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Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development

BACKGROUND: Management, culture and systems for better quality and patient safety in hospitals have been widely studied in Norway. Nursing homes and home care, however have received much less attention. An increasing number of people need health services in nursing homes and at home, and the service...

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Autores principales: Johannessen, Terese, Ree, Eline, Aase, Ingunn, Bal, Roland, Wiig, Siri
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118914/
https://www.ncbi.nlm.nih.gov/pubmed/32245450
http://dx.doi.org/10.1186/s12913-020-05149-x
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author Johannessen, Terese
Ree, Eline
Aase, Ingunn
Bal, Roland
Wiig, Siri
author_facet Johannessen, Terese
Ree, Eline
Aase, Ingunn
Bal, Roland
Wiig, Siri
author_sort Johannessen, Terese
collection PubMed
description BACKGROUND: Management, culture and systems for better quality and patient safety in hospitals have been widely studied in Norway. Nursing homes and home care, however have received much less attention. An increasing number of people need health services in nursing homes and at home, and the services are struggling with fragmentation of care, discontinuity and restricted resource availability. The aim of the study was to explore the current challenges in quality and safety work as perceived by managers and employees in nursing homes and home care services. METHOD: The study is a multiple explorative case study of two nursing homes and two home care services in Norway. Managers and employees participated in focus groups and individual interviews. The data material was analyzed using directed content analysis guided by the theoretical framework ‘Organizing for Quality’, focusing on the work needed to meet quality and safety challenges. RESULTS: Challenges in quality and safety work were interrelated and depended on many factors. In addition, they often implied trade-offs for both managers and employees. Managers struggled to maintain continuity of care due to sick leave and continuous external-facilitated change processes. Employees struggled with heavier workloads and fewer resources, resulting in less time with patients and poorer quality of patient care. The increased external pressure affected the possibility to work towards engagement and culture for improvement, and to maintain quality and safety as a collective effort at managerial and employee levels. CONCLUSION: Despite contextual differences due to the structure, size, nature and location of the nursing homes and home care services, the challenges were similar across settings. Our study indicates a dualistic contextual dimension. Understanding contextual factors is central for targeting improvement interventions to specific settings. Context is, however, not independent from the work that managers do; it can be and is acted upon in negotiations and interactions to better support managers’ and employees’ work on quality and safety in nursing homes and home care.
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spelling pubmed-71189142020-04-07 Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development Johannessen, Terese Ree, Eline Aase, Ingunn Bal, Roland Wiig, Siri BMC Health Serv Res Research Article BACKGROUND: Management, culture and systems for better quality and patient safety in hospitals have been widely studied in Norway. Nursing homes and home care, however have received much less attention. An increasing number of people need health services in nursing homes and at home, and the services are struggling with fragmentation of care, discontinuity and restricted resource availability. The aim of the study was to explore the current challenges in quality and safety work as perceived by managers and employees in nursing homes and home care services. METHOD: The study is a multiple explorative case study of two nursing homes and two home care services in Norway. Managers and employees participated in focus groups and individual interviews. The data material was analyzed using directed content analysis guided by the theoretical framework ‘Organizing for Quality’, focusing on the work needed to meet quality and safety challenges. RESULTS: Challenges in quality and safety work were interrelated and depended on many factors. In addition, they often implied trade-offs for both managers and employees. Managers struggled to maintain continuity of care due to sick leave and continuous external-facilitated change processes. Employees struggled with heavier workloads and fewer resources, resulting in less time with patients and poorer quality of patient care. The increased external pressure affected the possibility to work towards engagement and culture for improvement, and to maintain quality and safety as a collective effort at managerial and employee levels. CONCLUSION: Despite contextual differences due to the structure, size, nature and location of the nursing homes and home care services, the challenges were similar across settings. Our study indicates a dualistic contextual dimension. Understanding contextual factors is central for targeting improvement interventions to specific settings. Context is, however, not independent from the work that managers do; it can be and is acted upon in negotiations and interactions to better support managers’ and employees’ work on quality and safety in nursing homes and home care. BioMed Central 2020-04-03 /pmc/articles/PMC7118914/ /pubmed/32245450 http://dx.doi.org/10.1186/s12913-020-05149-x Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Johannessen, Terese
Ree, Eline
Aase, Ingunn
Bal, Roland
Wiig, Siri
Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development
title Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development
title_full Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development
title_fullStr Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development
title_full_unstemmed Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development
title_short Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development
title_sort exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118914/
https://www.ncbi.nlm.nih.gov/pubmed/32245450
http://dx.doi.org/10.1186/s12913-020-05149-x
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