Victoria Parker1,2, Ryann L Engle1, Melissa K Afable3, Denise A Tyler4, Katelyn Gormley1, Kelly Stolzmann1, Michael Shwartz1,5, Jennifer L Sullivan1,6. 1. a Center for Healthcare Organization & Implementation Research , VA Boston Healthcare System , Boston , MA. 2. b Peter T. Paul College of Business and Economics , University of New Hampshire , Durham , NH. 3. c Department of Quality, Safety & Value , Partners HealthCare , Boston , MA. 4. e Program on Aging, Disability, and Long-term care, RTI , Waltham , MA. 5. f Questrom School of Business , Boston University , Boston , MA. 6. d Department of Health Law, Policy and Management , Boston University School of Public Health , Boston , MA.
Abstract
OBJECTIVES: The purpose of this study was to understand if and how Veterans Affairs (VA) nursing home (CLC) staff experience difficulty in providing care that is both resident-centered (RCC) and concordant with quality standards. METHODS: Twelve VA CLCs were selected for site visits, stratified based on rankings on a composite quality measure (calculated from various indicators) and resident-centered care (RCC) progress (based on a culture change tool). Staff were interviewed about efforts and barriers to achieving goals in RCC and quality, and the interview transcripts systematically analyzed for themes. RESULTS: We interviewed 141 participants, including senior leaders, middle managers, and front-line staff. An emergent theme was conflict between RCC and quality, although participants varied in their perceptions of its impact. Participants perceived three conflict types: 1) between resident preferences and medically indicated actions; 2) between resident preferences and the needs or safety of others; and 3) limits of staff time or authority. CONCLUSIONS: CLC staff perceive conflicts between RCC and care consistent with quality imperatives. CLINICAL IMPLICATIONS: Variation in perceived RCC-quality conflicts suggests that policy clarifications and additional training may provide guidance in dealing with such dilemmas. It may be prudent to clearly communicate to what boundaries exist to RCC in the evolving CLC environment.
OBJECTIVES: The purpose of this study was to understand if and how Veterans Affairs (VA) nursing home (CLC) staff experience difficulty in providing care that is both resident-centered (RCC) and concordant with quality standards. METHODS: Twelve VA CLCs were selected for site visits, stratified based on rankings on a composite quality measure (calculated from various indicators) and resident-centered care (RCC) progress (based on a culture change tool). Staff were interviewed about efforts and barriers to achieving goals in RCC and quality, and the interview transcripts systematically analyzed for themes. RESULTS: We interviewed 141 participants, including senior leaders, middle managers, and front-line staff. An emergent theme was conflict between RCC and quality, although participants varied in their perceptions of its impact. Participants perceived three conflict types: 1) between resident preferences and medically indicated actions; 2) between resident preferences and the needs or safety of others; and 3) limits of staff time or authority. CONCLUSIONS:CLC staff perceive conflicts between RCC and care consistent with quality imperatives. CLINICAL IMPLICATIONS: Variation in perceived RCC-quality conflicts suggests that policy clarifications and additional training may provide guidance in dealing with such dilemmas. It may be prudent to clearly communicate to what boundaries exist to RCC in the evolving CLC environment.
Entities:
Keywords:
Health care; quality indicators; resident-centered care; skilled nursing facilities
Authors: Liza L Behrens; Marie Boltz; Ann Kolanowski; Mark Sciegaj; Caroline Madrigal; Katherine Abbott; Kimberly Van Haitsma Journal: Gerontologist Date: 2020-11-23
Authors: Jennifer L Sullivan; Dana Beth Weinburg; Stefanie Gidmark; Ryann L Engle; Victoria A Parker; Denise A Tyler Journal: Int J Care Coord Date: 2019-06-01
Authors: Jennifer L Sullivan; Ryann L Engle; Denise Tyler; Melissa K Afable; Katelyn Gormley; Michael Shwartz; Omonyêlé Adjognon; Victoria A Parker Journal: Inquiry Date: 2018 Jan-Dec Impact factor: 1.730