Skip to main content
Article
Quality improvement implementation in the nursing home
Quantitative Health Sciences Publications and Presentations
  • Dan R. Berlowitz, Bedford Veterans Affairs Medical Center
  • Gary J. Young, Greater Boston Veterans Affairs Medical Center
  • Elaine C. Hickey, Bedford Veterans Affairs Medical Center
  • Debra Saliba, Center for the Study of Healthcare Provider Behavior
  • Brian S. Mittman, Center for the Study of Healthcare Provider Behavior
  • Elaine Czarnowski, Greater Boston Veterans Affairs Medical Center
  • Barbara Simon, Center for the Study of Healthcare Provider Behavior
  • Jennifer J. Anderson, Greater Boston Veterans Affairs Medical Center
  • Arlene S. Ash, University of Massachusetts Medical School
  • Lisa V. Rubenstein, Center for the Study of Healthcare Provider Behavior
  • Mark A. Moskowitz, Boston University
UMMS Affiliation
Department of Quantitative Health Sciences
Date
3-26-2003
Document Type
Article
Medical Subject Headings
Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Homes for the Aged; Humans; Linear Models; Male; Middle Aged; Multivariate Analysis; Nursing Homes; Organizational Culture; Organizational Innovation; Outcome Assessment (Health Care); Pressure Ulcer; Quality Assurance, Health Care; Total Quality Management; United States; United States Department of Veterans Affairs; Veterans; Virginia
Abstract
OBJECTIVE: To examine quality improvement (QI) implementation in nursing homes, its association with organizational culture, and its effects on pressure ulcer care. DATA SOURCES/STUDY SETTING: Primary data were collected from staff at 35 nursing homes maintained by the Department of Veterans Affairs (VA) on measures related to QI implementation and organizational culture. These data were combined with information obtained from abstractions of medical records and analyses of an existing database. STUDY DESIGN: A cross-sectional analysis of the association among the different measures was performed. DATA COLLECTION/EXTRACTION METHODS: Completed surveys containing information on QI implementation, organizational culture, employee satisfaction, and perceived adoption of guidelines were obtained from 1,065 nursing home staff. Adherence to best practices related to pressure ulcer prevention was abstracted from medical records. Risk-adjusted rates of pressure ulcer development were calculated from an administrative database. PRINCIPAL FINDINGS: Nursing homes differed significantly (p<.001) in their extent of QI implementation with scores on this 1 to 5 scale ranging from 2.98 to 4.08. Quality improvement implementation was greater in those nursing homes with an organizational culture that emphasizes innovation and teamwork. Employees of nursing homes with a greater degree of QI implementation were more satisfied with their jobs (a 1-point increase in QI score was associated with a 0.83 increase on the 5-point satisfaction scale, p<.001) and were more likely to report adoption of pressure ulcer clinical guidelines (a 1-point increase in QI score was associated with a 28 percent increase in number of staff reporting adoption, p<.001). No significant association was found, though, between QI implementation and either adherence to guideline recommendations as abstracted from records or the rate of pressure ulcer development. CONCLUSIONS: Quality improvement implementation is most likely to be successful in those VA nursing homes with an underlying culture that promotes innovation. While QI implementation may result in staff who are more satisfied with their jobs and who believe they are providing better care, associations with improved care are uncertain.
Rights and Permissions
Citation: Health Serv Res. 2003 Feb;38(1 Pt 1):65-83. Link to article on publisher's site
Related Resources
Link to Article in PubMed
Citation Information
Dan R. Berlowitz, Gary J. Young, Elaine C. Hickey, Debra Saliba, et al.. "Quality improvement implementation in the nursing home" Vol. 38 Iss. 1 Pt 1 (2003) ISSN: 0017-9124 (Linking)
Available at: http://works.bepress.com/arlene_ash/25/