Tuesday October 5, 2021

Culture change in nursing homes (NHs) is a broad-based effort to transform NHs from impersonal institutions to genuine person-centered homes. Culture change practices have been implemented increasingly with varying levels of success. This study (a) generated an empirical typology of culture change implementation across Minnesota NHs using latent profile analysis based on the survey data from administrators in 102 NHs and (b) examined variations in NH characteristics and quality outcomes associated with the typology. Three types of culture change implementation were identified: high performers, average performers, and low performers. The distributions of culture change scores were distinct across the three types, with low performers lagging far behind others in family and community engagement, and end-of-life care. High performers were distinguished through demonstrating better resident quality of life and higher family satisfaction. The findings provide empirical support for policymakers, providers, and advocates to direct culture change expansion and resource allocation.

The high rates of nursing home deaths in the wake of COVID-19 have led to calls for their elimination and their replacement by home care. Based on years of research in Canada and abroad, this article argues that nursing homes are not just necessary. They provide significant benefits for those living in, working in, and visiting in them. In developing this argument, the article begins by setting out why long-term residential care is necessary before moving on to consider the benefits of such care, benefits that go beyond the clinical. It concludes by identifying factors that can make nursing homes a positive option while helping to avoid pandemic horrors in the future.

Culture change (CC) is an innovation to improve nursing home resident quality of life. Inconsistencies in how CC is measured make the interpretation of findings inconclusive. The purpose of this study is to determine the underlying factors of CC among Ohio nursing homes to extract the core essence of CC. Data from the 2015 Ohio Biennial Survey of Long-Term Care Facilities with n = 721 nursing homes answering a CC module comprising of 21 questions are included in an exploratory factor analysis (EFA). EFA results identified two underlying factors of CC that are extracted using principal factor method. These factors include items related to resident preferences for care (RPC) and certified nursing assistant (CNA) empowerment. This study presents two valid and reliable scales to advance the measurement of CC. These scales can be used to explore both RPC and CNA empowerment components as predictors or outcomes.

PURPOSE: The study describes the implementation of a novel strategy, entitled the Action Learning Set Facilitation Model, to develop internal facilitation capability to lead change. The Model incorporated the Novice-Experienced-Expert pathway, a facilitation development approach underpinning the integrated-Promoting Action on Research Implementation in Health Services Implementation Framework, with action learning methodology. DESIGN/METHODOLOGY/APPROACH: A mixed-methods descriptive approach reports the results of 22 interviews, 182 Action Learning Sets and 159 post program survey data sets to explore facilitator experiences, strengths and potential application of the Model. FINDINGS: At program completion, five novice (of 174) and one experienced (of 27) facilitator transitioned to the next facilitation level. The three groups of facilitators described positive change in confidence and facilitation skill, and experience of action learning sets. Inconsistencies between self-report competence and observed practice amongst novices was reported. Novices had decreasing exposure to the Model due to factors related to ongoing organisational change. Internal facilitators were considered trusted and credible facilitators. RESEARCH LIMITATIONS/IMPLICATIONS: There are practical and resource implications in investing in internal facilitation capability, noting proposed and real benefits of similar development programs may be compromised during, or as a consequence of organisational change. Further research describing application of the facilitation model, strategies to enhance multisystemic support for programs and evaluation support are suggested. PRACTICAL IMPLICATIONS: The Action Learning Set Facilitation Model offers promise in developing internal facilitation capability supporting change in organisations. Critical success factors include building broad scale internal capability, stable leadership and longitudinal support to embed practice. ORIGINALITY/VALUE: This is the first application of the facilitation component of the integrated-Promoting Action on Research Implementation in Health Services implementation framework embedded to action learning sets as an implementation science strategy for leader development supporting organisational change.

OBJECTIVE: To identify the barriers and strategies perceived by orthodontists when obtaining consent from their adult patients concerning patients’ comprehension or recollection of treatment information. SETTINGS AND SAMPLE POPULATION: The sample comprised 12 orthodontists working in 8 different cities in Alberta, Canada. METHODS: An exploratory investigation using qualitative inquiry was conducted. Participants were recruited through a combination of purposive, maximum variation and snowball sampling. Data were collected through audio-recorded, semi-structured interviews until saturation was reached. Then, data were analysed using thematic analysis. Quality and credibility were achieved by employing member checks, memo writing and analyst triangulation strategies. RESULTS: Two major themes were identified, with subthemes: (1) Challenges that may interfere with patients’ comprehension and recollection of treatment information (i. patients’ internal barriers, ii. patients’ external barriers and iii. financial barriers); and (2) strategies to optimize information delivery and communication (i. tailoring the content to be delivered, ii. communication fashion, iii. communication timing and iv. being accommodative). CONCLUSION: The participants reported barriers that may be overlooked in the daily routine of orthodontic practices. Information is provided that may guide orthodontists to overcome or minimize these challenges, increase patient comprehension and improve the quality of informed consent processes.

This report focuses on the crucial and timely subject of diagnosis. Diagnosis is still a major challenge globally, with those who seek a diagnosis often experiencing long wait times, if they are able to receive a diagnosis at all. Societal stigma, self-stigma and clinician related stigma also exacerbate what is already a difficult journey.

Key findings from the report include:
75% of people with dementia globally are undiagnosed, equating to 41 million people
Clinician stigma still a major barrier to diagnosis, with 1 in 3 believing nothing can be done
90% Clinicians identified additional delays/wait times due to COVID-19
33% of clinicians in our survey believe that nothing can be done about dementia so why bother
The report includes over 50 essays from leading experts from around the world and is supported by findings from 3 key global surveys, which received responses from 1,111 clinicians, 2,325 people with dementia and carers, and over 100 national Alzheimer and dementia associations.