Quality Improvement Implementation in the Nursing Home
Objective. To examine quality improvement (QI) implementation in nursing homes, its association with organizational culture, and its effects on pressure ulcer care. Data Sources/Study Settings. Primary data were collected from staff at 35 nursing homes maintained by the Department of Veterans Affair...
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| creator | Berlowitz, Dan R. Young, Gary J. Hickey, Elaine C. Saliba, Debra Mittman, Brian S. Czarnowski, Elaine Simon, Barbara Anderson, Jennifer J. Ash, Arlene S. Rubenstein, Lisa V. Moskowitz, MarkA |
| description | Objective. To examine quality improvement (QI) implementation in nursing homes, its association with organizational culture, and its effects on pressure ulcer care.
Data Sources/Study Settings. Primary data were collected from staff at 35 nursing homes maintained by the Department of Veterans Affairs (VA) on measures related to QI implementation and organizational culture. These data were combined with information obtained from ions of medical records and analyses of an existing database.
Study Design. A cross‐sectional analysis of the association among the different measures was performed.
Data Collection/Extraction Methods. Completed surveys containing information on QI implementation, organizational culture, employee satisfaction, and perceived adoption of guidelines were obtained from 1,065 nursing home staff. Adherence to best practices related to pressure ulcer prevention was ed from medical records. Risk‐adjusted rates of pressure ulcer development were calculated from an administrative database.
Principal Findings. Nursing homes differed significantly (p |
| doi_str_mv | 10.1111/1475-6773.00105 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1360874</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A99290660</galeid><sourcerecordid>A99290660</sourcerecordid><originalsourceid>FETCH-LOGICAL-c7055-7e9b7708f442cf9e869e1c169a31542b1b547c19fa9405661bf0d944e3037c423</originalsourceid><addsrcrecordid>eNqFktFv0zAQxiMEYt3gmTcUITHxsGx27NjxC9KoRjup2rQBGm-W615SDycucTLof4-zVmVBlYgfYp1_953P90XRG4xOcfjOMOVZwjgnpwhhlD2LRrvI82gUYjwROKUH0aH39wihnOT0ZXSAU5YhkuNRxG46ZU27ji-rVeMeoIK67ff2cada4-rY1HG7hPiqa7ypy3jqKngVvSiU9fB6-z-Kvn2--DqeJrPryeX4fJZojrIs4SDmnKO8oDTVhYCcCcAaM6EIzmg6x_OMco1FoQRFGWN4XqCFoBQIIlzTlBxFHze6q25ewUKHOzXKylVjKtWspVNGDk9qs5Sle5CYMJRzGgSOtwKN-9mBb2VlvAZrVQ2u85ITnPI87Su9-we8d11Th-ZkijHHGRNZgE42UKksSFMXLhTVJdQQarsaChPC50KkAjGGAp7swcNaQGX0Pv7DgA9IC7_bUnXey3wyG6An-1DtrIUSZBjC-HqAv3-CL0HZdumd7fr5-gF3tuF047xvoNg9NUayd5zs_SV7f8lHx4WMt08n9JffWiwAdAP8Cs2u_6cnpxdfbje627czPjS2S1PNj0CTkHN3NZF3Nzz9_ul2LKfkDysK6qg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211715695</pqid></control><display><type>article</type><title>Quality Improvement Implementation in the Nursing Home</title><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Berlowitz, Dan R. ; Young, Gary J. ; Hickey, Elaine C. ; Saliba, Debra ; Mittman, Brian S. ; Czarnowski, Elaine ; Simon, Barbara ; Anderson, Jennifer J. ; Ash, Arlene S. ; Rubenstein, Lisa V. ; Moskowitz, MarkA</creator><creatorcontrib>Berlowitz, Dan R. ; Young, Gary J. ; Hickey, Elaine C. ; Saliba, Debra ; Mittman, Brian S. ; Czarnowski, Elaine ; Simon, Barbara ; Anderson, Jennifer J. ; Ash, Arlene S. ; Rubenstein, Lisa V. ; Moskowitz, MarkA</creatorcontrib><description>Objective. To examine quality improvement (QI) implementation in nursing homes, its association with organizational culture, and its effects on pressure ulcer care.
