Lee R, Wendling L; AcademyHealth. Meeting (2003 : Nashville, Tenn.).

Abstr AcademyHealth Meet. 2003; 20: abstract no. 401.

University of Kansas, Health Policy and Management, 3901 Rainbow Boulevard, Kansas City, KS 66160 Tel. (913)-908-8202 Fax (913) 588-8236

RESEARCH OBJECTIVE: To assess the use of quality improvement techniques and the preparation of nursing home managers to lead quality improvement efforts. STUDY DESIGN: Our pilot studies suggested that direct questions elicited socially acceptable responses about participation in quality improvement activities. For example, respondents would claim to have constructed control charts, but later ask what control charts were. This study used four techniques to minimize such responses. First, it used telephone interviews to avoid prompting respondents with expected responses. Second, it used open-ended questions during much of the interview. Third, its questions focused on aims (e.g., tracking performance over time) rather than use of specific quality tools. Fourth, a number of the direct questions about quality improvement were focused on what was done in conjunction with 'last year's most important quality improvement project' rather than what was done in general. As a result, use of quality improvement techniques was reported roughly half as often as in our pilot studies. POPULATION STUDIED: Administrators and Directors of Nursing at 106 randomly selected free-standing Kansas nursing homes. PRINCIPAL FINDINGS: Our analysis found that only 27.4% of the responding facilities had ever developed a flowchart to describe a process; only 16.0% had ever developed a run or control chart; and only 20.0% used frequent resident or family satisfaction surveys. Only three of the facilities met a weak definition of CQI implementation, meaning that they had ever developed a flow chart; had ever used a run or control chart; did a satisfaction survey of residents or families; and had trained staff in CQI principles.The training of these leaders was limited, especially for Directors of Nursing: 79.2% of the Directors of Nursing and 24.5% of the Administrators had two years or less of post-high school education. Only 4.2% of the Directors of Nursing and 20.4% of the Administrators had master's degrees, and only a handful of these degrees were management oriented.Rapid turnover was the norm, especially for Directors of Nursing: 50% of the Directors of Nursing and 25% of the Administrators had been in their current position for a year or less. CONCLUSIONS: The results are consistent with the hypothesis that few of the surveyed nursing homes had well-developed quality improvement programs. Only a minority were using any quality improvement techniques. The results also suggest that few of the Directors of Nursing had the training, experience, or time in their current position to lead quality improvement activities. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The near-term success of the Nursing Home Quality Initiative and improvements in the quality of care in nursing homes may require a more stable, better trained leadership workforce.

Publication Types:

• Meeting Abstracts

Keywords:

• Breast Feeding
• Data Collection
• Interviews as Topic
• Kansas
• Leadership
• Nursing Homes
• Personnel Turnover
• nursing
• hsrmtgs

Other ID:

• GWHSR0003700

UI: 102275379

From Meeting Abstracts