Challenges of using quality improvement methods in nursing homes that "need improvement"

Area of Science:

• Gerontology
• Healthcare Quality Improvement
• Nursing Home Administration

Background:

• Nursing homes often require improvement in quality of care and resident outcomes.
• Identifying facilities ready for quality improvement is crucial for resource allocation.

Purpose of the Study:

• To qualitatively describe strategies and challenges in nursing homes participating in a quality improvement initiative.
• To understand how staff utilize federal quality indicator/quality measure (QI/QM) scores and reports.
• To examine how staff support and sustain changes recommended by quality improvement teams.

Main Methods:

• A randomized, two-group, repeated-measures design tested a 2-year intervention in nursing homes needing improvement.
• The intervention focused on quality improvement methods, team-based decision-making, care basics, and leadership commitment.
• Qualitative analysis was used to identify readiness indicators for improvement.

Main Results:

• Facilities likely to improve demonstrated leadership interest in using QI/QM reports.
• A "change champion" leader was key to consistently sharing QI/QM reports.
• Involvement of all staff in education and quality improvement activities fostered ownership and sustained change.

Conclusions:

• Qualitative findings aid in directing expert nurse support to facilities prepared for improvement.
• Widespread adoption of the intervention is feasible, facilitated by medical directors and advanced practice nurses.