scholarly journals Quality Improvement Efforts in VA Community Living Centers Increased Following Public Reporting of Performance

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 22-22
Author(s):  
Heather Davila ◽  
Whitney Mills ◽  
Valerie Clark ◽  
Christine Hartmann ◽  
David Mohr ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Nursing Homes ◽  
Positive Impact ◽  
Public Reporting ◽  
Performance Ratings ◽  
Comparative Case Study ◽  
Community Living ◽  
Structured Interviews ◽  
Improve Performance ◽  
Community Living Centers

Abstract In 2018, the US Department of Veterans Affairs (VA) began publicly reporting performance ratings for its 134 Community Living Centers (CLCs; nursing homes) based on health inspections, staffing, and clinical quality measures. CLCs operate within a large, integrated healthcare system with unique financial and market incentives. Although public reporting has led to quality improvements in non-VA nursing homes, we do not know whether CLCs respond to public reporting differently than private sector nursing homes. To address this knowledge gap, we used a comparative case study approach involving 3 purposively selected CLCs with varied (low, medium, high) performance ratings. We conducted semi-structured interviews with personnel (n=12) responsible for quality measurement and improvement. Interviews focused on opinions of public reporting, actions taken to improve performance ratings, and motivations for change. Participants indicated public reporting improved transparency and provided an “outside perspective” on their performance. Strategies to improve performance ratings involved 1) data/information, 2) individual roles, and 3) teamwork/communication. All 3 CLCs made changes in these areas, yet respondents in the higher performing CLCs described implementing more strategies immediately after learning their ratings. Respondents in all 3 CLCs described being motivated to deliver good care and achieve public ratings that reflected the care they provided. This meant addressing internal weaknesses that contributed to lower scores for 2 CLCs. Our findings suggest public reporting may improve internal data collection, reporting, and quality improvement efforts in CLCs. They highlight the potential positive impact of public reporting in prompting quality improvement in nursing homes.

scholarly journals De-implementing and sustaining an intervention to eliminate nursing home resident bed and chair alarms: interviews on leadership and staff perspectives

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Christine W. Hartmann ◽  
Christopher Gillespie ◽  
George G. Sayre ◽  
A. Lynn Snow
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Community Living ◽  
Position Change ◽  
Improvement Program ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Local Leadership ◽  
Positive Effects ◽  
Community Living Centers

Abstract Background Improving nursing home quality of care relies partly on reducing or stopping ineffective or harmful practices, a process known as de-implementation. We know little about de-implementation in this setting. Relatively recent policy changes reclassified resident position-change (bed and chair) alarms, which monitor resident movement, as restraints. This created an optimal environment in which to study impressions of an alarm de-implementation and sustainment intervention. Methods This cross-sectional interview study focused on understanding participants’ experience of a quality improvement program in the Department of Veterans Affairs Community Living Centers (nursing homes). The program’s goal was to improve resident outcomes and staff communication and teamwork through, among other foci, eliminating resident position-change alarms. The Community Living Centers were located in geographically dispersed areas of the continental United States. Interview participants were leadership and staff members from seven Community Living Centers. We conducted in-depth, semi-structured qualitative interviews using a convenience sample and used a thematic analytic approach. Results We conducted seventeen interviews. We identified five main themes: Initiating De-implementation (compelling participants with evidence, engaging local leadership, and site-level education and training), Changing Expectations (educating staff and family members), Using Contrasting Approaches (gradual or abrupt elimination of alarms), Witnessing Positive Effects of De-implementation (reduction in resident falls, improved resident sleep, reduction in distressing behaviors, and increased resident engagement), and Staying the Course (sustainment of the initiative). Conclusions Findings highlight how participants overcame barriers and successfully eliminated resident position-change alarms and sustained the de-implementation through using convincing evidence for the initiative, local leadership involvement and support, and staff and family member education and engagement. These findings and the resulting three-phase process to support nursing homes' de-implementation efforts expand the de-implementation science knowledge base and provide a promising framework for other nursing home-based de-implementation initiatives.

