Designing and pilot testing of a leadership intervention to improve quality and safety in nursing homes and home care (the SAFE-LEAD intervention)

Abstract

ObjectiveTo describe the design of a leadership intervention for nursing home and home care, including a leadership guide for managers to use in their quality and safety improvement work. The paper reports results from the pilot test of the intervention and describes the final intervention programme.DesignQualitative design, using the participation of stakeholders.MethodsThe leadership guide and intervention were designed in collaboration with researchers, coresearchers and managers in nursing homes and home care organisations, through workshops and focus group interviews. The pilot test consisted of three workshops with managers working on the leadership guide, facilitated and observed by researchers, and evaluated by means of observation and focus group interviews with the participants. The analysis combined the integration of data from interviews and observations with directed content analysis.SettingNorwegian nursing homes and home care services.ParticipantsManagers at different levels in three nursing homes and two home care services, coresearchers, and patient and next-of-kin representatives.ResultsThe managers and coresearchers suggested some revisions to the leadership guide, such as making it shorter, and tailoring the terminology to their setting. Based on their suggestions, we modified the intervention and developed learning resources, such as videos demonstrating the practical use of the guide. Evaluation of the pilot test study showed that all managers supported the use of the guide. They adapted the guide to their organisational needs, but found it difficult to involve patients in the intervention.ConclusionsA participatory approach with stakeholders is useful in designing a leadership intervention to improve quality and safety in nursing homes and home care, although patient participation in its implementation remains difficult. The participatory approach made it easier for managers to adapt the intervention to their context and to everyday quality and safety work practice.

Linking transformational leadership, patient safety culture and work engagement in home care services

“…There is a need for collective reflexive spaces and arenas for home care managers to discuss patient safety. Our research has demonstrated how home care managers can take advantage of facilitated arenas and tools to support discussions of their role in developing a culture of patient safety (Johannessen et al, ). From a policy perspective, we recommend policy guidelines and regulations to enable making such efforts in healthcare organizations, by emphasizing the importance of transformational leadership for sound work environments and patient safety cultures and by providing resources to leadership and work environment interventions.…”

Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development

“…The data material was analyzed using directed content analysis approach according to predefined categories [18]. The predefined categories derived from theory, the OQ framework [17] and a further refinement by Johannessen [14]. The categories were structure (plan and structure for the organizations' quality work), coordination and organizational politics (interaction within the organization and between service levels), culture (create an organizational culture where quality is a common value), competence (continuous competence development in the organization),engagement (support and mobilize employees to create motivation in the quality improvement work), physical design and technology (implies premises, outdoor areas and the importance of home environment for quality improvement work), and external demands (awareness and decision related to social, political and economic factors such as regulatory requirements, national professional guidelines).…”

“…This paper is part of a larger project titled 'Improving Quality and Safety in Primary Care -Implementing a Leadership Intervention in Nursing Homes and Home care' (SAFE-LEAD) [12], based on an intervention implementing a leadership guide for managers over a period of 12 months in 2018-2019 [12]. The leadership guide comprises seven common quality challenges (structure, coordination/organizational politics, culture, competence, engagement, physical design/technology, external demands) in which the organizations work with and diagnose themselves [13,14]. In this paper, we map the status of the organizations in relation to the seven challenges before the intervention.…”

“…In this paper, we map the status of the organizations in relation to the seven challenges before the intervention. The aim of this intervention is to build leadership competence and guide managers in improving quality strategies and practice and in tailoring them to their needs [14].…”

“…The cases were selected based on criteria such as size, geography and variation between city-and rural-based services [12,14,15]. Recruitment of the study sites (nursing homes and home care services) was conducted by three nurse-counselors from the Centre for Development of Institutional Care and Home Care Services (USHT).…”