The Most Significant Change: An Evaluation of Predictive Performance Measures in Nursing Homes

Due to their frailty, older people living in nursing homes are at risk of harm if the care provided is not evidence-based and high quality. The performance measures routinely collected to measure quality care in public sector nursing homes in Victoria, Australia, are currently acute care focused and collected 'after the fact', so there is a need for predictive performance measures that identify circumstances that reflect poor-quality care that will cause harm to residents.

To evaluate the readiness of public sector nursing homes in Victoria, Australia to introduce predictive performance measures in aged care.

A qualitative descriptive design was used to evaluate the introduction of eight predictive performance measures in six geographically diverse public sector nursing homes in Victoria, Australia. After implementing the performance measures interviews with staff were undertaken which were used to create 18 most significant change stories. The stories were workshopped by key stakeholders, to detect subtle changes in nursing home staff behaviours and clinical practice.

In the workshop, using the most significant change methodology six themes from the stories, each with sub-themes were identified which reflect the preparedness of nursing homes for the introduction of predictive performance measures, revealing 'gaps' in aged care practice, and the need for improvements. These included staff-identified strategies, changes in practice, gaps in aged care practice, areas for improvement, and the need for improvement plans, which prompted changes in staff behaviours and better care for residents.

The study highlights the value and adaptability of using the most significant change methodology to evaluate complex interventions. This method enriches analysis by emphasising individual experiences, and the dynamics of organisational change. It highlighted subtle changes in aged care practice that would have been difficult to measure including staff behaviour, organisational culture, and the role of leadership in improving care quality for residents.