Conditions for successfully implementing resident‐oriented care in nursing homes

Abstract

This study reports an investigation of the conditions for a successful introduction of a resident-oriented care model on six somatic and psychogeriatric intervention wards in three Dutch nursing homes. This study aims to answer the following research question: 'What are the conditions for successfully implementing resident-oriented care?' To answer the research question, the organisational change process was monitored by using the '7-S' model of Peters and Waterman as a diagnostic framework. Based on this model, the following change characteristics were studied: structure, strategy, systems, staff, skills, style and shared values. Our study involved a one group pretest/post-test design. To measure the conditions for change, we operationalised the factors of the 7-S model serving as a diagnostic framework and studied their presence and nature on the intervention wards. For this purpose qualitative interviews were held with the change agents of the nursing homes and the wards' supervisors. To determine the degree of 'success' of the implementation, we measured the extent to which resident-oriented care was implemented. For this purpose a quantitative questionnaire was filled in by the nurses of the intervention wards. By relating the extent to which resident-oriented care was implemented to the differences in change conditions, we were able to distinguish the 'most' from the 'least' successful intervention ward and so, pointing out the conditions contributing to a successful implementation of resident-oriented care. The results showed that, in contrast to the least successful intervention ward, the most successful intervention ward was characterised by success conditions related to the 7-S model factors strategy, systems, staff and skills. The factor structure did not contribute to the success of the implementation. Success conditions appeared to be related to the ward level and not to the organisational or project level. Especially the supervisors' role appeared to be crucial for a successful implementation.

Nurturing Cultural Change in Care for Older People: Seeing the Cherry Tree Blossom

“…Reflecting on the question of what had contributed to the improvement of daily activities and the development of cultural values associated with person-centred care, this research largely confirms that of earlier research [6,9,13,14,51]. The promotion of dialogue, participation and influence of the staff during every phase of the project, joint decision-making and continuous appreciative and adaptive facilitation all contributed to transformational change.…”

“…A complexity approach modifies the value of a detailed and realistic plan of change, which Berkhout et al [6] thought important for transformation towards a culture change facility, and offers an explanation for the co-evolution of the daily activities and the context through which this process of change took place. This indicates that development towards a culture change facility should begin somewhere, and on a small scale as is also suggested by Shield et al [53], instead of waiting for more ideal conditions for change or a certain organisational readiness, which according to Manley et al [33] is a favourable factor in the realisation of an effective workplace culture.…”

“…The focus is mainly on enabling conditions, such as staff participation, joint decision-making, training of staff, a willingness and capacity to change, facilitative leadership, and appropriate procedures and policies [6,14,51,53] and the development of supporting tools, like training modules [21], the Artifacts of Culture Change Tool [7], and Culture Change Living Toolkit (PiDC), among others, in which these knowable conditions can be managed. Only recently some authors have contributed to the discussion on implementing culture change on a philosophical level by approaching the transformational process from complexity theory [13,59].…”

What is desirable care in the opinion of formal and informal caregivers in nursing‐home care for patients with dementia?

“…(2005)Quality of life instruments used in dementiaZwakhalen, Hamers, and Berger (2007)A behavioural pain scaleAchterberg, Pot, Scherder, and Ribbe (2007)The nottingham health profileGerritsen et al. (2008)The MDS challenging behaviour profileMcCool, Jogerst, Daly, and Xu (2009)Multidisciplinary reportsCooper, Maxmin, Selwood, Blanchard, and Livingston (2009)The Modified Conflict Tactics ScaleBerkhout, Boumans, Mur, and Nijhuis (2009)“7‐S” modelAcierno et al. (2010)The National Elder Mistreatment StudyTriemstra, Winters, Kool, and Wiegers (2010)The consumer quality index long‐term careInspectie voor de Gezondheidszorg, (2010)VrijheidsbeperkingHeidstra‐Wolke (2011)Zelf‐check voor verpleeghuisartsenPillemer et al.…”

Factors to Make the VIPS Practice Model More Effective in the Treatment of Neuropsychiatric Symptoms in Nursing Home Residents with Dementia

“…Especially the supervisors' role was crucial for a successful implementation. The study had a one-group pre-test versus post-test design [35]. A study into residents' sedative drug utilization showed that the use of pro re nata medicines was strongly determined by the characteristics of the ward (unit) the patients lived in, not so much by institutional characteristics [36].…”