How Is Quality of Care in Home Healthcare Created? A Qualitative Study of Health Professionals’ Perspectives

Abstract

The demographic challenges with an increase in older adults in need of nursing care has put home healthcare services under pressure. However, research on what constitutes quality of home healthcare services and what factors influence good nursing care and patient safety is scarce. The aim of this study was to gain insight into health professionals’ perceptions of how quality of care in home healthcare is created and what factors put patient safety at risk. The present study was a qualitative study with semi-structured interviews of eight health professionals working in home healthcare services. Qualitative content analysis was used. Four categories of factors the staff thought had to be present to provide good quality services were identified: (1) A workplace with adequate competence; (2) Communication, information flow and collaboration; (3) Continuity and organisation of care; and (4) Resources. Conclusions: The healthcare professionals perceived that the quality of the services overall was good, and if important factors were present, quality of care was achieved. However, they pointed out some factors that were important to prevent inadequate care and improve services, as quality of care was at risk when deficiencies in these areas occurred.

How do the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home? A qualitative interview study with multiple stakeholders

“…Previous studies, reporting on single aspects of the homecare services or derived from a single stakeholder group, support our findings, including professionals asking WMTY-questions, and providing extensive practical support ( 45 , 46 ). Currently, senior citizens must adapt to an unpredictable and predetermined service ecosystem, including professionals’ working routines ( 45 , 47 ), inaccessible public transport ( 48 – 50 ), and incompetent professionals ( 51 , 52 ). As a consequence, senior citizens risk becoming “ guests ” in their own homes ( 1 , 53 , 54 ).…”

Nurses' professional discretion in the purchaser‐provider split in home care in Norway

“…Most municipalities in Norway organize home health care according to the PPS model (Martinussen & Magnussen, 2009;Nakrem & Kvanneid, 2022), and the provision of care is carried out under the 'National Regulation of Quality of Care' (Ministry of Social Affairs and Health, 2003). The main arguments for implementing the PPS model were cost efficiency, reduced bureaucracy and greater legal protection for care recipients (Hood, 1991;NOU, 2006;Nylenna, 2014;RO, 2004;Vabø, 2012).…”

“…The municipalities organize primary health care, while the national government is responsible for specialty care, including hospital services, through the state‐owned regional health authorities (Ringard et al, 2013). Primary care, care services and rehabilitation, in addition to social services, are organized locally by the municipality and under the same legislation (Health and Care Services Act, 2011; Nakrem & Kvanneid, 2022). While health care policies are centrally controlled, the responsibility for the provision of health care is decentralized.…”

“…Since then, the PPS model has replaced the traditional organizational model that did not distinguish between providing and administering home care and nursing; now, the provider fulfils the duties that were previously performed by the purchaser (Deloitte, 2012; Vabo, 2014). Most municipalities in Norway organize home health care according to the PPS model (Martinussen & Magnussen, 2009; Nakrem & Kvanneid, 2022), and the provision of care is carried out under the ‘National Regulation of Quality of Care’ (Ministry of Social Affairs and Health, 2003). The main arguments for implementing the PPS model were cost efficiency, reduced bureaucracy and greater legal protection for care recipients (Hood, 1991; NOU, 2006; Nylenna, 2014; RO, 2004; Vabø, 2012).…”

“…The purchaser may tend towards standardization, while the provider may want as much freedom as possible based on their professional discretion and the ideals of holistic care (Busch & Vanebo, 2011; Strandås, 2021). Home health nursing requires nurses with adequate competence (Bing‐Jonsson et al, 2015; Nakrem & Kvanneid, 2022), and they are required to combine different ideologies in their work, such as professional autonomy and discretion, provide comprehensive and individual care to patients and legitimize an organizational framework of standardization—all of which may involve conflicting expectations (Tønnessen et al, 2017).…”