Challenges of using quality improvement methods in nursing homes that "need improvement"
Journal of the American Medical Directors Association
Rantz, M.J., Zwygart-Stauffacher, M., Flesner, M., Hicks, L., Mehr, D., Russell, T., & Minner, D.
A randomized, two-group, repeated-measures design was used to test a two year intervention for improving quality of care and resident outcomes in facilities in “need of improvement”. Intervention group (n=29) received an experimental multilevel intervention designed to help them: 1) use quality-improvement methods, 2) use team and group process for direct-care decision-making, 3) focus on accomplishing the basics of care, and 4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. A qualitative analysis revealed a subgroup of homes likely to continue quality improvement activities and readiness indicators of homes likely to improve: 1) a leadership team (NHA, DON) interested in learning how to use their federal QI/QM reports as a foundation for improving resident care and outcomes; 2) one of the leaders to be a “change champion” and make sure that current QI/QM reports are consistently printed and shared monthly with each nursing unit; 3) leaders willing to involve all staff in the facility in educational activities to learn about the QI/QM process and the reports that show how their facility compares with others in the state and nation; 4) leaders willing to plan and continuously educate new staff about the MDS and federal QI/QM reports and how to do quality improvement activities; 5) leaders willing to continuously involve all staff in quality improvement committee and team activities so they “own” the process and are responsible for change.
Key words: quality improvement, readiness indicators, nursing homes, randomized clinical trial, qualitative analysis
Rantz, M.J., Zwygart-Stauffacher, M., Flesner, M., Hicks, L., Mehr, D., Russell, T., & Minner, D. (In press). Challenges of using quality improvement methods in nursing homes that "need improvement". Submitted to Journal of the American Medical Directors Association.