groups' capabilities. Our objectives were to examine the functions of universities, as an example of intermediary organizations, in facilitating the construction of an AFC, and identify critical factors that enable intermediary organizations to perform their functions. Research Design and Methods We conducted three focus groups and one individual interview with multiple interest groups including older adults and social workers from nonprofit organizations and local government involved in a 6-year citywide AFC project in Hong Kong. Participants were asked to share their views on the role of universities in relation to their own experiences and roles in the project. Data generated from the interviews were analyzed using thematic analysis. Results Four themes pertinent to the functions of universities in facilitating development were identified: facilitating cross-sector collaborations, knowledge diffusion, interest-group building, and mediating divergent interests. We also found that neutrality and reputability are key characteristics for intermediary organizations to wield sufficient legitimacy to perform their functions efficiently. Discussion and Implications Findings underscore the important yet overlooked role of intermediary organizations in bridging and mediating different interest groups to facilitate AFC development. We advance gerontological scholarship by providing insights into the theoretical mechanisms and practice implications for intermediary organizations in fostering an AFC.
Collapse
Affiliation(s)
- Cheryl Hiu-Kwan Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Shiyu Lu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - On Fung Chan
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Johnson Chun-Sing Cheung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Yingqi Guo
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China
| | - Yuqi Liu
- Department of Urban Planning, School of Architecture, South China University of Technology, Guangzhou, China
| | - Terry Y S Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
2
|
Pimentel CB, Mills WL, Snow AL, Palmer JA, Sullivan JL, Wewiorski NJ, Hartmann CW. Adapting Strategies for Optimal Intervention Implementation in Nursing Homes: A Formative Evaluation. Gerontologist 2021; 60:1555-1565. [PMID: 32449764 DOI: 10.1093/geront/gnaa025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing homes pose unique challenges for implementation of research and quality improvement (QI). We previously demonstrated successful implementation of a nursing home-led intervention to improve relationships between frontline staff and residents in 6 U.S. Department of Veterans Affairs (VA) Community Living Centers (CLCs). This article discusses early adaptations made to the intervention and its implementation to enhance frontline staff participation. RESEARCH DESIGN AND METHODS This is a formative evaluation of intervention implementation at the first 2 participating CLCs. Formative evidence-including site visitors' field notes, implementation facilitation records, and semistructured frontline staff interviews-were collected throughout the study period. Data analysis was informed by the Capability, Opportunity, Motivation, and Behavior model of behavior change. RESULTS Adaptations were made to 5 a priori intervention implementation strategies: (a) training leaders, (b) training frontline staff, (c) adapting the intervention to meet local needs, (d) auditing and providing feedback, and (e) implementation facilitation. On the basis of a 6-month implementation period at the first CLC, we identified elements of the intervention and aspects of the implementation strategies that could be adapted to facilitate frontline staff participation at the second CLC. DISCUSSION AND IMPLICATIONS Incremental implementation, paired with ongoing formative evaluation, proved critical to enhancing capability, opportunity, and motivation among frontline staff. In elucidating what was required to initiate and sustain the nursing home-led intervention, we provide a blueprint for responding to emergent challenges when performing research and QI in the nursing home setting.