Two Decades of Nursing Home Compare: What Have We Learned?

2020 ◽  
pp. 107755872093165
Author(s):  
R. Tamara Konetzka ◽  
Kevin Yan ◽  
Rachel M. Werner
Keyword(s):  
Systematic Review ◽  
Quality Improvement ◽  
Nursing Home ◽  
Quality Of Care ◽  
Nursing Homes ◽  
Risk Adjustment ◽  
Public Reporting ◽  
Review Of The Literature ◽  
Nursing Home Compare

Approximately two decades ago, federally mandated public reporting began for U.S. nursing homes through a system now known as Nursing Home Compare. The goals were to provide information to enable consumers to choose higher quality nursing homes and to incent providers to improve the quality of care delivered. We conduct a systematic review of the literature on responses to Nursing Home Compare and its effectiveness in meeting these goals. We find evidence of modest but meaningful response by both consumers and providers. However, we also find evidence that some improvement in scores does not reflect true quality improvement, that disparities by race and income have increased, that risk-adjustment of the measures is likely inadequate, and that several key domains of quality are not represented. Our results support moderate success of Nursing Home Compare in achieving intended goals but also reveal the need for continued refinement.

scholarly journals Medical students as agents of change: a qualitative exploratory study

2018 ◽  
Vol 7 (3) ◽  
pp. e000420 ◽  
Author(s):  
Emma Burnett ◽  
Peter Davey ◽  
Nicola Gray ◽  
Vicki Tully ◽  
Jenna Breckenridge
Keyword(s):  
Quality Improvement ◽  
Medical Students ◽  
Positive Impact ◽  
Healthcare Setting ◽  
Structured Interviews ◽  
Roles And Responsibilities ◽  
Changing Practice ◽  
Effective Change ◽  
Agents Of Change ◽  
Facilitators And Barriers

BackgroundThere is evidence that medical students have the potential to actively initiate, lead and bring about change through quality improvement within healthcare organisations. For effective change to occur, it is important that students are introduced to, and exposed to the value and necessity of quality improvement early in their careers. The aim of this study was to explore the perspectives and experiences of medical students and their mentors after undertaking quality improvement projects within the healthcare setting, and if such practice-based experiences were an effective way of building improvement capacity and changing practice.MethodsA qualitative interpretive description methodology, using focus groups with medical students and semi-structured interviews with academic and clinical mentors following completion of students’ 4-week quality improvement projects was adopted.ResultsThe findings indicate that there are a range of facilitators and barriers to undertaking and completing quality improvement projects in the clinical setting, such as time-scales, differing perspectives, roles and responsibilities between students and multidisciplinary healthcare professionals.ConclusionsThis study has demonstrated that quality improvement experiential learning can develop knowledge and skills among medical students and transform attitudes towards quality improvement. Furthermore, it can also have a positive impact on clinical staff and healthcare organisations. Despite inherent challenges, undertaking quality improvement projects in clinical practice enhances knowledge, understanding and skills, and allows medical students to see themselves as important influencers of change as future doctors.

scholarly journals National Partnership to Improve Dementia Care in Nursing Homes Campaign: State and Facility Strategies, Impact, and Antipsychotic Reduction Outcomes

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Stephen Crystal ◽  
Olga F Jarrín ◽  
Marsha Rosenthal ◽  
Richard Hermida ◽  
Beth Angell
Keyword(s):  
Quality Improvement ◽  
Nursing Homes ◽  
Social Process ◽  
Public Reporting ◽  
Dementia Care ◽  
Prescribing Patterns ◽  
Clinical Practices ◽  
Antipsychotic Medications ◽  
Study Results ◽  
The Impact

