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Related Concept Videos

Documentation in Long-Term and Home Healthcare Setting01:29

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Planning Nursing Care I01:21

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Implementation is the execution of the nursing care plan developed during the planning phase.
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Systemic failures in nursing home care-A scoping study.

Joachim P Sturmberg1,2, Len Gainsford3,4, Nicholas Goodwin5

  • 1College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.

Journal of Evaluation in Clinical Practice
|January 23, 2024
PubMed
Summary

Nursing home systemic failures stem from unclear purpose and governance. Addressing these is crucial for improving care quality, resident satisfaction, and staff experience in aged care facilities.

Keywords:
aged carecomplexity sciencecomplexity thinkinggeriatricshealth system redesignhealth system reformhealth systemshealthcare financenursing homesorganisational systemsquality of careregulationscoping reviewsystems thinking

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Area of Science:

  • Gerontology and Health Services Research
  • Organizational Studies
  • Public Policy

Background:

  • Nursing homes, or residential aged care facilities, face global challenges balancing resident needs, regulatory demands, and financial imperatives.
  • This systemic tension often leads to a lack of clarity regarding the facility's core purpose, potentially causing dysfunction across all organizational levels.

Purpose of the Study:

  • To conduct a scoping study synthesizing existing knowledge on systemic functions and failures within the nursing home sector.
  • To analyze the impact of these systemic issues on the broader health and aged care landscape.

Main Methods:

  • Searched MEDLINE, EMBASE, PSYCHINFO, CINAHL, and SCOPUS for system-focused articles up to February 2021.
  • Included snowballing of references and grey literature searches.
  • Defined system-focused articles as those examining inter-level impacts or impacts on multiple agents at the same level.

Main Results:

  • Analyzed 38 articles across the US, Canada, Australia, and Europe, identifying 29 key systemic issues across five layers.
  • Found that only four studies reported whole-of-system findings.
  • Negative outcomes include regulatory reprimands, resident/family/staff dissatisfaction, and a negative perception of nursing homes as workplaces.

Conclusions:

  • Key systemic issues in nursing homes arise from a lack of shared purpose and inadequate national governance/accountability frameworks.
  • Redesigning the nursing home system requires addressing these core issues to achieve integration and desired resident outcomes.
  • Implementing 'systems thinking' is essential for simultaneously enhancing care quality, strengthening regulation, and ensuring financial viability.