Lessons learnt from nursing home and homecare managers’ experiences with using the SAFE-LEAD guide

Abstract

Background: In the SAFE-LEAD intervention we implemented a research-based guide (paper-and web-version) for managers to support their quality improvement work. This paper explores managers' experiences with the SAFE-LEAD guide, and key factors of relevance for sustainability. Methods: Four Norwegian nursing homes and four homecare services participated, and 36 workshops with managers working together with researchers on the guide were conducted. After the intervention, nine focus groups with managers were conducted. Systematic text condensation was used for analysis. Results: Managers perceived the guide as useful in their quality improvement work. It helped create a systematic approach and overview of improvement activities. The guide supported collaborative reflections, awareness and fitted with their daily work. Most preferred the web-version, but technical adjustments were required to ease its use. Prioritization, anchoring, super users, and local adjustments were key factors for sustainability. Conclusion: Key factors for successful implementation were adapting the guide to the local context, access to supporting learning tools, thorough anchoring, acknowledging its benefits, and prioritizing. Further implementation studies should take technological maturity, ongoing changes and reorganizations in the sector and units into account. Careful planning and timing of the intervention, involving all relevant stakeholders at an early stage, is important.

Managers' role in supporting resilience in healthcare: a proposed model of how managers contribute to a healthcare system's overall resilience

“…Based on these data, several papers have been published that are of relevance for the current paper. The previously published papers explore the influence of contextual factors in quality and safety work (Ree et al, 2019), challenges in quality and safety work (Johannessen et al, 2020), reflexive spaces as key for resilience in healthcare (Wiig et al, 2020a), the role of transformational leadership for patient safety culture (Ree and Wiig, 2019b;Seljemo et al, 2020), and how managers use and experience the SAFE-LEAD guide in their quality work (Ree et al, 2020a). Furthermore, it was explored how quality is conceptualized in nursing homes and homecare (Aase et al, 2020), as well as the importance of and challenges related to user involvement (Aase et al, 2020;Ree et al, 2020b).…”

“…Furthermore, they focused on involving employees in sensemaking. Many engaged a professional development nurse to help them being up to date and to be a driving force in quality improvement work (Ree et al, 2019(Ree et al, , 2020a. They highlighted the importance of having professional staff with high competence (Johannessen et al, 2020;Ree et al, 2019).…”

“…During the SAFE-LEAD intervention period, managers were shadowed on site to observe their work on quality and safety. They emphasized the value of working together on the guide in management teams, as it stimulated joint reflections, and greater awareness about their quality work and challenges (Ree et al, 2020a). Discussing and reflecting in groups made them more pro-active and helped them find good solutions on emerging risks, challenges and changes facing the organizations.…”

“…Discussing and reflecting in groups made them more pro-active and helped them find good solutions on emerging risks, challenges and changes facing the organizations. This intervention acted as a reflexive space, where managers came together to reflect upon current challenges, adaptations and needs in their daily work (Ree et al, 2020a;Wiig et al, 2020a). It also acted as a bridge between departments as managers met across departments to exchange knowledge, reflections, and action plans, and to agree on new improvement efforts (Ree et al, 2020a;Wiig et al, 2020a).…”

“…This intervention acted as a reflexive space, where managers came together to reflect upon current challenges, adaptations and needs in their daily work (Ree et al, 2020a;Wiig et al, 2020a). It also acted as a bridge between departments as managers met across departments to exchange knowledge, reflections, and action plans, and to agree on new improvement efforts (Ree et al, 2020a;Wiig et al, 2020a). This is an example of how healthcare managers can use reflexive spaces to stimulate resilience in healthcare (Wiig et al, 2020a).…”