Data Sources/Study Settings. Primary data were collected from staff at 35 nursing homes maintained by the Department of Veterans Affairs (VA) on measures related to QI implementation and organizational culture. These data were combined with information obtained from ions of medical records and analyses of an existing database.
Study Design. A cross‐sectional analysis of the association among the different measures was performed.
Data Collection/Extraction Methods. Completed surveys containing information on QI implementation, organizational culture, employee satisfaction, and perceived adoption of guidelines were obtained from 1,065 nursing home staff. Adherence to best practices related to pressure ulcer prevention was ed from medical records. Risk‐adjusted rates of pressure ulcer development were calculated from an administrative database.
Principal Findings. Nursing homes differed significantly (p<.001) in their extent of QI implementation with scores on this 1 to 5 scale ranging from 2.98 to 4.08. Quality improvement implementation was greater in those nursing homes with an organizational culture that emphasizes innovation and teamwork. Employees of nursing homes with a greater degree of QI implementation were more satisfied with their jobs (a 1‐point increase in QI score was associated with a 0.83 increase on the 5‐point satisfaction scale, p<.001) and were more likely to report adoption of pressure ulcer clinical guidelines (a 1‐point increase in QI score was associated with a 28 percent increase in number of staff reporting adoption, p<.001). No significant association was found, though, between QI implementation and either adherence to guideline recommendations as ed from records or the rate of pressure ulcer development.
Conclusions. Quality improvement implementation is most likely to be successful in those VA nursing homes with an underlying culture that promotes innovation. While QI implementation may result in staff who are more satisfied with their jobs and who believe they are providing better care, associations with improved care are uncertain.</description><identifier>ISSN: 0017-9124</identifier><identifier>EISSN: 1475-6773</identifier><identifier>DOI: 10.1111/1475-6773.00105</identifier><identifier>PMID: 12650381</identifier><identifier>CODEN: HESEA5</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing</publisher><subject>Aged ; Aged, 80 and over ; Corporate culture ; Cross-Sectional Studies ; decubitus ulcers ; Female ; Homes for the Aged - standards ; Humans ; Job satisfaction ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Nursing homes ; Nursing Homes - standards ; Organizational Culture ; Organizational Innovation ; Outcome Assessment (Health Care) ; Pressure Ulcer - epidemiology ; Pressure Ulcer - therapy ; Pressure ulcers ; Quality and Outcomes of Care ; Quality Assurance, Health Care - methods ; Quality Assurance, Health Care - organization & administration ; Quality improvement ; Quality management ; quality of care ; Quality of service ; Studies ; Total Quality Management - methods ; Total Quality Management - organization & administration ; United States ; United States Department of Veterans Affairs ; Veterans - statistics & numerical data ; Virginia - epidemiology</subject><ispartof>Health services research, 2003-02, Vol.38 (1p1), p.65-83</ispartof><rights>COPYRIGHT 2003 Health Research and Educational Trust</rights><rights>Copyright Hospital Research and Educational Trust Feb 2003</rights><rights>2003 Health Research and Education Trust. All rights reserved 2003</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c7055-7e9b7708f442cf9e869e1c169a31542b1b547c19fa9405661bf0d944e3037c423</citedby><cites>FETCH-LOGICAL-c7055-7e9b7708f442cf9e869e1c169a31542b1b547c19fa9405661bf0d944e3037c423</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360874/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360874/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,1411,27901,27902,30976,45550,45551,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12650381$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Berlowitz, Dan R.</creatorcontrib><creatorcontrib>Young, Gary J.</creatorcontrib><creatorcontrib>Hickey, Elaine C.</creatorcontrib><creatorcontrib>Saliba, Debra</creatorcontrib><creatorcontrib>Mittman, Brian S.</creatorcontrib><creatorcontrib>Czarnowski, Elaine</creatorcontrib><creatorcontrib>Simon, Barbara</creatorcontrib><creatorcontrib>Anderson, Jennifer J.</creatorcontrib><creatorcontrib>Ash, Arlene S.</creatorcontrib><creatorcontrib>Rubenstein, Lisa V.</creatorcontrib><creatorcontrib>Moskowitz, MarkA</creatorcontrib><title>Quality Improvement Implementation in the Nursing Home</title><title>Health services research</title><addtitle>Health Serv Res</addtitle><description>Objective. To examine quality improvement (QI) implementation in nursing homes, its association with organizational culture, and its effects on pressure ulcer care.
