Importance of Team Functioning as a Target of Quality Improvement Initiatives in Nursing Homes: A Qualitative Process Evaluation

Desveaux, Laura; Halko, Roxanne; Marani, Husayn; Feldman, Sid; Ivers, Noah

doi:10.1097/ceh.0000000000000238

Cited by 17 publications

(38 citation statements)

References 41 publications

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“…Our findings also suggest the A&F report did not reinforce behaviour change, indicating that A&F may not be effective as a standalone strategy when prescriber beliefs are such a strong determinant and Environmental context and resources has such a strong negative impact. Our results are consistent with the evidence for moving beyond education and individual interventions to explicitly address team functioning and communication, 26 27 as well as system-level changes, such as optimising staffing models. When a team approach is used in combination with system-level changes, it may allow physicians to fulfil their clinical and professional role and support improved antibiotic prescribing.…”

Section: Discussionsupporting

confidence: 87%

“…Our findings echo those of similar initiatives to influence prescribing in nursing homes, 25 26 35 particularly regarding the impact of team functioning on prescribing. 26 Physician prescribers in this setting must move from ‘letting it happen’ to ‘making it happen’. 36 To achieve this shift, the use of the TDF in this study provides an opportunity to map the key drivers of behaviour to Behaviour Change Techniques (BCTs), informing an evidence-based intervention to improve antibiotic prescribing that is tailored to the problem at hand.…”

Section: Discussionmentioning

confidence: 99%

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Improving antibiotic initiation and duration prescribing among nursing home physicians using an audit and feedback intervention: a theory-informed qualitative analysis

et al. 2021

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BackgroundIn nursing homes, 25%–75% of antibiotic days of treatment are inappropriate or unnecessary and are often continued for longer durations than necessary. In Ontario, physicians can receive a provincial audit and feedback report that provides individualised, confidential, data about their antibiotic prescribing. Objectives of this study were to explore antibiotic prescribing of nursing home physicians and the influence of the report.MethodsAll physicians who received a personalised MyPractice: Long-Term Care report from Ontario Health (Quality) (OH(Q)) in January 2019 (n=361) were eligible to participate in semistructured telephone interviews that were recorded then transcribed verbatim. Recruitment emails were sent from OH(Q) until saturation of ideas. Analysis was conducted by two team members inductively, then deductively using the theoretical domains framework, a comprehensive, theory-informed framework to classify determinants of specific behaviours.ResultsInterviews were conducted with n=18 physicians; 78% (n=14) were men, practising for an average of 27 years, with 18 years of experience working in nursing homes. Physicians worked in a median of 2 facilities (range 1–6), with 72% (n=13) in an urban setting. 56% (n=10) were medical directors for at least one home. Professional role and identity impacted all aspects of antibiotic prescribing. Key roles included being an ‘Appropriate prescriber’, an ‘Educator’ and a ‘Change driver’. For antibiotic initiation, these roles interacted with Knowledge, Skills, Beliefs about consequence, Beliefs about capabilities, and Social influence to determine the resulting prescribing behaviour. When considering the impact of interacting with the report, participants’ perceived roles interacted with Reinforcement, Social influence, and Intention. Environmental context and resources was an overarching domain.ConclusionThis theory-informed approach is being used to inform upcoming versions of existing audit and feedback initiatives. Appealing to the role that prescribers see themselves offers a unique opportunity to encourage desired changes, such as providing tools for physicians to be Educators and facilitating, particularly medical directors, to be Change drivers.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Improving antibiotic initiation and duration prescribing among nursing home physicians using an audit and feedback intervention: a theory-informed qualitative analysis

et al. 2021

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“…A theme of supportive leadership occurred 51 times (31.48%) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. Capable and motivated employees occurred 25 times (15.43%) [ 22 , 27 , 30 , 32 , 35 , 45 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. Positive organizational values occurred 20 times (12.35%) [ 22 , 23 , 24 , 29 , 31 , 32 , 33 , 48 ,…”