Abstract Background and Objectives Antipsychotic medications have been widely used in nursing homes to manage behavioral and psychological symptoms of dementia, despite significantly increased mortality risk. Use grew rapidly during the 2000s, reaching 23.9% of residents by 2011. A national campaign for safer dementia care in U.S. nursing homes was launched in 2012, with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. By the second quarter of 2019, use had declined by 40.1% to 14.3%. We assessed the impact of state and facility initiatives during the Campaign aimed at encouraging more-judicious prescribing of antipsychotic medications. Research Design and Methods Our mixed-methods strategy integrated administrative and clinical data analyses with state and facility case studies. Results Results suggest that substantial change in prescribing is achievable through sustained, data-informed quality improvement initiatives integrating educational and regulatory interventions, supported by public quality reporting. Adequate staffing, particularly of registered nurses, is key to support individualized management of symptoms through nonpharmacological strategies. Case study results suggest that state and facility initiatives during the campaign achieved considerable buy-in for the goal of more conservative prescribing, through a social process of normalization. Reporting and reduction of antipsychotic use was not followed by increases in sedative-hypnotic medication use. Rather, sedative-hypnotic use declined in tandem with antipsychotic reduction, suggesting that increased attention to prescribing patterns led to more cautious use of other risky psychotropic medications. Discussion and Implications Quality improvement initiatives to change entrenched but problematic clinical practices face many barriers to success, including provider-level inertia; perceptions that alternatives are not available; and family and staff resistance. Nevertheless, systemic change is possible through concerted, collaborative efforts that touch prescribing practices at multiple points; integrate educational and regulatory influences; activate local and state champions for improvement; foster reputational influences through public reporting and benchmarking; and support a social process of normalization of preferred care processes as a best practice that is in the interest of patients.

scholarly journals Is Variation in Resident-Centered Care and Quality Performance Related to Health System Factors in Veterans Health Administration Nursing Homes?

2018 ◽  
Vol 55 ◽  
pp. 004695801878703 ◽  
Author(s):  
Jennifer L. Sullivan ◽  
Ryann L. Engle ◽  
Denise Tyler ◽  
Melissa K. Afable ◽  
Katelyn Gormley ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Health System ◽  
Veterans Health Administration ◽  
Community Living ◽  
Veterans Health ◽  
Health Administration ◽  
Staff Members ◽  
Centered Care ◽  
Community Living Centers ◽  
System Factors

The purpose of this research was to explore and compare common health system factors for 5 Community Living Centers (ie Veterans Health Administration nursing homes) with high performance on both resident-centered care and clinical quality and for 5 Community Living Centers (CLC) with low performance on both resident-centered care and quality. In particular, we were interested in “how” and “why” some Community Living Centers were able to deliver high levels of resident-centered care and high quality of care, whereas others did not demonstrate this ability. Sites were identified based on their rankings on a composite quality measure calculated from 28 Minimum Data Set version 2.0 quality indicators and a resident-centered care summary score calculated from 6 domains of the Artifacts of Culture Change Tool. Data were from fiscal years 2009-2012. We selected high- and low-performing sites on quality and resident-centered care and conducted 12 in-person site visits in 2014-2015. We used systematic content analysis to code interview transcripts for a priori and emergent health system factor domains. We then assessed variations in these domains across high and low performers using cross-site summaries and matrixes. Our final sample included 108 staff members at 10 Veterans Health Administration CLCs. Staff members included senior leaders, middle managers, and frontline employees. Of the health system factors identified, high and low performers varied in 5 domains, including leadership support, organizational culture, teamwork and communication, resident-centered care recognition and awards, and resident-centered care training. Organizations must recognize that making improvements in the factors identified in this article will require dedicated resources from leaders and support from staff throughout the organization.

scholarly journals QUALITY IMPROVEMENT IN LTC: EFFECTIVENESS OF MONTESSORI-BASED ACTIVITY PROGRAMMING IN VA COMMUNITY LIVING CENTER

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S949-S950
Author(s):  
Thomas Chacko ◽  
Kim Curyto ◽  
Michelle M Hilgeman ◽  
Virginia Keleher
Keyword(s):  
Quality Improvement ◽  
Depressive Symptoms ◽  
Physical Functioning ◽  
Psychological Symptoms ◽  
Preliminary Evidence ◽  
Veterans Affairs ◽  
Community Living ◽  
Antipsychotic Medications ◽  
Meaningful Engagement ◽  
Community Living Centers

