SCOPEOUT: sustainability and spread of quality improvement activities in long-term care- a mixed methods approach

Abstract

BackgroundInterventions to improve quality of care for residents of long-term care facilities, and to examine the sustainability and spread of such initiatives, remain a top research priority. The purpose of this exploratory study was to assess the extent to which activities initiated in a quality improvement (QI) collaborative study using care aide led teams were sustained or spread following cessation of the initial project and to identify factors that led to its success.MethodsThis study used an exploratory mixed methods study design and was conducted in seven residential long-term care facilities in two Canadian provinces. Sustainability and spread of QI activities were assessed by a questionnaire over five time points for 18 months following the collaborative study with staff from both intervention with non-intervention units. Semi-structured interviews were conducted with care managers at six and 12 months. QI team success in applying the QI model was ranked as high, medium, or low using criteria developed by the research team. Descriptive statistics, bivariate analyses, and General Estimating Equations were used to analyze the data. Interview data were analyzed using thematic analysis.ResultsIn total, 683 surveys were received over the five time periods from 476 unique individuals on a facility unit. Seven managers were interviewed. A total of 533 surveys were analyzed. While both intervention and non-intervention units experienced a decline over time in all outcome measures, this decline was significantly less pronounced on intervention units. Facilities with medium and high success ranking had significantly higher scores in all four outcomes than facilities with a low success ranking. Care aides reported significantly less involvement of others in QI activities, less empowerment and less satisfaction with the quality of their work life than regulated care providers. Manager interviews provided evidence of sustainability of QI activities on the intervention units in four of the seven facilities up to 18 months following the intervention and demonstrated the need for continued staff and leadership engagement.ConclusionSustainability of a QI project which empowers and engages care aides is possible and achievable, but requires ongoing staff and leadership engagement.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2978-0) contains supplementary material, which is available to authorized users.

Quality improvement in long-term care settings: a scoping review of effective strategies used in care homes

“…Specifically, the following process measures were assessed: hourly rounding [26], care planning [29], collaborative practice [68]. Finally, one study described changes to the care home (social) environment, such as mealtime ambience [23]. Overall, these data indicate that quality improvement strategies can be successfully implemented in care home settings, but do not differentiate between various quality improvement strategies applied.…”

“…To do so comprehensively, authors must report on the change management, and also describe resident interventions and outcomes. To do so within the editorial limitations of a journal article is challenging and this may be reflected in the six QI interventions included here where the authors chose to describe intervention development and evaluation over multiple papers [12,23,27,44,77,92]. The SQUIRE checklist [100] is relatively recent (2016) and was published after many of the papers included in our review and this may explain why many authors did not adhere to this reporting guideline.…”

Blended Facilitation as an Effective Implementation Strategy for Quality Improvement and Research in Nursing Homes

“…4 All of these factors also contribute to poor sustainability after study completion, despite a given study's demonstrated efficacy or benefit to nursing home residents. 3…”

“…Strong leadership from management and ongoing engagement of staff allow QI processes to become embedded into routine practices to improve resident care. 3 Meaningful and ongoing engagement with nursing home leaders prior to the formal implementation period, therefore, is imperative for connecting with individuals to fill the internal facilitation role and for sustaining positive impacts of the QI and research efforts.…”

“…2 Despite these recognized needs, nursing homes often fail to implement or sustain innovative practices. 3,4 Unique challenges such as time constraints, top-down flow of communication, and high staff turnover may contribute to this lack of uptake. Limited attention has been paid to methods that nursing home stakeholders and the research community employ to improve the adoption and maintenance of practice innovations.…”