Characteristics of Quality Improvement Champions in Nursing Homes: A Systematic Review With Implications for Evidence‐Based Practice

Abstract

Background Improving care quality while reducing cost has always been a focus of nursing homes. Certified nursing assistants comprise the largest proportion of the workforce in nursing homes and have the potential to contribute to the quality of care provided. Quality improvement initiatives using certified nursing assistants as champions have the potential to improve job satisfaction, which has been associated with care quality. Aims To identify the role, use and preparation of champions in a nursing home setting as a way of informing future quality improvement strategies in nursing homes. Methods A systematic literature review. Medical Subject Headings and text words for “quality improvement” were combined with those for “champion*” to search Medline, CINAHL, Joanna Briggs Institute, MedLine In-Process and other Nonindexed Citations. After duplicates were removed a total of 337 potential articles were identified for further review. After full text review, seven articles from five original studies met inclusion criteria and were included in the synthesis. Results Various types of quality improvement initiatives and implementation strategies were used together with champions. Champions were identified by study authors as one of the single most effective strategies employed in all studies. The majority of studies described the champion role as that of a leader, who fosters and reinforces changes for improvement. Although all the included studies suggested that implementing nurse or aid champions in their quality improvement initiatives were important facilitators of success, how the champions were selected and trained in their role is either missing or not described in any detail in the studies included in the review. Linking Evidence to Action Utilizing certified nursing assistants as quality improvement champions can increase participation in quality improvement projects and has the potential to improve job satisfaction and contribute to improve quality of care and improved patient outcomes in nursing homes.

Factors related to screening for problem gambling among healthcare and social service providers in Ontario, Canada: A concept mapping study

“…Similarly, Zoorob and colleagues discussed the importance of identifying a practice champion to promote the implementation and the use of an alcohol screener and brief intervention to address risky drinking behaviours (Zoorob, Grubb, Gonzalez, & Kowalchuk, ). When identifying a champion to promote the implementation of practice change, the individual should be a leader within the organisation, well‐respected among peers and informally helping others (Shaw et al, ; Woo, Milworm, & Dowding, ). Our findings highlight the need for further inquiry in how to best enhance and support the development of staff skills and training for routine screening of problem gambling, such as using practice champions.…”

Effect of a Palliative Care Nurse Champion Program on Nursing Care of Dying Patients in the Hospital: A Controlled before and after Study

“…Furthermore, non-essential nursing interventions were more frequently discontinued in the last 24 h. In the post-intervention period, nurses were more often -though not statistically -aware of whether or not the physician had informed the patient about imminent death, which suggests a change towards a more end-of-life care minded attitude. Nurse champions have been found to facilitate successful quality improvement initiatives in various settings [19].…”

“…Our findings might have been affected by the high turnover rate of nurse champions and by the 5-month run-up period which might have been too short for nurse champions to prepare for their new roles before we started the postintervention assessment. A main element of the intervention is knowledge transfer; this is a complex process that implies that nurse champions first have to improve their own knowledge and then have to learn how to disseminate knowledge and skills among their colleagues in the multidisciplinary team [17][18][19]. It is suggested that nurse champions can only have an effect when they have knowledge of palliative care, teaching capacities, and authority towards managers, nurse colleagues and physicians [24,31].…”

“…Several hospitals have implemented networks of 'nurse champions' or 'link nurses' to improve these fields of care. The empowerment of nurses towards leadership in a field of care may contribute to the quality of care [14,[17][18][19]. Being intermediates between experts and ward nurses, nurse champions are expected to improve the results of education.…”

“…Furthermore, it is easier to adapt an educational program to the educational needs of nurse champions than of all nurses on all the wards [20]. Although evaluation of the effects of such nurse champions on the quality of care is scarce, the results are promising [19,[21][22][23][24][25][26]. Based on this concept we previously studied the impact of a palliative care nurse champions program on the quality of dying in the hospital, as experienced by bereaved relatives [27,28].…”