Health Care Innovation and Quality Assurance

Collection of articles on Health Care Innovation and Quality Assurance is available here.

Palliative care delivery at nursing homes before and after an educational intervention from professionals’ perspective: A pre-post design.
Access if not affiliated with University of Alberta

Åvik Persson H, Ahlström G, Årestedt K, Behm L, Drevenhorn E, Sandgren A.
Scandinavian journal of caring sciences. 2022 May;
BACKGROUND: The principles of palliative care were developed in hospices and specialised palliative care units and have not been sufficiently adapted to and evaluated in nursing homes. Therefore, an educational intervention from an interprofessional education perspective was performed within the project Implementation of Knowledge-Based Palliative Care in Nursing Homes. The aim of this study was to evaluate professionals’ experience of palliative care delivery before and after the educational intervention. METHODS: The educational intervention for nursing home professionals consisted of five 2-h seminars over 6 months at 20 nursing homes. The intervention and control groups consisted of 129 and 160 professionals from 30 nursing homes respectively. The questionnaire ‘Your experience of palliative care’ was completed 1 month before (baseline) and after (follow-up) the intervention. Descriptive and inferential statistics were calculated. RESULTS: The positive effects at follow-up concerned the use of a valid scale for grading symptoms, attendance to the needs of next of kin (including bereavement support), documentation of older persons’ wishes regarding place to die and conversations about their transition to palliative care and about how they were treated. CONCLUSIONS: This study demonstrates a promising interprofessional educational model. However, the paucity of improvements brought to light at follow-up indicates a need for research directed towards a revision of this model. Supervision of professionals during palliative care delivery is one suggestion for change.

How do health and allied health practitioners perceive excellence in residential aged care? An exploratory qualitative study.
Access if not affiliated with University of Alberta

Cameron N, Fetherstonhaugh D, Rayner JA, McAuliffe L.
Australasian journal on ageing. 2022 May.
OBJECTIVE: To identify factors that health and allied health practitioners consider central to excellence in residential aged care facilities (RACFs) with the objective of supporting improvements in monitoring, accountability and service delivery within the sector. METHODS: In a qualitative, exploratory designed study, interviews were undertaken with seventeen participants from 10 health and allied health disciplines (general practice, dentistry, pharmacy, psychiatry, psychology, neuropsychology, physiotherapy, speech pathology, occupational therapy and palliative care) with experience of working in Victorian RACFs. The interviews focused on how practitioners perceived excellence within RACFs. Data were analysed thematically. RESULTS: Thematic analysis yielded five themes, which correspond with different dimensions or ways of understanding excellence, including resident well-being, residences as a true home, good practice models, effective management and skilled staff, and unmet needs. Under each of these themes, participants referred to issues closely related to the concerns of their particular professions as well as those more general in nature. CONCLUSIONS: The diversity in issues to which participants drew attention highlights the importance of obtaining the perspectives of a broad range of practitioners providing services to RACF residents to achieving excellence in the sector. Commonalities in their responses indicate the potential for a greater level of collaboration among the health and allied health professions.

Refining a capability development framework for building successful consumer and staff partnerships in healthcare quality improvement: A coproduced eDelphi study.
Access if not affiliated with University of Alberta

Cox R, Kendall M, Molineux M, Miller E, Tanner B.
Health expectations : an international journal of public participation in health care and health policy. 2022 Apr.
BACKGROUND: The capability of consumers and staff may be critical for authentic and effective partnerships in healthcare quality improvement (QI). Capability frameworks describe core knowledge, skills, values, attitudes, and behaviours and guide learning and development at individual and organizational levels. OBJECTIVE: To refine a capability framework for successful partnerships in healthcare QI which was coproduced from a scoping review. DESIGN: A two-round eDelphi design was used. The International Expert Panel rated the importance of framework items in supporting successful QI partnerships, and suggested improvements. They also rated implementation options and commented on the influence of context. PARTICIPANTS: Seven Research Advisory Group members were recruited to support the research team. The eDelphi panel included 53 people, with 44 (83%) and 42 (77. 8%) participating in rounds 1 and 2, respectively. They were from eight countries and had diverse backgrounds. RESULTS: The Research Advisory Group and panel endorsed the framework and summary diagram as valuable resources to support the growth of authentic and meaningful partnerships in QI across healthcare contexts, conditions, and countries. A consensus was established on content and structure. Substantial rewording included a stronger emphasis on growth, trust, respect, inclusivity, diversity, and challenging the status quo. The final capability development framework included three domains: Personal Attributes, Relationships and Communication, and Principles and Practices. The Equalizing Decision Making, Power, and Leadership capability was foundational and positioned across all domains. Ten capabilities with twenty-seven capability descriptions were also included. The Principles and Practices domain, Equalizing Decision Making, Power, and Leadership capability, and almost half (44.4%) of the capability descriptions were rated as more important for staff than consumers (p < .01). However, only the QI processes and practices capability description did not meet the inclusion threshold for consumers. Thus, the framework was applicable to staff and consumers. CONCLUSION: The refined capability development framework provides direction for planning and provision of learning and development regarding QI partnerships. PATIENT OR PUBLIC CONTRIBUTION: Two consumers were full members of the research team and are coauthors. A Research Advisory Group, inclusive of consumers, guided study execution and translation planning. More than half of the panel were consumers.