Collapse
Affiliation(s)
- Camilla B Pimentel
- Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.,New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Whitney L Mills
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Rhode Island.,Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Andrea Lynn Snow
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, Alabama.,Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa, Alabama.,Department of Psychology, University of Alabama, Tuscaloosa
| | - Jennifer A Palmer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts.,Department of Health Law, Policy and Management, School of Public Health, Boston University, Massachusetts
| | - Nancy J Wewiorski
- Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.,Department of Public Health, University of Massachusetts Lowell
| |
Collapse
|
3
|
Ozkaynak M, Reeder B, Drake C, Ferrarone P, Trautner B, Wald H. Characterizing Workflow to Inform Clinical Decision Support Systems in Nursing Homes. Gerontologist 2019; 59:1024-1033. [PMID: 30124814 DOI: 10.1093/geront/gny100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical decision support systems (CDSS) hold promise to influence clinician behavior at the point of care in nursing homes (NHs) and improving care delivery. However, the success of these interventions depends on their fit with workflow. The purpose of this study was to characterize workflow in NHs and identify implications of workflow for the design and implementation of CDSS in NHs. RESEARCH DESIGN AND METHODS We conducted a descriptive study at 2 NHs in a metropolitan area of the Mountain West Region of the United States. We characterized clinical workflow in NHs, conducting 18 observation sessions and interviewing 15 staff members. A multilevel work model guided our data collection and framework method guided data analysis. RESULTS The qualitative analysis revealed specific aspects of multilevel workflow in NHs: (a) individual, (b) work group/unit, (c) organization, and (d) industry levels. Data analysis also revealed several additional themes regarding workflow in NHs: centrality of ongoing relationships of staff members with the residents to care delivery in NHs, resident-centeredness of care, absence of memory aids, and impact of staff members' preferences on work activities. We also identified workflow-related differences between the two settings. DISCUSSION AND IMPLICATIONS Results of this study provide a rich understanding of the characteristics of workflow in NHs at multiple levels. The design of CDSS in NHs should be informed by factors at multiple levels as well as the emergent processes and contextual factors. This understanding can allow for incorporating workflow considerations into CDSS design and implementation.
Collapse
Affiliation(s)
- Mustafa Ozkaynak
- College of Nursing, University of Colorado-Denver, Anschutz Medical Campus, Aurora
| | - Blaine Reeder
- College of Nursing, University of Colorado-Denver, Anschutz Medical Campus, Aurora
| | - Cynthia Drake
- School of Medicine, University of Colorado-Denver, Anschutz Medical Campus, Aurora
| | - Peter Ferrarone
- School of Medicine, University of Colorado-Denver, Anschutz Medical Campus, Aurora
| | | | - Heidi Wald
- School of Medicine, University of Colorado-Denver, Anschutz Medical Campus, Aurora.,SCL Health, Broomfield, Colorado
| |
Collapse
|
4
|
Fishleder S, Petrescu-Prahova M, Harris JR, Steinman L, Kohn M, Bennett K, Helfrich CD. Bridging the Gap After Physical Therapy: Clinical-Community Linkages With Older Adult Physical Activity Programs. Innov Aging 2018; 2:igy006. [PMID: 30480131 PMCID: PMC6177034 DOI: 10.1093/geroni/igy006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Many barriers exist to older adult participation in physical activity, despite known benefits. Referrals from physical therapists (PTs) through clinical-community linkages offer novel, promising opportunities to increase older adult engagement in appropriate community-based physical activity programs. We assessed the capacity of PTs to participate in such linkages. RESEARCH DESIGN AND METHODS We collected qualitative data using semistructured phone interviews (n = 30) with PTs across 14 states. We conducted thematic analysis using a priori themes based on the 2008 Bridging Model of Etz and colleagues: capacity to assess patient risk, ability to provide brief counseling, capacity and ability to refer, and awareness of community resources. RESULTS Risk assessment and counseling were already part of routine practice for our respondents, but counseling could be further facilitated if PTs had more skills to engage less-motivated patients. PTs expressed a desire to refer their patients to community programs; however, barriers to referrals included lack of knowledge of and trust in community programs, and limited infrastructure for communicating with potential partners. DISCUSSION AND IMPLICATIONS PTs have the capacity to develop patient referral linkages with community-based physical activity programs. PT session length and content facilitates patient risk assessment and behavioral counseling. Integrating motivational techniques can help PTs engage less-motivated patients in physical activity. Systemic improvements should include innovations in communication infrastructure, identifying clinic-level champions, and in-person outreach initiated by organizations that deliver community physical activity programs.