Section: Resultsmentioning

confidence: 99%

“…The 162 occurrences were grouped into 11 different themes for the facilitators. The eleven "facilitator" themes as demonstrated in Table 2 and represented in Figure 1 included supportive leadership , capable and motivated employees [22,27,30,32,35,45,[49][50][51][52][53][54][55][56][57][58][59][60], positive organizational values [22][23][24]29,[31][32][33]48,51,53,54,57,[61][62][63][64], social support mechanisms, adequate job resources [32,38,45,47,54,55,[69][70][71], career/professional development [25,35,37,38,…”

Section: Most Impactful Themesmentioning

confidence: 99%

Facilitators and Barriers Surrounding the Role of Administration in Employee Job Satisfaction in Long-Term Care Facilities: A Systematic Review

et al. 2020

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Previous literature has shown how associate engagement has positively impacted on productivity, job satisfaction, safety, retention, consumer sentiment, and financial performance in hospitals and healthcare systems. However, a lack of research showing the relationship between associate engagement and job satisfaction within the long-term care environment has existed. Our objective was to investigate characteristics within the long-term care environment that promote and detract from associate job satisfaction and extrapolate the best practices in maintaining job satisfaction and engagement. This systematic review queried CINAHL, PubMed (MEDLINE), and Academic Search Ultimate databases for peer-reviewed publications for facilitators and barriers commensurate with employee job satisfaction in long-term care facilities using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Kruse Protocols. The authors identified 11 facilitators for job satisfaction and 18 barriers to job satisfaction in the 60 selected articles. The top four facilitators were Supportive Leadership, Capable and Motivated Employees, Positive Organizational Values, and Social Support Mechanisms. The top four barriers were condescending management style, high job demands, lack of self-care, and lack of training with medically complex patients. The systematic review revealed the importance of maintaining satisfied employees in the long-term care workplace through am emphasis leadership and on the facilitators identified to best serve their associates and improve care for residents.

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“…Strong team functioning, with effective communication and clarity about roles, seems to mediate improved evidence uptake in an interdisciplinary setting. 32 …”

Section: Discussionmentioning

confidence: 99%

Towards Better Perioperative Pain Management in Mexico: A Study in a Network of Hospitals Using Quality Improvement Methods from PAIN OUT

Garduño-López

Nava

Garcés

et al. 2021

JPR

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Objective This was a pre–post study in a network of hospitals in Mexico-City, Mexico. Participants developed and implemented Quality Improvement (QI) interventions addressing perioperative pain management. Methods PAIN OUT, an international QI and research network, provided tools for web-based auditing and feedback of pain management and patient-reported outcomes (PROs) in the clinical routine. Ward- and patient-level factors were evaluated with multi-level models. Change in proportion of patients reporting worst pain ≥6/10 between project phases was the primary outcome. Results Participants created locally adapted resources for teaching and pain management, available to providers in the form of a website and a special issue of a national anesthesia journal. They offered teaching to anesthesiologists, surgeons, including residents, and nurses. Information was offered to patients and families. A total of 2658 patients were audited in 9 hospitals, between July 2016 and December 2018. Participants reported that the project made them aware of the importance of: training in pain management; auditing one’s own patients to learn about PROs and that QI requires collaboration between multi-disciplinary teams. Participants reported being unaware that their patients experienced severe pain and lacked information about pain treatment options. Worst pain decreased significantly between the two project phases, as did PROs related to pain interfering with movement, taking a deep breath/coughing or sleep. The opportunity of patients receiving information about their pain treatment options increased from 44% to 77%. Conclusions Patients benefited from improved care and pain-related PROs. Clinicians appreciated gaining increased expertise in perioperative pain management and methods of QI.

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Importance of Team Functioning as a Target of Quality Improvement Initiatives in Nursing Homes: A Qualitative Process Evaluation

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 17 publications

References 41 publications

Improving antibiotic initiation and duration prescribing among nursing home physicians using an audit and feedback intervention: a theory-informed qualitative analysis

Improving antibiotic initiation and duration prescribing among nursing home physicians using an audit and feedback intervention: a theory-informed qualitative analysis

Facilitators and Barriers Surrounding the Role of Administration in Employee Job Satisfaction in Long-Term Care Facilities: A Systematic Review

Towards Better Perioperative Pain Management in Mexico: A Study in a Network of Hospitals Using Quality Improvement Methods from PAIN OUT

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