Quality of care plans in long-term care facilities for the older persons-How well is information from RAI assessments utilised in care planning?
Access if not affiliated with University of Alberta

Kuha S, Niemelä K, Vähäkangas P, Noro A, Lotvonen S, Kanste O.
International journal of older people nursing. 2022 May;17(3):e12442.
BACKGROUND: In Finland, care plans at long-term care facilities (LTCF) for the older persons should be based on information from Resident Assessment Instrument (RAI) assessments and the principles of structured data. Hence, managers are responsible for ensuring that the RAI system is used to a satisfactory extent, the provided information is used in care planning, and that staff members are competent at composing high-quality care plans. AIM: To explore the congruence between first-line managers’ assessments of the extent to which care plans include RAI information and separately observed RAI-related contents of care plans. METHODS: The study was based on a descriptive, cross-sectional survey of first-line managers (n = 15) from three LTCF organisations and a randomly selected sample of care plans (n = 45) from two LTCF organisations in Finland. Manager responses and analysis of care plans were reviewed at a general level. The data were gathered in 2019 and analysed using statistical methods and content analysis. RESULTS: First-line managers’ assessments of the extent to which their units’ care plans included RAI information did not match the observed care plan contents. The care plan analysis revealed that managers significantly overestimated the extent to which care plans included RAI-related content. CONCLUSION: Managers at LTCF organisations need more training to be able to sufficiently support their staff in using RAI information to draft high-quality care plans. IMPLICATION FOR PRACTICE: Care plans must include a higher level of information related to RAI assessments. To develop competencies in drafting high-quality care plans, training related to RAI information utilisation on all aspects of the care plan should be emphasised and training should be provided to first-line managers and more broadly across the nursing staff.

An Equity Agenda for the Field of Health Care Quality Improvement
Access if not affiliated with University of Alberta

O’Kane M, Agrawal S, Binder L, Dzau V, Gandhi TK, Harrington R, et al.
National Academy of Medicine perspectives; 2022.
On the occasion of the 20th anniversary of the publication of To Err Is Human: Building a Safer Health System (IOM, 2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001), the National Academy of Medicine convened the leaders of seven prominent U.S. health care quality organizations to discuss and author a paper identifying the most important priorities for the health care quality movement in the next 20 years. The authors identified equity as the area of most urgent and cross-cutting concern for the field. This paper summarizes the authors’ conclusions about key barriers and strategies to advancing equity in health care quality.

A qualitative study of the perception of nursing home practitioners about the implementation of quality indicators for drug consumption in nursing homes.
Access if not affiliated with University of Alberta

Sanchez S, Ecarnot F, Voilmy D, Ndiongue BM, Cormi C, Letty A, et al.
Aging clinical and experimental research. 2022 Apr;34(4):897–903.
INTRODUCTION: Nursing homes (NHs) are an ideal environment in which to implement interventions aimed at reducing inappropriate prescriptions. Quality indicators (QIs) may be useful to standardize practices, but it is unclear how they mediate change. In the framework of a quantitative study aimed at reducing the prescription of anticholinergic drugs among NH residents using QIs, we performed a qualitative study to describe the investigators’ perception of the utility of QIs. METHODS: Qualitative study using focus group methodology. Focus groups were recorded and transcribed, and analyzed by thematic analysis. Participants were purposefully recruited from among the medical directors of the NHs in the quantitative study. RESULTS: Five medical directors participated in two focus group meetings. The main themes to emerge were: (1) communication is key to introducing new practices and achieving lasting uptake; (2) improved coordination and communication provided useful information to help interpret the quantitative results observed: e.g., participants reported that they were able to obtain contextual and patient-specific information that explained why some prescribers had consistently, but justifiably “poor” performance on the quantitative indicators; (3) negative aspects reported included reluctance to change among prescribers and the tendency to shirk responsibility. CONCLUSION: From the point of view of medical directors of NHs participating in an interventional program to reduce inappropriate prescriptions of anticholinergic drugs, the main factor driving the success of the program was communication, which is key to achieving adherence. Improved communication provides useful insights into the reasons why no quantitative reduction is observed in objective quality indicators.

Effects of a person-centred and thriving-promoting intervention on nursing home residents’ experiences of thriving and person-centredness of the environment.
Access if not affiliated with University of Alberta

Sjögren K, Bergland Å, Kirkevold M, Lindkvist M, Lood Q, Sandman PO, et al.
Nursing open. 2022 Apr.
AIM: To evaluate the effects of a person-centred and thriving-promoting intervention on nursing home residents´ experiences of thriving and person-centredness of the environment, and to evaluate if the effects varied between female and male residents. DESIGN: A multi-centre, non-equivalent controlled group before-after intervention design. METHODS: Six nursing homes in Australia, Norway and Sweden were allocated to either intervention or control group. The intervention comprised a staff educational programme. A survey using proxy-ratings by staff was administered before (T0), immediately after (T1) and six months after (T2) the intervention. The sample varied between 205 and 292 residents. Linear regression models were used to explore effects. RESULTS: Statistically significant effects were found on experiences of thriving and person-centredness of the environment. These effects were significant for male residents but not for female residents. The results emphasize the importance of individually tailored social and recreational activities.