Improving and supporting quality of care in Dutch nursing homes: a quantitative study

Previous research showed the potential of quality improvement programs in nursing home care. However, studies that quantitatively evaluate the effectiveness of quality of care improvement programs are scarce. In this study, we examine the results of a Dutch nation-wide programme that was established to support the implementation of the Quality Framework for Nursing Home care.

The Dignity & Pride at every Facility (D&PF) program was accessible to all Dutch nursing home facilities. Problem analysis per facility was conducted by means of a quantitative Quality Scan targeting all eight themes of the quality framework. Based on the baseline measurements nursing home facilities received tailored support from an external expert coach. The Quality Scan was repeated at the end of the support trajectories, 9 to 24 months later depending on the type of support provided. Scan data of 331 nursing home facilities was used to quantify the effectiveness of the D&PF program, the contribution of tailored support and the influence of organizational factors on care outcomes.

The entire pool of participating facilities scored better on the final scan (M = 3.21, SD = 0.74) than on the baseline scan (M = 2.64, SD = 0.87, p < 0.001). Greater improvements on theme level were seen when (partial) support was provided by an external expert coach. The probability of achieving high scores on care outcomes (person-centred care, resident safety and well-being) was significantly increased with high scores on organizational conditions. A multilevel model demonstrated that the themes Learning and improvement, Responsive workforce and Use of resources were statistically significant associated with positive care outcomes.

This study demonstrates significant improvements across all themes of the quality framework and provides supporting evidence for the positive contribution of tailored on-site support of external expert coaches. This study also indicates that a supportive organizational environment and a learning-oriented culture are of significant importance for good care outcomes in terms of safety, person-centred care and resident well-being.