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Iaconi A, Hoben M, Berta, PhD W, Duan Y, Norton PG, Song Y, Chamberlain SA, Beeber A, Anderson RA, Lanham HJ, Perez J, Wang J, Choroschun K, Shrestha S, Cummings G, Estabrooks CA. The Association of Nursing Homes' Organizational Context With Care Aide Empowerment: A Cross-Sectional Study. THE GERONTOLOGIST 2024; 64:gnae033. [PMID: 38695153 PMCID: PMC11129593 DOI: 10.1093/geront/gnae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Organizational context is thought to influence whether care aides feel empowered, but we lack empirical evidence in the nursing home sector. Our objective was to examine the association of features of nursing homes' unit organizational context with care aides' psychological empowerment. RESEARCH DESIGN AND METHODS This cross-sectional study analyzed survey data from 3765 care aides in 91 Western Canadian nursing homes. Random-intercept mixed-effects regressions were used to examine the associations between nursing home unit organizational context and care aides' psychological empowerment, controlling for care aide, care unit, and nursing home covariates. RESULTS Organizational (IVs) culture, social capital, and care aides' perceptions of sufficient time to do their work were positively associated with all four components of psychological empowerment (DVs): competence (0.17 [0.13, 0.21] for culture, 0.18 [0.14, 0.21] for social capital, 0.03 [0.01, 0.05] for time), meaning (0.21 [0.18, 0.25] for culture, 0.19 [0.16, 0.23] for social capital, 0.03 [0.01, 0.05 for time), self-determination (0.38 [0.33, 0.44] for culture, 0.17 [0.12, 0.21] for social capital, 0.08 [0.05, 0.11] for time), and impact (0.26 [0.21, 0.31] for culture, 0.23 [0.19, 0.28] for social capital, 0.04 [0.01, 0.07] for time). DISCUSSION AND IMPLICATIONS In this study, modifiable elements of organizational context (i.e., culture, social capital, and time) were positively associated with care aides' psychological empowerment. Future interventions might usefully target these modifiable elements of unit level context in the interest of assessing their effects on staff work attitudes and outcomes, including the quality of resident care.
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Affiliation(s)
- Alba Iaconi
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Matthias Hoben
- Faculty of Health, School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Whitney Berta, PhD
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yinfei Duan
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yuting Song
- Faculty of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Holly J Lanham
- Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Janelle Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jing Wang
- Nursing Department, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire, USA
| | | | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Greta Cummings
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Yousefi Nooraie R, Qin Q, Wagg A, Berta W, Estabrooks C. Building a communication and support network among quality improvement teams in nursing homes: a longitudinal study of the SCOPE trial. Implement Sci Commun 2024; 5:19. [PMID: 38438921 PMCID: PMC10913450 DOI: 10.1186/s43058-024-00559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND We applied a longitudinal network analysis approach to assess the formation of knowledge sharing and collaboration networks among care aide-led quality improvement (QI) teams in Canadian nursing homes participating in the Safer Care for Older Persons (in residential) Environments (SCOPE) trial which aimed to support unregulated front-line staff to lead unit-based quality improvement (QI) teams in nursing homes. We hypothesized that SCOPE's communicative and participatory nature would provide opportunities for peer support, knowledge sharing, and collaboration building among teams. METHODS Fourteen QI teams in Alberta (AB) and seventeen QI teams in British Columbia (BC) participated in the study. Communications across nursing homes occurred through a series of 4 collaborative Learning Congresses (training sessions) over a 1-year period. The senior leaders of QI teams participated in two online network surveys about the communication/collaboration between teams in their province, 1 month after the first, and 6 months later, after the fourth Learning Congress. We developed communication and collaboration network maps pertaining to three time points: before SCOPE, at 2 months, and at 9 months. RESULTS Over time, teams made significantly more new connections and strengthened existing ones, within and across regions. Geographic proximity and co-membership in organizational chains were important predictors of connectivity before and during SCOPE. Teams whose members were well connected at baseline disproportionately improved connectivity over time. On the other hand, teams that did not have prior opportunities to connect appeared to use SCOPE to build new ties. CONCLUSIONS Our findings suggest the importance of network-altering activities to the formation of collaboration networks among QI teams across nursing homes. Active strategies could be used to better connect less connected teams and facilitate collaboration among geographically proximate teams. These findings may inform the development of interventions to leverage existing networks and provide new networking opportunities to develop and sustain organizational improvements.