Data Sources/Study Settings. Primary data were collected from staff at 35 nursing homes maintained by the Department of Veterans Affairs (VA) on measures related to QI implementation and organizational culture. These data were combined with information obtained from ions of medical records and analyses of an existing database.
Study Design. A cross‐sectional analysis of the association among the different measures was performed.
Data Collection/Extraction Methods. Completed surveys containing information on QI implementation, organizational culture, employee satisfaction, and perceived adoption of guidelines were obtained from 1,065 nursing home staff. Adherence to best practices related to pressure ulcer prevention was ed from medical records. Risk‐adjusted rates of pressure ulcer development were calculated from an administrative database.
Principal Findings. Nursing homes differed significantly (p<.001) in their extent of QI implementation with scores on this 1 to 5 scale ranging from 2.98 to 4.08. Quality improvement implementation was greater in those nursing homes with an organizational culture that emphasizes innovation and teamwork. Employees of nursing homes with a greater degree of QI implementation were more satisfied with their jobs (a 1‐point increase in QI score was associated with a 0.83 increase on the 5‐point satisfaction scale, p<.001) and were more likely to report adoption of pressure ulcer clinical guidelines (a 1‐point increase in QI score was associated with a 28 percent increase in number of staff reporting adoption, p<.001). No significant association was found, though, between QI implementation and either adherence to guideline recommendations as ed from records or the rate of pressure ulcer development.
Conclusions. Quality improvement implementation is most likely to be successful in those VA nursing homes with an underlying culture that promotes innovation. While QI implementation may result in staff who are more satisfied with their jobs and who believe they are providing better care, associations with improved care are uncertain.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Corporate culture</subject><subject>Cross-Sectional Studies</subject><subject>decubitus ulcers</subject><subject>Female</subject><subject>Homes for the Aged - standards</subject><subject>Humans</subject><subject>Job satisfaction</subject><subject>Linear Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Nursing homes</subject><subject>Nursing Homes - standards</subject><subject>Organizational Culture</subject><subject>Organizational Innovation</subject><subject>Outcome Assessment (Health Care)</subject><subject>Pressure Ulcer - epidemiology</subject><subject>Pressure Ulcer - therapy</subject><subject>Pressure ulcers</subject><subject>Quality and Outcomes of Care</subject><subject>Quality Assurance, Health Care - methods</subject><subject>Quality Assurance, Health Care - organization & administration</subject><subject>Quality improvement</subject><subject>Quality management</subject><subject>quality of care</subject><subject>Quality of service</subject><subject>Studies</subject><subject>Total Quality Management - methods</subject><subject>Total Quality Management - organization & administration</subject><subject>United States</subject><subject>United States Department of Veterans Affairs</subject><subject>Veterans - statistics & numerical data</subject><subject>Virginia - epidemiology</subject><issn>0017-9124</issn><issn>1475-6773</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqFktFv0zAQxiMEYt3gmTcUITHxsGx27NjxC9KoRjup2rQBGm-W615SDycucTLof4-zVmVBlYgfYp1_953P90XRG4xOcfjOMOVZwjgnpwhhlD2LRrvI82gUYjwROKUH0aH39wihnOT0ZXSAU5YhkuNRxG46ZU27ji-rVeMeoIK67ff2cada4-rY1HG7hPiqa7ypy3jqKngVvSiU9fB6-z-Kvn2--DqeJrPryeX4fJZojrIs4SDmnKO8oDTVhYCcCcAaM6EIzmg6x_OMco1FoQRFGWN4XqCFoBQIIlzTlBxFHze6q25ewUKHOzXKylVjKtWspVNGDk9qs5Sle5CYMJRzGgSOtwKN-9mBb2VlvAZrVQ2u85ITnPI87Su9-we8d11Th-ZkijHHGRNZgE42UKksSFMXLhTVJdQQarsaChPC50KkAjGGAp7swcNaQGX0Pv7DgA9IC7_bUnXey3wyG6An-1DtrIUSZBjC-HqAv3-CL0HZdumd7fr5-gF3tuF047xvoNg9NUayd5zs_SV7f8lHx4WMt08n9JffWiwAdAP8Cs2u_6cnpxdfbje627czPjS2S1PNj0CTkHN3NZF3Nzz9_ul2LKfkDysK6qg</recordid><startdate>200302</startdate><enddate>200302</enddate><creator>Berlowitz, Dan R.