Whitney L Mills1,2, Camilla B Pimentel3, Jennifer A Palmer4, A Lynn Snow5,6,7, Nancy J Wewiorski4, Rebecca S Allen5,6, Christine W Hartmann4,8. 1. Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas. 2. Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas. 3. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. 4. Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, Massachusetts. 5. Alabama Research Institute on Aging, University of Alabama, Tuscaloosa. 6. Department of Psychology, University of Alabama, Tuscaloosa. 7. Tuscaloosa Veterans Affairs Medical Center, Alabama. 8. Department of Health Law, Policy and Management, School of Public Health, Boston University, Massachusetts.
Abstract
Purpose of the Study: Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. Design and development: The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. Results: The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. Implications: The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.
Purpose of the Study: Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. Design and development: The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. Results: The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. Implications: The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.
Authors: A Lynn Snow; M Lindsey Jacobs; Jennifer A Palmer; Patricia A Parmelee; Rebecca S Allen; Nancy J Wewiorski; Michelle M Hilgeman; Latrice D Vinson; Dan R Berlowitz; Anne D Halli-Tierney; Christine W Hartmann Journal: Gerontologist Date: 2018-03-19
Authors: Randi E Berkowitz; Zachary Fang; Benjamin K I Helfand; Richard N Jones; Robert Schreiber; Michael K Paasche-Orlow Journal: J Am Med Dir Assoc Date: 2013-04-20 Impact factor: 4.669
Authors: Jennifer L Carnahan; Kathleen T Unroe; Russell Evans; Sarah Klepfer; Timothy E Stump; Patrick O Monahan; Alexia M Torke Journal: Innov Aging Date: 2022-05-11
Authors: Camilla B Pimentel; Whitney L Mills; Jennifer A Palmer; Kristen Dillon; Jennifer L Sullivan; Nancy J Wewiorski; Andrea Lynn Snow; Rebecca S Allen; Susan D Hopkins; Christine W Hartmann Journal: J Nurs Care Qual Date: 2019 Jul/Sep Impact factor: 1.597
Authors: A Lynn Snow; Julia Loup; Robert O Morgan; Kathy Richards; Patricia A Parmelee; Rosa R Baier; Ellen McCreedy; Barbara Frank; Cathie Brady; Liam Fry; Megan McCullough; Christine W Hartmann Journal: BMC Geriatr Date: 2021-04-27 Impact factor: 3.921