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Affiliation(s)
- Reza Yousefi Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.
| | - Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Whitney Berta
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Wagg A, Hoben M, Ginsburg L, Doupe M, Berta W, Song Y, Norton P, Knopp-Sihota J, Estabrooks C. Safer Care for Older Persons in (residential) Environments (SCOPE): a pragmatic controlled trial of a care aide-led quality improvement intervention. Implement Sci 2023; 18:9. [PMID: 36991434 PMCID: PMC10054219 DOI: 10.1186/s13012-022-01259-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/20/2022] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The increased complexity of residents and increased needs for care in long-term care (LTC) have not been met with increased staffing. There remains a need to improve the quality of care for residents. Care aides, providers of the bulk of direct care, are well placed to contribute to quality improvement efforts but are often excluded from so doing. This study examined the effect of a facilitation intervention enabling care aides to lead quality improvement efforts and improve the use of evidence-informed best practices. The eventual goal was to improve both the quality of care for older residents in LTC homes and the engagement and empowerment of care aides in leading quality improvement efforts. METHODS Intervention teams participated in a year-long facilitative intervention which supported care aide-led teams to test changes in care provision to residents using a combination of networking and QI education meetings, and quality advisor and senior leader support. This was a controlled trial with random selection of intervention clinical care units matched 1:1 post hoc with control units. The primary outcome, between group change in conceptual research use (CRU), was supplemented by secondary staff- and resident-level outcome measures. A power calculation based upon pilot data effect sizes resulted in a sample size of 25 intervention sites. RESULTS The final sample included 32 intervention care units matched to 32 units in the control group. In an adjusted model, there was no statistically significant difference between intervention and control units for CRU or in secondary staff outcomes. Compared to baseline, resident-adjusted pain scores were statistically significantly reduced (less pain) in the intervention group (p=0.02). The level of resident dependency significantly decreased statistically for residents whose teams addressed mobility (p<0.0001) compared to baseline. CONCLUSIONS The Safer Care for Older Persons in (residential) Environments (SCOPE) intervention resulted in a smaller change in its primary outcome than initially expected resulting in a study underpowered to detect a difference. These findings should inform sample size calculations of future studies of this nature if using similar outcome measures. This study highlights the problem with measures drawn from current LTC databases to capture change in this population. Importantly, findings from the trial's concurrent process evaluation provide important insights into interpretation of main trial data, highlight the need for such evaluations of complex trials, and suggest the need to consider more broadly what constitutes "success" in complex interventions. TRIAL REGISTRATION ClinicalTrials.gov , NCT03426072, registered August 02, 2018, first participant site April, 05, 2018.
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Affiliation(s)
- Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Liane Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Malcolm Doupe
- Departments of Community Health Sciences, Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Whitney Berta
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Toronto, Canada
| | - Yuting Song
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University & Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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MacEachern L, Ginsburg LR, Hoben M, Doupe M, Wagg A, Knopp-Sihota JA, Cranley L, Song Y, Estabrooks CA, Berta W. Developing a tool to measure enactment of complex quality improvement interventions in healthcare. BMJ Open Qual 2023; 12:bmjoq-2022-002027. [PMID: 36754540 PMCID: PMC9923287 DOI: 10.1136/bmjoq-2022-002027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023] Open
Abstract
Quality improvement (QI) projects are common in healthcare settings and often involve interdisciplinary teams working together towards a common goal. Many interventions and programmes have been introduced through research to convey QI skills and knowledge to healthcare workers, however, a few studies have attempted to differentiate between what individuals 'learn' or 'know' versus their capacity to apply their learnings in complex healthcare settings. Understanding and differentiating between delivery, receipt, and enactment of QI skills and knowledge is important because while enactment alone does not guarantee desired QI outcomes, it might be reasonably assumed that 'better enactment' is likely to lead to better outcomes. This paper describes the development, application and validation of a tool to measure enactment of core QI skills and knowledge of a complex QI intervention in a healthcare setting. Based on the Institute for Healthcare Improvement's Model for Improvement, existing QI assessment tools, literature on enactment fidelity and our research protocols, 10 indicators related to core QI skills and knowledge were determined. Definitions and assessment criteria were tested and refined in five iterative cycles. Qualitative data from four QI teams in long-term care homes were used to test and validate the tool. The final measurement tool contains 10 QI indicators and a five-point scale. Inter-rater reliability ranged from good to excellent. Usability and acceptability among raters were considered high. This measurement tool assists in identifying strengths and weaknesses of a QI team and allows for targeted feedback on core QI components. The indicators developed in our tool and the approach to tool development may be useful in other health related contexts where similar data are collected.