</creator><creator>Young, Gary J.</creator><creator>Hickey, Elaine C.</creator><creator>Saliba, Debra</creator><creator>Mittman, Brian S.</creator><creator>Czarnowski, Elaine</creator><creator>Simon, Barbara</creator><creator>Anderson, Jennifer J.</creator><creator>Ash, Arlene S.</creator><creator>Rubenstein, Lisa V.</creator><creator>Moskowitz, MarkA</creator><general>Blackwell Publishing</general><general>Health Research and Educational Trust</general><general>Blackwell Publishing Ltd</general><general>Blackwell Science Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>7QJ</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>200302</creationdate><title>Quality Improvement Implementation in the Nursing Home</title><author>Berlowitz, Dan R. ; Young, Gary J. ; Hickey, Elaine C. ; Saliba, Debra ; Mittman, Brian S. ; Czarnowski, Elaine ; Simon, Barbara ; Anderson, Jennifer J. ; Ash, Arlene S. ; Rubenstein, Lisa V. ; Moskowitz, MarkA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c7055-7e9b7708f442cf9e869e1c169a31542b1b547c19fa9405661bf0d944e3037c423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Corporate culture</topic><topic>Cross-Sectional Studies</topic><topic>decubitus ulcers</topic><topic>Female</topic><topic>Homes for the Aged - standards</topic><topic>Humans</topic><topic>Job satisfaction</topic><topic>Linear Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Nursing homes</topic><topic>Nursing Homes - standards</topic><topic>Organizational Culture</topic><topic>Organizational Innovation</topic><topic>Outcome Assessment (Health Care)</topic><topic>Pressure Ulcer - epidemiology</topic><topic>Pressure Ulcer - therapy</topic><topic>Pressure ulcers</topic><topic>Quality and Outcomes of Care</topic><topic>Quality Assurance, Health Care - methods</topic><topic>Quality Assurance, Health Care - organization & administration</topic><topic>Quality improvement</topic><topic>Quality management</topic><topic>quality of care</topic><topic>Quality of service</topic><topic>Studies</topic><topic>Total Quality Management - methods</topic><topic>Total Quality Management - organization & administration</topic><topic>United States</topic><topic>United States Department of Veterans Affairs</topic><topic>Veterans - statistics & numerical data</topic><topic>Virginia - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Berlowitz, Dan R.</creatorcontrib><creatorcontrib>Young, Gary J.</creatorcontrib><creatorcontrib>Hickey, Elaine C.</creatorcontrib><creatorcontrib>Saliba, Debra</creatorcontrib><creatorcontrib>Mittman, Brian S.</creatorcontrib><creatorcontrib>Czarnowski, Elaine</creatorcontrib><creatorcontrib>Simon, Barbara</creatorcontrib><creatorcontrib>Anderson, Jennifer J.</creatorcontrib><creatorcontrib>Ash, Arlene S.</creatorcontrib><creatorcontrib>Rubenstein, Lisa V.</creatorcontrib><creatorcontrib>Moskowitz, MarkA</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Health services research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Berlowitz, Dan R.</au><au>Young, Gary J.</au><au>Hickey, Elaine C.</au><au>Saliba, Debra</au><au>Mittman, Brian S.</au><au>Czarnowski, Elaine</au><au>Simon, Barbara</au><au>Anderson, Jennifer J.</au><au>Ash, Arlene S.</au><au>Rubenstein, Lisa V.