Applying a Theory-Driven Framework to Guide Quality Improvement Efforts in Nursing Homes: The LOCK Model

Area of Science:

• Healthcare Quality Improvement
• Geriatric Care
• Organizational Learning

Background:

• Nursing homes face persistent challenges in implementing quality improvement (QI) programs.
• QI initiatives offer opportunities for staff collaboration to enhance care delivery.
• Existing QI approaches require adaptation for the unique nursing home environment.

Purpose of the Study:

• To present a theory-driven, adaptable framework and facilitation package to address QI challenges in nursing homes.
• To guide nursing home staff in developing and testing strategies for improved care.
• To overcome barriers in implementing effective quality improvement in long-term care settings.

Main Methods:

• Development of the "LOCK" framework, integrating concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning.
• Adaptation of foundational QI concepts for the nursing home setting.
• Dissemination of the LOCK framework within the Veterans Health Administration.

Main Results:

• The LOCK framework comprises five tenets: Look for bright spots, Observe, Collaborate in huddles, Keep it bite-sized, and facilitation.
• A case study illustrates the implementation of the LOCK framework to improve staff-resident engagement.
• The framework demonstrates practical applications, adaptability for various QI projects, and the crucial role of facilitation.

Conclusions:

• The LOCK framework offers a valuable approach to complement national efforts in enhancing nursing home quality of care and life.
• The framework is adaptable for diverse QI projects and long-term care settings.
• Effective facilitation is key to successful implementation and outcomes in nursing home QI initiatives.