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Affiliation(s)
- Lauren MacEachern
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Liane R Ginsburg
- Health Policy & Management, York University, Toronto, Ontario, Canada
| | - Matthias Hoben
- School of Health Policy and Management, York University, Toronto, Ontario, Canada,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Malcolm Doupe
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Centre for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lisa Cranley
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Yuting Song
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada,School of Nursing, Qingdao University, Edmonton, Shandong, China
| | | | - Whitney Berta
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Estabrooks C, Song Y, Anderson R, Beeber A, Berta W, Chamberlain S, Cummings G, Duan Y, Hayduk L, Hoben M, Iaconi A, Lanham H, Perez J, Wang J, Norton P. The Influence of Context on Implementation and Improvement: Protocol for a Mixed Methods, Secondary Analyses Study. JMIR Res Protoc 2022; 11:e40611. [PMID: 36107475 PMCID: PMC9523530 DOI: 10.2196/40611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/13/2022] [Accepted: 07/30/2022] [Indexed: 12/05/2022] Open
Abstract
Background Caring for the well-being of older adults is one of the greatest challenges in modern societies. Improving the quality of care and life for older adults and the work lives of their care providers calls for effective knowledge translation of evidence-based best practices. Objective This study’s purpose is to contribute to knowledge translation by better understanding the roles of organizational context (workplace environment) and facilitation (process or role) in implementation and improvement success. Our study has 2 goals: (1) to advance knowledge translation science by further developing and testing the Promoting Action on Research Implementation in Health Services framework (which outlines how implementation relies on the interplay of context, facilitation, and evidence) and (2) to advance research by optimizing implementation success via tailoring of modifiable elements of organizational context and facilitation. Methods This is secondary analyses of 15 years of longitudinal data from the Translating Research in Elder Care (TREC) program’s multiple data sources. This research is ongoing in long-term care (LTC) homes in western Canada. TREC data include the following: 5 waves of survey collection, 2 clinical trials, and regular ongoing outcome data for LTC residents. We will use a sequential exploratory and confirmatory mixed methods design. We will analyze qualitative and quantitative data holdings in an iterative process: (1) comprehensive reanalysis of qualitative data to derive hypotheses, (2) quantitative modeling to test hypotheses, and (3) action cycles to further refine and integrate qualitative and quantitative analyses. The research team includes 4 stakeholder panels: (1) system decision- and policy makers, (2) care home managers, (3) direct care staff, and (4) a citizen engagement group of people living with dementia and family members of LTC residents. A fifth group is our panel of external scientific advisors. Each panel will engage periodically, providing their perspectives on project direction and findings. Results This study is funded by the Canadian Institutes of Health Research. Ethics approval was obtained from the University of Alberta (Pro00096541). The results of the secondary analyses are expected by the end of 2023. Conclusions The project will advance knowledge translation science by deepening our understanding of the roles of context, the interactions between context and facilitation, and their influence on resident and staff quality outcomes. Importantly, findings will inform understanding of the mechanisms by which context and facilitation affect the success of implementation and offer insights into factors that influence the implementation success of interventions in nursing homes. International Registered Report Identifier (IRRID) DERR1-10.2196/40611
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Affiliation(s)
| | - Yuting Song
- School of Nursing, Qingdao University, Qingdao, China
| | - Ruth Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Greta Cummings
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Leslie Hayduk
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Alba Iaconi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Holly Lanham
- Department of Medicine, University of Texas Health Sciences Center San Antonio, San Antonio, TX, United States
| | - Janelle Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jing Wang
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
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Doupe M, Brunkert T, Wagg A, Ginsburg L, Norton P, Berta W, Knopp-Sihota J, Estabrooks C. Correction to: SCOPE: safer care for older persons (in residential) environments—a pilot study to enhance care aide-led quality improvement in nursing homes. Pilot Feasibility Stud 2022; 8:47. [PMID: 35232497 PMCID: PMC8886763 DOI: 10.1186/s40814-022-01004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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