</au><au>Moskowitz, MarkA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quality Improvement Implementation in the Nursing Home</atitle><jtitle>Health services research</jtitle><addtitle>Health Serv Res</addtitle><date>2003-02</date><risdate>2003</risdate><volume>38</volume><issue>1p1</issue><spage>65</spage><epage>83</epage><pages>65-83</pages><issn>0017-9124</issn><eissn>1475-6773</eissn><coden>HESEA5</coden><abstract>Objective. To examine quality improvement (QI) implementation in nursing homes, its association with organizational culture, and its effects on pressure ulcer care.
Data Sources/Study Settings. Primary data were collected from staff at 35 nursing homes maintained by the Department of Veterans Affairs (VA) on measures related to QI implementation and organizational culture. These data were combined with information obtained from ions of medical records and analyses of an existing database.
Study Design. A cross‐sectional analysis of the association among the different measures was performed.
Data Collection/Extraction Methods. Completed surveys containing information on QI implementation, organizational culture, employee satisfaction, and perceived adoption of guidelines were obtained from 1,065 nursing home staff. Adherence to best practices related to pressure ulcer prevention was ed from medical records. Risk‐adjusted rates of pressure ulcer development were calculated from an administrative database.
Principal Findings. Nursing homes differed significantly (p<.001) in their extent of QI implementation with scores on this 1 to 5 scale ranging from 2.98 to 4.08. Quality improvement implementation was greater in those nursing homes with an organizational culture that emphasizes innovation and teamwork. Employees of nursing homes with a greater degree of QI implementation were more satisfied with their jobs (a 1‐point increase in QI score was associated with a 0.83 increase on the 5‐point satisfaction scale, p<.001) and were more likely to report adoption of pressure ulcer clinical guidelines (a 1‐point increase in QI score was associated with a 28 percent increase in number of staff reporting adoption, p<.001). No significant association was found, though, between QI implementation and either adherence to guideline recommendations as ed from records or the rate of pressure ulcer development.
Conclusions. Quality improvement implementation is most likely to be successful in those VA nursing homes with an underlying culture that promotes innovation. While QI implementation may result in staff who are more satisfied with their jobs and who believe they are providing better care, associations with improved care are uncertain.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing</pub><pmid>12650381</pmid><doi>10.1111/1475-6773.00105</doi><tpages>19</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Corporate culture Cross-Sectional Studies decubitus ulcers Female Homes for the Aged - standards Humans Job satisfaction Linear Models Male Middle Aged Multivariate Analysis Nursing homes Nursing Homes - standards Organizational Culture Organizational Innovation Outcome Assessment (Health Care) Pressure Ulcer - epidemiology Pressure Ulcer - therapy Pressure ulcers Quality and Outcomes of Care Quality Assurance, Health Care - methods Quality Assurance, Health Care - organization & administration Quality improvement Quality management quality of care Quality of service Studies Total Quality Management - methods Total Quality Management - organization & administration United States United States Department of Veterans Affairs Veterans - statistics & numerical data Virginia - epidemiology |
| title | Quality Improvement Implementation in the Nursing Home |
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