Abstract Montessori-based Activity Programming (MAP) was adapted for Veterans Affairs (VA) Community Living Centers (CLCs) and aims to increase independence and meaningful engagement in residents with cognitive impairment. The Montessori model prioritizes offering choice, knowing and harnessing a resident’s abilities, and enabling them to carry out purposeful roles and activities. Any perceived deficit in cognitive functioning is “circumvented” by preparing the environment to support maximum independence. The implementation of MAP-VA in VA Western NY CLC involved 3 lodges, 52 staff, 16 champions, and 65 CLC residents. Standardized implementation measures demonstrated improvements over six months in five domains assessing development of a resident-directed community. Hypothesized outcomes included improved national percentile quality improvement (QI) rankings related to psychological symptoms and medications (e.g., depressive symptoms and use of antipsychotic/antianxiety medications) and physical functioning (e.g., less falls and ability to move independently). Scores six months prior to the implementation of MAP-VA (April, 2018 to September, 2018) were compared with scores during six months of implementation post training (November, 2018 to March, 2019). Compared to pre-intervention QI measures related to psychological symptoms, a clinically meaningful trajectory of symptom decrease was observed with rankings during implementation (e.g., depressive symptoms, amount of antipsychotic medications). Likewise, compared to pre-intervention QI rankings regarding physical functioning, post-training rankings showed a trajectory of improvement (e.g., help with ADLs, ability to move independently). Implementation of the MAP-VA intervention demonstrates preliminary evidence for improvement in QI measures related to psychological symptoms and physical functioning. Implications for QI efforts in VA CLCs will be presented.

Mayors’ leadership roles in direct participation processes – the case of community-owned wind farms

2018 ◽  
Vol 31 (5) ◽  
pp. 617-637 ◽  
Author(s):  
Franziska Wallmeier ◽  
Julia Thaler
Keyword(s):  
Wind Farm ◽  
Positive Impact ◽  
Wind Farms ◽  
Comparative Case Study ◽  
Leadership Roles ◽  
Structured Interviews ◽  
Content Type ◽  
Personal Involvement ◽  
Direct Participation ◽  
Participation Process

Purpose The design of participation processes influences their effectiveness. In light of processes which include both mandated and non-mandated direct participation and take place in collaboration with other actors, adequate leadership roles are an indispensable but challenging process element. The purpose of this paper is to analyze how mayors exercise leadership roles in such processes and how this relates to effective participation processes. Design/methodology/approach Applying a qualitative comparative case study design (n=7), this study investigates mayors’ leadership roles relative to other actors’ roles in the process of establishing a community-owned wind farm. Data collection relied on 21 semi-structured interviews, triangulated with documentary analyses and nine field-level expert interviews. Findings Findings reveal mayors’ exclusive roles of guarantor, formal convener, facilitator, and sponsor based on authority. Mayors’ various shared roles relate primarily to non-mandated participation. Mayors face tensions in their role exercise due to citizens’ expectations and their personal involvement. They experience a positive impact of shared leadership on the effectiveness of the participation process. Practical implications Mayors need to exercise specific leadership roles relative to other actors to effectively manage participation processes. Adequate role exercise relates to sensitization and mobilization for the issue, weakened opposition, and project adjustment to citizen demands. A strategic approach to process design can support mayors in their leadership efforts. Originality/value This paper adds to the knowledge on mayors’ leadership roles in participation processes and concretizes tensions and effectiveness of collaborative leadership. The paper reflects on the inference of findings for administrators as compared to mayors.

scholarly journals Collaborative capacity and patient-centered care in the Veterans’ Health Administration Community Living Centers

2019 ◽  
Vol 22 (2) ◽  
pp. 90-99 ◽  
Author(s):  
Jennifer L Sullivan ◽  
Dana Beth Weinburg ◽  
Stefanie Gidmark ◽  
Ryann L Engle ◽  
Victoria A Parker ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Care Coordination ◽  
Organizational Context ◽  
Community Living ◽  
Supervisory Support ◽  
Collaborative Capacity ◽  
Person Centered Care ◽  
Centered Care ◽  
Community Living Centers

