Nursing Home Staff Perceptions of Barriers and Facilitators to Implementing a Quality Improvement Intervention
Nursing Home Staff Perceptions of Barriers and Facilitators to Implementing a Quality Improvement Intervention
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DOI：
10.1016/j.jamda.2019.01.139
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发表时间：
2019-07-01
影响因子：
7.6
通讯作者：
Hartmann, Christine W.
中科院分区：
文献类型：
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作者：
Mills, Whitney L.;Pimentel, Camilla B.;Hartmann, Christine W.
目的：质量改进(QI)可能是疗养院工作人员提高护理质量的一种有前途的方法。然而，对养老院实施QI干预的挑战和促进者知之甚少。本研究探讨员工对实施过程的看法。设计：我们对参与实施循证QI干预(“锁定”)的员工进行半结构式访谈，以期通过有针对性的员工行为改变来改善住院医生与员工之间的互动。锁定干预包括4种做法：(1)学习亮点，(2)观察，(3)挤在一起合作，(4)保持咬合大小。背景和参与者：我们通过机会主义和滚雪球抽样采访了6家退伍军人健康管理疗养院[即社区生活中心(CLCs)]的工作人员。措施：半结构访谈基于行为变化的能力、机会、动机、行为(COM-B)模型，涵盖了员工在实施过程中的经验、挑战、促进者和经验教训。结果：总体而言，员工接受了干预，并欣赏对积极因素的关注。挑战主要属于能力和机会类别，包括难以找到时间完成干预活动、无法解读数据报告、需要持续培训以及对研究目标的误解。促进者在很大程度上属于动机类别，包括参与的激励、期望行为的强化、干预活动的可行性，以及使用数据量化改进。结论/暗示：随着QI计划在养老院变得越来越普遍，针对这种独特的环境量身定做干预措施至关重要。我们确定了我们干预措施实施的障碍和促进者，并了解到没有任何挑战是不可逾越的，也没有任何挑战会破坏锁定的实施。一线员工克服实施挑战的能力，可能归功于洛克与生俱来的激励特征。未来疗养院的QI干预应该考虑包括内置的激励成分。由爱思唯尔公司代表AMDA(急性后和长期护理医学学会)出版。
Objectives: Quality improvement (QI) may be a promising approach for staff to improve the quality of care in nursing homes. However, little is known about the challenges and facilitators to implementing QI interventions in nursing homes. This study examines staff perspectives on the implementation process.Design: We conducted semistructured interviews with staff involved in implementing an evidence-based QI intervention ("LOCK") to improve interactions between residents and staff through targeted staff behavior change. The LOCK intervention consists of 4 practices: (1) Learn from the bright spots, (2) Observe, (3) Collaborate in huddles, and (4) Keep it bite sized.Setting and participants: We interviewed staff members in 6 Veterans Health Administration nursing homes [ie, Community Living Centers (CLCs)] via opportunistic and snowball sampling.Measures: The semistructured interviews were grounded in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change and covered staff experience, challenges, facilitators, and lessons learned during the implementation process. The interviews were analyzed using thematic content analysis.Results: Overall, staff accepted the intervention and appreciated the focus on the positives. Challenges fell largely within the categories of capability and opportunity and included difficulty finding time to complete intervention activities, inability to interpret data reports, need for ongoing training, and misunderstanding of study goals. Facilitators were largely within the motivation category, including incentives for participation, reinforcement of desired behavior, feasibility of intervention activities, and use of data to quantify improvements.Conclusions/Implications: As QI programs become more common in nursing homes, it is critical that interventions are tailored for this unique setting. We identified barriers and facilitators of our intervention's implementation and learned that no challenge was insurmountable or derailed the implementation of LOCK. This ability of frontline staff to overcome implementation challenges may be attributed to LOCK's inherently motivational features. Future nursing home QI interventions should consider including built-in motivational components. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.