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Implementing Frontline Worker-Led Quality Improvement in Nursing Homes: Getting to "How".
Joint Commission Journal on Quality and Patient Safety
|September 1, 2018
Summary
Frontline worker-led quality improvement (QI) teams in nursing homes are feasible. Successful QI implementation requires supportive structures, skill development, and observable impacts, alongside strong leadership and positive staff relationships.
Area of Science:
- Gerontology
- Healthcare Management
- Implementation Science
Background:
- Limited understanding of quality improvement (QI) implementation processes in nursing homes.
- Need to explore how complex, frontline worker-led QI programs function in practice.
Purpose of the Study:
- To describe the implementation process of a frontline worker-led QI program in nursing homes.
- To identify key themes and factors influencing QI implementation in this setting.
Main Methods:
- Six focus groups conducted with 35 participants (health care aides, health professionals, managers) in seven Manitoba nursing homes.
- A year-long, multicomponent, unit-level QI intervention was studied.
- Constant comparative analysis used to examine participant perspectives.
Main Results:
- Five key themes emerged: supportive program structure, navigating the workplace, negotiating relationships, developing individual skills, and observable program impact.
- A reinforcing feedback loop between program structure, skill development, and impact was identified.
- This loop enhanced the ability to navigate challenges and implement QI.
Conclusions:
- Health care aide-led QI teams are feasible in nursing homes.
- A leadership paradox necessitates mechanisms for strong leadership and sponsor support.
- Interpersonal relationships significantly impact QI implementation success.