Introduction Previous research in acute care settings has shown that collaborative capacity, defined as the way providers collaborate as equal team members, can be improved by the ways in which an organization supports its staff and teams. This observational cross-sectional study examines the association between collaborative capacity and supportive organizational context, supervisory support, and person-centered care in nursing homes to determine if similar relationships exist. Methods We adapted the Care Coordination Survey for nursing homes and administered it to clinical staff in 20 VA Community Living Centers. We used random effects models to examine the associations between supportive organizational context, supervisory support, and person-centered care with collaborative capacity outcomes including quality of staff interactions, task independence, and collaborative influence. Results A total of 723 Community Living Center clinical staff participated in the Care Coordination Survey resulting in a response rate of 29%. We found that teamwork and collaboration—measured as task interdependence, quality of interactions and collaborative influence—did not differ significantly between Community Living Centers but did differ significantly across occupational groups. Moreover, staff members’ experiences of teamwork and collaboration were positively associated with supportive organizational context and person-centered care. Discussion Our findings suggest that elements of organizational context are important to facilitating collaborative capacity. Additionally, investing in staffing, rewards, and person-centered care may improve teamwork.

Implementing a cornerstone of culture change: Consistent staff assignment in VHA community living centers.

2017 ◽  
Vol 14 (3) ◽  
pp. 327-336 ◽  
Author(s):  
Sonne Lemke ◽  
Penny L. Brennan ◽  
Sonya SooHoo ◽  
Kathleen K. Schutte
Keyword(s):  
Culture Change ◽  
Community Living ◽  
Staff Assignment ◽  
Community Living Centers

scholarly journals Engaging community pharmacists in quality improvement (QI): a qualitative case study of a partnership between a Higher Education Institute and Local Pharmaceutical Committees

2021 ◽  
Vol 10 (1) ◽  
pp. e001047
Author(s):  
Asam Latif ◽  
Nargis Gulzar ◽  
Fiona Lowe ◽  
Theo Ansong ◽  
Sejal Gohil
Keyword(s):  
Quality Improvement ◽  
Focus Groups ◽  
Qualitative Methodology ◽  
Positive Impact ◽  
Community Pharmacists ◽  
Educational Institute ◽  
Collaboration And Communication ◽  
Improve Service Quality ◽  
The Impact

BackgroundQuality improvement (QI) involves the use of systematic tools and methods to improve the quality of care and outcomes for patients. However, awareness and application of QI among healthcare professionals is poor and new strategies are needed to engage them in this area.ObjectivesThis study describes an innovative collaboration between one Higher Educational Institute (HEI) and Local Pharmaceutical Committees (LPCs) to develop a postgraduate QI module aimed to upskill community pharmacists in QI methods. The study explores pharmacist engagement with the learning and investigates the impact on their practice.MethodsDetails of the HEI–LPCs collaboration and communication with pharmacist were recorded. Focus groups were held with community pharmacists who enrolled onto the module to explore their motivation for undertaking the learning, how their knowledge of QI had changed and how they applied this learning in practice. A constructivist qualitative methodology was used to analyse the data.ResultsThe study found that a HEI–LPC partnership was feasible in developing and delivering the QI module. Fifteen pharmacists enrolled and following its completion, eight took part in one of two focus groups. Pharmacists reported a desire to extend and acquire new skills. The HEI–LPC partnership signalled a vote of confidence that gave pharmacists reassurance to sign up for the training. Some found returning to academia challenging and reported a lack of time and organisational support. Despite this, pharmacists demonstrated an enhanced understanding of QI, were more analytical in their day-to-day problem-solving and viewed the learning as having a positive impact on their team’s organisational culture with potential to improve service quality for patients.ConclusionsWith the increased adoption of new pharmacist’s roles and recent changes to governance associated with the COVID-19 pandemic, a HEI–LPC collaborative approach could upskill pharmacists and help them acquire skills to accommodate new working practices.

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