Collapse
Affiliation(s)
| | | | | | | | | | - Kimberly Bennett
- Department of Rehabilitative Medicine, University of Washington, Seattle
| | | |
Collapse
|
5
|
Martindale-Adams J, Tah T, Finke B, LaCounte C, Higgins BJ, Nichols LO. Implementation of the REACH model of dementia caregiver support in American Indian and Alaska Native communities. Transl Behav Med 2017; 7:427-434. [PMID: 28585164 PMCID: PMC5645288 DOI: 10.1007/s13142-017-0505-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The Resources for Enhancing Alzheimer's Caregivers Health in the VA (REACH VA) dementia caregiving intervention has been implemented in the VA, in community agencies, and internationally. As identified in the 2013 and 2015 National Plan to Address Alzheimer's Disease, REACH is being made available to American Indian and Alaska Native communities. Implementation activities are carried out by local Public Health Nursing programs operated by Indian Health Service and Tribal Health programs, and Administration for Community Living/Administration on Aging funded Tribal Aging program staff already working in each community. The implementation is described using the Fixsen and Blasé implementation process model. Cultural, community, health system, and tribe-specific adaptations occur during the six implementation stages of exploration and adoption, program installation, initial implementation, full operation, innovation, and sustainability. Adaptations are made by local staff delivering the program. Implementation challenges in serving AI/AN dementia caregivers include the need to adapt the program to fit the unique communities and the cultural perceptions of dementia and caregiving. Lessons learned highlight the importance of using a clinically successful intervention, the need for support and buy-in from leadership and staff, the fit of the intervention into ongoing routines and practices, the critical role of modifications based on caregiver, staff, and organization needs and feedback, the need for a simple and easily learned intervention, and the critical importance of community receptivity to the services offered.
Collapse
Affiliation(s)
- Jennifer Martindale-Adams
- Department of Preventive Medicine, University of Tennessee Health Science Center and Co-Director Caregiver Center, Veterans Affairs Medical Center Memphis, Memphis, USA
| | - Tina Tah
- Division of Nursing Services, Office of Clinical and Preventive Services, Indian Health Service, Rockville, USA
| | - Bruce Finke
- Nashville Area Indian Health Service and Learning and Diffusion Group, CMS Innovation Center, Nashville, USA
| | - Cynthia LaCounte
- Office for American Indian, Alaska Natives and Native Hawaiian Programs, Administration for Community Living, Administration on Aging, Washington, USA
| | - Barbara J Higgins
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Linda O Nichols
- Caregiver Center, Veterans Affairs Medical Center Memphis and Departments of Preventive Medicine and Internal Medicine, University of Tennessee Health Science Center, 1030 Jefferson Avenue (11h), Memphis, TN, 38104, USA.
| |
Collapse
|
6
|
Roberts T, Nolet K, Bowers B. Consistent assignment of nursing staff to residents in nursing homes: a critical review of conceptual and methodological issues. Gerontologist 2013; 55:434-47. [PMID: 23996209 DOI: 10.1093/geront/gnt101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/24/2013] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF STUDY Consistent assignment of nursing staff to residents is promoted by a number of national organizations as a strategy for improving nursing home quality and is included in pay for performance schedules in several states. However, research has shown inconsistent effects of consistent assignment on quality outcomes. In order to advance the state of the science of research on consistent assignment and inform current practice and policy, a literature review was conducted to critique conceptual and methodological understandings of consistent assignment. DESIGN AND METHODS Twenty original research reports of consistent assignment in nursing homes were found through a variety of search strategies. RESULTS Consistent assignment was conceptualized and operationalized in multiple ways with little overlap from study to study. There was a lack of established methods to measure consistent assignment. Methodological limitations included a lack of control and statistical analyses of group differences in experimental-level studies, small sample sizes, lack of attention to confounds in multicomponent interventions, and outcomes that were not theoretically linked. IMPLICATIONS Future research should focus on developing a conceptual understanding of consistent assignment focused on definition, measurement, and links to outcomes. To inform current policies, testing consistent assignment should include attention to contexts within and levels at which it is most effective.
Collapse
Affiliation(s)
- Tonya Roberts
- Geriatric Research Education & Clinical Center (GRECC), William S. Middleton Veteran Affairs Hospital, Madison, Wisconsin. School of Nursing, University of Wisconsin, Madison.
| | | | | |
Collapse
|